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Kenichi Koyama
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P2.03 - Chemotherapy/Targeted Therapy (ID 704)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.03-015 - Efficacy of EGFR-TKIs for EGFR Mutatnt NSCLC Patients with Central Nervous System Metastases: A Retrospective Analysis (ID 8297)
09:30 - 16:00 | Presenting Author(s): Kenichi Koyama
- Abstract
Background:
Central nervous system (CNS) is a common site of metastases of non-small cell lung cancer (NSCLC). The prognosis for patients with brain metastases and/or leptomeningeal metastases is extremely poor. NSCLC harboring epidermal growth factor receptor (EGFR) mutation generally shows good response to tyrosine kinase inhibitors (TKI). However, the efficacy of EGFR-TKI in patients with CNS metastases is unclear. And the data on the occurrence of leptomeningeal metastases in the patients with brain metastases after use or EGFR-TKI remain limited.
Method:
We retrospectively evaluated clinical outcome and background of EGFR mutant NSCLC patients with CNS metastases who received EGFR-TKI for the first line drug therapy between January 2008 and December 2014 in the facilities belong to Niigata lung cancer treatment group.
Result:
A total of 104 eligible patients were enrolled. The response rate was 62%. The median time to treatment failure was 7.8 months. The median survival time (MST) was 24.0 months. The response rate of CNS was 37%. The median CNS-progression free survival (PFS) was 13.2 months. There was no statistical significant difference in TTF, overall survival (OS) and CNS-PFS between patients with exon 19 deletion and those with exon 21 L858R point mutation (mTTF 8.3 vs. 7.8 months, MST 26.1 vs. 24.9 months, mCNS-PFS 14.4 vs. 12.4 months) or between patients treated by Gefitinib and those treated by Erlotinib (mTTF 8.4 vs. 6.3 months, MST 26.0 vs. 20.2 months, mCNS-PFS 13.8 vs. 13.2months). Brain radiotherapy prior to EGFR-TKI prolonged TTF (11.2 vs. 6.8 months) and tended to prolong CNS-PFS (15.6 vs. 11.1 months), but was not significantly associated with OS (MST 26.1 vs. 24.0 months). There was no significant difference in treatment outcome between patients who received stereotactic irradiation and those who received whole brain irradiation as brain radiotherapy prior to EGFR-TKI. Leptomeningeal metastases (LM) were primarily found in 8 of 104 patients (8%), and those occurred subsequently during the clinical course in 19 patients (18%). Median time to occurrence of LM in the patients who had LM subsequently was 14.5 months. There was no significant difference in OS between patients who had LM subsequently and those without LM during the course (MST 28.1 vs. 24.9 months). MST from diagnosis of subsequent LM was 3.7 months.
Conclusion:
EGFR-TKI showed favorable effect for EGFR mutant NSCLC patients with CNS metastases. A longer TTF and CNS-PFS were observed with prior brain radiotherapy. Prognosis after occurrence of LM was poor.
