Icotinib Improves Intracranial PFS in EGFR-Mutant NSCLC and Brain Mets


“Treatment with icotinib more than doubled intracranial progression-free survival (iPFS) compared with whole brain irradiation (WBI) combined with standard chemotherapy, according to phase III trial results presented at the 17th World Lung Cancer Conference, the Annual Meeting of the International Association for the Study of Lung Cancer (IASLC), in Vienna.

“Icotinib significantly improved median iPFS, the trial’s primary endpoint, to 10.0 months compared with 4.8 months in patients treated with WBI and chemotherapy, HR = 0.56; 95% CI, 0.36-0.90 (P = .014). Secondary endpoints of the trial, including progression-free survival (PFS) and the objective response rate (ORR), were also significantly improved with icotinib over WBI/chemotherapy. Median PFS was 6.8 versus 3.4 months, respectively (HR, 0.44; 95% CI, 0.31-0.63 [P < .001]).”

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Anti-HER2 Therapy After WBRT Increases Survival in Brain Mets Patients

“Both chemotherapy and anti–human epidermal growth factor receptor 2 (HER2) therapy can improve survival outcomes in HER2-positive breast cancer patients with brain metastases who undergo whole-brain radiotherapy (WBRT), according to a new retrospective study.

“ ‘The incidence of brain metastases is higher in HER2-positive breast cancer compared with other breast cancer patients,’ wrote study authors led by Jiayi Chen, MD, of Shanghai Cancer Center at Fudan University in China. ‘Although adjuvant trastuzumab could not effectively prevent brain metastases, recent studies demonstrated a significant survival benefit of salvage trastuzumab-based therapy for these patients.’

“In the study, the authors retrospectively analyzed 60 patients with HER2-positive breast cancer and brain metastases who underwent WBRT to examine the benefits of various systemic therapies in this setting. The results were published in Breast Cancer.”

Localized Radiation for Brain Mets Has Similar Recurrence Rate at Tumor Site as Whole-Brain Radiation, but More New Mets over Time

“In patients who had undergone surgery for brain metastases, the rate of recurrence at the resected site was similar between patients who received adjuvant whole-brain radiotherapy vs those who underwent adjuvant localized radiotherapy, according to a retrospective study by Hsieh et al in the journal Neurosurgery. However, localized radiotherapy was associated with a higher incidence of distant metastases.

“Surgery followed by adjuvant whole-brain radiotherapy is a well-established treatment for brain metastases, particularly in patients who have a limited number of brain metastases. Yet discussions continue as to whether these patients require whole-brain radiotherapy or can be treated with localized radiotherapy. Localized radiotherapy is associated with fewer side effects compared with whole-brain radiotherapy, but some studies have documented an association with an increased risk for development of new intracranial metastases.

“Thus, the investigators  conducted a study to examine the rate of brain metastases recurrence between patients treated with whole-brain radiotherapy vs localized radiotherapy. They also analyzed overall survival and the risk of development of leptomeningeal disease…

“The investigators stated, ‘Our results support the conclusion that adjuvant treatment with localized radiotherapy instead of whole-brain radiotherapy as adjuvant provides equivalent control at the resection cavity and radiosurgically treated lesions, with no detectable difference in overall survival.’ ”