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. 2020 Oct 9:10:581729.
doi: 10.3389/fonc.2020.581729. eCollection 2020.

Treatment Patterns and Survival Outcomes of Non-Small Cell Lung Cancer Patients Initially Diagnosed With Brain Metastases in Real-World Clinical Practice

Xin-Ru Chen  1 , Xue Hou  1 , Xiao-Xiao Dinglin  2 , Yong-Dong Liu  3 , Yin Li  4 , Wei Zheng  4 , De-Lan Li  5 , Jing Chen  1 , Xiao-Liang Wu  6 , Kai-Cheng Wang  1 , Shu-Xiang Ma  7 , Yin-Duo Zeng  2 , Li-Kun Chen  1
Affiliations

Treatment Patterns and Survival Outcomes of Non-Small Cell Lung Cancer Patients Initially Diagnosed With Brain Metastases in Real-World Clinical Practice

Xin-Ru Chen et al. Front Oncol. .

Abstract

Background: This study aimed to comprehensively analyze the characteristics, treatment patterns, and survival outcomes of non-small-cell lung cancer (NSCLC) patients initially diagnosed with brain metastases (BMs) in real-world practice.

Methods: We enrolled NSCLC patients initially diagnosed with BMs between Jan 2004 and Jan 2018 in our institution. Patient demographics, treatment modalities, and survival outcomes were then analyzed. Brain localized treatment (BLT) included early brain radiotherapy (EBR), deferred brain radiotherapy (DBR), and surgery.

Results: A total of 954 patients were identified. Concerning initial treatment, 525 patients (55.0%) received systemic medication (SM)+BLT, 400 patients (41.9%) received SM only, and 29 patients received BLT only (3.0%). SM+BLT cohort was associated with longer median overall survival (mOS) than the SM only and the BLT only cohorts both in epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)-negative/unknown patients (15.3 months, 95% confidence interval [CI], 14.2-16.4; 11.1 months, 9.0-13.2; 7.0 months, 5.4-8.6; p<0.001) and in EGFR/ALK-positive patients (33.7 months, 28.5-38.9; 22.1 months, 17.8-26.4; 4.0 months, 3.6-4.4; p < 0.001). As for timing of radiotherapy, SM+EBR (14.1 months, 12.7-15.5) was associated with inferior mOS than SM+DBR (19.4 months, 14.2-24.6) in EGFR/ALK-negative/unknown patients. No significant difference was found in EGFR/ALK-positive patients (28.3 months, 19.1-37.5; 33.3 months, 28.1-38.5). Patients in the EGFR/ALK-negative/unknown cohort treated with first-line pemetrexed with platinum (PP) (15.8 months, 14.0-17.6, p<0.001) had longer mOS than those received non-PP regimens (13.1 months, 11.6-14.6). However, no difference was observed among EGFR/ALK-positive patients who were treated with tyrosine kinase inhibitors (TKIs) (29.5 months, 21.1-37.9; p = 0.140), PP (27.2 months, 21.6-32.8) and non-PP regimens (25.0 months, 16.0-34.0).

Conclusions: Our study confirmed that the use of SM+BLT is associated with superior mOS than those treated with SM only and BLT only. SM+DBR might be a better radiotherapeutic strategy for this patient population. EGFR/ALK-negative/unknown patients showed a survival benefit with PP treatment.

Keywords: brain metastases; brain radiotherapy; non-small-cell lung cancer; survival outcomes; systemic medication.

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Figures

Figure 1
Figure 1
Patient flow chart illustrating selection of the study population. BMs, brain metastases; NSCLC, non-small cell lung cancer; SYSUCC, Sun Yat-Sen University Cancer Center.
Figure 2
Figure 2
Treatment patterns and survival outcomes of NSCLC patients initially diagnosed with BMs. (A) Distribution of treatment patterns in 632 EGFR/ALK-negative/unknown patients. The mOS of EGFR/ALK-negative/unknown patients treated with SM only, (B) SM+BLT and BLT only. (C) The mOS of EGFR/ALK-negative/unknown patients treated with SM only, SM+EBR, SM+DBR, SM+BS, and BLT only. (D) Distribution of treatment patterns in 322 EGFR/ALK-positive patients. (E) The mOS of EGFR/ALK-positive patients treated with SM only, SM+BLT and BLT only. (F) The mOS of EGFR/ALK-positive patients treated with SM only, SM+EBR, SM+DBR, SM+BS, and BLT only. ALK, anaplastic lymphoma kinase; BLT, brain localized treatment; BMs, brain metastases; BS, brain surgery; DBR, deferred brain radiotherapy; EBR, early brain radiotherapy; EGFR, epidermal growth factor receptor; NSCLC, non-small cell lung cancer; mOS, median overall survival; SM, systemic medication.
Figure 3
Figure 3
Frequency and survival outcomes of different systemic medications used as first-line regimens. (A) Frequency of treatment regimens in 632 EGFR/ALK-negative/unknown patients. (B) The mOS of EGFR/ALK-negative/unknown patients treated with AP and non-AP regimens. (C) Frequency of treatment regimens in 322 EGFR/ALK-positive patients. (D) The mOS of EGFR/ALK-positive patients treated with TKIs, AP, and non-AP regimens. ALK, anaplastic lymphoma kinase; DP, docetaxel with platinum; EGFR, epidermal growth factor receptor; GP, gemcitabine with platinum; mOS, median overall survival; PP, pemetrexed with platinum; TKI, tyrosine kinase inhibitor; TP, paclitaxel with platinum.
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