BBB-penetrant tyrosine kinase inhibitor plus intracranial radiotherapy vs BBB-penetrant TKI alone in Asians with EGFR-mutated lung adenocarcinoma and brain metastases

Q: What was the main question of the study?

Whether combining osimertinib with intracranial radiotherapy improves intracranial outcomes compared with osimertinib alone in Asian patients with EGFR-mutated lung adenocarcinoma and brain metastases.

Q: Which outcomes were used to evaluate treatment effects?

Intracranial local control, intracranial distant control, and overall survival (OS), assessed using follow-up imaging and clinical follow-up with Kaplan–Meier and Cox regression analyses.

Q: Did adding radiotherapy to osimertinib improve survival?

No. The study reported no significant difference in overall survival between the TKI-alone and TKI+RT groups (p = 0.27).

Q: What factors were associated with better intracranial local control?

Multivariable analysis showed that T790M mutation presence and receiving TKI+RT were associated with improved intracranial local control (p = 0.01 for both).

Sep 29, 2026

Uploaded by Hazel

Background: Osimertinib, a third-generation EGFR tyrosine kinase inhibitor, penetrates the blood–brain barrier and can control intracranial tumors. This retrospective study assessed whether adding intracranial radiotherapy (RT) to osimertinib improves outcomes in Asian patients with EGFR-mutant lung adenocarcinoma and brain metastases. Methods: Patients receiving osimertinib with or without RT from 2014–2022 were analyzed using MRI follow-up and clinical endpoints. Outcomes included intracranial local control, distant control, and overall survival (OS), with Kaplan–Meier and Cox regression. Results: TKI+RT improved 3-year local control (77% vs 23%) and median distant control (23.2 vs 8.7 months), while OS showed no significant difference. Conclusion: RT addition enhanced intracranial control, though survival benefit was not observed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Methods

Results

Conclusion

J Chin MedAssoc Original article BBB-penetrant tyrosine kinase inhibitor plus intracranial radiotherapy vs BBB-penetrant TKI alone in Asians with EGFR-mutated lung adenocarcinoma and brain metastases You-Cong Chena, Chun-Fu Lina,b, Chi-Lu Chiangb,c,d, Huai-Che Yanga,b, Hsiu-Mei Wub,e, Ching-Jen Chenf, Yung-Hung Luob,c,d, Yong-Sin Hub,e, Chung-Jung Linb,e, Wen-Yuh Chunga,g, Cheng-Ying Shiaub,h, Wan-Yuo Guob,e, David Hung-Chi Pana,g, Cheng-Chia Leea,b,* aDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cDepartment of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dInstitute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan, ROC; eDepartment of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; fDepartment of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA; gDepartment of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ROC; hDepartment of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: Osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), penetrates the blood–brain barrier and provides intracranial tumor control in non–small-cell lung cancer (NSCLC) . This study investigated whether combining osimertinib with intracranial radiotherapy (RT) improved outcomes in the patients with EGFR-mutant lung adenocarcinoma and brain metastases. Methods: This is a retrospective analysis included patients who took osimertinib accompanying with or without RT between 2014 and 2022 from a single tertiary medical center. At least one session of magnetic resonance imaging and clinical follow-up after treatment. Outcomes assessed were intracranial local control, intracranial distant control, and overall survival (OS) . Kaplan–Meier curves were used for outcome demonstration. Cox regression analysis was also used to identify independent predictors from age, gender, smoking, characteristics of brain metastases, KPS, gene types (presence of T790M), and radiation modalities. Results: A total of 567 brain metastases from 69 patients were enrolled: TKI alone (n = 38) and TKI + RT (n = 31) . Intracranial local control was significantly higher with TKI+RT compared with TKI alone (77% vs 23%; p < 0 .01) at 3-year follow-up. Intracranial distant control was also longer in the TKI + RT group (23 .2 vs 8.7 months in median; p < 0 .01) . No significant difference in OS was observed between the two groups (p = 0.27) . Multivariable analysis demonstrated that the presence of T790M mutation (p = 0.01) and TKI + RT (p = 0 .01) were associated with improved intracranial local control, while TKI + RT was also associated with improved intracranial distant control (p = 0 .03) . Conclusion: The addition of RT to osimertinib enhanced intracranial local and distant control in the patients with EGFR-mutant lung adenocarcinoma and brain metastases, although no survival benefit was observed. Prospective studies are warranted to validate these findings. Keywords: Brain metastases; Gamma-knife radiosurgery; Non–small-cell lung cancer; Osimertinib; Tyrosine kinase inhibitor [www.ejcma.org](www.ejcma.org) 933 Chen et al. J Chin MedAssoc Lay Summary: Osimertinib is a new drug with the ability to cross the blood–brain barrier for intracranial tumor control in patients with lung cancer. Our objective in this study was to determine whether combining osimertinib treatment with intracranial radiotherapy would confer benefits exceeding those of osimertinib alone in terms of treatment outcomes among patients with lung cancer and brain metastases with a specific gene mutation. The efficacy of osimertinib therapy for these patients was enhanced by combining this trea

FAQs

What was the main question of the study?

Whether combining osimertinib with intracranial radiotherapy improves intracranial outcomes compared with osimertinib alone in Asian patients with EGFR-mutated lung adenocarcinoma and brain metastases.

Which outcomes were used to evaluate treatment effects?

Intracranial local control, intracranial distant control, and overall survival (OS), assessed using follow-up imaging and clinical follow-up with Kaplan–Meier and Cox regression analyses.

Did adding radiotherapy to osimertinib improve survival?

No. The study reported no significant difference in overall survival between the TKI-alone and TKI+RT groups (p = 0.27).

What factors were associated with better intracranial local control?

Multivariable analysis showed that T790M mutation presence and receiving TKI+RT were associated with improved intracranial local control (p = 0.01 for both).

Sep 29, 2026

Uploaded by Hazel