Optimal sequence of LT for symptomatic BM in EGFR-mutant NSCLC: a comparative study of first-line EGFR-TKIs with/without upfront LT

• DOI: 10.1007/s00432-023-05538-9
• Publication Date: 2024-02-19T03:02:27Z
• Authors: Lishui Niu; Honghua Wu; Ruihuan Gao; Liu Chen; Jiangtao Wang; Hexin Duan; Yujiao Long; Yi Xie; Qin Zhou; Rongrong Zhou
• Keywords: Osimertinib; Hematology; Progression-free survival

Abstract Background The third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) can penetrate blood–brain barrier and are effective for brain metastases (BMs). There is no consensus on the optimal sequence of local therapy (LT) EGFR-TKIs symptomatic BM patients because suffering neurological symptoms were not enrolled in most clinical trials. Methods Non-small cell lung cancer (NSCLC) with EGFR mutation (EGFRm) receiving first-line osimertinib aumolertinib from two medical centers collected. All participants allocated into (TKIs) group upfront LT (uLT) plus (TKIs + uLT) group. Demographic data, survival outcomes, treatment failure patterns, adverse events evaluated between groups. We also conducted subgroup analyses to explore impact number outcomes. Results 86 enrolled, 44 TKIs 42 uLT significant differences short-term response was associated significantly longer overall (OS) (43 vs. 28 months; hazard ratio [HR], 0.36, 95% confidence interval [CI], 0.17–0.77; p = .011). No progression-free (PFS), intracranial PFS (iPFS), or safety observed. In oligo-BM patients, could prolong OS 31 HR 0.22; CI 0.05–0.92; .015). Conclusions EGFRm NSCLC might benefit uLT, particularly patients. However, larger prospective cohort studies should be carried out confirm responses scheme.