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C.M.N. Gray
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-015 - The Management of Brain Metastases in Patients with EGFR Mutated Advanced Non-Small Cell Lung Cancer (ID 992)
09:30 - 09:30 | Author(s): C.M.N. Gray
- Abstract
Background:
Brain metastases (BM) are common in non-small cell lung cancer (NSCLC). They are often associated with significant impairment of quality of life and a poor prognosis. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have proven superior to chemotherapy in patients with advanced NSCLC that harbour an EGFR mutation.They are now standard of care as first line treatment. Many studies, however, have excluded patients with BM. Therefore the best treatment modality for these patients remains unknown. Different treatment options include: surgery, whole brain radiotherapy (WBRT), radiosurgery, chemotherapy and TKIs. This report looks at the outcomes of patients with EGFR mutated lung cancer and BM who have undergone different treatment modalities.
Methods:
The West of Scotland Network for Lung Cancer supports over 2,000 lung cancer patients per year. We collected data on patients diagnosed with EGFR mutated lung cancer between 2012 and 2014. Patients had to have radiological evidence of BM either at time of diagnosis or subsequently. Patient demographics were recorded alongside response to different treatment modalities. Outcomes included progression free survival and overall survival.
Results:
Between 2012 and 2014, 117 patients were diagnosed with EGFR mutated lung cancer. Eleven patients had confirmed BM: 10 women, 1 man, ages 48-83 years (median 62). Nine patients had BM at presentation, one developed BM while on erlotinib and another had BM on relapse post lobectomy. The median overall survival was 28 weeks (range 10-96). Three patients remain alive at 55, 64 and 139 weeks post diagnosis. Three patients were treated with erlotinib alone. Two remain alive 64 and 55 weeks from diagnosis. The first has controlled intra and extra cranial disease, whilst the other had extracranial progression at 49 weeks. The third patient only survived 22 weeks. Three patients had WBRT, two with erlotinib. Overall survival was 19 weeks without erlotinib and 34 and 42 weeks with erlotinib. A separate patient developed BM while on erlotinib and underwent WBRT. She survived a further 13 weeks from diagnosis of BM and had an overall survival of 96 weeks. One patient achieved stable extracranial disease for 81 weeks with erlotinib. At 16 weeks, however, there was progression of an isolated BM. She underwent radiosurgery with a single 20Gy fraction and on subsequent scans has stable intracranial disease 67 weeks post radiosurgery. She remains alive 139 weeks post diagnosis. Finally, two patients received no active treatment and died at 10 and 18 weeks post diagnosis.
Conclusion:
There is currently little trial data to guide our treatment decisions in patients with EGFR mutated lung cancer and BM. In our group only 9% of patients with EGFR mutated NSCLC had BM. They underwent a variety of treatment modalities, however, numbers are too small to draw firm conclusions. Without treatment, or with WBRT alone, survival is similar to patients with advanced non EGFR mutated NSCLC. The use of a TKI either with or without radiotherapy appears to have a prolonged survival and is probably the treatment of choice. Of note, no patient in this group had a change in TKI.
