Dynamic treatment regimen analysis to determine which treatment sequence can prolong survival of NSCLC patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19010-e19010
Author(s):  
Taro Koba ◽  
Fumio Imamura ◽  
Satoshi Morita ◽  
Masahide Mori ◽  
Kiyoshi Komuta ◽  
...  
Keyword(s):  
Overall Survival ◽  
Treatment Regimen ◽  
Performance Status ◽  
Treatment Sequence ◽  
Term Survival ◽  
Gefitinib Treatment ◽  
Dynamic Treatment ◽  
Nsclc Patients ◽  
Egfr Tki ◽  
Challenge Group

e19010^ Background: We often experience the re-challenge of EGFR-TKI on practice. However, it has not been reported which treatment sequence for EGFR-TKI re-challenge will contributes to long-term survival of NSCLC patients. Methods: We extracted information from retrospective cohort of advanced NSCLC patients with the following inclusion criteria: 1) Japanese patients who were diagnosed by October 2010 and treated with gefitinib after July 2002. 2) Performance status (PS) 0-2. 3) PR, CR, or long SD (6 months or more) by gefitinib. 4) Patients who had not received curative surgical operation or radiation therapy. The primary objective was to evaluate the effects of treatment histories on Overall Survival (OS). We also conducted a “Dynamic Treatment Regimen Analysis (DTRA)”. DTRA can be used to compare multiple treatment strategies/sequences in terms of time-to-event data like overall survival time. Results: A total of 335 NSCLC patient details were extracted. Sixty five patients experienced gefitinib re-challenge. There was a statistical difference in OS between gefitinib re-challenge group and non re-challenge group (median OS was 1272 days vs 774 days; p<0.001). We confirmed this result using DTRA, “Gefitnib-Singlet chemo-Gefitinib” treatment sequence extended survival most out of all treatment sequence. Conclusions: This study suggests that gefitinib re-challenge may have significant affects on OS in long survivors after responding gefitinib treatment. Clinical trial information: UMIN000006913. [Table: see text]

What factors affect long-term survival after responding to gefitinib in advanced non-small cell lung cancer? Real-world evidence.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18007-e18007
Author(s):  
Yoshiko Takeuchi ◽  
Fumio Imamura ◽  
Satoshi Morita ◽  
Masahide Mori ◽  
Kiyoshi Komuta ◽  
...  
Keyword(s):  
Survival Time ◽  
Treatment Regimen ◽  
Medical Records ◽  
Egfr Mutation ◽  
Performance Status ◽  
Primary Objective ◽  
Term Survival ◽  
Long Term Survival ◽  
Gefitinib Treatment

e18007 Background: After gefitinib was approved in July 2002, we experience long-term surviving patients in the actual clinical setting. However, it is not clear how the factors or treatment strategy are contributing to the long-term surviving patients.We evaluated the effects of clinical backgrounds and treatment histories on overall survival (OS). Methods: We extracted information on advanced NSCLC patients with the following inclusion criteria from the medical records: 1) Patients who were diagnosed by October 2010 and treated with gefitinib after July 2002: 2) Performance status (PS) 0 – 2, 3) PR, CR, or long SD (6 months or more) by gefitinib treatment : 4) Patients who had not received curative surgical operation or curative radiation therapy. Primary objective is to evaluate survival time of the patients who responded to gefitinib and clarify the relationship between clinical factors and survival time. We also conducted “Dynamic Treatment Regimen Analysis (DTRA)” to explore key treatment regimen and sequence of regimens contributing to long-term survival. Results: The medical records of total of 275 patients were extracted. 44% (122/275) were EGFR mutation examined and 93% (114/122) has shown the EGFR mutation positive. The mean age was 65 years, 72% (198/275) were women, 66% (182/275) were non-smokers, and 90% (247/275) had adenocarcinoma histology. 20% (54/275) and 21% (58/275) underwent re-administration and beyond PD administration of gefitinib respectively. Median survival time (MST) was 615 day (95% C.I; 519-691). 10% patients survived for more than 5 years. The multivariate Cox analysis demonstrated that sex (p=0.0108) and gefitinib re-administration (p=0.0012) were significant independent factors for long-term OS. Grade 3/4 interstitial lung disease, skin, diarrhea, and liver dysfunction were observed in 1.5%, 4.4%, 1.1%, and 13.1% of the patients, respectively. Conclusions: This study suggests that sex and gefitinib re-administration, may have significant affects on OS in long survivors after responding gefitinib treatment.

Preoperative survivin, ERCC1, and PTEN expression in stage III non-small cell lung cancer (NSCLC) patients (pts) treated with neoadjuvant and definitive chemoradiation and association with overall survival (OS).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7067-7067
Author(s):  
Marta Batus ◽  
Mary J. Fidler ◽  
Kelly Kaiser Walters ◽  
Mark Pool ◽  
Brett Mahon ◽  
...  
Keyword(s):  
Overall Survival ◽  
Dna Repair ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Stage Iii ◽  
Term Survival ◽  
Modest Improvement ◽  
Thoracic Radiation ◽  
Nsclc Patients

7067 Background: Thoracic radiation and concurrent chemotherapy consisting of platinum based doublets has produced modest improvement in long term survival for patient with locally advanced (LA) NSCLC. There is relatively little information regarding molecular profiles and outcome in LA-NSCLC patients (pts) treated with chemoradiation. The objective of this retrospective study is to evaluate potential relationships between expression of DNA repair enzyme ERCC1 and enzymes involved in cell survival – survivin and PTEN. Methods: Stage III NSCLC pts who were treated with chest radiation (40-60Gy) and concurrently with platinum doublet and who had sufficient pretreatment tissue were included in this study. Immunohistochemistry was used to detect nuclear and cytoplasmic expression (frequency 0-4 and intensity 0-4) of survivin, and PTEN, and for nuclear expression of ERCC1. Product of intensity and frequency was calculated for all markers and correlated with overall survival (OS). Results: 97 pts had adequate tumor samples for analysis. 53 women, median age 67. 48 pts with ERCC1 prod <=6 had longer OS than 41 pts with ERCC1 prod >6 (19.6 vs 1.0 months, p=0.034). 16 pts with ERCC1 prod >6, PETN prod <=6 and survivin prod >4 had significantly lower OS than 68 pts with ERCC1<=6, PETN >6 and survivin <=4 (17.2 vs 40.2 months, p<0.001). Conclusions: The association of inferior survival in LA-NSCLC pts whose tumors express high survivin, low PTEN, and high ERCC1, suggests that combining inhibitors of survivin and or of PI3KCA with chemoradiation and developing strategies to inhibit DNA repair might improve outcomes in this group of pts.

A meta-analysis of comparing EGFR-TKI with chemotherapy as the second-line treatment of NSCLC patients with wild-type EGFR.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19166-e19166 ◽  
Author(s):  
Guanghui Gao ◽  
Shengxiang Ren ◽  
Aiwu Li ◽  
Yayi He ◽  
Xiaoxia Chen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Egfr Mutations ◽  
Line Treatment ◽  
Second Line ◽  
Free Survival ◽  
Overall Response ◽  
Nsclc Patients ◽  
Egfr Tki

e19166 Background: The efficacy of comparing the EGFR-TKI with standard chemotherapy in the second-line treatment of advanced NSCLC with wide-type EGFR were still controversial. To derive a more precise estimation of the two regimens, a meta-analysis was performed. Methods: Medical databases and conference proceedings were searched for randomized controlled trials which compared EGFR-TKI (gefitinib or erlotinib) with standard second-line chemotherapy (docetaxel or pemetrexed) in patients with NSCLC. Endpoints were overall survival, progression-free survival and overall response. Results: Three eligible trials (INTEREST, TITAN and TAILOR) were identified. Lacking for data of overall survival of TAILOR trial, So we only make a preliminary meta-analysis for overall survival. The intention to treatment (ITT) analysis demonstrated that the patients receiving EGFR-TKI had a significantly shorter progression-free survival (PFS) than patients treated with chemotherapy (hazard ratio (HR) = 1.31; 95% confidence intervals (CI) = 1.10-1.56; P = 0.002). The overall survival (OS) and overall response rate (ORR) were coparable between this two groups (HR = 0.96; 95%CI = 0.77-1.19; P = 0.69; relative risk (RR) = 0.37; 95%CI = 0.09-1.54; P = 0.17). Conclusions: Although chemotherapy had a clear superiority in PFS as second-line treatment for patients without EGFR mutations compared with EGFR-TKI, OS and ORR were equal in this two regimens. The toxicity profiles might play an important role in the decision to choose EGFR-TKI or chemotherapy. These findings still need to be verified in larger confirmatory studies in future.

Gefitinib as third-line re-challenge treatment in advanced NSCLC patients with EGFR activating mutation who benefited from first-line gefitinib treatment followed by second-line chemotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9035-9035
Author(s):  
Yong Song ◽  
Yi-Long Wu ◽  
Lejie Cao ◽  
Jianhua Chen ◽  
Zhiyong Ma ◽  
...  
Keyword(s):  
Objective Response ◽  
Clinical Effects ◽  
Second Line ◽  
First Line ◽  
Second Line Chemotherapy ◽  
Gefitinib Treatment ◽  
Egfr Mutant ◽  
Nsclc Patients ◽  
Egfr Tki ◽  
Line Chemotherapy

9035 Background: Several studies show that EGFR-mutant NSCLC patients (pts) gained response to EGFR-TKI treatment again after a TKI free interval. To date, no prospective evaluation of the clinical effects of EGFR-TKI re-challenge in EGFR-mutant NSCLC pts has been performed. Methods: This was a multicenter, open-label, single-arm, phase II study (CTONG1304, NCT01933347). Stage IIIB/IV NSCLC pts with EGFR exon 19del/L858R mutation, who previously benefited from first-line gefitinib treatment followed by second-line chemotherapy, took gefitinib 250mg/d until disease progression or death or intolerable toxicity occurred. Blood samples were dynamically collected for EGFRmutation testing using droplet digital PCR at every visit (from baseline to the end of gefitinib treatment). The primary objective was disease control rate (DCR) at week 8. Secondary objectives were objective response rate (ORR), progression free survival (PFS), and overall survival (OS). Results: From March 2014 to May 2016, 45 eligible pts were enrolled and 43 pts were included in the full analysis set (FAS) for efficacy analysis. Gefitinib re-challenge achieved DCR of 69.8%. ORR was 4.7%. Median PFS and OS were 4.4 and 8.0 months (m) respectively. T790M- subgroup at baseline had higher DCR, longer mPFS and mOS, compared with T790M+ subgroup. EGFRstatus changed significantly after gefitinib re-challenge. Conclusions: Gefitinib re-challenge was an effective option in EGFR-mutant NSCLC pts. T790M negativity is a potentially predictive efficacy biomarker for gefitinib re-challenge. Clinical trial information: NCT01933347. [Table: see text]

Phase II study of irinotecan based fourth-line chemotherapy for gefitinib therapy-failed non-small cell lung cancer (NSCLC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18164-18164
Author(s):  
S. Lee ◽  
K. Lee ◽  
E. Lee ◽  
S. Lee ◽  
J. Kim ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Performance Status ◽  
Drop Out ◽  
First Response ◽  
Gefitinib Treatment ◽  
Grade 3 ◽  
Ecog Ps ◽  
Nsclc Patients ◽  
Line Chemotherapy ◽  
Time To Tumor Progression

18164 Background: Despite the undoubted gains from EGFR TK inhibitor therapy as 2nd or 3rd line chemotherapy, most of them will relapse during treatment. Among these patients, they might be young, with good performance status, and their disease is expressed with only minor symptoms. The objectives of this study were to evaluate the antitumor efficacy and safety of irinotecan based regimen as 4th line therapy for refractory or recurrent to gefitinib treatment. We report our experience with irinotecan-based 4th line chemotherapy. Methods: Eligibility required proven NSCLC refractory or recurrent after 3rd line chemotherapy(gefitinib), measurable lesions by RECIST, and ECOG PS 0–1. Irinotecan (60mg/m2, day 1,8,15) and/or cisplatin (60 mg/m2, day 1) were administered every four week for at least 2 course. We analyzed for time to tumor progression (TTP) for first, response rates and toxicities. Results: Since June 2004, 17 patients (consisting of 9 with squamous cell, 7 with adeno-, and 1 with NSCLC not further specified) with a median age of 61 years were enrolled, with 1 drop out during treatment. Chemotherapy was administered for a median 2 courses (range 2–6). Median TTP was 91 (range 35–210) days. Two pts achieved a PR and 5 pts a SD. Disease control rate was 41.2%. Response rate was 11.8%. Toxicity of grade 3 or 4 consisted of neutropenia (35.3%), anemia (29.4%), thrombocytopenia (17.7%), nausea (17.6%), and diarrhea (23.5%). There were no treatment related deaths. Conclusions: This irinotecan based chemotherapy for EGFR TK inhinbitor therapy failed NSCLC patients showed promising efficacy with tolerable toxicity. Irinotecan based chemotherapy may be considered a potential therapeutic option for 4th line chemotherapy in well selected patients. No significant financial relationships to disclose.

scholarly journals The Exploratory Research of NSCLC with Concomitant EGFR Mutations and ALK Rearrangements

2020 ◽  
Author(s):  
Qiman Han ◽  
Chuantao Zhang ◽  
Man Jiang ◽  
Tianjun Li ◽  
Jingjuan Zhu ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Targeted Therapies ◽  
Egfr Mutations ◽  
Survival Curves ◽  
First Line ◽  
Term Survival ◽  
Anaplastic Lymphoma ◽  
Significant Difference ◽  
Nsclc Patients ◽  
Egfr Tki

Abstract Background: Epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements are two driver alterations and are generally considered mutually exclusive in non-small cell lung cancer (NSCLC). The prevalence of EGFR/ALK co-alterations in patients with NSCLC is low, and the clinicopathological features and optimal targeted therapies of these subtype of patients are still controversial. Methods: We describe three cases of NSCLC harboring EGFR mutation and ALK rearrangement. All of them received more-line therapies and showed the long-term survival benefit from targeted therapies.In addition, we searched PUBMED, EMBASE and MEDLINE up to September, 2020. 91 EGFR/ALK co-altered patients of NSCLC included for analysis in our study. Survival curves were created by Kaplan-Meier method and group comparison analyses of progression free survival (PFS) were using log-rank test. Result: A total of 91 patients were summarized in our study from previous literatures. The patients of NSCLC with coexisting EGFR mutations and ALK rearrangements are more likely to occur in female, non-smoker, Asian origin, adenocarcinoma, and IV stage. The disease control rate (DCR) of tyrosine kinase inhibitors (TKIs) which targeted EGFR and ALK as first-line targeted therapy was 62% and 78%, respectively. The median PFS on first EGFR-TKI and first ALK-TKI therapy were 5.3 months (95% confidence interval [CI] 1.20 – 9.40 months) and 6.0 months (95% CI 0.00 – 14.69 months) in EGFR/ALK co-altered NSCLC patients. Among patients who were treated with EGFR-TKI as first-line targeted therapy, univariant analysis showed that PFS have no significant difference between male and female (p = 0.22), and there is also no difference between Asian and Caucasian (p =0.939). The median PFS between first- and second-line targeted therapies was 7.0 months (95% CI 4.83 -9.17 months) and 2.0 months (95% CI 0.96-3.05 months) (p = 0.075). Survival curves showed the significantly prolonged PFS between patients without and with CNS metastasis (p = 0.036). Conclusion: Both EGFR-TKIs and ALK-TKIs have been proved their effectiveness to EGFR/ALK double-positive NSCLC patients. The curative effect of combination targeted therapies and sequential treatment regimens are still in exploration.

Factors associated with overall survival in patients with non-squamous NSCLC in New Zealand: A comparative analysis by EGFR gene mutation status

2020 ◽  
Author(s):  
Phyu Sin Aye ◽  
Mark James McKeage ◽  
Sandar Tin Tin ◽  
Prashannata Khwaounjoo ◽  
J Mark Elwood
Keyword(s):  
Overall Survival ◽  
New Zealand ◽  
Cox Regression ◽  
Smoking Status ◽  
Performance Status ◽  
Specific Gene ◽  
Mutation Status ◽  
Lower Survival ◽  
Nsclc Patients ◽  
Positive Groups

Abstract Introduction: Non-small cell lung cancer (NSCLC) is increasingly regarded as a heterogeneous group of diseases defined by specific gene mutations. Previous studies reported inconsistent results regarding the influence of epidermal growth factor receptor (EGFR) mutations on overall survival. This study assesses the effect of EGFR mutation on overall survival, and how the effects of other survival predictors are modified by EGFR mutation status, in non-squamous NSCLC patients.Methods: The study was based on a population-based cohort of 1534 non-squamous NSCLC patients who were registered in northern New Zealand between 1 February 2010 and 31 July 2017. Kaplan-Meier analyses and log-rank tests were performed to assess the overall survival among different patient groups. Cox regression survival analyses were used to explore the associations between clinico-pathological factors and overall survival in terms of EGFR mutation status. The factors included were age at diagnosis, sex, ethnicity, smoking status, performance status, metastasis status and site of tumour. Results: In this cohort, 20.2% had an EGFR mutation. The median overall survival was 0.79 years and 2.81 years in EGFR mutation-negative and mutation-positive groups respectively (log-rank p<0.0001). Metastasis status showed large and significant effects on overall survival in both EGFR mutation-negative and mutation-positive groups (hazard ratio, HR=3.6 and 3.3, respectively). In subgroup analyses by mutation status and metastasis status, overall survival decreased with an increase in age and decrease in performance status, and was lower in current smokers in all subgroups. In specific groups, females had lower survival only if mutation-positive; Māori had lower survival compared to NZ Europeans only if the disease was metastatic; and tumour site had significant effects on overall survival only in patients without metastasis. Conclusion: EGFR mutation status and metastasis are the main predictors for overall survival in non-squamous NSCLC patients in northern New Zealand. The effects of age, smoking status and performance status are similar in all subgroups, but the effects of sex, ethnicity and site of tumour vary depending on EGFR mutation and metastasis status.

Prognostic factors in small-cell carcinoma of the lung: an analysis of 1,521 patients.

1989 ◽  
Vol 7 (3) ◽  
pp. 344-354 ◽  
Author(s):  
D Spiegelman ◽  
L H Maurer ◽  
J H Ware ◽  
M C Perry ◽  
A P Chahinian ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Performance Status ◽  
Response Rates ◽  
Small Cell ◽  
Term Survival ◽  
Metastatic Sites ◽  
The Impact

Cancer and Leukemia Group B (CALGB) accrued 1,745 patients with limited (LD) or extensive (ED) small-cell lung cancer (SCCL) to five separate trials between 1972 and 1986. We reviewed these data to evaluate the impact of pretreatment prognostic factors on outcome. In multivariate analysis, female gender was predictive of improved response (LD, P = .01; ED, P = .04) and survival (LD, P = .01; ED, P = .02). A performance status of 0 or 1 was associated with improved response rates in both subsets, but was statistically significant (P = .04) only for overall objective response in LD patients. Performance status was a highly significant predictor of survival in both LD and ED groups (P less than .001). Supraclavicular lymph node involvement, while still LD, had a borderline unfavorable impact on survival (P = .06) compared with a lesser extent of LD involvement. In ED patients, a decrease in survival rates was associated with an increased number of metastatic sites (P = .01). Changes in the patient population were noted with time: the percentage of women increased from 21% to greater than 35%; an increased number of metastatic sites was identified among ED patients; mean performance status improved for both LD and ED subsets. These trends reflect the changing demographics of lung cancer, improved lung cancer staging, and probably lead-time bias. Response rates, overall survival, and long-term (greater than 2-year) survival varied significantly among the five protocols, both before and after multivariate correction for identified prognostic variables. However, the changing character of the study population limits the ability to determine retrospectively how much improvements in therapy contributed to the positive changes in failure-free survival, overall survival, and long-term survival observed in our sequentially studied population.

Clinical benefit of second EGFR-TKI retreatment on overall survival in patients with advanced non-small-cell lung cancer harboring EGFR-mutation positive after failure of the initial EGFR-TKI treatment: A retrospective analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19164-e19164
Author(s):  
Masanao Nakashima ◽  
Takashi Hirose ◽  
Yasunari Oki ◽  
Yasunori Murata ◽  
Tomohide Sugiyama ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Egfr Mutation ◽  
Cytotoxic Chemotherapy ◽  
Small Cell ◽  
Control Group ◽  
Small Cell Lung ◽  
Gefitinib Treatment ◽  
Egfr Tki

e19164 Background: The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) bring the best result to EGFR-mutation positive non-small cell lung cancer patients, but most lead to drug resistance. These acquired resistances are associated with T790M mutation or Met amplification, HGF expression. To assess whether affects overall survival in these patients, we did a retrospective study comparing survival outcomes in 2nd EGFR-TKI treated patients with controls without 2nd EGFR-TKI screened during the same time period. Methods: We examined overall survival in thirty-two of 52 patients with advanced, EGFR-mutation-positive NSCLC who treated 1st EGFR-TKI (gefitinib) from January 2009 to December 2012. We identified 16 patients who were given 2nd EGFR-TKI (erlotinib) after failure of the initial gefitinib treatment (retreatment group) with 16 patients who were not given 2nd EGFR-TKI but given only chemotherapy (control group), 20 patients who might treat with 2nd EGFR-TKI or chemotherapy at that time were excluded in progress after failure of the initial gefitinib treatment. To assess differences in overall survival, we assessed subsets of clinically comparable 2nd EGFR-TKI retreatment group. Results: Among 16 patients who were given 2nd EGFR-TKI, retreatment group who were given one or two cytotoxic chemotherapy from 1st EGFR-TKI to 2nd EGFR-TKI, median overall survival from initiation of the diagnosis with advanced IIIB/IV stage or surgical recurrent NSCLC was 24.2 months. 16 patients of control group who were given from second to seven line cytotoxic chemotherapy, overall survival was 15.8 months (p=0.021). Retreatment group who were given 2nd EGFR-TKI was significantly longer than control group in EGFR mutation positive patients. Response rate and disease control rate with 2nd EGFR-TKI retreatment are 12.5% and 31.3%. Conclusions: In patients with advanced, EGFR mutation positive NSCLC, retreatment group who were given 2nd EGFR-TKI therapy was associated with improved survival compared with control group who were given only cytotoxic chemotherapy.

scholarly journals Comparative survival in patients with brain metastases from non-small-cell lung cancer treated before and after implementation of radiosurgery

2017 ◽  
Vol 24 (2) ◽  
pp. 146 ◽  
Author(s):  
J.N. Greenspoon ◽  
P.M. Ellis ◽  
G. Pond ◽  
S. Caetano ◽  
J. Broomfield ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung ◽  
Nsclc Patients

Introduction Survival after a diagnosis of brain metastasis in non-small-cell lung cancer (nsclc) is generally poor. We previously reported a median survival of approximately 4 months in a cohort of patients treated with whole-brain radiotherapy (wbrt). Since that time, we implemented a program of stereotactic radiosurgery (srs). In the present study, we examined survival and prognostic factors in a consecutive cohort of patients after the introduction of the srs program.Methods Data from a retrospective review of 167 nsclc patients with brain metastasis referred to a tertiary cancer centre during 2010–2012 were compared with data from a prior cohort of 91 patients treated during 2005–2007(“pre-srs cohort”).Results Median overall survival from the date of diagnosis of brain metastasis (4.3 months in the srs cohort vs. 3.9 months in the pre-srs cohort, p = 0.74) was not significantly different in the cohorts. The result was similar when the no-treatment group was excluded from the srs cohort. Within the srs cohort only, significant differences is overall survival were observed between treatment groups (srs, wbrt plus srs, wbrt, and no treatment), with improved survival being observed on univariate and multivariate analysis for patients receiving srs compared with patients receiving wbrt alone (p < 0.001).Conclusions No improvement in survival was observed for nsclc patients with brain metastases after the implementation of srs. Selected patients (younger age, female sex, good performance status, fewer brain metastases) treated with srs appeared to demonstrate improved survival. However, those observations might also reflect better patient selection for srs or a greater tendency to offer those patients systemic therapy in addition to srs.

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