Primary lesion radiotherapy during first-line icotinib treatment in EGFR-mutated NSCLC patients with multiple metastases and no brain metastases: a single-center retrospective study
Background The most frequent mode of progression in the majority of non-small cell lung cancer (NSCLC) patients treated with Epidermal growth factor – receptor tyrosine kinase inhibitors (EGFR-TKIs) is failure to respond to treatment at the primary lesion, suggesting that concurrent radiotherapy (C...
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| Veröffentlicht in: | Strahlentherapie und Onkologie 2022-12, Vol.198 (12), p.1082-1093 |
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| creator | Deng, Rui Liu, Jinkun Song, Tongjun Xu, Tao Li, Yong Duo, Long Xiang, Longchao Yu, Xiongjie Lei, Jinhua Cao, Fengjun |
| description | Background
The most frequent mode of progression in the majority of non-small cell lung cancer (NSCLC) patients treated with Epidermal growth factor – receptor tyrosine kinase inhibitors (EGFR-TKIs) is failure to respond to treatment at the primary lesion, suggesting that concurrent radiotherapy (CRT) to the primary lesion (CPRT) during first-line treatment with EGFR-TKI may be a novel therapeutic approach with a potential of additional benefit for metastatic NSCLC. Therefore, this study investigated the progression-free survival (PFS) and safety of CPRT during first-line icotinib treatment in NSCLC patients with EGFR mutations.
Methods
EGFR-mutant NSCLC patients diagnosed with limited multiple metastases were treated with first-line icotinib. The decision to treat the primary lesions with radiation largely depended on the patient’s preference. The study endpoints included PFS, toxicity, progression pattern, and acquisition of the T790M mutation.
Results
The median PFS in the CPRT and Non-CPRT groups was 13.6 and 10.6 months (hazard ratio [HR] 0.23, 95% confidence interval [CI] 0.15–0.37,
P
|
| doi_str_mv | 10.1007/s00066-022-01971-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2740170824</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2740170824</sourcerecordid><originalsourceid>FETCH-LOGICAL-c352t-3f3f03ab54eb603493eb0b8173d59b5017d4ad76e270d2123f3be0367d84f1c03</originalsourceid><addsrcrecordid>eNp9UV1rFTEQDWLBa_UP-DTgc3SS7G7u-iaXtgqXKrYF30J2M2tT9ssk28v9N_4Kf4C_rKkr9E0YGJg558xwDmNvBL4TiPp9RMSq4iglR1FrwQ_P2EYUquZY19-fsw0KXXMtyu0L9jLGO0RRFXWxYb-_Bj_YcISeop9GCNb5Kd1SsPMR3BL8-AM6H2LivR8JfDslP_oGUiCbBhoT-BHOLs6_8WFJNpGDy6vdfgezTT5vIxx8uoVh6ZOfe4KBko25KIIdHYwTNMFmhaf5B7B_fsV8tifeZgUKECiFKc7UJn9PENPijq_YSWf7SK__9VN2c352vfvE918uPu8-7nmrSpm46lSHyjZlQU2FqqgVNdhshVaurJsym-IK63RFUqOTQmZ8Q6gq7bZFJ1pUp-ztqjuH6edCMZm7aQljPmmkLjIft7LIKLmi2vxnDNSZeXXVCDSP-Zg1H5PzMX_zMYdMUispzo8uU3iS_g_rASQbmQY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2740170824</pqid></control><display><type>article</type><title>Primary lesion radiotherapy during first-line icotinib treatment in EGFR-mutated NSCLC patients with multiple metastases and no brain metastases: a single-center retrospective study</title><source>SpringerLink Journals - AutoHoldings</source><creator>Deng, Rui ; Liu, Jinkun ; Song, Tongjun ; Xu, Tao ; Li, Yong ; Duo, Long ; Xiang, Longchao ; Yu, Xiongjie ; Lei, Jinhua ; Cao, Fengjun</creator><creatorcontrib>Deng, Rui ; Liu, Jinkun ; Song, Tongjun ; Xu, Tao ; Li, Yong ; Duo, Long ; Xiang, Longchao ; Yu, Xiongjie ; Lei, Jinhua ; Cao, Fengjun</creatorcontrib><description>Background
The most frequent mode of progression in the majority of non-small cell lung cancer (NSCLC) patients treated with Epidermal growth factor – receptor tyrosine kinase inhibitors (EGFR-TKIs) is failure to respond to treatment at the primary lesion, suggesting that concurrent radiotherapy (CRT) to the primary lesion (CPRT) during first-line treatment with EGFR-TKI may be a novel therapeutic approach with a potential of additional benefit for metastatic NSCLC. Therefore, this study investigated the progression-free survival (PFS) and safety of CPRT during first-line icotinib treatment in NSCLC patients with EGFR mutations.
Methods
EGFR-mutant NSCLC patients diagnosed with limited multiple metastases were treated with first-line icotinib. The decision to treat the primary lesions with radiation largely depended on the patient’s preference. The study endpoints included PFS, toxicity, progression pattern, and acquisition of the T790M mutation.
Results
The median PFS in the CPRT and Non-CPRT groups was 13.6 and 10.6 months (hazard ratio [HR] 0.23, 95% confidence interval [CI] 0.15–0.37,
P
< 0.001). Subgroup analysis showed that the results were statistically significant with 14.7 and 11.5 months for the 19del mutation (HR 0.20, 95% CI 0.10–0.40,
P
< 0.001) and 12.9 and 9.9 months for the L858R mutation (HR 0.25, 95% CI 0.13–0.48,
P
< 0.001). There were no reports of interstitial pneumonia associated with treatment at grade 4 or above. Patients who received CPRT during first-line icotinib treatment had the potential to decrease the primary lesion progression (
P
< 0.05) without increasing newly metastatic lesions (
P
> 0.05). The proportion of acquired T790M mutations was 26.7% and 45.7% in both groups (
P
> 0.05).
Conclusion
This study suggests that CPRT is a viable option for patients with EGFR-sensitive mutations in NSCLC with limited multiple metastases during first-line icotinib treatment, which can significantly improve PFS with acceptable toxicities. Data on progression patterns and T790M mutations suggest the need to further investigate the benefits of radiation treatment from a molecular perspective.</description><identifier>ISSN: 0179-7158</identifier><identifier>EISSN: 1439-099X</identifier><identifier>DOI: 10.1007/s00066-022-01971-w</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Brain cancer ; Growth factors ; Kinases ; Lesions ; Lung cancer ; Medicine ; Medicine & Public Health ; Metastasis ; Mutation ; Oncology ; Original Article ; Radiation therapy ; Radiotherapy ; Subgroups ; Toxicity ; Tyrosine</subject><ispartof>Strahlentherapie und Onkologie, 2022-12, Vol.198 (12), p.1082-1093</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2022</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-3f3f03ab54eb603493eb0b8173d59b5017d4ad76e270d2123f3be0367d84f1c03</citedby><cites>FETCH-LOGICAL-c352t-3f3f03ab54eb603493eb0b8173d59b5017d4ad76e270d2123f3be0367d84f1c03</cites><orcidid>0000-0002-0494-3474</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00066-022-01971-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00066-022-01971-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids></links><search><creatorcontrib>Deng, Rui</creatorcontrib><creatorcontrib>Liu, Jinkun</creatorcontrib><creatorcontrib>Song, Tongjun</creatorcontrib><creatorcontrib>Xu, Tao</creatorcontrib><creatorcontrib>Li, Yong</creatorcontrib><creatorcontrib>Duo, Long</creatorcontrib><creatorcontrib>Xiang, Longchao</creatorcontrib><creatorcontrib>Yu, Xiongjie</creatorcontrib><creatorcontrib>Lei, Jinhua</creatorcontrib><creatorcontrib>Cao, Fengjun</creatorcontrib><title>Primary lesion radiotherapy during first-line icotinib treatment in EGFR-mutated NSCLC patients with multiple metastases and no brain metastases: a single-center retrospective study</title><title>Strahlentherapie und Onkologie</title><addtitle>Strahlenther Onkol</addtitle><description>Background
The most frequent mode of progression in the majority of non-small cell lung cancer (NSCLC) patients treated with Epidermal growth factor – receptor tyrosine kinase inhibitors (EGFR-TKIs) is failure to respond to treatment at the primary lesion, suggesting that concurrent radiotherapy (CRT) to the primary lesion (CPRT) during first-line treatment with EGFR-TKI may be a novel therapeutic approach with a potential of additional benefit for metastatic NSCLC. Therefore, this study investigated the progression-free survival (PFS) and safety of CPRT during first-line icotinib treatment in NSCLC patients with EGFR mutations.
Methods
EGFR-mutant NSCLC patients diagnosed with limited multiple metastases were treated with first-line icotinib. The decision to treat the primary lesions with radiation largely depended on the patient’s preference. The study endpoints included PFS, toxicity, progression pattern, and acquisition of the T790M mutation.
Results
The median PFS in the CPRT and Non-CPRT groups was 13.6 and 10.6 months (hazard ratio [HR] 0.23, 95% confidence interval [CI] 0.15–0.37,
P
< 0.001). Subgroup analysis showed that the results were statistically significant with 14.7 and 11.5 months for the 19del mutation (HR 0.20, 95% CI 0.10–0.40,
P
< 0.001) and 12.9 and 9.9 months for the L858R mutation (HR 0.25, 95% CI 0.13–0.48,
P
< 0.001). There were no reports of interstitial pneumonia associated with treatment at grade 4 or above. Patients who received CPRT during first-line icotinib treatment had the potential to decrease the primary lesion progression (
P
< 0.05) without increasing newly metastatic lesions (
P
> 0.05). The proportion of acquired T790M mutations was 26.7% and 45.7% in both groups (
P
> 0.05).
Conclusion
This study suggests that CPRT is a viable option for patients with EGFR-sensitive mutations in NSCLC with limited multiple metastases during first-line icotinib treatment, which can significantly improve PFS with acceptable toxicities. Data on progression patterns and T790M mutations suggest the need to further investigate the benefits of radiation treatment from a molecular perspective.</description><subject>Brain cancer</subject><subject>Growth factors</subject><subject>Kinases</subject><subject>Lesions</subject><subject>Lung cancer</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Mutation</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Radiation therapy</subject><subject>Radiotherapy</subject><subject>Subgroups</subject><subject>Toxicity</subject><subject>Tyrosine</subject><issn>0179-7158</issn><issn>1439-099X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9UV1rFTEQDWLBa_UP-DTgc3SS7G7u-iaXtgqXKrYF30J2M2tT9ssk28v9N_4Kf4C_rKkr9E0YGJg558xwDmNvBL4TiPp9RMSq4iglR1FrwQ_P2EYUquZY19-fsw0KXXMtyu0L9jLGO0RRFXWxYb-_Bj_YcISeop9GCNb5Kd1SsPMR3BL8-AM6H2LivR8JfDslP_oGUiCbBhoT-BHOLs6_8WFJNpGDy6vdfgezTT5vIxx8uoVh6ZOfe4KBko25KIIdHYwTNMFmhaf5B7B_fsV8tifeZgUKECiFKc7UJn9PENPijq_YSWf7SK__9VN2c352vfvE918uPu8-7nmrSpm46lSHyjZlQU2FqqgVNdhshVaurJsym-IK63RFUqOTQmZ8Q6gq7bZFJ1pUp-ztqjuH6edCMZm7aQljPmmkLjIft7LIKLmi2vxnDNSZeXXVCDSP-Zg1H5PzMX_zMYdMUispzo8uU3iS_g_rASQbmQY</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Deng, Rui</creator><creator>Liu, Jinkun</creator><creator>Song, Tongjun</creator><creator>Xu, Tao</creator><creator>Li, Yong</creator><creator>Duo, Long</creator><creator>Xiang, Longchao</creator><creator>Yu, Xiongjie</creator><creator>Lei, Jinhua</creator><creator>Cao, Fengjun</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><orcidid>https://orcid.org/0000-0002-0494-3474</orcidid></search><sort><creationdate>20221201</creationdate><title>Primary lesion radiotherapy during first-line icotinib treatment in EGFR-mutated NSCLC patients with multiple metastases and no brain metastases: a single-center retrospective study</title><author>Deng, Rui ; Liu, Jinkun ; Song, Tongjun ; Xu, Tao ; Li, Yong ; Duo, Long ; Xiang, Longchao ; Yu, Xiongjie ; Lei, Jinhua ; Cao, Fengjun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-3f3f03ab54eb603493eb0b8173d59b5017d4ad76e270d2123f3be0367d84f1c03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Brain cancer</topic><topic>Growth factors</topic><topic>Kinases</topic><topic>Lesions</topic><topic>Lung cancer</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Mutation</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Radiation therapy</topic><topic>Radiotherapy</topic><topic>Subgroups</topic><topic>Toxicity</topic><topic>Tyrosine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Deng, Rui</creatorcontrib><creatorcontrib>Liu, Jinkun</creatorcontrib><creatorcontrib>Song, Tongjun</creatorcontrib><creatorcontrib>Xu, Tao</creatorcontrib><creatorcontrib>Li, Yong</creatorcontrib><creatorcontrib>Duo, Long</creatorcontrib><creatorcontrib>Xiang, Longchao</creatorcontrib><creatorcontrib>Yu, Xiongjie</creatorcontrib><creatorcontrib>Lei, Jinhua</creatorcontrib><creatorcontrib>Cao, Fengjun</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>Strahlentherapie und Onkologie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Deng, Rui</au><au>Liu, Jinkun</au><au>Song, Tongjun</au><au>Xu, Tao</au><au>Li, Yong</au><au>Duo, Long</au><au>Xiang, Longchao</au><au>Yu, Xiongjie</au><au>Lei, Jinhua</au><au>Cao, Fengjun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Primary lesion radiotherapy during first-line icotinib treatment in EGFR-mutated NSCLC patients with multiple metastases and no brain metastases: a single-center retrospective study</atitle><jtitle>Strahlentherapie und Onkologie</jtitle><stitle>Strahlenther Onkol</stitle><date>2022-12-01</date><risdate>2022</risdate><volume>198</volume><issue>12</issue><spage>1082</spage><epage>1093</epage><pages>1082-1093</pages><issn>0179-7158</issn><eissn>1439-099X</eissn><abstract>Background
The most frequent mode of progression in the majority of non-small cell lung cancer (NSCLC) patients treated with Epidermal growth factor – receptor tyrosine kinase inhibitors (EGFR-TKIs) is failure to respond to treatment at the primary lesion, suggesting that concurrent radiotherapy (CRT) to the primary lesion (CPRT) during first-line treatment with EGFR-TKI may be a novel therapeutic approach with a potential of additional benefit for metastatic NSCLC. Therefore, this study investigated the progression-free survival (PFS) and safety of CPRT during first-line icotinib treatment in NSCLC patients with EGFR mutations.
Methods
EGFR-mutant NSCLC patients diagnosed with limited multiple metastases were treated with first-line icotinib. The decision to treat the primary lesions with radiation largely depended on the patient’s preference. The study endpoints included PFS, toxicity, progression pattern, and acquisition of the T790M mutation.
Results
The median PFS in the CPRT and Non-CPRT groups was 13.6 and 10.6 months (hazard ratio [HR] 0.23, 95% confidence interval [CI] 0.15–0.37,
P
< 0.001). Subgroup analysis showed that the results were statistically significant with 14.7 and 11.5 months for the 19del mutation (HR 0.20, 95% CI 0.10–0.40,
P
< 0.001) and 12.9 and 9.9 months for the L858R mutation (HR 0.25, 95% CI 0.13–0.48,
P
< 0.001). There were no reports of interstitial pneumonia associated with treatment at grade 4 or above. Patients who received CPRT during first-line icotinib treatment had the potential to decrease the primary lesion progression (
P
< 0.05) without increasing newly metastatic lesions (
P
> 0.05). The proportion of acquired T790M mutations was 26.7% and 45.7% in both groups (
P
> 0.05).
Conclusion
This study suggests that CPRT is a viable option for patients with EGFR-sensitive mutations in NSCLC with limited multiple metastases during first-line icotinib treatment, which can significantly improve PFS with acceptable toxicities. Data on progression patterns and T790M mutations suggest the need to further investigate the benefits of radiation treatment from a molecular perspective.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00066-022-01971-w</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-0494-3474</orcidid></addata></record> |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Brain cancer Growth factors Kinases Lesions Lung cancer Medicine Medicine & Public Health Metastasis Mutation Oncology Original Article Radiation therapy Radiotherapy Subgroups Toxicity Tyrosine |
| title | Primary lesion radiotherapy during first-line icotinib treatment in EGFR-mutated NSCLC patients with multiple metastases and no brain metastases: a single-center retrospective study |
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