Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of an Epithelial Growth Factor Receptor-Tyrosine Kinase Inhibitor Add-on in Stereotactic Radiosurgery for Brain Metastases Originating from Non-Small-Cell Lung Cancer

  • Kim, Hyun Jung (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Woo Sung (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kwon, Do Hoon (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cho, Young Hyun (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Chang-Min (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.10.06
  • Accepted : 2015.05.06
  • Published : 2015.10.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : This study was aimed at optimizing the treatment of non-small-cell lung cancer (NSCLC) patients who are candidates for stereotactic radiosurgery (SRS) for brain metastases and harbor activating epithelial growth factor receptor (EGFR) mutations. Methods : We retrospectively reviewed the medical records from 2005 to 2010 of NSCLC patients with brain metastases harboring an activating EGFR mutation. Patients who received a combination therapy of SRS and EGFR-tyrosine kinase inhibitor (TKI) for brain metastases and those who received SRS without EGFR-TKI were compared. The primary endpoint was progression-free survival (PFS) of the brain metastases. Results : Thirty-one patients were eligible for enrolment in this study (SRS with TKI, 18; SRS without TKI, 13). Twenty-two patients (71.0%) were women and the median overall age was 56.0 years. PFS of brain lesions was not significantly prolonged in SRS with TKI treatment group than in SRS without TKI group (17.0 months vs. 9.0 months, p=0.45). Local tumor control rate was 83.3% in the combination therapy group, and 61.5% in the SRS monotherapy group (p=0.23). There were no severe adverse events related with treatment in both groups. Conclusions : Therapeutic outcome of concurrent SRS and TKI treatment was not superior to SRS monotherapy, however, there was no additive adverse events related with combined treatment.

Keywords

References

  1. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, et al. : Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases : a randomized controlled trial. JAMA 295 : 2483-2491, 2006 https://doi.org/10.1001/jama.295.21.2483
  2. Ceresoli GL, Cappuzzo F, Gregorc V, Bartolini S, Crino L, Villa E : Gefitinib in patients with brain metastases from non-small-cell lung cancer : a prospective trial. Ann Oncol 15 : 1042-1047, 2004 https://doi.org/10.1093/annonc/mdh276
  3. Clarke JL, Pao W, Wu N, Miller VA, Lassman AB : High dose weekly erlotinib achieves therapeutic concentrations in CSF and is effective in leptomeningeal metastases from epidermal growth factor receptor mutant lung cancer. J Neurooncol 99 : 283-286, 2010 https://doi.org/10.1007/s11060-010-0128-6
  4. Grommes C, Oxnard GR, Kris MG, Miller VA, Pao W, Holodny AI, et al. : "Pulsatile" high-dose weekly erlotinib for CNS metastases from EGFR mutant non-small cell lung cancer. Neuro Oncol 13 : 1364-1369, 2011 https://doi.org/10.1093/neuonc/nor121
  5. Heon S, Yeap BY, Britt GJ, Costa DB, Rabin MS, Jackman DM, et al. : Development of central nervous system metastases in patients with advanced non-small cell lung cancer and somatic EGFR mutations treated with gefitinib or erlotinib. Clin Cancer Res 16 : 5873-5882, 2010 https://doi.org/10.1158/1078-0432.CCR-10-1588
  6. Hotta K, Kiura K, Ueoka H, Tabata M, Fujiwara K, Kozuki T, et al. : Effect of gefitinib ('Iressa', ZD1839) on brain metastases in patients with advanced non-small-cell lung cancer. Lung Cancer 46 : 255-261, 2004 https://doi.org/10.1016/j.lungcan.2004.04.036
  7. Kim HS, Koh EJ, Choi HY : Multiple gamma knife radiosurgery for multiple metachronous brain metastases associated with lung cancer : survival time. J Korean Neurosurg Soc 52 : 334-338, 2012 https://doi.org/10.3340/jkns.2012.52.4.334
  8. Kim MK, Lee KH, Lee JK, Choi JH, Hyun MS : Gefitinib is also active for carcinomatous meningitis in NSCLC. Lung Cancer 50 : 265-269, 2005 https://doi.org/10.1016/j.lungcan.2005.05.022
  9. Kim ST, Uhm JE, Lee J, Sun JM, Sohn I, Kim SW, et al. : Randomized phase II study of gefitinib versus erlotinib in patients with advanced non-small cell lung cancer who failed previous chemotherapy. Lung Cancer 75 : 82-88, 2012 https://doi.org/10.1016/j.lungcan.2011.05.022
  10. Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG, et al. : Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases : results of the EORTC 22952-26001 study. J Clin Oncol 29 : 134-141, 2011
  11. Kuiper JL, Smit EF : High-dose, pulsatile erlotinib in two NSCLC patients with leptomeningeal metastases--one with a remarkable thoracic response as well. Lung Cancer 80 : 102-105, 2013 https://doi.org/10.1016/j.lungcan.2012.12.024
  12. Langer CJ, Mehta MP : Current management of brain metastases, with a focus on systemic options. J Clin Oncol 23 : 6207-6219, 2005 https://doi.org/10.1200/JCO.2005.03.145
  13. Ma S, Xu Y, Deng Q, Yu X : Treatment of brain metastasis from non-small cell lung cancer with whole brain radiotherapy and Gefitinib in a Chinese population. Lung Cancer 65 : 198-203, 2009 https://doi.org/10.1016/j.lungcan.2008.10.028
  14. Minniti G, Esposito V, Clarke E, Scaringi C, Bozzao A, Lanzetta G, et al. : Stereotactic radiosurgery in elderly patients with brain metastases. J Neurooncol 111 : 319-325, 2013 https://doi.org/10.1007/s11060-012-1016-z
  15. Mitsudomi T, Kosaka T, Endoh H, Horio Y, Hida T, Mori S, et al. : Mutations of the epidermal growth factor receptor gene predict prolonged survival after gefitinib treatment in patients with non-small-cell lung cancer with postoperative recurrence. J Clin Oncol 23 : 2513-2520, 2005 https://doi.org/10.1200/JCO.2005.00.992
  16. Mitsudomi T, Morita S, Yatabe Y, Negoro S, Okamoto I, Tsurutani J, et al. : Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405) : an open label, randomised phase 3 trial. Lancet Oncol 11 : 121-128, 2010 https://doi.org/10.1016/S1470-2045(09)70364-X
  17. Namba Y, Kijima T, Yokota S, Niinaka M, Kawamura S, Iwasaki T, et al. : Gefitinib in patients with brain metastases from non-small-cell lung cancer : review of 15 clinical cases. Clin Lung Cancer 6 : 123-128, 2004 https://doi.org/10.3816/CLC.2004.n.026
  18. National Comprehensive Cancer Network I : National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology Non-Small Cell lung cancer. Washington DC : National Comprehensive Cancer Network, 2014
  19. Park BJ, Lim YJ, Kim TS, Rhee BA, Leem W, Kim GK : Brain metastasis from lung cancer-treatment and prognosis-. J Korean Neurosurg Soc 27 : 53-58, 1998
  20. Park SJ, Kim HT, Lee DH, Kim KP, Kim SW, Suh C, et al. : Efficacy of epidermal growth factor receptor tyrosine kinase inhibitors for brain metastasis in non-small cell lung cancer patients harboring either exon 19 or 21 mutation. Lung Cancer 77 : 556-560, 2012 https://doi.org/10.1016/j.lungcan.2012.05.092
  21. Porta R, Sanchez-Torres JM, Paz-Ares L, Massuti B, Reguart N, Mayo C, et al. : Brain metastases from lung cancer responding to erlotinib : the importance of EGFR mutation. Eur Respir J 37 : 624-631, 2011 https://doi.org/10.1183/09031936.00195609
  22. Sheehan JP, Sun MH, Kondziolka D, Flickinger J, Lunsford LD : Radiosurgery for non-small cell lung carcinoma metastatic to the brain : long-term outcomes and prognostic factors influencing patient survival time and local tumor control. J Neurosurg 97 : 1276-1281, 2002 https://doi.org/10.3171/jns.2002.97.6.1276
  23. Siegel R, Ma J, Zou Z, Jemal A : Cancer statistics, 2014. CA Cancer J Clin 64 : 9-29, 2014 https://doi.org/10.3322/caac.21208
  24. Takano T, Ohe Y, Sakamoto H, Tsuta K, Matsuno Y, Tateishi U, et al. : Epidermal growth factor receptor gene mutations and increased copy numbers predict gefitinib sensitivity in patients with recurrent non-small-cell lung cancer. J Clin Oncol 23 : 6829-6837, 2005 https://doi.org/10.1200/JCO.2005.01.0793
  25. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. : New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92 : 205-216, 2000 https://doi.org/10.1093/jnci/92.3.205
  26. Tsao MN, Lloyd NS, Wong RK, Rakovitch E, Chow E, Laperriere N, et al. : Radiotherapeutic management of brain metastases : a systematic review and meta-analysis. Cancer Treat Rev 31 : 256-273, 2005 https://doi.org/10.1016/j.ctrv.2005.04.007
  27. Welsh JW, Komaki R, Amini A, Munsell MF, Unger W, Allen PK, et al. : Phase II trial of erlotinib plus concurrent whole-brain radiation therapy for patients with brain metastases from non-small-cell lung cancer. J Clin Oncol 31 : 895-902, 2013 https://doi.org/10.1200/JCO.2011.40.1174

Cited by

  1. 射频消融在EGFR-TKIs治疗非小细胞肺癌后局部进展的初步临床应用 vol.19, pp.12, 2015, https://doi.org/10.3779/j.issn.1009-3419.2016.12.09
  2. Surgery in oligometastatic NSCLC patients in the targeted therapy era vol.5, pp.3, 2015, https://doi.org/10.2217/lmt-2016-0012
  3. Combined irradiation and targeted therapy or immune checkpoint blockade in brain metastases: toxicities and efficacy vol.28, pp.12, 2015, https://doi.org/10.1093/annonc/mdx408
  4. Efficacy and Safety of Radiotherapy Plus EGFR-TKIs in NSCLC Patients with Brain Metastases: A Meta-Analysis of Published Data vol.11, pp.5, 2015, https://doi.org/10.1016/j.tranon.2018.07.003
  5. The Effect of Epidermal Growth Factor Receptor Mutation on Intracranial Progression-Free Survival of Non-Small Cell Lung Cancer Patients with Brain Metastasis Underwent Gamma Knife Radiosurgery vol.8, pp.2, 2015, https://doi.org/10.14791/btrt.2020.8.e15
  6. Tumor Primary Site and Histology Subtypes Role in Radiotherapeutic Management of Brain Metastases vol.10, pp.None, 2015, https://doi.org/10.3389/fonc.2020.00781
  7. Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases vol.13, pp.15, 2021, https://doi.org/10.3390/cancers13153682
  8. Continued versus Interrupted Targeted Therapy during Metastasis-Directed Stereotactic Radiotherapy: A Retrospective Multi-Center Safety and Efficacy Analysis vol.13, pp.19, 2015, https://doi.org/10.3390/cancers13194780