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- Title
Role of Epidermal Growth Factor Receptor (EGFR) Inhibitors and Radiation in the Management of Brain Metastases from EGFR Mutant Lung Cancers.
- Authors
Khandekar, Melin J.; Piotrowska, Zofia; Willers, Henning; Sequist, Lecia V.
- Abstract
Abstract: The growth of genotype‐directed targeted therapies, such as inhibitors of the epidermal growth factor receptor (EGFR), has revolutionized treatment for some patients with oncogene‐addicted lung cancer. However, as systemic control for these patients has improved, brain metastases remain an important source of morbidity and mortality. Traditional treatment for brain metastases has been radiotherapy, either whole‐brain radiation or stereotactic radiosurgery. The growing availability of drugs that can cross the blood‐brain barrier and have activity in the central nervous system (CNS) has led to many studies investigating whether targeted therapy can be used in combination with or in lieu of radiation. In this review, we summarize the key literature about the incidence and nature of EGFR‐mutant brain metastases (EGFR BMs), the data about the activity of EGFR inhibitors in the CNS, and whether they can be used as front‐line therapy for brain metastases. Although initial use of tyrosine kinase inhibitors for EGFR BMs can often be an effective treatment strategy, multidisciplinary evaluation is critical, and prospective studies are needed to clarify which patients may benefit from early radiotherapy. Implications for Practice: Management of brain metastases in epidermal growth factor receptor (EGFR) mutant lung cancer is a common clinical problem. The question of whether to start initial therapy with an EGFR inhibitor or radiotherapy (either whole‐brain radiotherapy or stereotactic radiosurgery) is controversial. The development of novel EGFR inhibitors with enhanced central nervous system (CNS) penetration is an important advance in the treatment of CNS disease. Multidisciplinary evaluation and evaluation of extracranial disease status are critical to choosing the best treatment option for each patient.
- Subjects
BRAIN tumor genetics; BRAIN tumor treatment; PROTEIN-tyrosine kinase inhibitors; EPIDERMAL growth factor; LUNG tumors; BLOOD-brain barrier; BRAIN tumors; CENTRAL nervous system; DRUG delivery systems; METASTASIS; GENETIC mutation; DISEASE management; TREATMENT effectiveness; DISEASE incidence; CHEMORADIOTHERAPY; GENETICS; THERAPEUTICS
- Publication
Oncologist, 2018, Vol 23, Issue 9, p1054
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2017-0557