NSCLC With Brain Metastases: Concurrent Chemotherapy and Whole-Brain Radiotherapy
Posted: Monday, April 12, 2021
An article published in Neuro-Oncology reported the findings of a phase III randomized trial investigating whether concurrent treatment with erlotinib and whole-brain radiotherapy for brain metastases and non–small cell lung cancer (NSCLC) was effective. David P. Carbone, MD, PhD, of The Ohio State University Medical Center, Columbus, and colleagues specifically examined whether the EGFR inhibitor erlotinib plus whole-brain radiotherapy successfully improved intracranial progression-free survival and cognitive function in this patient population. Their findings revealed “there was no justification” to using this concurrent treatment approach, with no improvement in intracranial progression-free survival.
A total of 220 patients with NSCLC and 2 or more brain metastases were included in this trial. This multicenter, randomized trial was undertaken in 10 different centers in China, and the primary endpoint was intracranial progression-free survival. Cognitive function was also assessed using the Mini–Mental State Examination. Patients were split into two groups: one received either whole-brain radiotherapy (40 Gy in 20 fractions) plus concurrent oral erlotinib at a dose of 150 mg daily, and the other received radiotherapy alone. Treatments were continued until unacceptable adverse events occurred.
Overall findings revealed a median intracranial progression-free survival rate of 11.2 months (95% confidence interval [CI] = 7.2–13.7 months) with the concurrent treatment versus 9.1 months (95% CI = 6.4–10.9 months) with radiotherapy alone. However, there were no statistically significant differences (P = .549) between the groups.
To assess cognitive differences between the two treatment groups over time, a multivariable linear mixed-effects model was used. The results revealed no difference over time for both groups (P = .861).
“…[I]t appears to be safe to continue the erlotinib in EGFR-mutant patients receiving brain radiation during their course of therapy, and the combination therapy did not rouse excessive [cognitive] detriment,” concluded Dr. Carbone and colleagues.
Disclosure: The authors reported no conflicts of interest.