P86.17 Continuous Administration of Low-Dose Apatinib Combined With WBRT for Non-Small Cell Lung Cancer With Symptomatic Brain Metastases

Abstract

Symptomatic multiple brain metastases occur in non-small cell lung cancer patients (NSCLC) who are without driver mutations or are resistant to epidermal growth factor tyrosine kinase (EGFR-TKI) are often associated with a unfavourable prognosis. Whole brain radiation therapy (WBRT) which comes with many complications and unsatisfactory effects, is the only option for the treatment. Previous studies have shown that antiangiogenesis combined with WBRT can improve efficiency and prolong survival. This study evaluated the effects and safety of apatinib combined with WBRT in NSCLC patients with symptomatic multiple brain metastases. We performed a retrospective review of 13 patients with multiple brain metastases from NSCLC treated with apatinib (125mg or 250mg, QD, oral) and WBRT. Intracranial objective response rate (IORR), peritumoral edema volumetric measurement, karnofsky performance status (KPS) and adverse events (AEs) were evaluated. Median intracranial progression-free survival (mIPFS) and median overall survival (mOS) were also analyzed. Thirteen patients with NSCLC who were diagnosed with symptomatic multiple brain metastases received apatinib combined with WBRT were inclued, including 1 lung squamous cell carcinoma (LSCC) and 12 lung adenocarcinoma. Six patients were EGFR-TKI resistant, while the other six were without driver mutations. Until the last follow-up in March 2020, 5 patients died, and 8 patients were still alive. The IORR was 84.6% (11/13) and intracranial disease control rate (IDCR) was 100% (13/13). The median edematous volume decreased by 87.96% (range 42% to 98%, p < 0.001), the average KPS score increased from 62.31 ± 12.35 to 82.31 ± 9.27 (t = -8.83, P < 0.001). The mIPFS was 6.7 months [95% confidence interval (CI): 4.3 - 9.1], and the mOS was 8.8months (95% CI: 5.8 - 11.8). The most commonly adverse events of apatinib combination WBRT included grade 1/2 fatigue (3, 23.1%), inappetence (3, 23.1%), hypertension (2, 15.4%) and leukopenia (2, 15.4%), and no grade 3/4 AEs were observed. This retrospective study suggests that NSCLC patients with multiple brain metastases treated with apatinib combined with WBRT, achieved encouraging therapeutic effects, showed a significant reduction in tumor size and peritumoral edema, enjoyed an improved KPS score and experienced prolonged survival time. Apatinib combined with WBRT is well tolerated and may be a potential choice for relapsed or drug-resistant advanced NSCLC patients with symptomatic multiple brain metastases.