Management of non-small cell lung cancer patients harboring activating mutations and CNS progression

• Published in: Revue des maladies respiratoires Vol. 36; no. 5; p. 583
• Main Authors: Rouviere, D, Veillon, R, Chaltiel, L, Simonneau, Y, Filleron, T, Milia, J, Guibert, N, Melloni, B, Raherison, C, Didier, A, Mazieres, J
• Format: Journal Article
• Language: English; French
• Published: France 01-05-2019
• Subjects: Adult; Aged; Aged, 80 and over; Anaplastic Lymphoma Kinase - genetics; Carcinoma, Non-Small-Cell Lung - genetics; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - therapy; Central Nervous System Neoplasms - genetics; Central Nervous System Neoplasms - secondary; Central Nervous System Neoplasms - therapy; Disease Progression; ErbB Receptors - genetics; Female; Gain of Function Mutation; Humans; Lung Neoplasms - genetics; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Middle Aged; Proto-Oncogene Proteins B-raf - genetics; Receptor, ErbB-2 - genetics; Retrospective Studies; ALK; Méningite carcinomateuse; EGFR lung meningitis targeted therapy; Cancer bronchique; Métastases cérébrales; Cerebral metastases; EGFR cancer
• ISSN: 1776-2588
• DOI: 10.1016/j.rmr.2019.04.003

The central nervous system (CNS), through carcinomatous meningitis or solid brain metastases, is the most common site of recurrence in non-small cell lung cancers (NSCLC) with activating mutations. Our retrospective study describes the population of patients with CNS metastases of NSCLC harboring activating mutation with targeted therapy (EGFR, ALK, BRAF, HER2) in 4 French regional reference hospitals. 60 patients were analyzed. The proposed treatments were heterogeneous and included combinations of chemotherapy, targeted therapy and radiotherapy±associated with topical treatments. Median overall survival following CNS metastasis in these patients was 15.8 months for meningitis carcinoma and 26 months for brain metastases. In patients with brain metastases, the addition of targeted therapy treatment allows a significant improvement in median progression free survival from 5.9 months to 10.6 months (HR 0.48 CI95 [0.24 to 0.97] P=0.035). These patients seem therefore benefit from systemic therapy and particularly targeted therapy with better survival than usual.