J.R.LIM1, C.P.JARAVATA1, G.K.LIM1, X.XU1, Y.C.A.CHANG1
Tan Tock Seng Hospital1
Lung cancer is associated with high incidence of brain metastases. We aim to show for NSCLC with brain metastases, comparing EGFR-negative, those with EGFR-positive and received EGFR Tyrosine-Kinase-Inhibitor(TKI) have improved survival.
Data was retrospectively obtained from medical records of patients diagnosed in TTSH and JHSIMC from years 2009 to 2015.
87 patients were evaluated (median ECOG 1; median age 63 years [range,56–71]; 63.2% male, 36.8% female). 47%(n=41) were EGFR-positive while 53%(n=46) were EGFR-negative. TKI used were Erlotinib, Gefitinib or Afatinib; 5 patients had Osimertinib.
Of the EGFR-positive, 53%(n=22) were female and 73%(n=30) were non-smokers. 83%(n=34) ever had TKI, 39%(n=16) ever had chemotherapy and/or immunotherapy. 59%(n=24) had brain radiation. 12%(n=5) never received treatment.
Of the EGFR-negative, 70%(n=32) ever had chemotherapy and/or immunotherapy, 30%(n=14) ever had TKI. 74%(n=34) had brain radiation. 28%(n=13) never received treatment.
Median OS(mOS) for EGFR-positive patients was 7.8 months(95% CI: 2.8–18) while EGFR-negative patients was 8.1 months(95% CI: 3.5–12.9), which is similar(p=0.19). However, EGFR-positive patients who ever received TKI had mOS 14.3 months(95% CI: 4.6-25.1); those who also had brain radiation had mOS 18 months(95% CI: 2.9-33.6) while those who did not had mOS 7.8 months(95% CI: 1.4-11.9).
This retrospective analysis showed although EGFR mutation status had no prognostic impact on OS in advanced NSCLC with brain metastases, those with EGFR-positive and received TKI showed improved survival compared with EGFR-negative, even more so in those who received both TKI and brain radiation. Nonetheless, outcomes for EGFR-positive may improve if 3rd Generation(3G) TKI were used more widely.