EGFR‐mutated stage IV non‐small cell lung cancer: What is the role of radiotherapy combined with TKI?. (10th August 2021)

• Record Type: Journal Article
• Authors: Liu, Bailong; Liu, Hui; Ma, Yunfei; Ding, Qiuhui; Zhang, Min; Liu, Xinliang; Liu, Min
• Is Part Of: Cancer medicine. Volume 10:Number 18(2021)
• Page Start: 6167
• Page End: 6188
• Publication Date: 2021-08-10
• Subjects: EGFR mutation -- radiotherapy -- TKI; 616.994005
• DOI: 10.1002/cam4.4192
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Lung cancer is the leading cause of cancer‐related death globally and poses a considerable threat to public health. Asia has the highest prevalence of epidermal growth factor receptor (EGFR) mutations in patients with non‐small cell lung cancer (NSCLC). Despite the reasonable response and prolonged survival associated with EGFR‐tyrosine kinase inhibitor (TKI) therapy, the acquisition of resistance to TKIs remains a major challenge. Additionally, patients with EGFR mutations are at a substantially higher risk of brain metastasis compared with those harboring wild‐type EGFR. The role of radiotherapy (RT) in EGFR‐mutated (EGFRm) stage IV NSCLC requires clarification, especially with the advent of next‐generation TKIs, which are more potent and exhibit greater central nervous system activity. In particular, the feasible application of RT, including the timing, site, dose, fraction, and combination with TKI, merits further investigation. This review focuses on these key issues, and provides a flow diagram with proposed treatment options for metastatic EGFRm NSCLC, aiming to provide guidance for clinical practice. Abstract : For the oligometastatic setting, radiotherapy (RT) to both primary and metastatic lesions might prolong both progression‐free survival and OS. Reduced‐dose thoracic RT and critical restriction of the mean lung dose before tyrosine kinase inhibitor (TKI) resistance onset hold some promise. Although epidermal growth factor receptor (EGFR) TKIs can exert synergistic effects with RT, this regimen should be applied with caution owing to the risk of adverse effects, especially lung damage. In the first‐ or second‐generation EGFR TKI era, upfront brain RT showed better efficacy; however, this is expected to change with the advent of next‐generation TKIs with increased central nervous system efficacy. The likely beneficiaries of upfront brain RT, especially stereotactic radiosurgery, with the arrival of the new drugs should be identified through clinical trials.