1282P - Brain metastases (BM) in patients with EGFR mutations - a review of incidence and outcomes

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Non-Small-Cell Lung Cancer, Metastatic
Cancer Aetiology, Epidemiology, Prevention
Pathology/Molecular Biology
Presenter Jennifer King
Citation Annals of Oncology (2014) 25 (suppl_4): iv426-iv470. 10.1093/annonc/mdu349
Authors J.A. King1, B. Macadam2, J. Cope3, N. Bayman4, F.H. Blackhall5, P. Burt4, R. Califano5, A. Chittalia4, C. Faivre-Finn4, L. Lee4, L. Pemberton4, H. Sheikh4, P.D. Taylor1, A. Wallace6, Y. Summers5
  • 1Pulmonary Oncology Unit, University Hospital of South Manchester, M23 9LT - Manchester/GB
  • 2Medicine, The University of Manchester, Manchester/GB
  • 3Medical Statistics, The Christie Hospital NHS Foundation Trust, Manchester/GB
  • 4Clinical Oncology, The Christie NHS Foundation Trust, Manchester/GB
  • 5Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 6Genomics Diagnostics Laboratory, St Mary's Hospital, Manchester/GB

Abstract

Aim

Patients (pts) with advanced NSCLC and BM have a poor prognosis. However, there are reports of improved survival of pts with epidermal growth factor receptor (EGFR) mutation positive NSCLC who develop BM. The aim of this study was to look at the incidence and survival of such pts at the Christie Hospital and the University Hospital of South Manchester.

Methods

The Manchester EGFR testing database was interrogated for the period Q4 2009 to Q2 2013. A retrospective case note review of pts with EGFR mutations was conducted and outcomes analysed for the cohort with data cut-off at February 2014.

Results

143 pts were identified (median age 67 yrs). 112 (78%) received an EGFR tyrosine kinase inhibitor (TKI) during the course of their treatment. 46 pts (32%) developed BM. There was no difference in median overall survival (OS) (20.5 month (m) vs 20.4m, p = 0.78) for the no-BM and BM group, respectively. 13 pts were diagnosed with BM within 3m of diagnosis and had a longer OS from BM diagnosis (OSB) than those diagnosed over 3m (n = 33) (21.4m vs 5.2m, p = 0.03), but no difference in overall OS (22.8m vs 21.0m, p = 0.13). Pts who had whole brain radiotherapy, stereotactic radiosurgery or surgical treatment for their BM had longer OSB (8.3 vs 4.6m, p = 0.04) compared to best supportive care. 13/ 46 (28%) pts who developed BM had meningeal involvement (9% overall). OSB was 4.5m vs 7.8m (p = 0.76) for pts with meningeal disease and without meningeal involvement, respectively.

Conclusions

In our series, the incidence of BM in pts with EGFR mutations (32%) was similar to that reported in the literature for unselected NSCLC pts. However, the incidence of meningeal involvement was higher (9%). The development of BM in pts with EGFR mutated NSCLC does not seem to have the negative impact on prognosis observed in unselected NSCLC pts, particularly for those diagnosed within the 1st 3m of diagnosis (OS 22.8m). Our results demonstrate that survival was improved in pts who received treatment for BM and underline that pts with EGFR mutations, who live on average twice as long as other groups of NSCLC pts, should be considered for active treatment of BM to improve outcomes.

Disclosure

All authors have declared no conflicts of interest.