Impact of central nervous system metastasis after complete resection of lung adenocarcinomas harboring common EGFR mutation - A real-world database study in Japan: The CReGYT-01 EGFR study.
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Katsumata Shinya, Shimokawa Mototsugu, Hamada Akira, Haratake Naoki, Nomura Kotaro, Fujino Kosuke, Yoshikawa Mao, Suzawa Ken, Shien Kazuhiko, Suda Kenichi, Ohara Shuta, Fukuda Shota, Kinoshita Fumihiko, Hayasaka Kazuki, Notsuda Hirotsugu, Takamori Shinkichi, Muto Satoshi, Takanashi Yusuke, Mizuno Kiyomichi, Kawase Akikazu, Hayakawa Takamitsu, Sekihara Keigo, Toda Michihito, Matsuo Somei, Takegahara Kyoshiro, Hashimoto Masaki, Nakahashi Kenta, Endo Makoto, Ozawa Hiroki, Fujikawa Ryo, Tomioka Yasuaki, Namba Kei, Matsubara Taichi, Suzuki Jun, Watanabe Hikaru, Takada Kazuki, Hoshino Hironobu, Kaiho Taisuke, Toyoda Takahide, Kouki Yasunobu, Shiono Satoshi, Soh Junichi, Ohde Yasuhisa
Аннотация
METHODS: We conducted the multicenter real-world database study for patients with radical resections for lung adenocarcinomas between 2015 and 2018 at 21 centers in Japan. EGFR mutational status was examined at each center.
RESULTS: Of 4181 patients enrolled, 1431 underwent complete anatomical resection for lung adenocarcinoma harboring common EGFR mutations. Three-hundred-and-twenty patients experienced disease relapse, and 78 (24%) had CNS metastasis. CNS metastasis was significantly more frequent in patients with conventional adjuvant chemotherapy than those without (30% vs. 20%, P = 0.036). Adjuvant chemotherapy did not significantly improve relapse-free survival at any pathological stage (adjusted hazard ratio for stage IA2-3, IB, and II-III was 1.363, 1.287, and 1.004, respectively). CNS metastasis did not affect PS at relapse. Subsequent treatment, mainly consisting of EGFR-tyrosine kinase inhibitors (TKIs), could be equally given in patients with or without CNS metastasis (96% vs. 94%). Overall survival after relapse was equivalent between patients with and without CNS metastasis.
CONCLUSION: The efficacy of conventional adjuvant chemotherapy may be limited in patients with lung adenocarcinoma harboring EGFR mutations. CNS metastasis is likely to be found in practice before deterioration in PS, and may have little negative impact on compliance with subsequent EGFR-TKIs and survival after relapse. In this era of adjuvant TKI therapy, further prospective observational studies are desirable to elucidate the optimal management of CNS metastasis.