Epidermal growth factor receptor tyrosine kinase inhibitor in treatment of brain metastasis from non-small cell lung cancer.

Abstract

e18121 Background: Brain metastasis (BM) presents 20-25% of patients with non-small cell lung cancer (NSCLC). Whole brain radiation therapy (WBRT) along with stereotactic radiosurgery (SRS), or surgical resection (SR) or chemotherapy (CXT) were usually used alone or in a combination modality for the treatment. In this study, we purposed to determine the outcome of patients with BM from non-small cell lung cancer treated with EGFR-TKI in combination with conventional therapy. Methods: A total of 201 BM patients with NSCLC were treated sequentially using EGFR-TKI combined with WBRT, or SRS, or SR, or CXT between Jan, 1999 and Nov, 2011 according to our institutional protocol. The median age was 56 yrs (range: 25-80). The histopathological type was predominantly adenocarcinoma (88%) and squamouscell carcinoma (9%), adenosquamous carcinoma (3%). Median follow-up was 28 months (range: 5-80). In addition to the treatment regimen, twelve potential prognostic factors were evaluated including age, gender, smoking status, primary tumor type, tumor size, expression of carcinoembryonic antigen (CEA), intracranial symptoms, lymph nodes metastasis (LNM), number of intracranial metastases, extracerebral metastases, time of taking EGFR-TKI, and TKI-related rash. Results: Median overall survival (OS) for the entire cohort was 29 months (95% CI: 25-34). The OS rate at 1, 2, 3 year were 61%, 38%, and 29%, respectively. On univariate analyses, improved OS was found to be significantly associated with age < 56 yrs (P=0.027), non-expression of CEA (P=0.016), absence of intracranial symptoms (P=0.018), no lymph nodes metastases (P=0.000), number of intracranial metastases < 3 (P=0.003), absence of extracerebral metastases (P=0.000), time of taking medicine ≥ 5 months (P=0.000), and appearance of acneiform rash (P=0.001). On multivariate analysis, time of taking medicine (P=0.000), age (P=0.046), absence of intracranial symptoms (P=0.002) and absence of extracerebral metastases (P=0.000) retained statistical significance. Conclusions: Patients with NSCLC and brain metastasis might benefit from treatment of EGFR-TKI in combination with conventional treatment.