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MO_8_2677 - Neurological death is common in patients with EGFR mutant non-small cell lung cancer

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Neurological death is common in patients with EGFR mutant non-small cell lung cancer
M. Ramotar1, S. Barnes1, M. Doherty2, and D. B. Shultz1,3; 1Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 2Odette Cancer Centre at Sunnybrook Health Sciences Centre, University Health Network, Toronto, ON, Canada, 3Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

Purpose/Objective(s): Patients with EGFR mutant non-small cell lung cancer (EGFRmNSCLC) have a high incidence of brain metastases (BM). We sought to determine the rate of neurologic death in EGFRmNSCLC patients diagnosed with brain metastases.

Materials/Methods: A single-institution prospectively managed database identified 204 patients with EGFRmNSCLC treated for brain metastases between 2000 and 2016. We estimated actuarial survival rates using the Kaplan-Meier method. The incidence of neurologic death (ND) was determined using a competing risks analysis. ND was correlated to clinical and treatment variables using Fisher’s exact test. Survival was calculated from the date of BM diagnosis. We defined neurologic death as death due to brain metastases or leptomeningeal disease.

Results: Fifty-six percent of patients had BM at the time of initial diagnosis. The initial BM treatment was up front stereotactic radiosurgery (SRS), whole brain radiation therapy (WBRT), or tyrosine-kinase inhibitor (TKI) alone in 22, 60, and 18 percent of patients, respectively. Two-year rates of OS in these subgroups were 64%, 38%, and 50%, respectively (p=0.016). The 5-year rate of neurologic death was 38%. Thirty-four percent died of non-neurologic causes, 8% died of unknown causes, and the remaining patients were alive at last follow-up. Median survival (MS) was 19 months; MS in patients who died of non-neurologic causes and neurologic causes was 23, and 15 months, respectively. Of age, staging, BM at diagnosis, history of TKI therapy, initial treatment of BM, staging at diagnosis, and leptomeningeal disease at diagnosis (LMD), only LMD was significantly associated with ND (p=0.047).

Conclusion: Neurologic death due to EGFRmNSCLC BM was more common in our cohort than has been previously reported, highlighting the need for dedicated studies focused on the best management of BM in this population.

Author Disclosure: M. Ramotar: None. S. Barnes: None. D.B. Shultz: None.

Matthew Ramotar, BS

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