医学
奥西默替尼
脑转移
累积发病率
内科学
肺癌
危险系数
入射(几何)
肿瘤科
胃肠病学
转移
癌症
置信区间
表皮生长因子受体
队列
埃罗替尼
物理
光学
作者
Caressa Hui,Vera Qu,Jen‐Yeu Wang,Rie von Eyben,Yu‐Cheng Chang,Po-Lin Chiang,Chih-Hung Liang,Jen-Tang Lu,Gordon Li,Melanie Hayden Gephart,Heather A. Wakelee,Joel W. Neal,Kavitha Ramchandran,Millie Das,Seema Nagpal,Scott G. Soltys,Nathaniel J. Myall,Erqi L. Pollom
标识
DOI:10.1007/s11060-022-04145-x
摘要
Although osimertinib has excellent intracranial activity in metastatic non-small cell lung cancer (NSCLC) with exon 19 deletion or L858R EGFR alterations, measures of local control of brain metastases are less well-reported. We describe lesion-level outcomes of brain metastases treated with osimertinib alone.We retrospectively reviewed patients with EGFR-mutant NSCLC with untreated brain metastasis measuring ≥ 5 mm at the time of initiating osimertinib. Cumulative incidence of local recurrence in brain (LRiB) was calculated with death as a competing risk, and univariable and multivariable analyses were conducted to identify factors associated with LRiB.We included 284 brain metastases from 37 patients. Median follow-up was 20.1 months. On initial MRI after starting osimertinib, patient-level response was complete response (CR) in 11 (15%), partial response (PR) in 33 (45%), stable disease (SD) in 18 (25%) and progressive disease (PD) in 11 (15%). The 1-year cumulative incidence of LRiB was 14% (95% CI 9.9-17.9) and was significantly different in patients with a CR (0%), PR (4%), and SD (11%; p = 0.02). Uncontrolled primary tumor (adjusted hazard ratio [aHR] 3.78, 95% CI 1.87-7.66; p < 0.001), increasing number of prior systemic therapies (aHR 2.12, 95% CI 1.49-3.04; p < 0.001), and higher ECOG score (aHR 7.8, 95% CI 1.99-31.81; p = 0.003) were associated with LRiB.Although 1-year cumulative incidence of LRiB is < 4% with a CR or PR, 1-year cumulative incidence of LRiB is over 10% for patients with less than a PR to osimertinib on initial MRI. These patients should be followed closely for need for additional treatment such as stereotactic radiosurgery.
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