Hanyang Med Rev.  2015 Aug;35(3):180-185. 10.7599/hmr.2015.35.3.180.

The Continuation of Erlotinib Treatment in Non-Small Cell Lung Cancer Patients Whose Brain Lesion Is the Only Site of Progression: Prospective Pilot Study

• Yoo KH
• Kim ST
• Jung KS
• Lee JY
• Lim SH
• Lee MY
• Kim HS
• Kwon HJ
• Kim IY
• Sun JM
• Ahn JS
• Park K
• Ahn MJ

• KMID: 2168364
• DOI: http://doi.org/10.7599/hmr.2015.35.3.180

Abstract

There have been conflicting reports on the continuation of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in patients with newly developed or progressive brain metastasis of non-small cell lung cancer (NSCLC). Patients with newly developed or progressive intracranial lesions, but who maintained well-controlled extracranial disease during erlotinib treatment, were enrolled in this study. The proposed therapy included stereotactic radiosurgery (SRS), whole brain radiotherapy (WBRT), and/or surgical resection for intracranial lesions. Erlotinib treatment was continued simultaneously unless extracranial disease progressed. The evaluation of both extra- and intra-cranial lesions was performed every 3 months. From October 2009 to June 2012, 14 patients were enrolled in this pilot study. For intracranial disease, 4 patients received SRS alone, 7 patients received both SRS and WBRT, 2 patients received SRS, WBRT and surgical resection, and 1 patient received no local therapy due to the presence of asymptomatic lesions. Of the patients with extracranial disease who were placed on continued erlotinib therapy, 6 patients (42.9%) showed partial response (PR), while 7 patients (50.0%) remained in stable disease (SD). The progression-free survival (PFS) of extracranial and intracranial disease was 11.1 (range 1.6-34.6) and 10.2 (range 1.5-34.6) months, respectively. In 5 cases, brain lesions relapsed before the progression of extracranial disease. Overall survival (OS) was 22.6 (range 2.1-50.4) months. For NSCLC patients with progression of only intracranial disease during erlotinib treatment, the continuation of erlotinib in combination with local therapy to brain metastases can be an effective treatment option.

Keyword

Carcinoma, Non-Small-Cell Lung; Central Nervous System; Quinazolines; Local therapy

MeSH Terms

Brain*
Carcinoma, Non-Small-Cell Lung*
Central Nervous System
Disease-Free Survival
Epidermal Growth Factor
Humans
Neoplasm Metastasis
Phosphotransferases
Pilot Projects*
Prospective Studies*
Quinazolines
Radiosurgery
Radiotherapy
Erlotinib Hydrochloride
Epidermal Growth Factor
Phosphotransferases
Quinazolines

Figure

• 

  Fig. 1 Progression-free survival (PFS) of extracranial disease. PFS of extracranial disease calculated as the period from the first day of erlotinib reinitiation after study enrollment to the date of extracranial disease progression or the date of last follow-up. *EGFR mutation positivity.

• 

  Fig. 2 Kaplan-Meier curve of overall survival (OS). OS calculated as the period from the first day of erlotinib reinitiation after study enrollment to the date of death or the date of last follow-up.

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