Chapter 16 – Intracranial Disease in Patients with Non-Small Cell Lung Cancer: Treatment with Erlotinib

The ability to target the epidermal growth factor receptor (EGFR) heralded an important development in the management of incurable non-small cell lung cancer (NSCLC). EGFR can be targeted by monoclonal antibodies and small molecule tyrosine kinase inhibitors (TKI) and the TKIs erlotinib and gefitinib are now routinely used in the management of lung cancer in the first- and second-line settings; they are particularly effective in tumors containing sensitizing mutations in EGFR. The development of metastasis to the brain is a frequent occurrence in NSCLC affecting ≈20–40% of patients, resulting in substantial morbidity and mortality. Patients with an EGFR sensitizing mutation appear to be more likely to develop metastases to the brain, though they also have a longer survival compared to those patients with wild-type EGFR. This chapter examines the evidence for the role of erlotinib in the management of patients with NSCLC, focusing on those patients with an EGFR sensitizing mutation and the development and treatment of brain metastases. Areas which require further investigation in clinical trials are highlighted.