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Frequent central nervous system failure after clinical benefit with epidermal growth factor receptor tyrosine kinase inhibitors in Korean patients with nonsmall-cell lung cancer
Version of Record online: 11 JAN 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 5, pages 1336–1343, 1 March 2010
How to Cite
Lee, Y. J., Choi, H. J., Kim, S. K., Chang, J., Moon, J. W., Park, I. K., Kim, J.-H. and Cho, B. C. (2010), Frequent central nervous system failure after clinical benefit with epidermal growth factor receptor tyrosine kinase inhibitors in Korean patients with nonsmall-cell lung cancer. Cancer, 116: 1336–1343. doi: 10.1002/cncr.24877
- Issue online: 18 FEB 2010
- Version of Record online: 11 JAN 2010
- Manuscript Accepted: 9 JUL 2009
- Manuscript Revised: 19 JUN 2009
- Manuscript Received: 26 APR 2009
- nonsmall cell lung cancer;
- epidermal growth factor receptor;
- central nervous system;
We investigated the risk of central nervous system (CNS) failure after clinical benefit with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in Korean patients with nonsmall-cell lung cancer (NSCLC)
We retrospectively evaluated the pattern of disease progression of 287 advanced NSCLC patients who were treated with gefitinib or erlotinib. Patients whose best tumor response was complete response, partial response, or stable disease (≥90 days) were classified into the group receiving clinical benefit with these drugs.
The clinical benefit group had a higher incidence of CNS failure as an initial progression, compared with the non-clinical benefit group (26% vs 4%; P < .001). Isolated CNS failure was also more frequent in the clinical benefit group than in the non-clinical benefit group (13% vs 1%; P < .001). In a multivariate analysis, clinical benefit with EGFR-TKIs significantly increased the risk of isolated CNS failure, with an adjusted hazard ratio of 10.9 (95% confidence interval [CI], 1.4-29.1, P = .01). In patients with isolated CNS failure, the median time from initial intracranial failure to extracranial failure was 9.9 months (95% CI, 1.9-21.9 months) and to death was 12.9 months (95% CI, 3.3-22.5 months).
The CNS was frequently the initial failure site after clinical benefit with EGFR-TKIs in Korean NSCLC patients. Patients with isolated CNS failure showed durable extracranial control after cranial progression. A role for close surveillance of the CNS during EGFR-TKI treatment or prophylactic measures appears worthy of further study in these patients. Cancer 2010. © 2010 American Cancer Society.