Bevacizumab and gefitinib enhanced whole-brain radiation therapy for brain metastases due to non-small-cell lung cancer

Non-small-cell lung cancer (NSCLC) patients who experience brain metastases are usually associated with poor prognostic outcomes. This retrospective study proposed to assess whether bevacizumab or gefitinib can be used to improve the effectiveness of whole brain radiotherapy (WBRT) in managing patients with brain metastases. A total of 218 NSCLC patients with multiple brain metastases were retrospectively included in this study and were randomly allocated to bevacizumab-gefitinib-WBRT group (n=76), gefitinib-WBRT group (n=77) and WBRT group (n=75). Then, tumor responses were evaluated every 2 months based on Response Evaluation Criteria in Solid Tumors version 1.0. Karnofsky performance status and neurologic examination were documented every 6 months after the treatment. Compared to the standard WBRT, bevacizumab and gefitinib could significantly enhance response rate (RR) and disease control rate (DCR) of WBRT (P<0.001). At the same time, RR and DCR of patients who received bevacizumab-gefitinib-WBRT were higher than those who received gefitinib-WBRT. The overall survival (OS) rates and progression-free survival (PFS) rates also differed significantly among the bevacizumab-gefitinib-WBRT (48.6 and 29.8%), gefitinib-WBRT (36.7 and 29.6%) and WBRT (9.8 and 14.6%) groups (P<0.05). Although bevacizumab-gefitinib-WBRT was slightly more toxic than gefitinib-WBRT, the toxicity was tolerable. As suggested by prolonged PFS and OS status, bevacizumab substantially improved the overall efficacy of WBRT in the management of patients with NSCLC.

发生脑转移的非小细胞肺癌（NSCLC）患者通常预后不良。本项回顾性研究旨在评估贝伐珠单抗或吉非替尼能否提升全脑放疗（WBRT）在脑转移患者管理中的疗效。本研究共纳入218例伴多发脑转移的NSCLC患者，按随机分配原则分为贝伐珠单抗-吉非替尼-全脑放疗组（n=76）、吉非替尼-全脑放疗组（n=77）及全脑放疗组（n=75）。研究人员每2个月依据实体瘤疗效评价标准1.0版（Response Evaluation Criteria in Solid Tumors version 1.0）评估肿瘤应答情况，并于治疗后每6个月记录患者的卡氏功能状态评分（Karnofsky performance status）与神经系统检查结果。与标准全脑放疗方案相比，贝伐珠单抗联合吉非替尼可显著提升全脑放疗的肿瘤应答率（Response Rate, RR）与疾病控制率（Disease Control Rate, DCR）（P<0.001）。同时，贝伐珠单抗-吉非替尼-全脑放疗组患者的RR与DCR均高于吉非替尼-全脑放疗组。三组患者的总生存期（Overall Survival, OS）率与无进展生存期（Progression-Free Survival, PFS）率均存在显著差异：贝伐珠单抗-吉非替尼-全脑放疗组分别为48.6%与29.8%，吉非替尼-全脑放疗组分别为36.7%与29.6%，全脑放疗组分别为9.8%与14.6%（P<0.05）。尽管贝伐珠单抗-吉非替尼-全脑放疗方案的毒性略高于吉非替尼-全脑放疗组，但整体毒性仍处于可耐受范围。综上，结合延长的无进展生存期与总生存期结果可见，贝伐珠单抗可显著改善全脑放疗在NSCLC脑转移患者管理中的整体疗效。