Concurrent brain radiotherapy and EGFR-TKI may improve intracranial metastases control in non-small cell lung cancer and have survival benefit in patients with low DS-GPA score

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// Yongmei Liu 1, 2, * , Lei Deng 1, * , Xiaojuan Zhou 1, * , Youling Gong 1 , Yong Xu 1 , Lin Zhou 1 , Jin Wan 1 , Bingwen Zou 1 , Yongsheng Wang 1 , Jiang Zhu 1 , Zhenyu Ding 1 , Feng Peng 1 , Meijuan Huang 1 , Li Ren 1 , Tim Lautenschlaeger 2 , Feng-Ming (Spring) Kong 2 and You Lu 1 1 Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China 2 Department of Radiation Oncology, IU Simon Cancer Center, IU School of Medicine, Indiana University, Indianapolis, IN, USA * These authors have contributed equally to this study Correspondence to: You Lu, email: radyoulu@hotmail.com Keywords: EGFR mutation; EGFR-TKI; brain radiotherapy; brain metastasis; non-small cell lung cancer Received: June 08, 2017 Accepted: November 13, 2017 Published: November 30, 2017 ABSTRACT Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) has intracranial activity in EGFR-mutant Non-Small Cell Lung Cancer (NSCLC). The optimal timing of brain radiotherapy (RT) and appropriate patients who need early brain RT remains undetermined. This is a retrospective study of EGFR-mutant NSCLC patients with newly diagnosed brain metastases (BMs) before EGFR-TKI initiation. Intra-cranial progression free survival (IC-PFS) and overall survival (OS) were measured from the date of EGFR-TKI treatment. A total of 113 patients were eligible, 49 received concurrent early brain RT with EGFR-TKI and 64 were treated with EGFR-TKI alone as initial therapy, including 27 with salvage RT upon BM progression. The patients with early brain RT had superior IC-PFS than those without early brain RT (21.4 vs 15.0 months, P=0.001), which remained significant in multivariate analysis (HR 0.30, P<0.001). The median overall survival (OS) for early RT, EGFR-TKI alone and salvage RT groups was 28.1, 24.5, and 24.6 months, respectively (P=0.604). Similar IC-PFS (23.6 vs 21.4 months, P=0.253) and OS (24.6 vs 28.1 months, P=0.385) were observed between salvage RT and early RT groups. For patients with Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) score of 0 to 2, early brain RT was the independent factor for improved OS (HR 0.33, P=0.025). In conclusion, concurrent early brain RT with EGFR-TKI may improve intracranial disease control in EGFR-mutant NSCLC with BM and have survival benefit in patients with low DS-GPA score. Salvage brain RT upon BM progression may be acceptable in some patients.