Oral Scientific Session
Deferring Radiation Therapy for Brain Metastases in Patients With EGFR-Mutant Non-Small Cell Lung Cancer: A Multi-Institutional Analysis

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Purpose/Objective(s)

Stereotactic radiosurgery (SRS) or whole brain radiotherapy (WBRT) remains the standard of care treatment for brain metastases from non-small cell lung cancer (NSCLC). Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) are being considered as treatment options for asymptomatic brain metastases in patients with EGFR-mutant NSCLC. This multi-institutional study looks to determine if the deferral of radiotherapy (RT) in favor of EGFR-TKI impacts patient outcomes.

Materials/Methods

Between January 1, 2008, and December 31, 2014, 162 patients from 4 institutions with EGFR-mutant NSCLC developed brain metastases and met inclusion criteria for the study. Exclusion criteria were the following: prior EGFR-TKI use, EGFR-TKI resistance mutation, failure to receive EGFR-TKI after WBRT/SRS or less than 6 months follow-up. Patients were treated with SRS followed by EGFR-TKI, WBRT followed by EGFR-TKI or EGFR-TKI followed by SRS or WBRT within two to four weeks of intra-cranial

Results

The median OS was longer in the upfront RT group compared to the upfront EGFR-TKI group (29.4 vs 20.5 months; P = 0.0015). On subgroup analysis, the SRS group had longer median OS than the upfront EGFR-TKI group (40.8 vs 20.5 months; P = 0.0001), but the WBRT group did not (25.3 vs. 20.5 months; P = 0.07). Median intra-cranial PFS was improved in patients receiving upfront RT compared to those receiving upfront EGFR-TKI (21.1 vs. 13.4 months; P = 0.003). A disease specific-graded prognostic

Conclusion

The current study suggests that the use of upfront EGFR-TKI, and the deferral of upfront RT, may result in inferior OS and IC-PFS in patients with EGFR-mutant NSCLC who develop brain metastases. A prospective, multi-institutional randomized trial of upfront EGFR-TKI with RT at intra-cranial progression versus upfront RT followed by EGFR-TKI is urgently needed.

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Author Disclosure: W.J. Magnuson: None. A. Amini: None. T. Patil: None. B.D. Kavanagh: None. D.R. Camidge: None. S.E. Braunstein: None. L. Boreta: None. A. Attia: None. N. Rana: None. J.N. Contessa: None. S.N. Gettinger: None. N.H. Lester-Coll: None. J.B. Yu: None. V.L. Chiang: None.

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