Second-Line TKI for Leptomeningeal Metastases in Lung Cancer
Posted: Friday, May 25, 2018
After the failure of first-line tyrosine kinase inhibitor (TKI) treatment in patients with leptomeningeal metastases associated with EGFR-mutated non–small cell lung carcinoma (NSCLC), second-line TKI treatment may be effective in extending overall survival. These findings were presented at the European Lung Cancer Conference (ELCC) 2018 (Abstract 144PD) and published simultaneously in the Journal of Thoracic Oncology. The development of leptomeningeal metastasis in patients with NSCLC has been associated with poorer outcomes.
Lead author Ronan Flippot, MD, of Gustave Roussy, Villejuif, France, noted the study included 66 patients treated with a TKI between April 2003 and September 2016; 51 (77%) were female, and 56 (85%) were non-smokers. More than half of the study patients received a second-line TKI treatment after progression of leptomeningeal metastasis: 19 (53%) with erlotinib, 10 (28%) with high-dose erlotinib (300 mg daily), 3 with osimertinib, 3 with gefitinib, and 1 with afatinib.
The overall clinical response rate and disease control rate for second-line TKI treatment were 43% and 77%, respectively. At 10 months, 9 patients were alive—6 whose second-line treatment was erlotinib, 1 treated with high-dose erlotinib, and 2 treated with osimertinib.
“Sequential erlotinib after prior gefitinib or afatinib seems to be a suitable strategy,” concluded Dr. Flippot and colleagues. “Increasing [the] erlotinib dose has demonstrated clinical benefit.”