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Multicenter analysis of stereotactic radiosurgery for multiple brain metastases from EGFR and ALK driven non-small
Narine E Wandrey1, Dexiang Gao1, Tyler P Robin1
1University of Colorado, Aurora, CO, United States.
Introduction:
Patients with brain metastases (BrMs) arising from EGFR and ALK driven non-small cell lung cancer (NSCLC) have favorable prognoses and evolving treatment options. We evaluated multicenter outcomes for stereotactic radiosurgery (SRS) to multiple (≥4) BrMs, where randomized data remain limited.
Methods:
Data were collected retrospectively from 5 academic centers on EGFR and ALK NSCLC who received SRS to ≥4 BrMs with their first SRS treatment between 2008 and 2018. Analyzed endpoints included overall survival (OS), freedom from CNS progression (FFCNSP), and freedom from whole-brain radiotherapy (FFWBRT).
Results:
Eighty-nine patients (50 EGFR, 39 ALK) received a total of 159 SRS treatments to 1,080 BrMs, with a median follow up of 51.3 months. The median number of BrMs treated with SRS treatment-1 was 6 (range 4-26) and median for all treatments was 9 (range 4-47). Sixteen patients (18 %) had received WBRT prior to SRS treatment-1. The median OS was 24.2, 21.2, and 33.2 months for all patients, EGFR, and ALK subsets, respectively. After multivariable adjustment, only receipt of a next-generation tyrosine kinase inhibitor was associated with OS (HR 0.40, p = 0.005). No differences in OS were observed based on number of BrMs treated. The median FFCNSP was 9.4, 11.6, and 7.5 months, for all patients, EGFR, and ALK subsets, respectively. After multivariable adjustment, the number of BrMs (continuous) treated during treatment-1 was the only negative prognostic factor associated with FFCNSP (HR 1.071, p = 0.045). The 5-year FFWBRT was 73.6 %.
Conclusions:
This multicenter analysis over a >10-year period demonstrated favorable OS, FFCNSP, and FFWBRT, in patients with EGFR and ALK driven NSCLC receiving SRS to ≥4 BrMs. These data support SRS as an option in the upfront and salvage setting for higher burden CNS disease in this population.
Insights
Stereotactic radiosurgery (SRS) for multiple brain metastases (BrMs) in EGFR/ALK non-small cell lung cancer (NSCLC) shows favorable outcomes. Next-generation TKIs improve overall survival, supporting SRS for CNS disease.
Area of Science:
- Oncology
- Neurology
- Radiotherapy
Background:
- Patients with EGFR and ALK-driven non-small cell lung cancer (NSCLC) and brain metastases (BrMs) have evolving treatment options.
- Limited randomized data exist for stereotactic radiosurgery (SRS) to multiple (≥4) BrMs in this population.
Purpose of the Study:
- To evaluate multicenter outcomes for SRS in patients with multiple BrMs from EGFR/ALK-driven NSCLC.
- To assess overall survival (OS), freedom from CNS progression (FFCNSP), and freedom from whole-brain radiotherapy (FFWBRT).
Main Methods:
- Retrospective analysis of 5 academic centers from 2008-2018.
- Included patients with EGFR/ALK NSCLC receiving SRS to ≥4 BrMs as their first SRS treatment.
- Analyzed endpoints: OS, FFCNSP, FFWBRT.
Main Results:
- Eighty-nine patients received SRS to 1,080 BrMs; median follow-up was 51.3 months.
- Median OS was 24.2 months (all), 21.2 (EGFR), and 33.2 (ALK). Next-generation TKI use was associated with improved OS (HR 0.40, p=0.005).
- Median FFCNSP was 9.4 months (all); increased number of BrMs treated was a negative prognostic factor (HR 1.071, p=0.045). 5-year FFWBRT was 73.6%.
Conclusions:
- Multicenter analysis over >10 years shows favorable OS, FFCNSP, and FFWBRT with SRS for ≥4 BrMs in EGFR/ALK NSCLC.
- SRS is a viable option for upfront and salvage treatment of higher-burden CNS disease in this patient group.
