Erlotinib versus radiation therapy for brain metastases in patients with EGFR-mutant lung adenocarcinoma Journal Article


Authors: Gerber, N. K.; Yamada, Y.; Rimner, A.; Shi, W.; Riely, G. J.; Beal, K.; Yu, H. A.; Chan, T. A.; Zhang, Z.; Wu, A. J.
Article Title: Erlotinib versus radiation therapy for brain metastases in patients with EGFR-mutant lung adenocarcinoma
Abstract: Purpose/Objectives Radiation therapy (RT) is the principal modality in the treatment of patients with brain metastases (BM). However, given the activity of EGFR tyrosine kinase inhibitors in the central nervous system, it is uncertain whether upfront brain RT is necessary for patients with EGFR-mutant lung adenocarcinoma with BM. Methods and Materials Patients with EGFR-mutant lung adenocarcinoma and newly diagnosed BM were identified. Results 222 patients were identified. Exclusion criteria included prior erlotinib use, presence of a de novo erlotinib resistance mutation, or incomplete data. Of the remaining 110 patients, 63 were treated with erlotinib, 32 with whole brain RT (WBRT), and 15 with stereotactic radiosurgery (SRS). The median overall survival (OS) for the whole cohort was 33 months. There was no significant difference in OS between the WBRT and erlotinib groups (median, 35 vs 26 months; P=.62), whereas patients treated with SRS had a longer OS than did those in the erlotinib group (median, 64 months; P=.004). The median time to intracranial progression was 17 months. There was a longer time to intracranial progression in patients who received WBRT than in those who received erlotinib upfront (median, 24 vs 16 months, P=.04). Patients in the erlotinib or SRS group were more likely to experience intracranial failure as a component of first failure, whereas WBRT patients were more likely to experience failure outside the brain (P=.004). Conclusions The survival of patients with EGFR-mutant adenocarcinoma with BM is notably long, whether they receive upfront erlotinib or brain RT. We observed longer intracranial control with WBRT, even though the WBRT patients had a higher burden of intracranial disease. Despite the equivalent survival between the WBRT and erlotinib group, this study underscores the role of WBRT in producing durable intracranial control in comparison with a targeted biologic agent with known central nervous system activity. © 2014 Elsevier Inc. All rights reserved.
Keywords: overall survival; radiotherapy; patient monitoring; brain; brain metastasis; central nervous systems; stereotactic radiosurgery; amino acids; disease control; tyrosine kinase inhibitor; neurophysiology; methods and materials; incomplete data; whole brains
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 89
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2014-06-01
Start Page: 322
End Page: 329
Language: English
DOI: 10.1016/j.ijrobp.2014.02.022
PROVIDER: scopus
PUBMED: 24679729
PMCID: PMC5691362
DOI/URL:
Notes: Int. J. Radiat. Oncol. Biol. Phys. -- Export Date: 2 June 2014 -- CODEN: IOBPD -- Source: Scopus
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MSK Authors
  1. Zhigang Zhang
    428 Zhang
  2. Timothy Chan
    317 Chan
  3. Weiji Shi
    121 Shi
  4. Yoshiya Yamada
    479 Yamada
  5. Helena Alexandra Yu
    281 Yu
  6. Kathryn Beal
    221 Beal
  7. Naamit Kurshan Gerber
    19 Gerber
  8. Gregory J Riely
    599 Riely
  9. Andreas Rimner
    524 Rimner
  10. Abraham Jing-Ching Wu
    401 Wu