The optimal therapy strategy for epidermal growth factor receptor‐mutated non‐small cell lung cancer patients with brain metastasis: A real‐world study from Taiwan
Abstract Background The treatment options for epidermal growth factor receptor (EGFR)‐mutated non‐small cell lung cancer (NSCLC) with brain metastases (BMs) include EGFR‐tyrosine kinase inhibitors (TKIs), stereotactic radiosurgery (SRS), whole‐brain radiotherapy, brain surgery, and antiangiogenesis...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-05-01
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| Series: | Thoracic Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/1759-7714.14423 |
| _version_ | 1811233917574840320 |
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| author | Wen‐Chien Cheng Yi‐Cheng Shen Chun‐Ru Chien Wei‐Chih Liao Chia‐Hung Chen Te‐Chun Hsia Chih‐Yeh Tu Hung‐Jen Chen |
| author_facet | Wen‐Chien Cheng Yi‐Cheng Shen Chun‐Ru Chien Wei‐Chih Liao Chia‐Hung Chen Te‐Chun Hsia Chih‐Yeh Tu Hung‐Jen Chen |
| author_sort | Wen‐Chien Cheng |
| collection | DOAJ |
| description | Abstract Background The treatment options for epidermal growth factor receptor (EGFR)‐mutated non‐small cell lung cancer (NSCLC) with brain metastases (BMs) include EGFR‐tyrosine kinase inhibitors (TKIs), stereotactic radiosurgery (SRS), whole‐brain radiotherapy, brain surgery, and antiangiogenesis therapy. As treatment options evolve, redefining optimal treatment strategies to improve survival are crucial. Methods A total of 150 EGFR‐mutant NSCLC patients with BMs who received first‐ or second‐generation EGFR‐TKIs as first‐line treatment between January 2012 and October 2019 were included in this analysis. Results After multivariate analysis, patients with the graded prognostic assessment for lung cancer using molecular markers (Lung‐mol GPA) ≥3 (hazard ratio [HR]: 0.538, 95% confidence interval [CI]: 0.35–0.83), who received afatinib or erlotinib as first‐line treatment (HR: 0.521, 95% CI: 0.33–0.82), underwent SRS therapy (HR: 0.531, 95% CI: 0.32–0.87), or were sequentially treated with osimertinib (HR: 0.400, 95% CI: 0.23–0.71) were associated with improved overall survival (OS). Furthermore, SRS plus EGFR‐TKI provided more OS benefits in patients with Lung‐mol GPA ≥3 compared with EGFR‐TKI alone in our patient cohort (44.9 vs. 26.7 months, p = 0.005). The OS in patients who received sequential osimertinib therapy was significantly longer than those without osimertinib treatment (43.5 vs. 24.3 months, p < 0.001), regardless of T790 mutation status (positive vs. negative vs. unknown: 40.4 vs. 54.6 vs.43.4 months, p = 0.227). Conclusions The study demonstrated that EGFR‐mutant NSCLC patients with BMs could be precisely treated with SRS according to Lung‐mol GPA ≥3. Sequential osimertinib was associated with prolonged survival, regardless of T790M status. |
| first_indexed | 2024-04-12T11:27:07Z |
| format | Article |
| id | doaj.art-f26a84ef953c417faf911ff9bc7d9ebc |
| institution | Directory Open Access Journal |
| issn | 1759-7706 1759-7714 |
| language | English |
| last_indexed | 2024-04-12T11:27:07Z |
| publishDate | 2022-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Thoracic Cancer |
| spelling | doaj.art-f26a84ef953c417faf911ff9bc7d9ebc2022-12-22T03:35:12ZengWileyThoracic Cancer1759-77061759-77142022-05-0113101505151210.1111/1759-7714.14423The optimal therapy strategy for epidermal growth factor receptor‐mutated non‐small cell lung cancer patients with brain metastasis: A real‐world study from TaiwanWen‐Chien Cheng0Yi‐Cheng Shen1Chun‐Ru Chien2Wei‐Chih Liao3Chia‐Hung Chen4Te‐Chun Hsia5Chih‐Yeh Tu6Hung‐Jen Chen7Division of Pulmonary and Critical Care, Department of Internal Medicine China Medical University Hospital Taichung TaiwanDivision of Pulmonary and Critical Care, Department of Internal Medicine China Medical University Hospital Taichung TaiwanSchool of Medicine, College of Medicine, China Medical University Taichung TaiwanDivision of Pulmonary and Critical Care, Department of Internal Medicine China Medical University Hospital Taichung TaiwanDivision of Pulmonary and Critical Care, Department of Internal Medicine China Medical University Hospital Taichung TaiwanDivision of Pulmonary and Critical Care, Department of Internal Medicine China Medical University Hospital Taichung TaiwanDivision of Pulmonary and Critical Care, Department of Internal Medicine China Medical University Hospital Taichung TaiwanDivision of Pulmonary and Critical Care, Department of Internal Medicine China Medical University Hospital Taichung TaiwanAbstract Background The treatment options for epidermal growth factor receptor (EGFR)‐mutated non‐small cell lung cancer (NSCLC) with brain metastases (BMs) include EGFR‐tyrosine kinase inhibitors (TKIs), stereotactic radiosurgery (SRS), whole‐brain radiotherapy, brain surgery, and antiangiogenesis therapy. As treatment options evolve, redefining optimal treatment strategies to improve survival are crucial. Methods A total of 150 EGFR‐mutant NSCLC patients with BMs who received first‐ or second‐generation EGFR‐TKIs as first‐line treatment between January 2012 and October 2019 were included in this analysis. Results After multivariate analysis, patients with the graded prognostic assessment for lung cancer using molecular markers (Lung‐mol GPA) ≥3 (hazard ratio [HR]: 0.538, 95% confidence interval [CI]: 0.35–0.83), who received afatinib or erlotinib as first‐line treatment (HR: 0.521, 95% CI: 0.33–0.82), underwent SRS therapy (HR: 0.531, 95% CI: 0.32–0.87), or were sequentially treated with osimertinib (HR: 0.400, 95% CI: 0.23–0.71) were associated with improved overall survival (OS). Furthermore, SRS plus EGFR‐TKI provided more OS benefits in patients with Lung‐mol GPA ≥3 compared with EGFR‐TKI alone in our patient cohort (44.9 vs. 26.7 months, p = 0.005). The OS in patients who received sequential osimertinib therapy was significantly longer than those without osimertinib treatment (43.5 vs. 24.3 months, p < 0.001), regardless of T790 mutation status (positive vs. negative vs. unknown: 40.4 vs. 54.6 vs.43.4 months, p = 0.227). Conclusions The study demonstrated that EGFR‐mutant NSCLC patients with BMs could be precisely treated with SRS according to Lung‐mol GPA ≥3. Sequential osimertinib was associated with prolonged survival, regardless of T790M status.https://doi.org/10.1111/1759-7714.14423brain metastasisepidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitorsgraded prognostic assessment for lung cancer using molecular markers (lung‐mol GPA)stereotactic radiosurgery |
| spellingShingle | Wen‐Chien Cheng Yi‐Cheng Shen Chun‐Ru Chien Wei‐Chih Liao Chia‐Hung Chen Te‐Chun Hsia Chih‐Yeh Tu Hung‐Jen Chen The optimal therapy strategy for epidermal growth factor receptor‐mutated non‐small cell lung cancer patients with brain metastasis: A real‐world study from Taiwan Thoracic Cancer brain metastasis epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors graded prognostic assessment for lung cancer using molecular markers (lung‐mol GPA) stereotactic radiosurgery |
| title | The optimal therapy strategy for epidermal growth factor receptor‐mutated non‐small cell lung cancer patients with brain metastasis: A real‐world study from Taiwan |
| title_full | The optimal therapy strategy for epidermal growth factor receptor‐mutated non‐small cell lung cancer patients with brain metastasis: A real‐world study from Taiwan |
| title_fullStr | The optimal therapy strategy for epidermal growth factor receptor‐mutated non‐small cell lung cancer patients with brain metastasis: A real‐world study from Taiwan |
| title_full_unstemmed | The optimal therapy strategy for epidermal growth factor receptor‐mutated non‐small cell lung cancer patients with brain metastasis: A real‐world study from Taiwan |
| title_short | The optimal therapy strategy for epidermal growth factor receptor‐mutated non‐small cell lung cancer patients with brain metastasis: A real‐world study from Taiwan |
| title_sort | optimal therapy strategy for epidermal growth factor receptor mutated non small cell lung cancer patients with brain metastasis a real world study from taiwan |
| topic | brain metastasis epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors graded prognostic assessment for lung cancer using molecular markers (lung‐mol GPA) stereotactic radiosurgery |
| url | https://doi.org/10.1111/1759-7714.14423 |
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