2021 Targeted Therapies of Lung Cancer (TTLC) Meeting - Posters-P07. Sequencing of TKI With or Without Brain Radiotherapy (RT) in EGFR Mutated or ALK Rearranged Non-small Cell Lung Cancer (NSCLC) with Brain Metastases

P07. Sequencing of TKI With or Without Brain Radiotherapy (RT) in EGFR Mutated or ALK Rearranged Non-small Cell Lung Cancer (NSCLC) with Brain Metastases - PDF

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This study aimed to evaluate the outcomes of patients with non-small cell lung cancer (NSCLC) and brain metastases (BMs) who received tyrosine kinase inhibitors (TKIs) with or without radiotherapy (RT). The study focused on patients with activating EGFR mutations or ALK rearrangements, as these mutations are associated with a high risk of developing BMs. The analysis included patients who received TKI alone, stereotactic radiosurgery (SRS) followed by TKI, or whole brain radiotherapy (WBRT) followed by TKI.<br /><br />The results showed that among the 85 patients evaluated, the majority had an EGFR mutation. Patients who received TKI alone were more likely to have asymptomatic and smaller BMs. The overall response rate (ORR) in the brain for upfront TKI, SRS, and WBRT cohorts was 73.9%, 67.5%, and 81.8% respectively. The disease control rate (DCR) was 82.6%, 92.5%, and 81.8% respectively. The median progression-free survival (PFS) was 12.7 months, 18.1 months, and 20.7 months respectively. The median overall survival (OS) was 35.0 months, 33.4 months, and 25.5 months respectively.<br /><br />Multivariable analysis revealed that patients who were 64 years old, had an ECOG PS of 0-1, and had certain characteristics of the BMs had prolonged survival. In the EGFR mutated cohort, the use of newer generation TKIs and the presence of EGFR exon 19 deletion were associated with prolonged survival.<br /><br />The study concluded that delaying upfront radiotherapy in favor of initial treatment with EGFR or ALK TKI alone for BMs did not result in inferior survival, especially in the era of newer generation TKIs. The use of osimertinib, a newer generation TKI, was associated with improved survival compared to older generation TKIs. However, the study was limited by its retrospective nature, small sample size, and heterogeneity among the analyzed groups.

Asset Subtitle

Nicholas Giustini

Meta Tag

Speaker Nicholas Giustini

Topic Targeted Therapies - ALK & ROS1 Inhibitors

Keywords

non-small cell lung cancer

brain metastases

tyrosine kinase inhibitors

EGFR mutations

ALK rearrangements

radiotherapy

overall response rate

progression-free survival

overall survival

newer generation TKIs