Impact of systemic targeted agents on the clinical outcomes of patients with brain metastases

• Published in: Oncotarget Vol. 6; no. 22; pp. 18945 - 18955
• Main Authors: Johnson, Adam G, Ruiz, Jimmy, Hughes, Ryan, Page, Brandi R, Isom, Scott, Lucas, John T, McTyre, Emory R, Houseknecht, Kristin W, Ayala-Peacock, Diandra N, Bourland, Daniel J, Hinson, William H, Laxton, Adrian W, Tatter, Stephen B, Debinski, Waldemar, Watabe, Kounosuke, Chan, Michael D
• Format: Journal Article
• Language: English
• Published: United States Impact Journals LLC 07.08.2015
• Subjects: Brain Neoplasms - drug therapy; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Brain Neoplasms - therapy; Cohort Studies; Combined Modality Therapy; Disease-Free Survival; Female; Humans; Male; Middle Aged; Molecular Targeted Therapy; Neoplasm Metastasis; Radiosurgery - methods; Research Paper; Retrospective Studies; Survival Analysis; Treatment Outcome; targeted agents; chemotherapy; brain metastases; stereotactic radiosurgery
• ISSN: 1949-2553; 1949-2553
• DOI: 10.18632/oncotarget.4153

To determine the clinical benefits of systemic targeted agents across multiple histologies after stereotactic radiosurgery (SRS) for brain metastases. Between 2000 and 2013, 737 patients underwent upfront SRS for brain metastases. Patients were stratified by whether or not they received targeted agents with SRS. 167 (23%) received targeted agents compared to 570 (77%) that received other available treatment options. Time to event data were summarized using Kaplan-Meier plots, and the log rank test was used to determine statistical differences between groups. Patients who received SRS with targeted agents vs those that did not had improved overall survival (65% vs. 30% at 12 months, p < 0.0001), improved freedom from local failure (94% vs 90% at 12 months, p = 0.06), improved distant failure-free survival (32% vs. 18% at 12 months, p = 0.0001) and improved freedom from whole brain radiation (88% vs. 77% at 12 months, p = 0.03). Improvement in freedom from local failure was driven by improvements seen in breast cancer (100% vs 92% at 12 months, p < 0.01), and renal cell cancer (100% vs 88%, p = 0.04). Multivariate analysis revealed that use of targeted agents improved all cause mortality (HR = 0.6, p < 0.0001). Targeted agent use with SRS appears to improve survival and intracranial outcomes.