ArticleZhongguo fei ai za zhi = Chinese journal of lung cancer2025
[Efficacy and Safety of High-dose Furmonertinib plus Intrathecal Pemetrexed for EGFR-mutant Non-small Cell Lung Cancer with Leptomeningeal Metastasis].
Article in Zhongguo fei ai za zhi = Chinese journal of lung cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLeptomeningeal metastasis (LM) is a devastating complication of epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC), with a poor prognosis. While high-dose third-generation EGFR-tyrosine kinase inhibitors (EGFR-TKIs) can enhance drug concentrations in the central nervous system, their efficacy as monotherapy remains limited. Intrathecal Pemetrexed (IP) offers a promising local treatment approach by bypassing the blood-brain barrier and acting directly within the cerebrospinal fluid. However, clinical data on the efficacy and safety of combining high-dose third-generation EGFR-TKIs Furmonertinib (160 mg/d) with IP in EGFR-mutant NSCLC-LM patients are still scarce. Therefore, this study aims to evaluate the efficacy and safety of this combination regimen in this population to provide real-world data support for clinical practice.
methodsIn this retrospective study, 40 patients with EGFR-mutant NSCLC-LM were enrolled at Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University between June 2021 and December 2024. All patients received oral Furmonertinib (160 mg/d) combined with IP. Primary endpoints were intracranial progression-free survival (iPFS), overall survival (OS), overall response rate (ORR) and adverse events. Survival analysis was performed using the Kaplan-Meier method, and prognostic factors were assessed via Cox proportional hazards regression by collecting the clinical data and follow-up information of the patients.
resultsAfter a median follow-up of 20.0 months, the combination therapy demonstrated significant efficacy. The ORR was 85.0%, with a median iPFS of 9.6 months and a median OS of 12.6 months. The 6-, 12- and 24-month OS rates were 79.9%, 53.9% and 27.0%, respectively. Multivariate analysis identified combination therapy with Bevacizumab as an independent protective factor [hazard ratio (HR)=0.283, 95%CI: 0.114-0.702, P=0.006], while a poor baseline Karnofsky performance status (KPS) score was an independent risk factor (HR=3.069, 95%CI: 1.313-7.170, P=0.010). Adverse events were primarily grade 1-2, including myelosuppression (42.5%), elevated transaminases (22.5%), and gastrointestinal reactions (nausea and/or vomiting, 20.0%). Only one case of grade 4 myelosuppression was reported and resolved after supportive care.
conclusionsHigh-dose Furmonertinib combined with IP is an effective and well-tolerated regimen for EGFR-mutant NSCLC-LM. The addition of Bevacizumab may further improve outcomes, offering a promising strategy for refractory patients.
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