Journal of Thoracic Oncology
First Author: B. Cai
Volume 18, Issue 3, Supplement e37 | DOI: 10.1016/j.jtho.2022.09.089
Abstract
Background: In a post-hoc analysis of GEOMETRY Mono-1 trial, 54% of patients with brain metastases treated with capmatinib had an intracranial response. Despite these data, NSCLC patients with METexon14 skipping mutations and brain metastases (BM) continue to receive IO or chemotherapy in community centers. In this study, we assessed the clinical outcomes associated with non-targeted therapies in the real-world setting for this population.
Methods: A retrospective medical record review was performed at two large community-based cancer centers. Eligible patients were aged ≥18 years, had confirmed NSCLC with METexon14 skipping mutations, BM diagnosis (≥1 lesion ≥5 mm), and had ≥12 months follow-up after BM diagnosis (except death). Patients treated with METi were excluded. Modified RECIST and RANO-BM criteria were used for response assessments. Key outcomes were time-to-treatment discontinuation (TTD), intracranial and systemic real-world overall response rate (rwORR), disease control rate (rwDCR), progression-free survival (rwPFS), and overall survival (OS).
Results: A total of 16 patient charts were abstracted (median age at BM diagnosis: 78.5 years; female: 50%; stage IV at initial diagnosis: 68.8%; median number of intracranial lesions: 3 [range: 1-10]; smoking history: 62.5%). Of the total sample, 75% (n=12) initiated first-line (1L) therapy after BM diagnosis and 18.8% (n=3) received second-line (2L) therapy. Immunotherapy (IO)-containing regimen (83.3% [n=10]) was the most commonly used 1L therapy (Table 1). Median TTD and OS for 1L were 5.8 and 9.3 months, respectively; median systemic and intracranial rwPFS for 1L were 5.5 and 9.3 months, respectively, with rwORR of 41.7% (95%CI: 15.2-72.3) for both systemic and intracranial responses.
Conclusion: Among NSCLC patients with METexon14 mutations and BM, IO and chemotherapy regimens were associated with poor clinical outcomes. These findings provide an important reference point for providers when making treatment decisions for this patient population.