Response and safety of whole‐brain radiotherapy plus temozolomide for patients with brain metastases of non‐small‐cell lung cancer: A meta‐analysis

Abstract

The aim of the present work was to investigate the response and safety of whole-brain radiotherapy (WBRT) plus temozolomide (TMZ) for patients with brain metastases of non-small-cell lung cancer (NSCLC). Methods: The electronic databases of Pubmed, EMbase, Cochrane, Wangfang, china national knowledge infrastructure (CNKI), and Google scholar were systematically searched to identify the prospective randomized trials relevant to WBRT plus TMZ for patients with brain metastases of NSCLC. The data associated with treatment response and toxicity were extracted from original included studies. The relative risk (RR) for treatment response and toxicity between WBRT+TMZ and WBRT alone was pooled by fixed or random effect model. Publication bias was investigated by Begg's funnel plot and Egger's line regression test. Results: Twenty-five clinical trials fulfilled the inclusion criteria and were included in the meta-analysis. The pooled results showed WBRT+TMZ can significant improve the objective response rate (ORR) compared with WBRT alone (RR = 1.43, 95% confidence interval [CI] 1.32-1.55, p < 0.05) under a fixed effect model. WBRT+TMZ significantly increased the III-IV hematological toxicity compared to WBRT alone (RR = 1.66, 95% CI 1.12-2.54, p < 0.05) in the fixed effect model. Grade III-IV gastrointestinal toxicity was increased in WBRT+TMZ compared to WBRT alone (RR = 1.72, 95% CI 1.29-2.30, p < 0.05). Begg's funnel plot and Egger's line regression test indicated publication bias. Conclusion: Based on the present work, WBRT+TMZ can improve the ORR for brain metastases of NSCLC, but the risk of treatment-associated grade III/IV hematological toxicity and gastrointestinal toxicity were also increased compared to WBRT alone.

Analysis of Immunotherapy Combined with Radiotherapy in Patients with Brain Metastasis of Driver Gene-Negative Non-Small-Cell Lung Cancer

“…However, due to dose limitation and the patient's organ tolerance, WBRT still has the risk of treatment failure or local recurrence [ 21 ]. In addition, WBRT can lead to irreversible neurological complications, which will affect patients' neurocognitive function, and has certain limitations [ 22 ]. In addition, local radiotherapy alone can achieve a high local control rate, but it cannot eliminate small metastases, and new brain metastases are easy to occur, with poor prognosis [ 23 ].…”

Zimberelimab combined with systemic therapy extended tumor control in post‐radiotherapy cervical cancer with brain metastases: A case report

“…Twenty-five clinical trials were included in the meta-analysis, which demonstrated that whole-brain radiation therapy plus temozolomide could significantly increase grade III-IV hematological and gastrointestinal toxicity in BMs of non-small-cell lung cancer, while significantly decreasing the objective response rate (ORR) compared to whole-brain radiation therapy alone (p = 0.05). 7 In the present case, the patient had previously experienced leukopenia and neutropenia after primary surgery and had a poor performance status (ECOG: 3). Therefore, the patient received temozolomide and bevacizumab in addition to radiotherapy.…”

“…Cisplatin and topotecan are the most common concomitant radiation chemotherapies for BMs; however, temozolomide, which could pass the blood–brain barrier and exhibit promising therapeutic effects in glioblastoma, may be a viable alternative. Twenty‐five clinical trials were included in the meta‐analysis, which demonstrated that whole‐brain radiation therapy plus temozolomide could significantly increase grade III‐IV hematological and gastrointestinal toxicity in BMs of non‐small‐cell lung cancer, while significantly decreasing the objective response rate (ORR) compared to whole‐brain radiation therapy alone ( p = 0.05) 7 …”

Lung cancer with brain metastases remaining in continuous complete remission due to pembrolizumab and temozolomide: a case report

“…The same results were observed in NSCLC patients with BM, with significant improvement in objective response rate and progression-free survival (6.0 vs. 3.5 months; P=0.038) with the TMZ+WBRT group, though the differences in OS were not significant ( 42 ). With regard to combination therapy with TMZ plus irinotecan or TMZ plus WBRT for BM originating from NSCLC, TMZ may control microscopic central nervous system disease ( 43 , 44 ). Nevertheless, TMZ combined with immunotherapy for BM patients is seldom used ( 45 ).…”