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. 2015 Aug 7;6(22):18945-55.
doi: 10.18632/oncotarget.4153.

Impact of systemic targeted agents on the clinical outcomes of patients with brain metastases

Adam G Johnson  1 , Jimmy Ruiz  2   3 , Ryan Hughes  1 , Brandi R Page  1 , Scott Isom  4 , John T Lucas  1 , Emory R McTyre  1 , Kristin W Houseknecht  1 , Diandra N Ayala-Peacock  1 , Daniel J Bourland  1 , William H Hinson  1 , Adrian W Laxton  5 , Stephen B Tatter  5 , Waldemar Debinski  6 , Kounosuke Watabe  7 , Michael D Chan  1
Affiliations

Impact of systemic targeted agents on the clinical outcomes of patients with brain metastases

Adam G Johnson et al. Oncotarget. .

Abstract

Background: To determine the clinical benefits of systemic targeted agents across multiple histologies after stereotactic radiosurgery (SRS) for brain metastases.

Methods: Between 2000 and 2013, 737 patients underwent upfront SRS for brain metastases. Patients were stratified by whether or not they received targeted agents with SRS. 167 (23%) received targeted agents compared to 570 (77%) that received other available treatment options. Time to event data were summarized using Kaplan-Meier plots, and the log rank test was used to determine statistical differences between groups.

Results: Patients who received SRS with targeted agents vs those that did not had improved overall survival (65% vs. 30% at 12 months, p < 0.0001), improved freedom from local failure (94% vs 90% at 12 months, p = 0.06), improved distant failure-free survival (32% vs. 18% at 12 months, p = 0.0001) and improved freedom from whole brain radiation (88% vs. 77% at 12 months, p = 0.03). Improvement in freedom from local failure was driven by improvements seen in breast cancer (100% vs 92% at 12 months, p < 0.01), and renal cell cancer (100% vs 88%, p = 0.04). Multivariate analysis revealed that use of targeted agents improved all cause mortality (HR = 0.6, p < 0.0001).

Conclusions: Targeted agent use with SRS appears to improve survival and intracranial outcomes.

Keywords: brain metastases; chemotherapy; stereotactic radiosurgery; targeted agents.

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Figures

Figure 1
Figure 1
Kaplan Meier plots comparing patients who received targeted agents vs. those who did not in terms of overall survival A. freedom from local failure B. freedom from distant failure C. and freedom from salvage WBRT D.
Figure 2
Figure 2
Primary tumor-specific Kaplan Meier plots for overall survival comparing patients who received targeted agents vs. those who did not receive targeted agents concurrently or soon after SRS for breast cancer A. lung cancer B. renal cell cancer C. and melanoma D.
Figure 3
Figure 3
Primary tumor-specific Kaplan Meier plots for freedom from local failure comparing patients who received targeted agents vs. those who did not receive targeted agents concurrently or soon after SRS for breast cancer A. lung cancer B. renal cell cancer C. and melanoma D.
Figure 4
Figure 4
Primary tumor-specific Kaplan Meier plots for distant failure-free survival comparing patients who received targeted agents vs. those who did not receive targeted agents concurrently or soon after SRS for breast cancer A. lung cancer B. renal cell cancer C. and melanoma D.
See this image and copyright information in PMC

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