Optimal treatment sequence for untreated EGFR-mutant NSCLC with brain metastases.

e14021Background: Currently, whole-brain radiation therapy (WBRT), stereotactic radiosurgery (SRS) or surgery can be combined with EGFR-tyrosine kinase inhibitors (TKIs) for EGFR-mutant non-small cell lung cancer (NSCLC) with brain metastases (BM). SRS is standard therapy for patients with 1–4 BM. This study aimed to determine the best treatment sequence for EGFR-mutant NSCLC with BM. Methods: We retrospectively evaluated EGFR-mutant NSCLC cases with BM from a single site. Cases were divided into two groups by upfront therapy: EGFR-TKI (TKI-group) or local therapies (LT-group). Overall survival (OS) was measured from the start of treatment; progression-free survival (PFS) was from the start of EGFR-TKI. Results: Among 118 patients, 66% received upfront EGFR-TKI, and 34% received WBRT (n = 20), SRS (n = 16) or surgery (n = 4) followed by EGFR-TKI. Clinical characteristic were as follows (LT-group/TKI-group): median age, 68/68 years; female, 65%/77%; PS 0–1, 68%/76%; activating EGFR mutation, 85%/99%, none ...