Cancer Management and Research (Aug 2021)

Anlotinib Combined with Cranial Radiotherapy for Non-Small Cell Lung Cancer Patients with Brain Metastasis: A Retrospectively, Control Study

  • He Z,
  • Liu J,
  • Ma Y,
  • Jiang H,
  • Cui Z,
  • Wang G,
  • Wu Y,
  • Liu J,
  • Cai X,
  • Qian J,
  • Huang J,
  • Zhang H,
  • Li H

Journal volume & issue
Vol. Volume 13
pp. 6101 – 6111

Abstract

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Zelai He,1,* Jia Liu,1,* Yuwei Ma,1,* Hao Jiang,1 Zhen Cui,1 Guowen Wang,1 Yufeng Wu,2 Jiuzhou Liu,3 Xixi Cai,4 Jing Qian,1 Jingwen Huang,1 Huijun Zhang,5 Hongwei Li1 1The First Affiliated Hospital of Bengbu Medical College & Tumor Hospital Affiliated to Bengbu Medical College, Bengbu, 233004, People’s Republic of China; 2Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, 450008, People’s Republic of China; 3The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, 471003, People’s Republic of China; 4Department of Radiation Oncology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, People’s Republic of China; 5Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huijun Zhang; Hongwei Li Email [email protected]; [email protected]: Cranial radiotherapy (CRT) is the main treatment for non-small cell lung cancer (NSCLC) with brain metastasis (BM) and non-EGFR/ALK/ROS1-TKIs indication, and anlotinib can improve overall prognosis. However, the clinical effects of CRT combined with anlotinib for the treatment of NSCLC with BM remain unclear.Methods: We retrospectively analyzed the clinical effects of anlotinib + CRT versus CRT alone in NSCLC patients with BM and non-EGFR/ALK/ROS1-TKIs indication from September 2016 to June 2020. The progression-free survival (PFS) and overall survival (OS) of anlotinib + CRT versus CRT alone were analyzed. After evaluation of the clinical characteristics to generate a baseline, the independent prognostic factors for intracranial PFS (iPFS) and OS were subjected to univariate and multivariate analysis. Finally, subgroup analysis for iPFS and OS was performed to assess treatment effects using randomized stratification factors and stratified Cox proportional hazards models.Results: This study included data for 73 patients with BM at baseline. Of the 73 patients, 45 patients received CRT alone, and 28 patients received CRT + anlotinib. There was no significant difference in clinical features between the two groups (P > 0.05). Compared with the CRT group, the combined group had longer iPFS (median iPFS [miPFS]: 3.0 months vs 11.0 months, P = 0.048). However, there were no significant differences in OS, extracranial PFS, and systemic PFS. For clinical features, univariate and multivariate analysis showed that the plus anlotinib treatment was an independent advantage predictor of iPFS (hazard ratio [HR] 0.51; 95% confidence interval [CI] 0.27– 0.95; P = 0.04), and age ≥ 57 years (HR 1.04, 95% CI 1.01– 1.08, P = 0.014) and KPS score ≤ 80 (HR 1.04, 95% CI 1.01– 1.08, P = 0.014) were independent disadvantage predictors of OS (P 0.05), the patients with the anlotinib + local CRT (LCRT) treatment had the longest iPFS (miPFS: 27.0 months) and OS (median OS [mOS]: 36 months). The miPFS and mOS values for the LCRT group were 11 months and 18 months, respectively, with shorter values for whole-brain RT (WBRT) + anlotinib group, WBRT + LCRT + anlotinib group, WBRT, and WBRT + LCRT.Conclusion: Anlotinib can improve the intracranial lesion control and survival prognosis of NSCLC patients with CRT.Keywords: radiotherapy, lung cancer, brain metastases, progression-free survival, overall survival

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