Response rate of patients with baseline brain metastases from recently diagnosed non ‐small cell lung cancer receiving radiotherapy according to EGFR, ALK and KRAS mutation status

AbstractBackgroundPrevious studies have identified that patients withEGFR mutations tend to have better responses to targeted therapy, as well as chemotherapy; however, the effect of genetic alterations in terms of radiotherapy (RT) ‐related outcomes has not been fully assessed. We studied the impact of common non‐small cell lung cancer (NSCLC) genetic alterations (EGFR,ALK andKRAS) in relation to objective response rate (ORR) to RT in patients with brain metastases.MethodsFrom 2009 –2015, 153 patients with an available genotyping status were treated with whole‐brain irradiation (WBI) before receiving systemic therapy. Primary outcome was ORR; secondary outcomes included intracranial progression‐free survival (IPFS) and overall survival (OS).ResultsOverall, ORR was 47.1%. ORR to RT varied significantly according to molecular status:EGFR (64.5%)ALK (54.5%)KRAS (20%) and WT (35.4%) (P =  0.001).EGFR mutation was the only independently associated factor for response to WBI (RR 3.52 [95% CI 1.6 –7.7];P  = 0.002). Median IPFS was 10.8 months [95% CI 8.2 –13.5] overall; however, IPFS also varied significantly according to molecular status:EGFR (18.2 months),ALK (18.4 months),KRAS (6.0 months) and WT (8.7 months) (P
Source: Thoracic Cancer - Category: Cancer & Oncology Authors: Tags: ORIGINAL ARTICLE Source Type: research

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Authors: Nakashima K, Demura Y, Oi M, Tabata M, Tada T, Shiozaki K, Akai M, Ishizuka T Abstract We herein report a 66-year-old woman with advanced lung adenocarcinoma (PD-L1 tumor proportion score 60%) lacking driver oncogenes in whom meningeal carcinomatosis, along with sudden onset dizziness, deafness, and consciousness disturbance, appeared after second-line chemotherapy. Whole-brain radiation therapy (WBRT) and Pembrolizumab were subsequently administered, and third-line chemotherapy with Pembrolizumab is now ongoing. At the time of writing, the patient has achieved a 23-month survival without disease progressi...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
álföldi R Abstract Small-cell lung carcinoma (SCLC) and the rare large-cell neuroendocrine carcinoma belong to the high grade pulmonary neuroendocrine carcinomas. Making the correct diagnosis and selection of treatment modalities require multidisciplinary meetings due to the morphological overlaps, aggressive behaviour and debated therapeutic guidelines of these entities. A 52-year-old woman was admitted to the hospital because of headache, nausea and tenebrous vision. The CT revealed metastatic tumour mass in the occipital lobe and in the cerebellum. Both tumours were removed and resulted in histologi...
Source: Orvosi Hetilap - Category: General Medicine Authors: Tags: Orv Hetil Source Type: research
Shekar Patil, Krishna Kumar RathnumIndian Journal of Cancer 2019 56(5):1-9 In leptomeningeal metastasis (LM), malignant lung cancer cells reach the sanctuary site of the leptomeningeal space through haematogenous or lymphatic route and thrive in the leptomeninges because of restricted access of chemotherapeutic agents across the blood brain barrier. The incidence of LM is 3%–5% in non-small cell lung cancer (NSCLC) patients; the incidence is higher in patients with anaplastic lymphoma kinase (ALK) gene rearrangement or epidermal growth factor receptor (EGFR) mutations. However, the real-world burden of undia...
Source: Indian Journal of Cancer - Category: Cancer & Oncology Authors: Source Type: research
Conclusions: This retrospective analysis of a real-world experience confirms the therapeutic benefit of crizotinib in advanced ALK-positive NSCLC. Our data showed crizotinib is tolerable and effective, comparable with literature report. Occasional serious cardiac toxicity requires attention. PMID: 31656659 [PubMed]
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
Conclusions: Patients with clinical N0-1 NSCLC and synchronous isolated bone metastases may achieve longer survival rates following primary lung tumor resection. PMID: 31656656 [PubMed]
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
Several anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors have been developed for the treatment of EML4-ALK-rearranged non-small-cell lung cancer, with the newer generation agents brigatinib, alectinib and lorlatinib showing pronounced central nervous system activities. Intracranial efficacy is an important feature for these agents, as metastatic lesions frequently occur in the central nervous system in the ALK-positive setting. Here, we report on an updated case of a patient who received her diagnosis in 2005 and has had disease progression with new lesions on six occasions over the last 8 years. During the firs...
Source: Anti-Cancer Drugs - Category: Cancer & Oncology Tags: Case Reports Source Type: research
In this study, we aimed to explore the efficacy and safety profile of apatinib monotherapy, or combined with chemotherapy or endothelial growth factor receptor (EGFR)-TKI in heavily pretreated non-small cell lung cancer (NSCLC) patients with brain metastases. We performed a retrospective analysis for relapsed NSCLC patients with brain metastases from our institute, whom received apatinib (250mg or 500mg p.o. qd) monotherapy, or combination with EGFR-TKI or chemotherapy as second- or more line systemic therapy until disease progression or unacceptable toxicity occurred. The objective response rate (ORR), disease control rat...
Source: Oncology Research - Category: Cancer & Oncology Tags: Oncol Res Source Type: research
We describe here a case of 48 y.o. male patient with ALK-positive NSCLC who was clinically managed for 6.5 years from the diagnosis. The tumor was surgically resected, but 8 months later multiple brain metastases were discovered. The patient started receiving platinum-based chemotherapy and then was enrolled in a clinical trial of second-generation ALK inhibitor ceritinib, which resulted in a 21 months stabilization. Following disease relapse, the patient was successfully managed for 33 months with different lines of chemo- and local ablative therapies. Chemotherapy regimens, including off-label combination of crizotinib +...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Purpose of review The current article reviews the state of art of prevention strategies for brain metastases from solid tumors and touches both old pivotal studies and new directions of personalized molecular approaches. Recent findings Prophylactic cranial irradiation (PCI) has a definite role in the prevention of relapse into the brain for patients with small cell lung cancer (SCLC) responding to chemotherapy and radiotherapy as it prolongs overall survival (OS). However, the risk of late cognitive deficit following whole brain radiotherapy (WBRT) in this patient population is still not well known. Conversely, PCI s...
Source: Current Opinion in Oncology - Category: Cancer & Oncology Tags: BRAIN AND NERVOUS SYSTEM: Edited by Marc Sanson Source Type: research
ConclusionsEfficacy of ceritinib, either in pts with or without a prior exposure to crizotinib, as reported in other studies, is confirmed in this study where only pts with active brain metastases were eligible. Safety profile of ceritinib in these pts remain consistent to what was reported earlier.Clinical trial identificationNCT02336451.Editorial acknowledgementShiva Krishna Rachamadugu, Novartis Healthcare Pvt Ltd, Hyderabad, India.Legal entity responsible for the studyNovartis Pharmaceuticals Corporation.FundingNovartis Pharmaceuticals Corporation.DisclosureL.Q. Chow: Advisory / Consultancy, Consultation Honoraria/Revi...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
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