Author of

• 36336

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  P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Targeted Therapy - Clinically Focused
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 36438

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    P76.84 - EGFR Status, Risk Factors for Brain Metastases and Overall Survival in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients (ID 3542)

    00:00 - 00:00  |  Presenting Author(s): Maisha T Chowdhury
    • Abstract
    • Slides

    Introduction
    

    EGFR mutations are the most prevalent targetable molecular alterations in lung adenocarcinoma patients, and up to 40% with advanced/metastatic disease develop brain metastases during the course of their disease. We explored the role of EGFR mutations on the development of brain metastases, and subsequent impact on overall survival.

    Methods
    

    A retrospective cohort analysis was conducted on NSCLC patients first seen at the Princess Margaret Cancer Centre, Toronto, CA in 2014, who were tested for EGFR mutation. We analyzed clinico-demographic and pathologic data, incidence of brain metastases at any point in the disease course, and overall survival, using multivariable logistic regression, Kaplan-Meier plots, log-rank tests, and Cox Proportional Hazard models.

    Results
    

    Among 302 patients studied, 196 received MRIs within 1 year of stage-IV diagnosis; 85% of EGFR-positive patients received MRI screening for brain metastasis when compared to 75% of EGFR-negative patients. The cumulative incidence of brain metastasis after stage-IV diagnosis was significantly greater for EGFR-positive patients in all patients (3-year cumulative incidence 62%) than for EGFR-negative patients and (40%, p = 0.01), and was borderline significant in patients actively screened radiologically for brain metastasis (p=0.06).

    Development of brain metastasis within 1 year of stage-IV diagnosis was associated with EGFR status in unadjusted analysis (EGFR+ odds ratio (OR) 1.76, p=0.04), but not in the subset of brain-metastasis-screened patients (p=0.12). Among patients screened within 1 year, younger age was associated with increased risk of developing brain metastasis (adjusted OR (aOR) 2.43, p = 0.02 for ≤65 years versus ≥75 years); in sensitivity analysis, this relationship persisted among only patients who survived to one year after stage-IV diagnosis.

    In patients who developed brain metastasis, median overall survival (OS) after brain metastasis diagnosis among EGFR-positive patients (23.3 months; 95% CI 14.7-33.3) was non-significantly higher than in EGFR-negative patients (9.8 months; 95% CI 6.9-13.6).

    

    In adjusted analysis, improved overall survival from diagnosis of brain metastases was associated with being female (adjusted hazard ratio (aHR) 0.62, p=0.031), never-smoked (aHR 0.26; p<0.001) or having quit smoking (aHR 0.49, p=0.023) when compared to current smokers and lack of non-brain metastatic sites present at stage-IV diagnosis (aHR 0.37; p=0.003).

    Conclusion
    

    Brain metastases in NSCLC represent a unique subgroup of patients. individuals with EGFR mutations and younger patients have a greater risk of developing cumulative brain metastasis. From the diagnosis of brain metastasis, EGFR status, sex, smoking status, and other metastatic sites, each influenced overall survival.

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