1368TiP - Radiotherapy with or without concomitant temozolomide for brain metastases of non-small cell lung cancer

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Cytotoxic agents
Surgical oncology
Non-small-cell lung cancer
Therapy
Biological therapy
Radiation oncology
Presenter Mirjana Rajer
Authors M. Rajer, M. Vrankar, V. Kovac, M. Zwitter
  • Radiotherapy, Institute of Oncology Ljubljana, 1000 - Ljubljana/SI

Abstract

Introduction

Brain metastases from solid tumours are the most common CNS neoplasm, and non-small cell lung cancer is their single most common origin. The standard therapeutic option for multiple lesions is palliative radiotherapy, which while able to offer an efficient palliation of symptoms cannot prolong life. Chemotherapy has a limited role in the treatment of CNS neoplasms, almost exclusively in primary neoplasms. Standard chemotherapy for non-small cell lung cancer is not very useful in treatment of brain metastases. In some trials temozolomide, an alkylating agent used in treatment of gliomas, has shown some efficacy, while the combination of temozolomide and radiotherapy has not yet proven its value.

Patients and methods

Patients with cytologically or histologically confirmed non-small cell lung cancer in performance status of 2 or better, brain metastases not amenable to local treatment (either surgery or SRS) and with adequate haematological and biochemistry function are randomized between either radiotherapy or concomitant chemo-radiotherapy with temozolomide. Radiotherapy is given in dose 35 Gy in 14 fractions and temozolomide in dose 75 mg per m2 from day 1 to 14 of radiotherapy including any eventual breaks. Standard haematologic and biochemistry tests are performed weekly. Response to treatment is assessed using CT/MRI, symptom relief and TTP/OS.

Results

Currently, recruitment is still on-going, but an interim analysis was performed. Until now 20 patients were included. All patients had stage IV lung cancer with radiologically proven brain metastases. Median age was 55,8 (40-67 years) and 7 were males. 12 patients received concomitant temozolomide. The main toxicity was haematologic. Although the number of patients is still small, the difference in survival seems to indicate there might be a connection between concomitant temozolomide use and longer survival.

Conclusions

Chemo-radiotherapy with temozolomide for non-small cell lung cancer brain metastases seems to be a feasible treatment option, pending further evaluation. However, toxicity despite a lower cumulative dose is more pronounced than in primary CNS neoplasms and treatment should not be given outside clinical trials with cautious patient selection.

Disclosure

All authors have declared no conflicts of interest.