Stereotactic Radiosurgery Recommended as Initial Treatment in Brain-metastatic NSCLC

Stereotactic radiosurgery followed by erlotinib is efficacious for treating patients with brain metastatic, epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer (NSCLC), according to an article published in the Journal of Clinical Oncology.¹

Brain metastases in this patient setting are usually treated with radiosurgery or whole-brain radiotherapy (WBRT), though both methods carry significant toxicity. For this pooled analysis, researchers attempted to determine whether upfront erlotinib—an EGFR tyrosine kinase inhibitor (TKI)—is an effective treatment before radiosurgery or WBRT in this setting.

Of 351 patients identified from 6 institutions, 100 received radiosurgery followed by EGFR-TKI, 120 received WBRT followed by EGFR-TKI, and 131 received EGFR-TKI followed by radiosurgery or WBRT.

Patients who received SRS first had a median overall survival (OS) of 46 months; for those who received WBRT or EGFR-TKI first, median OS was 30 months and 25 months, respectively. Two-year OS rates for initial SRS, initial WBRT, and initial EGFR-TKI were 78%, 62%, and 51%, respectively.

Patients with “favorable prognostic features” who received radiosurgery first had twice the median OS of those who received EGFR-TKI first (64 vs 32 months).

The authors concluded that a randomized trial comparing initial radiosurgery with initial EGFR-TKI when the patient has intracranial progression is “urgently needed.”

Reference

1. Magnuson WJ, Lester-Coll NH, Wu AJ, et al. Management of brain metastases in tyrosine kinase inhibitor–naïve epidermal growth factor receptor–mutant non–small-cell lung cancer: a retrospective multi-institutional analysis. J Clin Oncol. 2017 Jan 23. doi: 10.1200/JCO.2016.69.7144 [Epub ahead of print]