Open AccessFirst‐line epidermal growth factor receptor ( EGFR )–tyrosine kinase inhibitor alone or with whole‐brain radiotherapy for brain metastases in patients with EGFR ‐mutated lung adenocarcinoma
Author(s) -
Chen Yongshun,
Yang Jing,
Li Xue,
Hao Daxuan,
Wu Xiaoyuan,
Yang Yuanyuan,
He Chunyu,
Wang Wen,
Wang Jianhua
Publication year - 2016
Publication title -
cancer science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.035
H-Index - 141
eISSN - 1349-7006
pISSN - 1347-9032
DOI - 10.1111/cas.13079
Subject(s) - medicine , epidermal growth factor receptor , concomitant , tyrosine kinase inhibitor , gastroenterology , adenocarcinoma , epidermal growth factor , brain metastasis , radiation therapy , oncology , asymptomatic , lung cancer , lung , receptor , cancer , metastasis
We proposed to compare the outcomes of first‐line epidermal growth factor receptor–tyrosine kinase inhibitor ( EGFR ‐ TKI ) alone with EGFR ‐ TKI plus whole‐brain radiotherapy ( WBRT ) for the treatment of brain metastases ( BM ) in patients with EGFR ‐mutated lung adenocarcinoma. A total of 1665 patients were screened from 2008 to 2014, and 132 were enrolled in our study. Among the 132 patients, 72 (54.5%) harbored a deletion in exon 19, 97 (73.5%) showed multiple intracranial lesions, and 67 (50.8%) had asymptomatic BM . Seventy‐nine patients (59.8%) were treated with EGFR ‐ TKI alone, 53 with concomitant WBRT . The intracranial objective response rate was significantly higher in the EGFR ‐ TKI plus WBRT treatment group (67.9%) compared with the EGFR ‐ TKI alone group (39.2%) ( P = 0.001). After a median follow‐up of 36.2 months, 62.1% of patients were still alive. The median intracranial TTP was 24.7 months (95% CI , 19.5–29.9) in patients who received WBRT , which was significantly longer than in those who received EGFR ‐ TKI alone, with the median intracranial TTP of 18.2 months (95% CI , 12.5–23.9) ( P = 0.004). There was no significant difference in overall survival between WBRT and EGFR ‐ TKI alone groups, (median, 48.0 vs 41.1 months; P = 0.740). The overall survival is significantly prolonged in patients who had an intracranial TTP exceeding 22 months compared to those who developed intracranial progression <22 months after treatment, (median, 58.0 vs 28.0 months; P = 0.001). For EGFR ‐mutated lung adenocarcinoma patients with BM , treatment with concomitant WBRT achieved a higher response rate of BM and significant improvement in intracranial progression‐free survival compared with EGFR ‐ TKI alone.