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M.E. Olmedo Garcia
Poster Display session (Friday) (ID 65)
- Event: ELCC 2018
- Type: Poster Display session
- Presentations: 1
- Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
209P - The management of brain disease (BD) in ALK-rearranged non-small cell lung cancer (ALK NSCLC): Can systemic treatment delay the initiation of local treatments? Experience of the Ramón y Cajal University Hospital (RyCUH, Madrid) (ID 625)
12:30 - 13:00 | Author(s): M.E. Olmedo Garcia
The arrival of oral tyrosine kinase inhibitors (TKI) to the treatment of ALK NSCLC is becoming a paradigm shift in the treatment of BD (brain metastases and meningeal carcinomatosis), given the intracranial activity thereof, with the possibility of delaying the start of local treatments, as radiotherapy (RT), radiosurgery or neurosurgery, and the comorbidity that they entail.
Between October 2013 and October 2017 were registered patients diagnosed with ALK NSCLC at the RyCUH. Patients with BD were considered eligible, well at diagnostic of the primary tumor, well at progression of it. The systemic treatment carried out is collected as well as the local treatment at diagnosis of the BD if this is done. We studied systemic (PFSs) and brain progression free survival (PFSb) as well as overall survival (OS) according to the type of treatment and moment received. Other variables were included as neurological symptomatology and corticotherapy.
Of the 33 patients diagnosed of ALK NSCLC, 42.42% had BD at some point of their evolution (57.14% at diagnosis and 42.86% at progression). As a first-line systemic treatment, 57.14% received chemotherapy and 42.85% received a TKI, although 71.43% received a TKI as a second-line treatment. 57.14% of the patients received whole radiation therapy and 28.57% radiosurgery at some point during their evolution. PFSb is higher in those patients without brain metastases at diagnosis, who initiate systemic treatment, and who perform local treatment at brain progression (14 months), compared to patients who change systemic treatment for brain progression (12 months). The median OS is higher in patients who do not initially receive local treatment (25.5 months) versus those who do (21 months).
There are multiple strategies in the management of ALK NSCLC BD. Systemic treatment with TKIs allows to delay local treatment with RT or surgery and comorbidity. However, the use of RT or surgery for exclusive brain progression with controlled systemic disease allows the maintenance of TKI and prolong the PFSs.
Clinical trial identification:
Legal entity responsible for the study:
Hospital Universitario Ramón y Cajal (Madrid)
Has not received any funding
All authors have declared no conflicts of interest.
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