Therapeutic Effect Of First-Line EGFR-TKIs Combined With Concurrent Cranial Radiotherapy On NSCLC Patients With EGFR Activating Mutation And Brain Metastasis: A Retrospective Study

Abstract

Ning An,1 Haoyi Wang,2 Ji Li,3 Xiaoyang Zhai,3 Wang Jing,3 Wenxiao Jia,3 Li Kong,3 Hui Zhu,3 Jinming Yu3 1Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People’s Republic of China; 2Department of Hematology, Qilu Hospital, Shandong University, Jinan, People’s Republic of China; 3Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of ChinaCorrespondence: Hui Zhu; Jinming YuDepartment of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, People’s Republic of ChinaTel/fax [phone]Email [email protected]; [email protected]: Non-small cell lung cancer (NSCLC) patients with EGFR mutation are suffering from a high incidence of brain metastasis (BM). It is still controversial whether cranial radiotherapy could be delayed when the EGFR-tyrosine kinase inhibitors (TKIs) used as first-line therapy for EGFR-positive patients with BM. This study aims to investigate the therapeutic effect of TKIs combined with concurrent cranial radiotherapy on BM.Patients and methods: NSCLC patients with EGFR mutation and BM were retrospectively analyzed from January 2013 to December 2016 in Shandong Cancer Hospital. Identified cases were treated with first-line EGFR-TKIs with or without concurrent cranial radiation.Results: A total of 64 eligible patients were enrolled in this study, while 35 patients received first-line EGFR-TKIs plus cranial radiotherapy (RT+TKI group) and 29 patients received first-line EGFR-TKIs only (TKI alone group). The intracranial progression-free survival (PFS) of the RT+TKI group was significantly longer than the TKI alone group (25 vs 16 months; p=0.019), but no significant differences were observed between the two groups on extracranial PFS (20 vs 17 months, p=0.660). The median overall survival was also longer in the RT+TKI group (31 vs 24 months, p=0.019).Conclusion: Our retrospective data suggest that first-line TKIs plus concurrent cranial radiotherapy is a promising therapeutic strategy that led to remarkable intracranial PFS improvement and survival benefits for EGFR-mutant NSCLC with BM. Hence, it should be considered as a crucial treatment method during clinical management.Keywords: non-small cell lung cancer, EGFR mutation, brain metastasis, radiotherapy, tyrosine kinase inhibitor

Keywords

• Non-small cell lung cancer
• EGFR mutation
• Brain metastasis
• Radiotherapy
• Tyrosine kinase inhibitor