Upfront Radiotherapy Tied to Better Outcomes for Brain Metastases in EGFR-Mutant NSCLC
Although many clinicians have opted to try targeted therapy in patients with EGFR-mutant advanced NSCLC first, before initiating local treatments (eg, stereotactic radiosurgery, whole-brain radiation, surgical radiation) for brain metastases, a new study suggests that upfront radiotherapy should be considered. Patients fared best with upfront stereotactic radiosurgery, whether they had a more favorable or less favorable prognosis.
Reporting these unexpected findings in an editorial in the January 23, 2017, issue of the Journal of Clinical Oncology, the investigators observed, “Medical oncologists have been very excited over the past few years to learn that TKIs cross the blood brain barrier and have demonstrable efficacy in the brain.…” This study suggests that upfront use of radiation needs to continue to be considered despite its side-effect profile, and “maybe we should not be so willing yet to accept this recent change in practice.”
