First-line EGFR-TKI alone or with whole-brain radiotherapy for brain metastases in EGFR-mutated lung adenocarcinoma patients

Abstract

We proposed to compare the outcome of first-line epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) alone with EGFR-TKI plus whole-brain radiotherapy (WBRT) in treatment of brain metastases (BM) from EGFR-mutated lung adenocarcinoma patients. 1665 patients were screened from 2008 to 2014, and 132 were enrolled in our study. Among the 132 patients, 72 (54.5%) harbored a deletion in exon 19, 97 (73.5%) showed multiple intracranial lesions, and 67 (50.8%) had asymptomatic BM. 79 patients (59.8%) were treated with EGFR-TKI alone, 53 with concomitant WBRT. The intracranial objective response rate was significantly higher in EGFR-TKI plus WBRT (67.9%) compared with EGFR-TKI alone group (39.2%), P = 0.001. After a median follow-up of 36.2 months, 62.1% of patients were still alive. The median intracranial time to progression (TTP) was 24.7 months (95% CI, 19.5 to 29.9) in patients who received WBRT, which was significantly longer than that in those who received EGFR-TKI alone with the median intracranial TTP of 18.2 months (95% CI, 12.5 to 23.9), P = 0.004. There was no significant difference in overall survival (OS) between WBRT and EGFR-TKI alone groups, (median, 48.0 vs. 41.1 months; P = 0.740). The OS is significantly prolonged in patients who had an intracranial TTP exceeding 22 months compared to those who developed intracranial progression less than 22 months after treatment, (median, 58.0 vs. 28.0 months; P = 0.001). For EGFR-mutated lung adenocarcinoma patients with BM, administration of concomitant WBRT achieved higher response rate of BM and significant improvement in intracranial progression-free survival compared with EGFR-TKI alone.

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