Non-Small cell lung cancer intracranial metastases outcome

The number of brain metastases does not impact outcomes in the EGFR/ALK+ Non-Small-cell lung cancer patients, implying that targeted therapy along with surgery and/or radiation may improve OS irrespective of the number of BM. The number of BM, extracranial metastases (ECM), and KPS independently affected OS/PFS in WT NSCLC BM, which was consistent with the known literature ¹⁾.

Most patients with BM have a limited life expectancy, measured in months. Selected patients may experience a very long progression free survival, for example, patients with a targetable driver mutation.

The prognosis is poor for untreated patients, with median overall survival (OS) 1–2 months ²⁾ ³⁾ ⁴⁾.

The combination of neurosurgery with stereotactic radiosurgery (SRS) and/or whole-brain radiotherapy (WBRT) can increase the OS up to 3–6 months, and in selected cases over 12 months ⁵⁾ ⁶⁾ ⁷⁾ ⁸⁾ ⁹⁾ ¹⁰⁾ ¹¹⁾.

see Non-Small cell lung cancer intracranial metastases treatment.

see Non-Small cell lung cancer intracranial metastases recurrence.

The series of Lind et al. of Non Small-cell lung cancer intracranial metastases patients receiving surgery or radiosurgery to the brain and aggressive management of their extracranial disease reported a median overall survival (OS) of 12.1 months ¹²⁾.

Those receiving Gamma Knife surgery (GK) or gefitinib demonstrated extended survival. The improved survival seen with GK and gefitinib suggests a survival benefit in selected patients receiving the combined treatment. Further Phase II study should be conducted to assessment these influence ¹³⁾.

Many patients with brain metastases from non-Small-cell lung cancer have limited survival, while others survive for several years, depending on patterns of spread, EGFR and ALK alterations, among others.

Lung-molGPA

DS-GPA: Diagnosis Specific Graded Prognostic Assessment.

see EGFR Non Small-cell lung cancer intracranial metastases.

¹⁾

Balasubramanian SK, Sharma M, Venur VA, Schmitt P, Kotecha R, Chao ST, Suh JH, Angelov L, Mohammadi AM, Vogelbaum MA, Barnett GH, Jia X, Pennell NA, Ahluwalia MS. Impact of EGFR mutation and ALK rearrangement on the outcomes of non-small cell lung cancer patients with brain metastases. Neuro Oncol. 2019 Oct 24. pii: noz155. doi: 10.1093/neuonc/noz155. [Epub ahead of print] PubMed PMID: 31648302.

²⁾ , ⁵⁾

Schettino C, Bareschino MA, Rossi A, Maione P, Sacco PC, Colantouni G, Rossi E, Gdidelli C. Targeting angiogenesis for treatment of NSCLC brain metastases. Curr Cancer Drugs Targets. 2012;12:289–99.

³⁾ , ⁶⁾

Villalva C, Duranton-Tanneur V, Guilloteau K, et al. EGRF, KRAS, BRAF and HER-2 molecular status in brain metastases from 77 NSCLC patients. Cancer Med. 2013;2:296–304.

⁴⁾

Barlesi F, Khobta N, Tablet A, et al. Strategies de prise en charge des metastases cerebrales des maladies atteints de cancers bronchiques primitives. Bull Cancer. 2013;100:303–8.

⁷⁾

Bradley KA, Mehta MP. Management of brain metastases. Semin Oncol. 2004;31:693–701.

⁸⁾

Andrews DW, Scott CB, Sperduto PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results for the RTOG 9508 randomised trial. Lancet. 2004;363:1665–72.

⁹⁾

Sundstrom JT, Minn H, Lertola, Nordman E. Prognosis of patients treated for intracranial metastases with whole-brain irradiation. Ann Med. 1998;30:296–9.

¹⁰⁾

Bailon O, Kallel A, Chouahnia K, Billot S, Ferrari D, Carpentier AF. Management of brain metastases from non-small cell lung carcinoma. Revue Neurol. 2011;16:579–91.

¹¹⁾

Renfrow JJ, Lesser GJ. Molecular subtyping of brain metastases and implications for therapy. Curr Treat Options Oncol. 2013;14:514–27.

¹²⁾

Lind JS, Lagerwaard FJ, Smit EF, Postmus PE, Slotman BJ, Senan S. Time for reappraisal of extracranial treatment options? Synchronous brain metastases from nonSmall-cell lung cancer. Cancer. 2011 Feb 1;117(3):597-605. doi: 10.1002/cncr.25416. Epub 2010 Sep 24. PubMed PMID: 20872880.

¹³⁾

Lin CH, Hsu KH, Chang SN, Tsou HK, Sheehan J, Sheu ML, Pan HC. Increased survival with the combination of stereotactic radiosurgery and gefitinib for non-Small-cell lung cancer brain metastases patients: a nationwide study in Taiwan. Radiat Oncol. 2015 Jun 6;10(1):127. [Epub ahead of print] PubMed PMID: 26048754.