Extended survival and prognostic factors for patients with ALK-rearranged non-small-cell lung cancer and brain metastasis Journal Article
| Authors: | Johung, K. L.; Yeh, N.; Desai, N. B.; Williams, T. M.; Lautenschlaeger, T.; Arvold, N. D.; Ning, M. S.; Attia, A.; Lovly, C. M.; Goldberg, S.; Beal, K.; Yu, J. B.; Kavanagh, B. D.; Chiang, V. L.; Camidge, D. R.; Contessa, J. N. |
| Article Title: | Extended survival and prognostic factors for patients with ALK-rearranged non-small-cell lung cancer and brain metastasis |
| Abstract: | Purpose. We performed a multi-institutional study to identify prognostic factors and determine outcomes for patients with ALK-rearranged non-small-cell lung cancer (NSCLC) and brain metastasis. Patients and Methods A total of 90 patients with brain metastases from ALK-rearranged NSCLC were identified from six institutions; 84 of 90 patients received radiotherapy to the brain (stereotactic radiosurgery [SRS] or whole-brain radiotherapy [WBRT]), and 86 of 90 received tyrosine kinase inhibitor (TKI) therapy. Estimates for overall (OS) and intracranial progression-free survival were determined and clinical prognostic factors were identified by Cox proportional hazards modeling. Results. Median OS after development of brain metastases was 49.5 months (95% CI, 29.0 months to not reached), and median intracranial progression-free survival was 11.9 months (95% CI, 10.1 to 18.2 months). Forty-five percent of patients with follow-up had progressive brain metastases at death, and repeated interventions for brain metastases were common. Absence of extracranial metastases, Karnofsky performance score ≥ 90, and no history of TKIs before development of brain metastases were associated with improved survival (P = .003, < .001, and < .001, respectively), whereas a single brain metastasis or initial treatment with SRS versus WBRT were not (P=.633 and .666, respectively). Prognostic factors significant by multivariable analysis were used to describe four patient groups with 2-year OS estimates of 33%, 59%, 76%, and 100%, respectively (P<.001). Conclusion. Patientswith brain metastases from ALK-rearranged NSCLC treated with radiotherapy (SRS and/or WBRT) and TKIs have prolonged survival, suggesting that interventions to control intracranial disease are critical. The refinement of prognosis for this molecular subtype of NSCLC identifies a population of patients likely to benefit from first-line SRS, close CNS observation, and treatment of emergent CNS disease. © Copyright 2016 American Society of Clinical Oncology. All rights reserved. |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 34 |
| Issue: | 2 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2016-01-10 |
| Start Page: | 123 |
| End Page: | 129 |
| Language: | English |
| DOI: | 10.1200/jco.2015.62.0138 |
| PROVIDER: | scopus |
| PUBMED: | 26438117 |
| PMCID: | PMC5070549 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 February 2016 -- Source: Scopus |
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