Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study
Zhi-Yong He,1,2,* Mei-Fang Li,1,2,* Jing-Hui Lin,1,2 Dong Lin,1,2 Ren-Jang Lin3 1Department of Thoracic Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People’s Republic of China; 2Fujian Provincial Key Laboratory of Tran...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2019-03-01
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| Series: | Cancer Management and Research |
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| Online Access: | https://www.dovepress.com/comparing-the-efficacy-of-concurrent-egfr-tki-and-whole-brain-radiothe-peer-reviewed-article-CMAR |
| _version_ | 1818485433874513920 |
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| author | He ZY Li MF Lin JH Lin D Lin RJ |
| author_facet | He ZY Li MF Lin JH Lin D Lin RJ |
| author_sort | He ZY |
| collection | DOAJ |
| description | Zhi-Yong He,1,2,* Mei-Fang Li,1,2,* Jing-Hui Lin,1,2 Dong Lin,1,2 Ren-Jang Lin3 1Department of Thoracic Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People’s Republic of China; 2Fujian Provincial Key Laboratory of Translation Cancer Medicine, Fuzhou 350014, Fujian Province, People’s Republic of China; 3Department of Molecular and Cellular Biology, Beckman Research Institute of the City of Hope, Duarte, CA 91010, USA *These authors contributed equally to this work Background: Non-small-cell lung cancer (NSCLC) is a global public health problem, and brain is a common metastatic site in advanced NSCLC. Currently, whole-brain radiotherapy (WBRT) remains a major treatment for brain metastases, while EGFR-tyrosine kinase inhibitor (TKI) is the standard treatment for advanced NSCLC harboring EGFR mutations, which is also effective for brain metastases. However, whether EGFR-TKIs plus radiotherapy is superior to EGFR-TKIs alone for the treatment of advanced EGFR-mutant NSCLS with brain metastases remains controversial. This study aimed to compare the efficacy of concurrent EGFR-TKIs and WBRT vs EGFR-TKI alone in a retrospective cohort of advanced EGFR-mutant NSCLS with brain metastases.Patients and methods: The medical records of 104 treatment-naïve, advanced EGFR-mutant NSCLC patients with brain metastases were retrospectively reviewed, and there were 56 patients undergoing concurrent EGFR-TKI and WBRT, and 48 patients given EGFR-TKI alone, including 20 cases with salvage WBRT upon brain metastasis progression. The survival prognosis was compared between the two cohorts.Results: The baseline clinicopathologic factors were balanced between the two cohorts. After a median follow-up of 23 months, 35.6% of the study subjects survived. Concurrent EGFR-TKI and WBRT significantly improved the median intracranial PFS (iPFS) compared with EGFR-TKI alone (17.7 vs 11.0 months, P=0.015); however, no significant difference was seen in median overall survival between the two cohorts (28.1 vs 24.0 months, P=0.756). In addition, the median iPFS was found to significantly vary in the number of brain metastases (≤3 vs>3 metastases: 18.0 vs 12.5 months, P=0.044). Subgroup analysis showed that concurrent EGFR-TKI and WBRT improved median iPFS compared with EGFR-TKI alone in patients with more than three brain metastases (P=0.001); however, no significant difference was observed between the two regimens in patients with three or less brain metastases (P=0.526).Conclusion: Our data demonstrate that concurrent EGFR-TKI and WBRT achieves longer iPFS than EGFR-TKI alone in advanced EGFR-mutant NSCLC with brain metastases. In advanced EGFR-mutant NSCLC with three or less brain metastases, EGFR-TKI alone may be an option as a first-line therapy. Keywords: non-small-cell lung cancer, brain metastasis, epidermal growth factor receptor, tyrosine kinase inhibitor, whole-brain radiotherapy |
| first_indexed | 2024-12-10T16:08:59Z |
| format | Article |
| id | doaj.art-71dde3de599d4432b6f2dd12e3476f08 |
| institution | Directory Open Access Journal |
| issn | 1179-1322 |
| language | English |
| last_indexed | 2024-12-10T16:08:59Z |
| publishDate | 2019-03-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Cancer Management and Research |
| spelling | doaj.art-71dde3de599d4432b6f2dd12e3476f082022-12-22T01:42:10ZengDove Medical PressCancer Management and Research1179-13222019-03-01Volume 112129213844582Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort studyHe ZYLi MFLin JHLin DLin RJZhi-Yong He,1,2,* Mei-Fang Li,1,2,* Jing-Hui Lin,1,2 Dong Lin,1,2 Ren-Jang Lin3 1Department of Thoracic Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People’s Republic of China; 2Fujian Provincial Key Laboratory of Translation Cancer Medicine, Fuzhou 350014, Fujian Province, People’s Republic of China; 3Department of Molecular and Cellular Biology, Beckman Research Institute of the City of Hope, Duarte, CA 91010, USA *These authors contributed equally to this work Background: Non-small-cell lung cancer (NSCLC) is a global public health problem, and brain is a common metastatic site in advanced NSCLC. Currently, whole-brain radiotherapy (WBRT) remains a major treatment for brain metastases, while EGFR-tyrosine kinase inhibitor (TKI) is the standard treatment for advanced NSCLC harboring EGFR mutations, which is also effective for brain metastases. However, whether EGFR-TKIs plus radiotherapy is superior to EGFR-TKIs alone for the treatment of advanced EGFR-mutant NSCLS with brain metastases remains controversial. This study aimed to compare the efficacy of concurrent EGFR-TKIs and WBRT vs EGFR-TKI alone in a retrospective cohort of advanced EGFR-mutant NSCLS with brain metastases.Patients and methods: The medical records of 104 treatment-naïve, advanced EGFR-mutant NSCLC patients with brain metastases were retrospectively reviewed, and there were 56 patients undergoing concurrent EGFR-TKI and WBRT, and 48 patients given EGFR-TKI alone, including 20 cases with salvage WBRT upon brain metastasis progression. The survival prognosis was compared between the two cohorts.Results: The baseline clinicopathologic factors were balanced between the two cohorts. After a median follow-up of 23 months, 35.6% of the study subjects survived. Concurrent EGFR-TKI and WBRT significantly improved the median intracranial PFS (iPFS) compared with EGFR-TKI alone (17.7 vs 11.0 months, P=0.015); however, no significant difference was seen in median overall survival between the two cohorts (28.1 vs 24.0 months, P=0.756). In addition, the median iPFS was found to significantly vary in the number of brain metastases (≤3 vs>3 metastases: 18.0 vs 12.5 months, P=0.044). Subgroup analysis showed that concurrent EGFR-TKI and WBRT improved median iPFS compared with EGFR-TKI alone in patients with more than three brain metastases (P=0.001); however, no significant difference was observed between the two regimens in patients with three or less brain metastases (P=0.526).Conclusion: Our data demonstrate that concurrent EGFR-TKI and WBRT achieves longer iPFS than EGFR-TKI alone in advanced EGFR-mutant NSCLC with brain metastases. In advanced EGFR-mutant NSCLC with three or less brain metastases, EGFR-TKI alone may be an option as a first-line therapy. Keywords: non-small-cell lung cancer, brain metastasis, epidermal growth factor receptor, tyrosine kinase inhibitor, whole-brain radiotherapyhttps://www.dovepress.com/comparing-the-efficacy-of-concurrent-egfr-tki-and-whole-brain-radiothe-peer-reviewed-article-CMARnon-small-cell lung cancerbrain metastasisepidermal growth factor receptortyrosine kinase inhibitorwhole-brain radiotherapy |
| spellingShingle | He ZY Li MF Lin JH Lin D Lin RJ Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study Cancer Management and Research non-small-cell lung cancer brain metastasis epidermal growth factor receptor tyrosine kinase inhibitor whole-brain radiotherapy |
| title | Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study |
| title_full | Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study |
| title_fullStr | Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study |
| title_full_unstemmed | Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study |
| title_short | Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study |
| title_sort | comparing the efficacy of concurrent egfr tki and whole brain radiotherapy vs egfr tki alone as a first line therapy for advanced egfr mutated non small cell lung cancer with brain metastases a retrospective cohort study |
| topic | non-small-cell lung cancer brain metastasis epidermal growth factor receptor tyrosine kinase inhibitor whole-brain radiotherapy |
| url | https://www.dovepress.com/comparing-the-efficacy-of-concurrent-egfr-tki-and-whole-brain-radiothe-peer-reviewed-article-CMAR |
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