Abstract
Control of non-small-cell lung cancer (NSCLC) with brain metastasis is clinically challenging. This study retrospectively evaluated the efficacy of different adjuvant therapies for 776 cases of advanced NSCLCs with brain metastasis who treated with chemotherapy, chemotherapy plus bevacizumab, tyrosine kinase inhibitor (TKI) alone, or supportive care. The median progression-free survival (mPFS) and median overall survival (mOS) of patients treated with chemotherapy plus bevacizumab were 8.5 and 10.5 months, respectively, which were better than those of patients treated with other three therapies(P < 0.01). For patients with EGFR-mutated NSCLC, the efficacy of TKI treatment was not statistically better than that of chemotherapy plus bevacizumab but was significantly better than that of other therapies. Moreover, for patients with EGFR wild-type NSCLC, the mPFS and mOS after chemotherapy plus bevacizumab were greater than those with other two therapies (P < 0.01). The local response rate (RR)and disease control rate (DCR)with regimen including pemetrexed were greater than those with regimen including paclitaxel (P < 0.05). Chemotherapy plus bevacizumab was more effective for NSCLC patients with brain metastasis. Further studies will investigate the benefit of TKI alone for patients with EGFR-mutated. For patients with EGFR wild-type, chemotherapy plus bevacizumab did improve PFS and OS. Furthermore, regimens including pemetrexed led to a greater RR.
Highlights
Lung cancer is the leading cause of cancer-related deaths in the world [1] and non-small cell lung cancer (NSCLC) accounts for approximately 80% of all lung cancer cases [1]
NSCLC is usually diagnosed at the advanced stages of disease, and brain metastasis is a common complication in NSCLC patients, with more than 10% of NSCLC patients presenting with brain metastases at their first hospital visit [2, 3] and 30%–40% of NSCLC patients developing brain metastasis during the course of the disease [4]
All patients had brain metastasis and 37% had pulmonary metastasis, 24% had ossary metastasis, and 7% had hepatic metastasis. These patients were treated with chemotherapy alone, chemotherapy plus bevacizumab, tyrosine kinase inhibitors (TKIs) alone, or supportive care
Summary
Lung cancer is the leading cause of cancer-related deaths in the world [1] and non-small cell lung cancer (NSCLC) accounts for approximately 80% of all lung cancer cases [1]. The standard treatment protocol for patients with multiple metastases is whole brain radiotherapy (WBRT) [5] and steriotactic radiosurgery (SRS) used to treat solitary or oligo-metastatic disease that contains the following techniques: gamma knife, threedimensional conformal radiation therapy (3DCRT), and/or intensity modulation radiated therapy (IMRT) [6,7,8,9]. For patients with multiple cerebral lesions, the prognosis is still poor; the median overall survival (mOS) was reported to be only 4–6 months after radiotherapy [10, 11] or only approximately 1 month without treatment. More effective treatment regimens or strategies to control NSCLC with brain metastasis are urgently needed
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