학술논문
Clinical Outcomes of Patients with Non-Small Cell Lung Cancer Leptomeningeal Disease Following Receipt of EGFR-Targeted Therapy, Immune-Checkpoint Blockade, Intrathecal Chemotherapy, or Radiation Therapy Alone.
Document Type
Academic Journal
Author
Mills MN; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.; Uno A; Morsani College of Medicine, University of South Florida, Tampa, FL.; Li P; Morsani College of Medicine, University of South Florida, Tampa, FL.; Liveringhouse C; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.; Kim Y; Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.; Oliver DE; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.; Perez BA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.; Creelan BC; Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.; Yu M; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.; Forsyth PA; Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.; Pina Y; Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. Electronic address: yolanda.pina@moffitt.org.; Ahmed KA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. Electronic address: kamran.ahmed@moffitt.org.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 100893225 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1938-0690 (Electronic) Linking ISSN: 15257304 NLM ISO Abbreviation: Clin Lung Cancer Subsets: MEDLINE
Subject
Language
English
Abstract
Background: EGFR-targeted therapy (ETT) and immune-checkpoint blockade (ICB) have shown promising results in treating NSCLC brain metastases (BM). However, little is known of their effect in treating leptomeningeal disease (LMD).
Patients and Methods: This is a retrospective review of 80 patients diagnosed with NSCLC LMD from January 2014 to March 2021. Patients were grouped based on initial LMD treatment: radiotherapy (RT) alone, ETT, ICB, and intrathecal chemotherapy (ITC).
Results: EGFR mutation was present in 22 patients (28%). Twenty patients had positive cytology in cerebrospinal fluid, while 60 patients were diagnosed based on MRI with clinical correlation. The RT alone group consisted primarily of whole brain radiation (n = 20; 77%), stereotactic radiation (n = 3; 12%), and palliative spine radiation (n = 2; 7%). There were no significant differences amongst the treatment groups in age, performance status, or neurologic symptoms. Overall, the 6-month overall survival (OS) and craniospinal progression free survival (CS-PFS) were 35% and 24%, respectively. The 6-month OS for the ETT, ICB, ITC, and RT alone groups was 64%, 33%, 57%, and 29% respectively (log-rank P = .026). The 6-month CS-PFS for the ETT, ICB, ITC, and RT alone groups was 43%, 33%, 29%, and 19% respectively (log-rank P = .049). Upon univariate analysis, receipt of ETT compared to RT alone reached significance for OS (HR 0.35, P = .006) and CS-PFS (HR 0.39, P = .013).
Conclusions: The prognosis for patients with NSCLC LMD remains poor overall. However, the receipt of ETT for patients with EGFR-positive disease was associated with improved outcomes.
Competing Interests: Conflicts of Interest Michael Yu has received speaker's honoraria from BrainLab and is on the advisory boards of Novocure and Abbvie. Peter A. Forsyth has received research funding from BMS, Pfizer, and Genentech. Yolanda Pina received research funding from Bristol-Myers Squibb. Kamran A. Ahmed has received research funding from Bristol-Myers Squibb, Eli Lilly, and Genentech and consulting fees from Castle Biosciences. All author authors have no conflicts to disclose.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Patients and Methods: This is a retrospective review of 80 patients diagnosed with NSCLC LMD from January 2014 to March 2021. Patients were grouped based on initial LMD treatment: radiotherapy (RT) alone, ETT, ICB, and intrathecal chemotherapy (ITC).
Results: EGFR mutation was present in 22 patients (28%). Twenty patients had positive cytology in cerebrospinal fluid, while 60 patients were diagnosed based on MRI with clinical correlation. The RT alone group consisted primarily of whole brain radiation (n = 20; 77%), stereotactic radiation (n = 3; 12%), and palliative spine radiation (n = 2; 7%). There were no significant differences amongst the treatment groups in age, performance status, or neurologic symptoms. Overall, the 6-month overall survival (OS) and craniospinal progression free survival (CS-PFS) were 35% and 24%, respectively. The 6-month OS for the ETT, ICB, ITC, and RT alone groups was 64%, 33%, 57%, and 29% respectively (log-rank P = .026). The 6-month CS-PFS for the ETT, ICB, ITC, and RT alone groups was 43%, 33%, 29%, and 19% respectively (log-rank P = .049). Upon univariate analysis, receipt of ETT compared to RT alone reached significance for OS (HR 0.35, P = .006) and CS-PFS (HR 0.39, P = .013).
Conclusions: The prognosis for patients with NSCLC LMD remains poor overall. However, the receipt of ETT for patients with EGFR-positive disease was associated with improved outcomes.
Competing Interests: Conflicts of Interest Michael Yu has received speaker's honoraria from BrainLab and is on the advisory boards of Novocure and Abbvie. Peter A. Forsyth has received research funding from BMS, Pfizer, and Genentech. Yolanda Pina received research funding from Bristol-Myers Squibb. Kamran A. Ahmed has received research funding from Bristol-Myers Squibb, Eli Lilly, and Genentech and consulting fees from Castle Biosciences. All author authors have no conflicts to disclose.
(Copyright © 2024 Elsevier Inc. All rights reserved.)