ArticleBMC cancer2026
EGFR-TKI monotherapy versus combination therapy as first-line treatment for EGFR-mutant NSCLC with brain metastases: a real-world comparison analysis.
Article in BMC cancer, 2026. 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
backgroundOptimal first-line treatment for epidermal growth factor receptor (EGFR) mutant NSCLC with brain metastases (BMs) has not been fully defined. We aimed to compare different first-line tyrosine kinase inhibitor (TKI) combination therapies and monotherapy for these patients in a real-world setting, especially in the era of 3rd generation TKIs.
methodsPatients with EGFR-mutant NSCLC and BMs receiving first-line EGFR-TKIs from 2019 to 2023 were retrospectively reviewed (n = 150): TKI alone (n = 73), TKI plus brain radiation (TKI + BRT, n = 25), TKI plus bevacizumab (TKI + BEV, n = 38) and TKI plus chemotherapy (TKI + CT, n = 14). Intracranial progression-free survival (iPFS), PFS, overall survival (OS), responses and adverse events of each group were compared and survival beneficial population were explored.
resultsAmong enrolled patients, majority (70.7%) received 3rd generation EGFR-TKIs and 29.3% received 1st /2nd generation drugs. The median iPFS of TKI alone group was significantly inferior than those in TKI + BRT, TKI + BEV and TKI + CT groups (22.1 vs. 32.9 months vs. not reached [NR] vs. NR, p = 0.001). The median PFS and OS were 11.1 and 40.1 months, 18.9 and 67.1 months, 16.5 and 38.8 months, 39.8 and 79.8 months, respectively, with TKI alone, TKI + BRT, TKI + BEV and TKI + CT (PFS, p = 0.014; OS, p = 0.015). The combination therapies brought iPFS and PFS benefits over TKI alone regardless of TKI generations. A linear correlation was demonstrated between iPFS and OS (R
conclusionEGFR-TKI combination therapies improved iPFS, PFS and OS than TKI monotherapy for patients with EGFR-mutant NSCLC and BMs irrespective of TKI generation or combination strategy.
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