Value and significance of brain radiation therapy during first‐line <scp>EGFR‐TKI</scp> treatment in lung adenocarcinoma with <scp><i>EGFR</i></scp> sensitive mutation and synchronous brain metastasis: Appropriate timing and technique

Gu, Yangchun; Xu, Yan; Zhuang, Hongqing; Wang, Jiang; Zhang, Hua; Li, Xiaofeng; Liu, Yonggang; Ma, Li; Zhao, Dahai; Cheng, Yuan; Yu, Yan; Liu, Ping; Qin, Jianwen; Chen, Xueqin; Gao, Jun; Wang, Mengzhao; Liang, Li; Cao, Bangwei

doi:10.1111/1759-7714.14169

Cited by 8 publications

(5 citation statements)

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“…Several studies ( 22 ) believe that SRS combined with targeted therapy should be administered early, which can significantly prolong the prognosis of patients. However, another study by our team ( 23 ) and Chen et al. ( 24 ) showed that, as long as radiotherapy is administered during the course of targeted therapy, the patients’ OS can be prolonged.…”

Section: Discussionmentioning

confidence: 93%

Prognostic Factors and Survival Benefits of Antitumor Treatments for Advanced Non-Small Cell Lung Cancer Patients With Central Nervous System Metastasis With or Without Driver Genes: A Chinese Single-Center Cohort Study

et al. 2022

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BackgroundThe prognosis of non-small cell lung cancer (NSCLC) patients with central nervous system (CNS) metastasis is poor. The treatment for CNS metastasis could prolong the overall survival of NSCLC patients. We aimed to investigate the prognostic factors of Chinese NSCLC patients with CNS metastasis and the survival benefits of various treatments for CNS metastasis in NSCLC patients with or without driver genes.MethodsBased on the CAPTRA-Lung database, NSCLC patients with CNS metastasis admitted at the Peking Union Medical College Hospital between January 2010 and October 2018 were enrolled in the study. The prognostic factors were analyzed using univariate and multivariate Cox regression analyses.ResultsOverall, 418 patients were enrolled in the study. A total of 206 patients (49.3%) had CNS metastasis with positive driver genes, while 97 patients (23.2%) had negative driver genes. The median survival time after CNS metastasis was 20.8 months. In the multivariable analysis, an Eastern Cooperative Oncology Group performance status of ≥2 (hazard ratio [HR]: 1.750, 95% confidence interval [CI]: 1.184-2.588, P=0.005), number of CNS metastases ≥5 (HR: 1.448, 95% CI: 1.084 -1.934, P=0.012), and CNS metastasis developed during treatment (HR: 1.619, 95% CI: 1.232-2.129, P=0.001) were independent risk factors for poor survival. Lung adenocarcinoma (HR: 0.490, 95% CI: 0.279-0.861, P=0.013) and driver gene positivity (HR: 0.464, 95% CI: 0.302-0.715, P=0.001) were independent predictors of prolonged survival. Radiotherapy for CNS metastasis showed a survival benefit in NSCLC patients in the entire groups (HR: 0.472, 95% CI: 0.360-0.619, P <0.001), and in patients with positive driver genes.ConclusionPerformance status, number of CNS metastases, timing of CNS metastasis, histological subtype, and driver gene status are prognostic factors for NSCLC patients with CNS metastasis. Furthermore, radiotherapy improved the survival in NSCLC patients with CNS metastasis.

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Section: Discussionmentioning

confidence: 93%

Prognostic Factors and Survival Benefits of Antitumor Treatments for Advanced Non-Small Cell Lung Cancer Patients With Central Nervous System Metastasis With or Without Driver Genes: A Chinese Single-Center Cohort Study

et al. 2022

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“…Several studies have indicated that WBRT plus target drugs may have potential survival benefit for improving the treatment response and long‐term survival of NSCLC cases with brain metastasis. 26 However, the conclusion of these studies was different due to the different treatment modalities and clinical heterogeneity of patients. In the present study, we pooled the treatment response and toxicity of the 18 studies included and found the ORR and 1‐year survival rate in the WBRT+TKI group was higher than that of the WBRT only group with a statistical difference ( p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of WBRT+EGFR‐TKI versus WBRT only in the treatment of NSCLC patients with brain metastasis: An updated meta‐analysis

et al. 2021

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Background To investigate the efficacy and safety of whole brain radiotherapy (WBRT) combined with epidermal growth factor receptor‐tyrosine kinase inhibitor (EGFR‐TKI) versus WBRT only in the treatment of brain metastasis in non‐small cell lung cancer (NSCLC) patients by pooling open published data. Methods Prospective clinical studies relevant to WBRT+EGFR‐TKI versus WBRT only in the treatment of NSCLC brain metastasis were electronically searched in the Pubmed, EMbase, Cochrane, Wangfang, CNKI and Google scholar databases. The treatment response, 1‐year survival and treatment‐associated toxicity were pooled and expressed by odds ratio (OR) under a fixed or random effect model. The publication bias was evaluated by Begg's funnel plot and Egger's line regression test. Results Eighteen prospective clinical studies were included in the study. The combined results indicated that the objective response rate (ORR) in the WBRT+TKI group was superior to WBRT only with a statistical difference (OR = 2.67, 95% CI: 2.10–3.38, p < 0.05) under a fixed effect model. Ten studies reported the 1‐year survival rate between the WBRT+TKI and WBRT only groups. The combined results showed that 1‐year survival rate in the WBRT+TKI group was higher than that of the WBRT only group with a statistical difference (OR = 2.70, 95% CI: 1.95–3.74, p < 0.05). For treatment‐associated toxicity, the combined data indicated that the treatment‐related rash in the WBRT+TKI group was significantly higher than that of the WBRT only group with a statistical difference (OR = 2.72, 95% CI: 1.53–4.84, p < 0.05). However, the incidence of nausea/vomiting (OR = 0.84, 95% CI: 0.60–1.17, p > 0.05), diarrhea (OR = 1.31, 95% CI: 0.83–2.07, p > 0.05), fatigue (OR = 1.40, 95% CI: 0.70–2.81, p > 0.05) and myelosuppression (OR = 0.86, 95% CI: 0.56–1.32, p > 0.05) were not statistically different between the two groups. Conclusions Based on the current publications, WBRT+EGFR‐TKI can improve the treatment response and 1‐year survival rate but not increase the toxicity except for rash compared to WBRT alone in the treatment of brain metastasis in NSCLC patients.

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“…There were also meta-analysis that showed that upfront RT including stereotactic radiosurgery (SRS) was associated with better OS and iPFS for EGFR-mutated NSCLC with brain metastases [ 15 , 16 , 17 ]. Some clinical trials draw a conclusion that upfront brain RT based on first-line EGFR-TKIs might improve intra-cranial PFS but not OS in EGFR-mutant lung adenocarcinoma patients with BMs [ 18 , 19 , 20 ]. It is important to note that the radiotherapy technique involved in these studies are predominantly WBRT, whereas SRS is now the primary treatment option for patients with limited brain metastases.…”

Section: Introductionmentioning

confidence: 99%

Effect of Different Timing of Local Brain Radiotherapy on Survival of EGFR-Mutated NSCLC Patients with Limited Brain Metastases

Wang,

Wu,

et al. 2023

Brain Sciences

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(1) Background: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been the first line therapy for EGFR-mutant lung adenocarcinoma (LAC) patients with brain metastases (BMs). However, the role and the optimal time of brain radiotherapy remains controversial. We aimed to investigate the role of upfront brain stereotactic radiotherapy (SRS) and the impact of deferral radiotherapy on patients’ clinical outcomes. (2) Methods: We retrospectively studied 53 EGFR-mutant LAC patients with limited synchronous BMs between 2014 and 2020 at our institute. The limited BMs was defined with one to four BM lesions, with a maximal size of ≤4 cm. Patients were categorized into two groups: upfront brain SRS (upfront RT) and upfront TKIs. The intracranial progression-free survival (iPFS), progression-free survival (PFS), and overall survival (OS) between groups were analyzed. (3) Results: The median iPFS (21.0 vs. 12.0 months, p = 0.002) and PFS (20.0 vs. 11.0 months, p = 0.004) of the upfront RT group was longer than that of the upfront TKI group. There were no significant differences in median OS (30.0 vs. 26.0 months, p = 0.552) between the two groups. The upfront RT group is less likely to suffer from intracranial progression of the original sites than that of upfront TKIs during the disease course (36.1% vs. 0.0%, p = 0.025). Multivariate analysis showed that the Karnofsky Performance Scale and the presence of synchronous meningeal metastases were associated with overall survival. (4) Conclusions: Compared with upfront TKI, the combination of upfront SRS with TKIs can improve the iPFS and PFS in EGFR-mutant LAC with synchronous BMs. The addition of upfront brain SRS was useful for the original intracranial metastatic lesions.

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Value and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique

Cited by 8 publications

References 34 publications

Prognostic Factors and Survival Benefits of Antitumor Treatments for Advanced Non-Small Cell Lung Cancer Patients With Central Nervous System Metastasis With or Without Driver Genes: A Chinese Single-Center Cohort Study

Prognostic Factors and Survival Benefits of Antitumor Treatments for Advanced Non-Small Cell Lung Cancer Patients With Central Nervous System Metastasis With or Without Driver Genes: A Chinese Single-Center Cohort Study

Efficacy and safety of WBRT+EGFR‐TKI versus WBRT only in the treatment of NSCLC patients with brain metastasis: An updated meta‐analysis

Effect of Different Timing of Local Brain Radiotherapy on Survival of EGFR-Mutated NSCLC Patients with Limited Brain Metastases

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