Oncotarget

Research Papers:

Concurrent brain radiotherapy and EGFR-TKI may improve intracranial metastases control in non-small cell lung cancer and have survival benefit in patients with low DS-GPA score

Yongmei Liu, Lei Deng, Xiaojuan Zhou, Youling Gong, Yong Xu, Lin Zhou, Jin Wan, Bingwen Zou, Yongsheng Wang, Jiang Zhu, Zhenyu Ding, Feng Peng, Meijuan Huang, Li Ren, Tim Lautenschlaeger, Feng-Ming (Spring) Kong and You Lu _

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Oncotarget. 2017; 8:111309-111317. https://doi.org/10.18632/oncotarget.22785

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Abstract

Yongmei Liu1,2,*, Lei Deng1,*, Xiaojuan Zhou1,*, Youling Gong1, Yong Xu1, Lin Zhou1, Jin Wan1, Bingwen Zou1, Yongsheng Wang1, Jiang Zhu1, Zhenyu Ding1, Feng Peng1, Meijuan Huang1, Li Ren1, Tim Lautenschlaeger2, Feng-Ming (Spring) Kong2 and You Lu1

1Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China

2Department of Radiation Oncology, IU Simon Cancer Center, IU School of Medicine, Indiana University, Indianapolis, IN, USA

*These authors have contributed equally to this study

Correspondence to:

You Lu, email: radyoulu@hotmail.com

Keywords: EGFR mutation; EGFR-TKI; brain radiotherapy; brain metastasis; non-small cell lung cancer

Received: June 08, 2017     Accepted: November 13, 2017     Published: November 30, 2017

ABSTRACT

Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) has intracranial activity in EGFR-mutant Non-Small Cell Lung Cancer (NSCLC). The optimal timing of brain radiotherapy (RT) and appropriate patients who need early brain RT remains undetermined. This is a retrospective study of EGFR-mutant NSCLC patients with newly diagnosed brain metastases (BMs) before EGFR-TKI initiation. Intra-cranial progression free survival (IC-PFS) and overall survival (OS) were measured from the date of EGFR-TKI treatment. A total of 113 patients were eligible, 49 received concurrent early brain RT with EGFR-TKI and 64 were treated with EGFR-TKI alone as initial therapy, including 27 with salvage RT upon BM progression. The patients with early brain RT had superior IC-PFS than those without early brain RT (21.4 vs 15.0 months, P=0.001), which remained significant in multivariate analysis (HR 0.30, P<0.001). The median overall survival (OS) for early RT, EGFR-TKI alone and salvage RT groups was 28.1, 24.5, and 24.6 months, respectively (P=0.604). Similar IC-PFS (23.6 vs 21.4 months, P=0.253) and OS (24.6 vs 28.1 months, P=0.385) were observed between salvage RT and early RT groups. For patients with Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) score of 0 to 2, early brain RT was the independent factor for improved OS (HR 0.33, P=0.025). In conclusion, concurrent early brain RT with EGFR-TKI may improve intracranial disease control in EGFR-mutant NSCLC with BM and have survival benefit in patients with low DS-GPA score. Salvage brain RT upon BM progression may be acceptable in some patients.


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