Impact of Deferring Radiation Therapy in Patients With Epidermal Growth Factor Receptor–Mutant Non-Small Cell Lung Cancer Who Develop Brain Metastases

Magnuson, William J.; Yeung, Jacky T.; Guillod, Paul; Gettinger, Scott; Yu, James B.; Chiang, Veronica

doi:10.1016/j.ijrobp.2016.01.037

Cited by 94 publications

(86 citation statements)

References 37 publications

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“…That might explain the better cranial PFS we observed. In addition, another study compared the survival outcome of upfront TKI vs upfront RT, finding an inferior OS for upfront TKI than for upfront RT ( P = 0.01) [17]. Yet, other studies arrived at different conclusions [2, 18].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of tyrosine kinase inhibitors alone or combined with radiotherapy for brain metastases from epidermal growth factor receptor (EGFR) mutant non small cell lung cancer (NSCLC)

et al. 2017

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This study compared treatment outcomes between TKI monotherapy and TKI administration combined with brain radiotherapy (TKI + RT) in 133 non-small cell lung cancer (NSCLC) patients with brain metastasis (BM). We also evaluated the association of different epidermal growth factor receptor (EGFR) mutation subtypes with treatment outcome. To screen for potential variables affecting cranial progression free survival (PFS) and overall survival (OS), we performed univariate and multivariate analysis based on Cox proportional-hazards models. Median cranial PFS and OS were longer for the TKI + RT group (n = 67) than TKI alone group (n = 66). Intracranial metastasis correlated with a better median OS than extracranial metastasis. For patients with exon 21 mutations, TKI + RT yielded a better median OS and cranial PFS than TKI alone. However, there were no significant differences in median OS and cranial PFS between the two treatment groups for patients with exon 19 deletions. Thus EGFR-mutant NSCLC patients with BM could benefit more from TKI + RT than from TKI monotherapy, especially when they suffer from exon 21 mutations. However, TKI + RT confers no advantage over TKI treatment alone for patients with exon 19 deletions. These results underscore the urgent need to develop individualized disease management strategies in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome of tyrosine kinase inhibitors alone or combined with radiotherapy for brain metastases from epidermal growth factor receptor (EGFR) mutant non small cell lung cancer (NSCLC)

et al. 2017

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“…However, a recent retrospective analysis suggests that the use of upfront radiotherapy followed by EGFR TKI therapy among EGFR mutated NSCLCs with BMs is associated with increased OS when using SRS, but not WBRT. Moreover, upfront radiotherapy seems to prolong intracranial PFS compared with upfront EGFR TKI [47]. …”

Section: Discussionmentioning

confidence: 99%

Influence of EGFR mutational status on metastatic behavior in non squamous non small cell lung cancer

et al. 2017

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Epidermal Growth Factor Receptor (EGFR) mutated Non Small Cell Lung Cancers (NSCLCs) are a molecularly subgroup of patients with peculiar clinic-pathological characteristics. Previous studies have suggested a possible interaction between oncogene status and metastatic behavior in non squamous NSCLCs with conflicting results. The aim of this study was to compare the different metastatic patterns, at baseline and during the course of the disease, in a cohort of 137 Caucasian patients with non-squamous NSCLC according to the EGFR mutational status and survival differences according to the different metastatic behavior. We observed unique metastatic distributions between EGFR-mutated and EGFR wild type non-squamous NSCLCs. These data support the hypothesis that tumor bio-molecular characteristics and genotype may influence the metastatic process in NSCLC and might help the development of enrichment strategies for tumor genotyping in these tumors, especially in the presence of limited tissue availability.

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“…The relative benefits of upfront EGFR-TKIs combined with radiation therapy (RT) versus EGFR-TKIs alone for EGFR -mutant patients with BM have not been determined. Although one retrospective analysis suggested that the use of upfront EGFR-TKI and the deferral of SRS or WBRT may result in inferior overall survival (OS) for such patients19, no randomized study has been conducted to compare the effects of upfront EGFR-TKI with RT and those of upfront RT combined with EGFR-TKI on disease progression. Thus, the optimal treatment strategy for BM with EGFR mutations remains controversial.…”

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confidence: 99%

Effects of icotinib with and without radiation therapy on patients with EGFR mutant non-small cell lung cancer and brain metastases

Fan

Gong

et al. 2017

Sci Rep

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EGFR-TKIs and radiation therapy (RT) are the principal treatment for patients with brain metastases (BM) and EGFR mutant NSCLC. However, the optimal use of brain RT for patients with asymptomatic BM remains undefined. A total of 152 patients were identified. 58 patients were excluded. Of the remaining 97 patients, 56 patients received upfront RT followed by icotinib, including WBRT or SRS. 41 patients received icotinib therapy alone. The mOS from diagnosis of BM was 27.0 months for the whole cohort (95% CI, 23.9–30.1 months). There was no difference in OS between the RT followed by icotinib group and the icotinib alone group (31.9 vs. 27.9 months, P = 0.237), and similar results were found in the SRS subgroup (35.5 vs. 27.9 months, P = 0.12). Patients with the EGFR Del19 mutation had a longer OS than patients with the exon 21 L858R mutation (32.7 vs. 27.4, P = 0.037). Intracranial progression-free survival (PFS) was improved in the patients who received RT followed by icotinib compared to those receiving icotinib alone (22.4 vs. 13.9 months, P = 0.043). Patients with EGFR-mutant adenocarcinoma and BM treated with icotinib exhibited prolonged survival. A longer duration of intracranial control was observed with brain RT.

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Impact of Deferring Radiation Therapy in Patients With Epidermal Growth Factor Receptor–Mutant Non-Small Cell Lung Cancer Who Develop Brain Metastases

Cited by 94 publications

References 37 publications

Clinical outcome of tyrosine kinase inhibitors alone or combined with radiotherapy for brain metastases from epidermal growth factor receptor (EGFR) mutant non small cell lung cancer (NSCLC)

Clinical outcome of tyrosine kinase inhibitors alone or combined with radiotherapy for brain metastases from epidermal growth factor receptor (EGFR) mutant non small cell lung cancer (NSCLC)

Influence of EGFR mutational status on metastatic behavior in non squamous non small cell lung cancer

Effects of icotinib with and without radiation therapy on patients with EGFR mutant non-small cell lung cancer and brain metastases

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