WCLC 2016: Icotinib May Improve Progression-Free Survival vs Whole-Brain Irradiation in Patients With NSCLC With Brain Metastases
Patients whose lung cancer spreads to their brain typically have only 4 to 6 months left to live, but research presented by Chinese doctors suggests that using icotinib increases progression-free survival in these patients compared to whole-brain irradiation and chemotherapy combined. Yi-Long Wu, MD, of Guangdong Lung Cancer Institute & Guangdong General Hospital in Guangzhou, China, presented the data at the IASLC 17th World Conference on Lung Cancer (WCLC) in Vienna, Austria (Abstract PL03.05).
WBI is the standard of care for non–small cell lung cancer patients (NSCLC) whose cancer metastasizes, but whole-brain irradiation can produce side effects such as an increased risk of cognitive decline and other quality of life issues. Yet, there were no prospective randomized clinical trials to explore the efficacy of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors on patients with brain metastases.
Icotinib is indicated for the treatment for EGFR mutation–positive, advanced, or metastatic NSCLC as a second-line or third-line treatment for patients who have failed at least one prior treatment with chemotherapy.
Whole-brain irradiation is a standard of care for patients with brain metastases. However, small molecule inhibitors of EGFR—including icotinib—achieved very successful results in advanced NSCLC with EGFR mutations.
Study Findings
Dr. Wu and co-researchers randomized patients with brain metastases to receive whole-brain irradiation and chemotherapy or icotinib. All patients were required to have EGFR mutations and radiologically confirmed brain metastases with at least three lesions. This portion of the trial lasted for approximately 3 years.
Dr. Wu and colleagues found that the icotinib patients had higher median progression-free survival and better intracranial objective response rate than the patients who received whole-brain irradiation and chemotherapy. At 6 months, 72% icotinib patients experienced no brain progression, but 48% of whole-brain irradiation patients experienced brain progression.
Also, Dr. Wu noted that the icotinib group experienced far fewer adverse reactions than the whole brain radiation group.
“Icotinib demonstrated superior intracranial progression-free survival, progression-free survival, and overall response rate over whole-brain irradiation plus chemotherapy in EGFR-mutant advanced NSCLC with brain metastases along with a well-tolerated safety profile,” said Dr. Wu. “Icotinib should be used in the first-line setting for EGFR-mutant patients with brain metastases.”
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