Epidermal Growth Factor Receptor Mutations in Non–Small-Cell Lung Cancer With Brain Metastasis : Can Up-Front Radiation Therapy Be Deferred or Withheld ?
Menée à partir de données portant sur 351 patients présentant des métastases cérébrales ayant pour origine un cancer du poumon non à petites cellules avec mutation du récepteur EGFR, cette étude multicentrique compare, du point de vue de la survie sans progression intracrânienne et de la survie globale, l'efficacité de 4 protocoles comportant un traitement par inhibiteur de tyrosine kinase du récepteur EGFR en combinaison avec une radiochirurgie stéréotaxique ou une radiothérapie de l'ensemble du cerveau
Over the past decade, the advent of tyrosine kinase inhibitors (TKIs) has revolutionized the management of patients with non–small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutation. The dramatic efficacy has been shown in patients with EGFR-mutated NSCLC with brain metastases (BMs) as well as extracranial lesions. However, despite the availability of various treatment options in this group of patients with BMs, including EGFR-TKIs, whole-brain radiotherapy (WBRT), and stereotactic radiosurgery (SRS), the optimal treatment combination or sequence has been unclear. In the article accompanying this editorial, Magnuson et al pooled 351 TKI-naïve patients with EGFR-mutated NSCLC from six academic centers and found significantly worse survival in those who had delayed brain radiotherapy (RT), regardless of SRS or WBRT. This is the largest analysis so far in the literature analyzing the sequence of brain RT and TKIs in patients with EGFR-mutated NSCLC with BMs. From this retrospective study, it is suggested that the use of brain RT seems critical, as well as its up-front administration, especially for SRS.