Local Control of Brain Metastases with Osimertinib Alone in Patients with EGFR-mutant Non- Small Cell Lung Cancer
Year: 2022
Type: preprint
Study design: Observational Study
Abstract: Purpose: Although osimertinib has excellent intracranial activity in metastatic non-small cell lung cancer (NSCLC) with exon 19 deletion or L858R EGFR alterations, measures of local control of brain metastases are less well-reported. We describe lesion-level outcomes of brain metastases treated with osimertinib alone.Methods: We retrospectively reviewed patients with EGFR-mutant NSCLC with untreated brain metastasis measuring ≥5 mm at the time of initiating osimertinib. Cumulative incidence of local recurrence in brain (LRiB) was calculated with death as a competing risk, and univariable and multivariable analyses were conducted to identify factors associated with LRiB. Results: We included 284 brain metastases from 37 patients. Median follow-up was 20.1 months. On initial MRI after starting osimertinib, patient-level response was complete response (CR) in 11 (15%), partial response (PR) in 33 (45%), stable disease (SD) in 18 (25%) and progressive disease (PD) in 11 (15%). The 1-year cumulative incidence of LRiB was 14% (95% CI 9.9-17.9) and was significantly different in patients with a CR (0%), PR (4%), and SD (11%; p=0.02). Uncontrolled primary tumor (adjusted hazard ratio [aHR] 3.78, 95% CI 1.87-7.66; p<0.001), increasing number of prior systemic therapies (aHR 2.12, 95% CI 1.49-3.04; p<0.001), and higher ECOG score (aHR 7.8, 95% CI 1.99-31.81; p=0.003) were associated with LRiB. Conclusions: Although 1-year risk of LRiB is <4% with a CR or PR, 1-year risk of LRiB is over 10% for patients with less than a PR to osimertinib. These patients should be followed closely for need for additional treatment such as stereotactic radiosurgery.
Source: Research Square
Institution: Stanford University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4293493085