Central Nervous System
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): To compare overall (OS) and intracranial progression-free survival (iPFS) effects of whole-brain radiotherapy (WBRT) and tyrosine kinase inhibitors (TKIs) in NSCLC patients with brain metastases (BM) stratified by EGFR mutation status (positive+, negative-, unknown)
Materials/Methods: We performed a retrospective analysis of 595 NSCLC BM patients diagnosed in 2013-2015 and followed-up to December 1 2016. The stratified K-M curves and multivariate Cox models were used to evaluate effects of WBRT (defined as ≥30Gy, ' W ') and TKIs application (after BM, ' T ') on OS and iPFS independently and jointly. Covariates includes sex, age, KPS,CVD,NSCLC history length, resection of primary tumor, number of BM lesions, brain/brainstem/meningeal involvement status, BM resection, BM chemotherapy after screening. two-sided p>0.05 as ns.
Results: BM age mean (range) was 59 (22 - 87) and female 44%. Overall MTS of OS and iPFS were 9.3 and 8.9 months respectively. EGFR+ (114 pts, 53% of mutation tests), W+31% and T+76%. Multivariate HR(p) of W+ and T+ were OS - 0.768 (ns), 0.180 (0.00), iPFS - 1.057(ns) and 0.255 (0.00). Compared with W-T- (14 pts), multivariate HR(p) of W+T+(22 pts),W-T+(65) and W+T- (13) were OS - 0.196 (0.00), 0.114 (0.00), 0.434 (ns) and iPFS - 0.272 (0.01), 0.200 (0.00), 0.622 (ns). W+T+ vs. W-T+ had OS 1.717(ns) and iPFS 1.361 (ns). EGFR- (101 pts), W+43%. Multivariate HR(p) of W+ vs. W- were OS - 0.539 (0.11), iPFS - 0.485(0.05). EGFR unknown (380 pts), W+38%, T+17%. Compared with W-T- (202 pts), multivariate HR(p) of W+T+(30 pts),W-T+(35) and W+T- (113) were OS-0.304 (0.00), 0.370 (0.00), 0.465 (ns) and iPFS - 0.365(0.00), 0.556 (0.01), 0.562 (ns). W+T+ vs. W-T+ had OS 0.821(ns) and iPFS 0.657 (ns).
Conclusion: Compared with EGFR-, TKIs use in EGFR+ or EGFR-unknown patients reduces the survival effect of WBRT on OS and iPFS in patients with NSCLC brain metastases. Whether to delay WBRT in TKIs users for EGFR+ BM patients for better survival or QoL benefit deserves RCTs.
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