Managing Brain Metastases in Patients with Non-Small-Cell Lung Cancer

It is unclear whether upfront radiotherapy or initiation of EGFR tyrosine kinase inhibitor (TKI) therapy is the better approach for patients with EGFR-mutated non-small-cell lung cancer (NSCLC) who present with baseline brain metastases.

To address this issue, investigators retrospectively analyzed 351 EGFR-mutant NSCLC patients with brain metastases who were EGFR-TKI naive. Patients received one of three treatments: stereotactic radiosurgery (SRS) followed by EGFR TKI, whole-brain radiotherapy (WBRT) followed by EGFR TKI, or EGFR TKI followed by SRS or WBRT at time of intracranial progression. EGFR-resistant mutations were excluded.

Median overall survival (OS) was longer with SRS followed by EGFR TKI than with either WBRT followed by EGFR T…