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Erschienen in:
09.11.2018 | Lung Cancer (R Mudad, Section Editor)
The Changing Paradigm of Treatment for Non-Small Cell Lung Cancer Intracranial Metastases
Erschienen in: Current Pulmonology Reports | Ausgabe 4/2018
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Purpose of Review
Evaluate safety and efficacy of newer systemic therapies for intracranial metastases (IM) from non-small cell lung cancer (NSCLC) when given alone and with concurrent radiation therapy (RT) and determine which patients with IM may benefit from upfront systemic therapy while withholding RT.
Recent Findings
In NSCLC, chemotherapy regimens are associated with approximately 20% intracranial overall response rates (ORRs) and immunotherapies 30–50% intracranial ORRs. However, tyrosine kinase inhibitor (TKI) therapies for EGFR-mutated patients provide ORRs ranging from 50 to 90%. Prospective data suggest erlotinib, when combined with stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT), substantially increases grade 3–5 toxicities. For immunotherapy, retrospective studies suggest increased intracranial control rates with concurrent RT, though possibly with increased radiation necrosis rates.
Summary
Upfront TKIs may allow appropriately selected patients to avoid or delay RT and possible resultant RT side effects. However, delayed RT is counterbalanced by retrospective data that suggests upfront RT prolongs overall survival (OS) when performed before starting TKI therapy.