EGFR tyrosine kinase inhibitors versus cranial radiation therapy for EGFR mutant non-small cell lung cancer with brain metastases: a systematic review and meta-analysis

Soon, Yu Yang; Leong, Cheng Nang; Koh, Wee Yao; Tham, Ivan Weng Keong

doi:10.1016/j.radonc.2014.12.011

Cited by 110Brain Metastases and TreatmentLung Cancer Treatments and MutationsGlioma Diagnosis and Treatment

EGFR tyrosine kinase inhibitors versus cranial radiation therapy for EGFR mutant non-small cell lung cancer with brain metastases: a systematic review and meta-analysis

Soon, Yu Yang, Leong, Cheng Nang, Koh, Wee Yao, Tham, Ivan Weng Keong·2015·Radiotherapy and Oncology

DOI 10.1016/j.radonc.2014.12.011

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Abstract

Background and purpose EGFR TKIs alone have demonstrated activity against intracranial disease in EGFR mutant non-small cell lung cancer (NSCLC). This study aimed to determine if upfront cranial radiotherapy improves intracranial disease control and survival outcomes in EGFR mutant NSCLC with brain metastases relative to TKIs alone.Materials and methods We searched MEDLINE and various conference proceedings from 2008 to July 2014 for eligible studies where patients received upfront cranial radiotherapy or TKIs alone. Outcomes of interest were overall intracranial disease response rate (ORR), four-month intracranial disease progression-free survival (PFS), two-year overall survival (OS) and neurological adverse events (AE). We used random effects models to pool outcomes across studies and compared them using interaction tests.Results We found 12 non-comparative observational studies (n=363) with severe methodological limitations. Upfront cranial radiotherapy results in similar intracranial disease ORR (relative risk (RR) 0.93, 95% confidence interval (CI) 0.82-1.06; interaction p value (p)=0.53), improved four-month intracranial disease PFS (RR 1.06, 95% CI 1.00-1.12; p=0.03), improved two-year OS (RR 1.33, 95% CI 1.00-1.77; p=0.05) but caused more neurological AEs than TKIs alone.Conclusion There is evidence, albeit of low quality, that upfront cranial radiotherapy may improve intracranial disease control and survival outcomes compared with TKI alone.

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It has not been established in this clinical scenario that local therapy increases survival.
“it has not been established in this clinical scenario that local therapy increases survival.114”
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Authors: Soon, Y. Y., Leong, C. N., Koh, W. Y., & Tham, I. W. K.
Affiliations: National University of Singapore (SG)
Corresponding author: Soon, Yu Yang
ORCID: Soon, Yu Yang
Leong, Cheng Nang
Koh, Wee Yao
Tham, Ivan Weng Keong
Venue: Radiotherapy and Oncology
Publisher: Elsevier BV
Published: 2015-02
Volume: 114
Issue: 2
Pages: 167-172
ISSN: 0167-8140 (ISSN-L)
DOI: 10.1016/j.radonc.2014.12.011
OpenAlex: W2021095467
Cited by: 110
References: 42
Citations by year: 2025: 5 · 2024: 5 · 2023: 4 · 2022: 8 · 2021: 10 · 2020: 13 · 2019: 15 · 2018: 12 · 2017: 21 · 2016: 16 · 2015: 1
FWCI: 2.95
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Radiotherapy and Oncology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Brain Metastases and Treatment
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
Keywords: EGFR tyrosine kinase inhibitors, cranial irradiation, EGFR mutation, non-small cell lung cancer, brain metastases, intracranial disease control, progression-free survival, overall survival, neurological adverse events, upfront radiotherapy
MeSH terms: Brain Neoplasms, Carcinoma, Non-Small-Cell Lung, Humans, Lung Neoplasms, Mutation, Cranial Irradiation, Disease-Free Survival, Protein Kinase Inhibitors, Chemoradiotherapy, ErbB Receptors

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EGFR tyrosine kinase inhibitors versus cranial radiation therapy for EGFR mutant non-small cell lung cancer with brain metastases: a systematic review and meta-analysis

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