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Treatment outcomes and prognostic factors in patients with driver mutant non-small cell lung cancer and de novo brain metastases
oleh: Seda Kahraman, Serdar Karakaya, Muhammed Ali Kaplan, Sema Sezgin Goksu, Akin Ozturk, Zehra Sucuoglu Isleyen, Jamshid Hamdard, Sedat Yildirim, Tolga Dogan, Selver Isik, Abdussamet Celebi, Burcu Belen Gulbagci, Nail Paksoy, Mutlu Dogan, Haci Mehmet Turk, Ahmet Bilici, Ali Murat Tatli, Sinem Akbas, Nedim Turan, Ilhan Hacibekiroglu, Gamze Gokoz Dogu, Adnan Aydiner, Ahmet Taner Sumbul, Serap Akyurek, Merih Yalciner, Ahmet Demirkazik, Pinar Gursoy, Musa Baris Aykan, Elif Sahin, İbrahim Karadag, Osman Kostek, Muhammed Muhiddin Er, Mehmet Artaç, Yakup Duzkopru, Dincer Aydin, Deniz Isik, Yusuf Karakas, Saadettin Kilickap, Cihan Erol, Bilgin Demir, Burak Civelek, Yakup Ergun, Muhammed Bulent Akinci, Izzet Dogan, Nuri Karadurmus, Perran Fulden Yumuk, Mehmet Ali Nahit Sendur
Format: | Article |
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Diterbitkan: | Nature Portfolio 2024-03-01 |
Deskripsi
Abstract Central nervous system (CNS) metastases can be seen at a rate of 30% in advanced stages for patients with non-small cell lung cancer (NSCLC). Growing evidence indicates the predictive roles of driver gene mutations in the development of brain metastases (BM) in recent years, meaning that oncogene-driven NSCLC have a high incidence of BM at diagnosis. Today, 3rd generation targeted drugs with high intracranial efficacy, which can cross the blood–brain barrier, have made a positive contribution to survival for these patients with an increased propensity to BM. It is important to update the clinical and pathological factors reflected in the survival with real-life data. A multi-center, retrospective database of 306 patients diagnosed with driver mutant NSCLC and initially presented with BM between between November 2008 and September 2022 were analyzed. The median progression-free survival (mPFS) was 12.25 months (95% CI, 10–14.5). While 254 of the patients received tyrosine kinase inhibitor (TKI), 51 patients received chemotherapy as first line treatment. The median intracranial PFS (iPFS) was 18.5 months (95% CI, 14.8–22.2). The median overall survival (OS) was 29 months (95% CI, 25.2–33.0). It was found that having 3 or less BM and absence of extracranial metastases were significantly associated with better mOS and iPFS. The relationship between the size of BM and survival was found to be non-significant. Among patients with advanced NSCLC with de novo BM carrying a driver mutation, long-term progression-free and overall survival can be achieved with the advent of targeted agents with high CNS efficacy with more conservative and localized radiotherapy modalities.