Evidence map›Paper›PMID 37721662›Full record

SynthesisJournal of neuro-oncology2023

Improved survival and intracranial tumor control of EGFR-mutated NSCLC patients with newly developed brain metastases following stereotactic radiosurgery and EGFR-TKI: a large retrospective cohort study and meta-analyses.

Ai Seon Kuan, Chi-Lu Chiang, Hsiu-Mei Wu, Huai-Che Yang, Ching-Jen Chen, Chung-Jung Lin, Wan-Yuo Guo, David Hung-Chi Pan, Wen-Yuh Chung, Cheng-Chia Lee

Abstract readMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis 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 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
1.3field-weighted citation impact, top 18% of its field
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

8 citing papers in PubMed, 5 citations in OpenAlex.

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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

10 authors at 4 institutions in 2 countries.

Ai Seon KuanDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Chi-Lu ChiangCancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.
Hsiu-Mei WuSchool of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Huai-Che YangDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Ching-Jen ChenDepartment of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA.
Chung-Jung LinSchool of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Wan-Yuo GuoSchool of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
David Hung-Chi PanDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Wen-Yuh ChungDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Cheng-Chia LeeDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. yfnaughty@gmail.com.
Taipei Veterans General Hospital · TWNational Yang Ming Chiao Tung University · TWTaipei Medical University-Shuang Ho Hospital · TWThe University of Texas Health Science Center at Houston · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo examine the differential effects of SRS and TKI on EGFR-mutated NSCLC patients with brain metastases (BMs) and outcomes following continuation of the same TKI agent in case of new BMs.

methodsThis study included 608 NSCLC patients (2,274 BMs) while meta-analyses included 1,651 NSCLC patients (> 3,944 BMs). Overall survival (OS) and intracranial progression free survival (iPFS) were estimated using Kaplan-Meier methods. Hazard ratios (95% CI) of prognostic factors were estimated using Cox regression models.

resultsThe median OS/iPFS (95% CI) (months) for patients with wildtype EGFR/ALK, EGFR mutations, and ALK rearrangements were 17.7 (12.9-23.6)/12.1 (9.8-15.6), 28.9 (23.8-33.3)/17.7 (14.8-21.2), and 118.0 (not reached)/71.7 (15.1-not reached), respectively. In EGFR-mutated patients, meta-analyses combining our data showed significantly improved OS and iPFS of patients who received SRS and TKI (OS:35.1 months, iPFS:20.0 months) when compared to those who have SRS alone (OS:20.8 months, iPFS:11.8 months) or TKI alone (OS:24.3 months, iPFS:13.8 months). Having SRS for newly diagnosed BMs while keeping the existing TKI agent yielded OS (30.0 vs. 32.1 months, p = 0.200) non-inferior to patients who started combined SRS and TKI therapy for their newly diagnosed NSCLC with BMs. Multivariable analyses showed that good performance score and TKI therapy were associated with improved outcomes.

conclusionsCombined SRS and TKI resulted in favorable outcomes in EGFR-mutated NSCLC patients with newly diagnosed BMs. Continuation of the same TKI agent plus SRS in case of new brain metastases yielded good clinical outcomes and may be considered a standard-of-care treatment.

Indexed as

Brain NeoplasmsCarcinoma, Non-Small-Cell LungLung NeoplasmsRadiosurgeryErbB ReceptorsHumansProtein Kinase InhibitorsRetrospective StudiesEGFR protein, humanErbB ReceptorsProtein Kinase InhibitorsALK-rearrangedBrain metastasisEGFR co-mutationEGFR-driven NSCLCEGFR-mutantGamma Knife Radiosurgery

Identifiers

PMID37721662
OpenAlexW4386817779

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.