The Effect of Gene Alterations and Tyrosine Kinase Inhibition on Survival and Cause of Death in Patients With Adenocarcinoma of the Lung and Brain Metastases

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• 作者：Paul W. Sperduto ; MD ; MPP ; FASTRO^&lowast ; ; ^{psperduto@mropa.com" class="auth_mail" title="E-mail the corresponding author} ; T. Jonathan Yang ; MD^&dagger ; ; Kathryn Beal ; MD^&dagger ; ; Hubert Pan ; MD^&Dagger ; ; Paul D. Brown ; MD^&Dagger ; ; Ananta Bangdiwala ; MS^&sect ; ; Ryan Shanley ; MS^&sect ; ; Norman Yeh ; MD^|| ; Laurie E. Gaspar ; MD ; MBA ; FASTRO^|| ; Steve Braunstein ; MD ; PhD^¶ ; ; Penny Sneed ; MD^¶ ; ; John Boyle ; MD^# ; John P. Kirkpatrick ; MD ; PhD^# ; Kimberley S. Mak ; MD^&lowast ; &lowast ; ; Helen A. Shih ; MD^&lowast ; &lowast ; ; Alex Engelman ; MD^&dagger ; &dagger ; ; David Roberge ; MD^&Dagger ; &Dagger ; ; Nils D. Arvold ; MD^&sect ; &sect ; ; Brian Alexander ; MD^&sect ; &sect ; ; Mark M. Awad ; MD ; PhD^&sect ; &sect ; ; Joseph Contessa ; MD^|||| ; Veronica Chiang ; MD^|||| ; John Hardie ; MD ; PhD^¶ ; ¶ ; ; Daniel Ma ; MD^¶ ; ¶ ; ; Emil Lou ; MD ; PhD^## ; William Sperduto ; BA^# ; Minesh P. Mehta ; MD ; FASTRO^&dagger ; &dagger ;
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2016
• 出版时间：1 October 2016
• 年：2016
• 卷：96
• 期：2
• 页码：406-413
• 全文大小：357 K

文摘

Lung cancer remains the most common cause of both cancer mortality and brain metastases (BM). The purpose of this study was to assess the effect of gene alterations and tyrosine kinase inhibition (TKI) on median survival (MS) and cause of death (CoD) in patients with BM from lung adenocarcinoma (L-adeno).

Methods

A multi-institutional retrospective database of patients with L-adeno and newly diagnosed BM between 2006 and 2014 was created. Demographics, gene alterations, treatment, MS, and CoD were analyzed. The treatment patterns and outcomes were compared with those in prior trials.

Results

Of 1521 L-adeno patients, 816 (54%) had known alteration status. The gene alteration rates were 29%, 10%, and 26% for EGFR, ALK, and KRAS, respectively. The time from primary diagnosis to BM for EGFR−/+ was 10/15 months (P=.02) and for ALK−/+ was 10/20 months (P<.01), respectively. The MS for the group overall (n=1521) was 15 months. The MS from first treatment for BM for EGFR and ALK−, EGFR+, ALK+ were 14, 23 (P<.01), and 45 (P<.0001) months, respectively. The MS after BM for EGFR+ patients who did/did not receive TKI before BM was 17/30 months (P<.01), respectively, but the risk of death was not statistically different between TKI-naïve patients who did/did not receive TKI after the diagnosis of BM (EGFR/ALK hazard ratios: 1.06 [P=.84]/1.60 [P=.45], respectively). The CoD was nonneurologic in 82% of patients with known CoD.

Conclusion

EGFR and ALK gene alterations are associated with delayed onset of BM and longer MS relative to patients without these alterations. The CoD was overwhelmingly nonneurologic in patients with known CoD.