Gefitinib plus chemotherapy could be considered a first-line treatment option for patients with EGFR-mutated NSCLC with brain metastases.
Gefitinib, a tyrosine kinase inhibitor (TKI), plus chemotherapy improved outcomes in patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with brain metastases, according to recent study results.
Specifically, progression-free survival (time during and after treatment when the patient lives without disease progression) was significantly improved with the combination at 15.6 months compared with gefitinib alone at 9.1 months.
“The findings of this randomized clinical trial suggest that gefitinib plus chemotherapy may be a viable first-line treatment for patients with brain metastases associated with EGFR-mutated NSCLC,” the study authors wrote.
The use of TKIs in EGFR-mutated NSCLC with brain metastases has become standard therapy, and several studies have shown that adding chemotherapy could improve progression-free survival. However, the efficacy of these agents in patients with brain metastases is unclear.
Additionally, brain metastases occur in 30% to 40% of patients with NSCLC and patients with EGFR are even more prone to develop brain metastases, at 44% to 63%.
The study, which was published in the journal JAMA, evaluated 161 patients who received gefitinib alone (81 patients) or in combination with chemotherapy (80 patients).
Gefitinib plus chemotherapy also had a better objective response rate (the rate of a measurable response to the treatment) of 85% and overall response rate (a percentage of patients with a partial or complete response to treatment) of 80% than gefitinib alone.
Median overall survival (time from diagnosis or treatment start when patients are alive) was also better with the combination at 35 months compared to gefitinib alone at 28.9 months.
Severe or worse side effects were more common with gefitinib plus chemotherapy; however most were manageable.
“Improving the treatment outcome of patients with brain metastases became the key point of management of treatment for patients with EGFR-mutated NSCLS,” the authors wrote.
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