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Survival of patients with brain metastases from non-small cell lung cancer harboring EGFR mutations treated with epidermal growth factor receptor tyrosine kinase inhibitors

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Abstract

Brain metastases (BM) is one of the most crucial distant metastases in patients with non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. There is no consensus about which EGFR tyrosine kinase inhibitor (TKI) is most effective against BM in such patients. Here, we compared prognoses of patients with EGFR-TKI naïve EGFR-positive BM treated with erlotinib or gefitinib after BM diagnosis. Of 269 patients with NSCLC treated with EGFR-TKIs at a single institution, we reviewed medical records of 205 patients with documented EGFR mutations. Eleven patients were administered erlotinib, and 52 patients were administered gefitinib as the first-line EGFR-TKI treatment after diagnosis. We used propensity score matching to balance patient backgrounds between groups, and the log-rank test to compare survival curves. Patients with BM at the induction of chemotherapy had a poorer prognosis than those without BM [median overall survival (OS) 18.5 vs. 28.0 months]. Meanwhile, there was no significant difference in OS between those with or without BM at the initiation of EGFR-TKI treatment (20.3 vs. 23.8 months). Median OS of patients treated with erlotinib was not significantly longer than that of patients treated with gefitinib (25.0 vs. 18.1 months). The presence of BM at the initiation of EGFR-TKI treatment had no apparent effect on survival. Erlotinib was deemed more effective than gefitinib in preventing intracranial lesions and prolonging survival; however, prospective studies are needed to confirm these results.

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Abbreviations

BM:

Brain metastases

NSCLC:

Non-small cell lung cancer

EGFR:

Epidermal growth factor receptor

TKI:

Tyrosine kinase inhibitors

OS:

Overall survival

PS:

Performance status

BMCP:

BM controlled period

CNS:

Central nervous system

PD:

Progressive disease

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Acknowledgments

This research did not receive any specific grants from public, commercial, or not-for-profit funding agencies. The authors thank Makoto Saito, Division of Clinical Research Support, Tokyo Metropolitan Cancer and the Infectious diseases Center Komagome Hospital, for his statistical expertise. The authors would like to thank Enago (www.enago.jp) for the English language review.

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Correspondence to Yusuke Okuma.

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Comflict of interest

Y. Hosomi has received speaker fees as honoraria from Eli Lilly Japan K.K., Chugai Pharmaceutical Co., AstraZeneca K.K., Taiho Pharmaceutical Co., and Ono Pharmaceutical Co. The rest of the authors declare that they have no competing interests.

Ethical approval

The study was approved by the Ethics Committee of Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital was also in accordance with the Declaration of Helsinki in 2013. The clinical information presented in the present investigation was obtained through Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital’s medical records.

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Kashima, J., Okuma, Y., Miwa, M. et al. Survival of patients with brain metastases from non-small cell lung cancer harboring EGFR mutations treated with epidermal growth factor receptor tyrosine kinase inhibitors. Med Oncol 33, 129 (2016). https://doi.org/10.1007/s12032-016-0843-8

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  • DOI: https://doi.org/10.1007/s12032-016-0843-8

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