Treating brain metastases in non-small cell lung cancer patients: what have we learnt from pharmaceutical recent clinical trials?
Journal
Expert Opinion on Pharmacotherapy
Journal Volume
19
Journal Issue
8
Pages
851-864
Date Issued
2018
Author(s)
Abstract
Introduction: Brain metastases (BMs) develop in up to 40% of patients with non-small cell lung cancer (NSCLC). In many recent practice-changing clinical trials, patients with BM were included; however, only few trials reported intracranial efficacies in either post hoc or pre-planned analysis. Clinically meaningful intracranial efficacy data of novel agents have not been completely disclosed. Areas covered: The authors performed a systemic review of recent pharmaceutical clinical trials, mainly pivotal or practice-changing trials. Some of the prospective clinical trials focused on patients with NSCLC and BM. The authors collected and compared intracranial efficacy reports of chemotherapy, epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), ALK inhibitors, and immune checkpoint inhibitors. Expert opinion: Many clinical trials, especially those on ‘brain-active’ EGFR-TKIs and ALK inhibitors, have robust reports of intracranial efficacies either as post hoc or pre-planned analysis. Physicians should interpret this data with caution and apply the results to patients accordingly. For the design of future clinical trials, enrolling patients with only BM, incorporating novel risk classifications, pre-planning intracranial efficacy endpoints, reporting prior local brain therapies, and applying novel response evaluation criteria are emerging trends in this area. ? 2018 Informa UK Limited, trading as Taylor & Francis Group.
SDGs
Other Subjects
alectinib; anaplastic lymphoma kinase inhibitor; atezolizumab; azd 3759; ceritinib; crizotinib; epidermal growth factor receptor; epidermal growth factor receptor kinase inhibitor; erlotinib; gefitinib; nivolumab; osimertinib; pembrolizumab; unclassified drug; ABC transporter subfamily B; antineoplastic agent; epidermal growth factor receptor; protein kinase inhibitor; brain metastasis; brain radiation; cancer chemotherapy; cancer patient; human; local therapy; Medline; non small cell lung cancer; prospective study; Review; systemic therapy; antagonists and inhibitors; brain tumor; clinical trial (topic); drug resistance; genetics; lung tumor; metabolism; mutation; non small cell lung cancer; pathology; secondary; Antineoplastic Agents; ATP Binding Cassette Transporter, Sub-Family B; Brain Neoplasms; Carcinoma, Non-Small-Cell Lung; Clinical Trials as Topic; Drug Resistance, Neoplasm; Humans; Lung Neoplasms; Mutation; Protein Kinase Inhibitors; Receptor, Epidermal Growth Factor
Publisher
Taylor and Francis Ltd
Type
review