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The Efficacy of Upfront Intracranial Radiation with TKI Compared to TKI Alone in the NSCLC Patients Harboring EGFR Mutation and Brain Metastases.
| Content Provider | Europe PMC |
|---|---|
| Author | Wang, Chunyu Lu, Xiaotong Zhou, Zongmei Wang, Jingbo Hui, Zhouguang Liang, Jun Feng, QinFu Chen, Dongfu Xiao, Zefen Lv, Jima Wang, Xiaozhen Wang, Xin Zhang, Tao Deng, Lei Wang, Wenqing Xiao, Jianping Li, Junling Bi, Nan Wang, Luhua |
| Copyright Year | 2019 |
| Abstract | Introduction: The high intracranial efficacy of EGFR-TKI challenges the role of upfront intracranial radiation therapy (RT) in non-small cell lung cancer (NSCLC) patients with EGFR mutation and brain metastases (BM). Therefore, we conducted a retrospective analysis to demonstrate the role of upfront RT in these patients.Materials and Methods: Patients that had histologically confirmed NSCLC with EGFR mutation, brain metastases, and received TKI or upfront RT with TKI were included in this study. Intracranial progression was estimated using the Fine-Gray competing risks model. Kaplan-Meier analysis and Log-rank test were used to evaluate and compare intracranial progression-free survival (iPFS), systemic PFS (sPFS), time to second-line systematic therapy (SST) and overall survival (OS).Results: Among the 93 patients included, 53 patients received upfront RT and TKI, and 40 patients received TKI only. Upfront RT group showed lower intracranial progression risk with adjusted SHR 0.38 (95% CI, 0.19 to 0.75, P= 0.006) and longer median time to sPFS (15.6 vs 8.9 months, P= 0.009). There were 9 out of 36 (25%) and 16 out of 34 (47.1%) patients who had oligo-progression received salvage RT in the RT group and TKI group, respectively. After the salvage RT, upfront RT did not prolong the median time to SST (23.6 vs 18.9 months, P=0.862) and OS (median time, 35.4 vs 35.8 months, P=0.695) compared to TKI alone.Conclusion: Compared to upfront intracranial RT, the salvage RT to oligo-progressive disease allowed patients getting TKI to have similar time on initial TKI and OS despite worse iPFS. The best timing of intracranial RT remains to be further verified. |
| Volume Number | 10 |
| PubMed Central reference number | PMC6548172 |
| Issue Number | 9 |
| PubMed reference number | 31205558 |
| Journal | Journal of Cancer [J Cancer] |
| e-ISSN | 18379664 |
| DOI | 10.7150/jca.30131 |
| Language | English |
| Publisher | Ivyspring International Publisher |
| Publisher Date | 2019-05-12 |
| Publisher Place | Sydney |
| Access Restriction | Open |
| Rights License | This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions. © Ivyspring International Publisher |
| Subject Keyword | non-small cell lung cancer EGFR mutation brain metastases radiation tyrosine kinase inhibitors |
| Content Type | Text |
| Resource Type | Article |
| Subject | Oncology |
