Leptomeningeal metastasis (LM) has become increasingly common in patients with advanced EGFR-mutated non-small cell lung cancer (NSCLC) treated with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), but data are incomplete with respect to clinical features and treatment outcomes of LM in this population.
We retrospectively evaluated 420 advanced NSCLC patients effectively treated with EGFR-TKI. We studied LM progression of those patients, defining this as newly developed leptomeningeal metastases after a response to EGFR-TKI with or without pre-existing brain parenchyma lesions.
Among 420 patients, LM occurred in 29 (6.9 %). Patients with EGFR L858R mutations were more likely to experience LM than those with exon 19 deletions (P = 0.006). The median time to LM progression was 16.5 months (95% CI, 11.9-20.8). The prognosis for LM patients was poor and the median survival was 5.2 months (95% CI, 3.2-7.2) after LM diagnosis. Patients who received BSC are significantly shorter than those with anti- tumor treatment (1.9m vs 6.0m, P 2 (14.2m vs 2.3m, P
For advanced EGFR-mutated NSCLC patients who were effectively treated with EGFR-TKI, L858R mutation might be associated with higher risk of LM progression compared with exon 19 deletion. Performance status was an important prognostic factor. WBRT was a rational choice of the appropriate therapy and can improve the outcomes after LM progression.
Clinical trial identification
Legal entity responsible for the study
National Natural Science Foundation of China (No. 81472196)
All authors have declared no conflicts of interest.