EGFR mutant locally advanced non-small cell lung cancer is at increased risk of brain metastasis
| Autor: | Katelyn M. Atkins, Elizabeth H. Baldini, Ayal A. Aizer, David Kozono, Ugonma Chukwueke, Raymond H. Mak, Devarati Mitra, Yu-Hui Chen, Richard Li, Gretchen Hermann |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Oncology
medicine.medical_specialty Multivariate analysis EGFR R895-920 medicine.disease_cause Article 030218 nuclear medicine & medical imaging 03 medical and health sciences Medical physics. Medical radiology. Nuclear medicine 0302 clinical medicine Internal medicine Genotype medicine Combined Modality Therapy Radiology Nuclear Medicine and imaging Cumulative incidence Lung cancer RC254-282 business.industry Brain metastasis Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease 030220 oncology & carcinogenesis Cohort KRAS business |
| Zdroj: | Clinical and Translational Radiation Oncology, Vol 18, Iss, Pp 32-38 (2019) Clinical and Translational Radiation Oncology |
| ISSN: | 2405-6308 |
| Popis: | Highlights • Locally advanced EGFR+ NSCLC patients have a high likelihood of brain metastasis. • The high likelihood of EGFR+ brain metastasis is independent of survival duration. • Surveillance MRI may allow early identification and treatment of brain metastasis. Background and purpose Small studies of primarily metastatic non-small cell lung cancer (NSCLC) have suggested an association between EGFR mutation (EGFR+) and likelihood of brain metastasis. However, these studies are confounded by follow-up time bias. We performed a competing risk analysis of brain metastasis in a more uniform locally advanced NSCLC (LA-NSCLC) cohort with known tumor genotype. Materials and methods Between 2002 and 2014, 255 patients with LA-NSCLC underwent tumor genotyping for EGFR, ALK and/or KRAS (180 patients had follow-up brain imaging). Cumulative incidence and Fine-Gray regression were performed on clinical variables including genotype and risk of brain metastasis, with death as a competing event. Results The proportion of tumors with aberrations in EGFR, ALK and KRAS were 17%, 4% and 28%, respectively. The median follow-up was 68 months. On multivariate analysis, EGFR+ was significantly associated with risk of brain metastasis in the full patient cohort (HR 2.04, 95% CI 1.22–3.39, p = 0.006) as well as in the subset of patients with brain follow-up imaging (HR 1.91. 95% CI 1.17–3.13, p = 0.01). This translated to a higher cumulative incidence of brain metastasis in EGFR+ patients at 3 and 5 years (33.3% vs. 23.2 and 43.8% vs. 24.2%, p = 0.006). Conclusion Patients with EGFR+ LA-NSCLC have a significantly higher likelihood of developing brain metastasis after standard combined modality therapy, independent of their longer overall survival. This high-risk genotypic subgroup may benefit from routine surveillance with brain MRI to allow early salvage with targeted systemic- and/or radiation-therapies. |
| Databáze: | OpenAIRE |
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