机构：[1]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100000, China内科系统神经内科神经科系统神经内科江苏省人民医院首都医科大学宣武医院[2]Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China内科系统外科系统肿瘤科胸外科江苏省人民医院[3]State Key Laboratory of Respiratory Disease & National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China内科系统呼吸与危重症医学科江苏省人民医院[4]Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China内科系统肿瘤科江苏省人民医院
Background: It has been confirmed that epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) presented better efficacy than brain radiotherapy (brain RT) in the treatment of brain metastasis (BM) in EGFR mutated NSCLC patients. However, whether the combination of EGFR-TKIs and brain RT is better than EGFR-TKIs alone remains unclear. We aim to compare the outcomes of adding brain RT to EGFR-TKIs and to screen for the beneficial population by a meta-analysis of currently available data. Methods: A systematic search for relevant articles was conducted in six databases. The outcomes were overall survival (OS) and intracranial progression-free survival (iPFS) between groups, both were measured as hazard ratios (HRs). Meta-regression and dominant subgroup analysis were used to explore advantageous subgroups. Results: A total of 12 retrospective studies involving 1,553 EGFR mutated patients with BM at the first diagnosis were included. EGFR-TKIs plus brain RI' showed a significant prolonged OS (HR =0.64, 95% CI: 0.52-0.78; P<0.001) and iPFS (HR =0.62, 95% CI: 0.50-0.78; P<0.001) compared to EGFR-TKIs alone. Meta-regression analyses showed that potential factors contributed to the heterogeneity were the proportion of ECOG performance score (2+ vs. 0-1, P=0.070) and brain symptomatic patients (no vs. yes, P=0.077) regarding iPFS and was age (younger vs. older, P=0.075) for OS. Dominant subgroup analyses suggested that symptomatic patients (HR 0.46 vs. 0.74, interaction P=0.01) for iPFS, and older patients (HR 0.55 vs. 0.75, interaction P=0.03) and 19Del mutation (HR 0.55 vs. 0.74, interaction P=0.04) for OS, seemed to benefit more from the combination therapy than their counterparts. However, direct subgroup results based on only two studies did not show significant difference in iPFS benefit between age, mutation type and sex subgroup. Conclusions: EGFR-TK Is plus brain RT is superior to EGFR-TKIs alone in the management of EGFR-mutated NSCLC patients with BM, of which the benefits might be influenced by age, BM-related symptoms and mutation type.
基金：
Chinese National Natural Science Foundation [81501996]; Key Project of Guangzhou Scientific Research Project [201804020030]; Guangdong Doctoral Launching Program [2014A030310460]; Doctoral Launching Program of Guangzhou Medical University [2014C27]
第一作者机构：[1]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100000, China
共同第一作者：
通讯作者：
通讯机构：[1]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100000, China[2]Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China[3]State Key Laboratory of Respiratory Disease & National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China[*1]Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.[*2]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100000, China
推荐引用方式(GB/T 7714)：
Dong Kai,Liang Wenhua,Zhao Shen,et al.EGFR-TKI plus brain radiotherapy versus EGFR-TKI alone in the management of EGFR-mutated NSCLC patients with brain metastases[J].TRANSLATIONAL LUNG CANCER RESEARCH.2019,8(3):268-+.doi:10.21037/tlcr.2019.06.12.
APA：
Dong, Kai,Liang, Wenhua,Zhao, Shen,Guo, Minzhang,He, Qihua...&Xia, Xiaojun.(2019).EGFR-TKI plus brain radiotherapy versus EGFR-TKI alone in the management of EGFR-mutated NSCLC patients with brain metastases.TRANSLATIONAL LUNG CANCER RESEARCH,8,(3)
MLA：
Dong, Kai,et al."EGFR-TKI plus brain radiotherapy versus EGFR-TKI alone in the management of EGFR-mutated NSCLC patients with brain metastases".TRANSLATIONAL LUNG CANCER RESEARCH 8..3(2019):268-+
