Treatment preferences for epidermal growth factor receptor mutation-positive non-small cell lung cancer with brain metastasis: a large-scale survey from Chinese oncologists

Yang, Yu; Qian, Jie; Shen, Lan; Ji, Wei; Lü, Shun

doi:10.21037/atm-21-6413

Cited by 1 publication

(1 citation statement)

References 39 publications

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“…On the other hand, for patients with symptomatic BMs, uLT is recommended (radiosurgery or radiation therapy and/or surgery) as LT shows great potential for instant alleviation of neurological symptoms among them, indicating a novel BM management strategy of LT plus EGFR-TKIs (Rhun et al 2021 ; Vogelbaum et al 2022 ; Yang et al 2017 ; Ni et al 2019 ; Bhandari et al 2021 ; Gondi et al 2022 ). In a large survey from Chinese oncologists, the participants were unanimous in the view that radiotherapy (RT) plus TKIs were the preferred regimen for EGFRm NSCLC patients with BM when neurological symptoms presented (Yu et al 2022 ). The synergistic effects between EGFR-TKIs and RT have been proved in previous studies (Zeng et al 2015 ; Kong et al 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Optimal sequence of LT for symptomatic BM in EGFR-mutant NSCLC: a comparative study of first-line EGFR-TKIs with/without upfront LT

Niu,

Wu,

Gao

et al. 2024

J Cancer Res Clin Oncol

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Background The third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) can penetrate blood–brain barrier and are effective for brain metastases (BMs). There is no consensus on the optimal sequence of local therapy (LT) and EGFR-TKIs for symptomatic BM patients because patients suffering neurological symptoms were not enrolled in most clinical trials. Methods Non-small cell lung cancer (NSCLC) patients with EGFR mutation (EGFRm) and symptomatic BM receiving first-line osimertinib and aumolertinib from two medical centers were collected. All participants were allocated into the third-generation EGFR-TKIs (TKIs) group and the upfront LT (uLT) plus third-generation EGFR-TKIs (TKIs + uLT) group. Demographic data, survival outcomes, treatment failure patterns, and adverse events were evaluated between the two groups. We also conducted subgroup analyses to explore the impact of BM number on survival outcomes. Results 86 patients were enrolled, 44 in the TKIs group and 42 in the TKIs + uLT group. There were no significant differences in the short-term response between the groups. TKIs + uLT was associated with significantly longer overall survival (OS) (43 vs. 28 months; hazard ratio [HR], 0.36, 95% confidence interval [CI], 0.17–0.77; p = .011). No differences in progression-free survival (PFS), intracranial PFS (iPFS), failure patterns, or safety were observed. In subgroup analyses of oligo-BM patients, TKIs + uLT could prolong OS (43 vs. 31 months; HR 0.22; 95% CI 0.05–0.92; p = .015). Conclusions EGFRm NSCLC patients with symptomatic BM might benefit from uLT, particularly oligo-BM patients. However, larger prospective cohort studies should be carried out to confirm the responses of the TKIs + uLT scheme.

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