Evidence map›Paper›PMID 37691032›Full record

ArticleJournal of neuro-oncology2023

EGFR-mutated non-small lung cancer brain metastases and radiosurgery outcomes with a focus on leptomeningeal disease.

Juan Diego Alzate, Reed Mullen, Elad Mashiach, Kenneth Bernstein, Fernando De Nigris Vasconcellos, Lauren Rotmann, Assaf Berger, Tanxia Qu, Joshua S Silverman, John G Golfinos and 2 more

Abstract read
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Article in Journal of neuro-oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  3. Review
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Juan Diego AlzateDepartment of Neurological Surgery, NYU Langone Health, New York University, New York, USA. juan.alzateramirez@nyulangone.org.ORCID http://orcid.org/0000-0001-5663-8722
Reed MullenDepartment of Neurological Surgery, NYU Langone Health, New York University, New York, USA.
Elad MashiachDepartment of Neurological Surgery, NYU Langone Health, New York University, New York, USA.
Kenneth BernsteinDepartment of Radiation Oncology, NYU Langone Health, New York University, New York, USA.
Fernando De Nigris VasconcellosDepartment of Neurological Surgery, NYU Langone Health, New York University, New York, USA.
Lauren RotmannDepartment of Neurological Surgery, NYU Langone Health, New York University, New York, USA.
Assaf BergerDepartment of Neurological Surgery, NYU Langone Health, New York University, New York, USA.
Tanxia QuDepartment of Radiation Oncology, NYU Langone Health, New York University, New York, USA.
Joshua S SilvermanDepartment of Radiation Oncology, NYU Langone Health, New York University, New York, USA.
John G GolfinosDepartment of Neurological Surgery, NYU Langone Health, New York University, New York, USA.
Bernadine R DonahueDepartment of Radiation Oncology, NYU Langone Health, New York University, New York, USA.
Douglas KondziolkaDepartment of Neurological Surgery, NYU Langone Health, New York University, New York, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposePatients with EGFR-mutated NSCLC represent a unique subset of lung cancer patients with distinct clinical and molecular characteristics. Previous studies have shown a higher incidence of brain metastases (BM) in this subgroup of patients, and neurologic death has been reported to be as high as 40% and correlates with leptomeningeal disease (LMD).

methodsBetween 2012 and 2021, a retrospective review of our prospective registry identified 606 patients with BM from NSCLC, with 170 patients having an EGFR mutation. Demographic, clinical, radiographic, and treatment characteristics were correlated to the incidence of LMD and survival.

resultsLMD was identified in 22.3% of patients (n = 38) at a median follow-up of 19 (2-98) months from initial SRS. Multivariate regression analysis showed targeted therapy and a cumulative number of metastases as significant predictors of LMD (p = 0.034, HR = 0.44), (p = .04, HR = 1.02). The median survival time after SRS of the 170 patients was 24 months (CI 95% 19.1-28.1). In a multivariate Cox regression analysis, RPA, exon 19 deletion, and osimertinib treatment were significant predictors of overall survival. The cumulative incidence of neurological death at 2 and 4 years post initial stereotactic radiosurgery (SRS) was 8% and 11%, respectively, and correlated with LMD.

conclusionThe study shows that current-generation targeted therapy for EGFR-mutated NSCLC patients may prevent the development and progression of LMD, leading to improved survival outcomes. Nevertheless, LMD is associated with poor outcomes and neurologic death, making innovative strategies to treat LMD essential.

Indexed as

Brain NeoplasmsCarcinoma, Non-Small-Cell LungLung NeoplasmsMeningeal CarcinomatosisMeningeal NeoplasmsRadiosurgeryAdultAgedAged, 80 and overErbB ReceptorsFemaleFollow-Up StudiesHumansMaleMiddle AgedMutationEGFR protein, humanErbB ReceptorsEpidermal growth factor receptorLeptomeningeal diseaseNon-small cell lung cancerTyrosine kinase inhibitor

Identifiers

PMID37691032

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.