Value and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique

Abstract Background For lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) sensitive mutation and synchronous brain metastasis (syn‐BM), when and how to apply radiotherapy (RT) during first‐line tyrosine kinase inhibitor (TKI) treatment remains debatable. Methods From a real‐w...

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Autores principales:	Yangchun Gu, Yan Xu, Hongqing Zhuang, Weijuan Jiang, Hua Zhang, Xiaofeng Li, Yonggang Liu, Li Ma, Dahai Zhao, Yuan Cheng, Yan Yu, Ping Liu, Jianwen Qin, Xueqin Chen, Junzhen Gao, Mengzhao Wang, Li Liang, Baoshan Cao
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	brain metastasis EGFR mutation EGFR‐TKIs lung adenocarcinoma radiation therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/13557e99f1774b2fab8474230466f55f
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spelling	oai:doaj.org-article:13557e99f1774b2fab8474230466f55f2021-12-02T02:34:55ZValue and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique1759-77141759-770610.1111/1759-7714.14169https://doaj.org/article/13557e99f1774b2fab8474230466f55f2021-12-01T00:00:00Zhttps://doi.org/10.1111/1759-7714.14169https://doaj.org/toc/1759-7706https://doaj.org/toc/1759-7714Abstract Background For lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) sensitive mutation and synchronous brain metastasis (syn‐BM), when and how to apply radiotherapy (RT) during first‐line tyrosine kinase inhibitor (TKI) treatment remains debatable. Methods From a real‐world multicenter database, EGFR‐mutant patients with syn‐BM diagnosed between 2010–2020 and treated with first‐line TKIs were enrolled and divided into upfront TKI + RT and upfront TKI groups. Median intracranial progression‐free survival (mIC‐PFS), median overall survival (mOS), and their risk factors were estimated. Results There were 60 and 186 patients in the upfront TKI + RT group and upfront TKI group, respectively. Their mIC‐PFS were 28.9 months (m) and 17.5 m (p = 0.023), and mOS were 42.7 m and 40.1 m (p = 0.51). Upfront brain RT improved mIC‐PFS in patients ≤60‐year‐old (p = 0.035), with symptomatic BM (p = 0.002), and treated with first‐generation TKIs (p = 0.012). There was no significant difference in mOS in any subgroup. Upfront brain stereotactic radiosurgery (SRS) showed a trend of better mIC‐PFS and mOS. mIC‐PFS was independently correlated with symptomatic BM (HR = 1.54, p = 0.030), EGFR L858R mutation (HR = 1.57, p = 0.019), and upfront brain RT (HR = 0.47, p = 0.001). mOS was independently correlated with being female (HR = 0.54, p = 0.007), ECOG 3–4 (HR = 10.47, p < 0.001), BM number>3 (HR = 2.19, p = 0.002), and third‐generation TKI (HR = 0.54, p = 0.044) or antiangiogenic drugs (HR = 0.11, p = 0.005) as first/second‐line therapy. Conclusions Upfront brain RT based on first‐line EGFR‐TKI might improve IC‐PFS but not OS in EGFR‐mutant lung adenocarcinoma patients, indicating potential survival benefit from brain SRS and early application of drugs with higher intracranial activity.Yangchun GuYan XuHongqing ZhuangWeijuan JiangHua ZhangXiaofeng LiYonggang LiuLi MaDahai ZhaoYuan ChengYan YuPing LiuJianwen QinXueqin ChenJunzhen GaoMengzhao WangLi LiangBaoshan CaoWileyarticlebrain metastasisEGFR mutationEGFR‐TKIslung adenocarcinomaradiation therapyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENThoracic Cancer, Vol 12, Iss 23, Pp 3157-3168 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	brain metastasis EGFR mutation EGFR‐TKIs lung adenocarcinoma radiation therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	brain metastasis EGFR mutation EGFR‐TKIs lung adenocarcinoma radiation therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Yangchun Gu Yan Xu Hongqing Zhuang Weijuan Jiang Hua Zhang Xiaofeng Li Yonggang Liu Li Ma Dahai Zhao Yuan Cheng Yan Yu Ping Liu Jianwen Qin Xueqin Chen Junzhen Gao Mengzhao Wang Li Liang Baoshan Cao Value and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique
description	Abstract Background For lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) sensitive mutation and synchronous brain metastasis (syn‐BM), when and how to apply radiotherapy (RT) during first‐line tyrosine kinase inhibitor (TKI) treatment remains debatable. Methods From a real‐world multicenter database, EGFR‐mutant patients with syn‐BM diagnosed between 2010–2020 and treated with first‐line TKIs were enrolled and divided into upfront TKI + RT and upfront TKI groups. Median intracranial progression‐free survival (mIC‐PFS), median overall survival (mOS), and their risk factors were estimated. Results There were 60 and 186 patients in the upfront TKI + RT group and upfront TKI group, respectively. Their mIC‐PFS were 28.9 months (m) and 17.5 m (p = 0.023), and mOS were 42.7 m and 40.1 m (p = 0.51). Upfront brain RT improved mIC‐PFS in patients ≤60‐year‐old (p = 0.035), with symptomatic BM (p = 0.002), and treated with first‐generation TKIs (p = 0.012). There was no significant difference in mOS in any subgroup. Upfront brain stereotactic radiosurgery (SRS) showed a trend of better mIC‐PFS and mOS. mIC‐PFS was independently correlated with symptomatic BM (HR = 1.54, p = 0.030), EGFR L858R mutation (HR = 1.57, p = 0.019), and upfront brain RT (HR = 0.47, p = 0.001). mOS was independently correlated with being female (HR = 0.54, p = 0.007), ECOG 3–4 (HR = 10.47, p < 0.001), BM number>3 (HR = 2.19, p = 0.002), and third‐generation TKI (HR = 0.54, p = 0.044) or antiangiogenic drugs (HR = 0.11, p = 0.005) as first/second‐line therapy. Conclusions Upfront brain RT based on first‐line EGFR‐TKI might improve IC‐PFS but not OS in EGFR‐mutant lung adenocarcinoma patients, indicating potential survival benefit from brain SRS and early application of drugs with higher intracranial activity.
format	article
author	Yangchun Gu Yan Xu Hongqing Zhuang Weijuan Jiang Hua Zhang Xiaofeng Li Yonggang Liu Li Ma Dahai Zhao Yuan Cheng Yan Yu Ping Liu Jianwen Qin Xueqin Chen Junzhen Gao Mengzhao Wang Li Liang Baoshan Cao
author_facet	Yangchun Gu Yan Xu Hongqing Zhuang Weijuan Jiang Hua Zhang Xiaofeng Li Yonggang Liu Li Ma Dahai Zhao Yuan Cheng Yan Yu Ping Liu Jianwen Qin Xueqin Chen Junzhen Gao Mengzhao Wang Li Liang Baoshan Cao
author_sort	Yangchun Gu
title	Value and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique
title_short	Value and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique
title_full	Value and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique
title_fullStr	Value and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique
title_full_unstemmed	Value and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique
title_sort	value and significance of brain radiation therapy during first‐line egfr‐tki treatment in lung adenocarcinoma with egfr sensitive mutation and synchronous brain metastasis: appropriate timing and technique
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/13557e99f1774b2fab8474230466f55f
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Value and significance of brain radiation therapy during first‐line EGFR‐TKI treatment in lung adenocarcinoma with EGFR sensitive mutation and synchronous brain metastasis: Appropriate timing and technique

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