gms | German Medical Science

Objective: Since the introduction of targeted therapies against lung cancer in 2010, a dramatic turning point has been reached in therapy and survival of non-small cell lung cancer. EGFR tyrosine-kinase inhibitors (TKIs) have a definite activity in brain metastases (BM) from NSCLC with activating EGFR mutations.

Method: The incidence of brain metastases and survival was analyzed for primary adenocarcinoma of the lung diagnosed between 2007 and 2012 with regard to EGFR mutations and adjuvant therapies.

Results: A total of 402 patients were diagnosed with primary adenocarcinoma of the lung. 56,6% were male, mean age at diagnosis was 65,7 ± 10,9 years. Since 2010, EGFR mutation analyses were performed in 233 patients, in 13,3% mutated EGFR was detected. For all patients, median survival after primary diagnosis was 22 months. 37% developed brain metastases (BM) during the course of their disease. The median annual incidence of brain metastases was 43,6% and 45,8% for the years 2007-2009 and 2010-2012, respectively. Post-brain metastastic survival was 8 months.

70,2% patients were diagnosed at UICC stadium III or IV, in whom 35 patients received first-line therapy with TKI. First-line TKI therapy not only lead to a prolonged OS of 27 months (versus 19 and 12 months for Platinum-based and Permetrexed-based chemotherapies, p=0,002), but patients with BM significantly showed a better post-metastatic survival (19 versus 7 months if treated without TKI, p=0,001).

Surprisingly, the incidence of BM in patients treated with first-line-TKI between 2010 and 2012, was as low as 10,5%, whereas the incidence reached 48,8% in those without primary TKI treatment.

Conclusions: TKI in adenocarcinomas of the lung not only positively influence OS and postmetastatic survival in patients with BM. Moreover, TKI seem to lower the incidence of BM when given as first-line treatment for primary tumor.