Katsumata, Shinya, Shimokawa, Mototsugu, Hamada, Akira, Haratake, Naoki, Nomura, Kotaro, Fujino, Kosuke, Yoshikawa, Mao, Suzawa, Ken, Shien, Kazuhiko, Suda, Kenichi, Ohara, Shuta, Fukuda, Shota, Kinoshita, Fumihiko, Hayasaka, Kazuki, Notsuda, Hirotsugu, Takamori, Shinkichi, Muto, Satoshi, Takanashi, Yusuke, Mizuno, Kiyomichi, and Kawase, Akikazu
To clarify the impact of central nervous system (CNS) metastasis on performance status (PS) at relapse, on subsequent treatment(s), and on survival of patients with lung adenocarcinoma harboring common epidermal growth factor receptor (EGFR) mutation. We conducted the multicenter real-world database study for patients with radical resections for lung adenocarcinomas between 2015 and 2018 at 21 centers in Japan. EGFR mutational status was examined at each center. Of 4181 patients enrolled, 1431 underwent complete anatomical resection for lung adenocarcinoma harboring common EGFR mutations. Three-hundred-and-twenty patients experienced disease relapse, and 78 (24%) had CNS metastasis. CNS metastasis was significantly more frequent in patients with conventional adjuvant chemotherapy than those without (30% vs. 20%, P = 0.036). Adjuvant chemotherapy did not significantly improve relapse-free survival at any pathological stage (adjusted hazard ratio for stage IA2–3, IB, and II-III was 1.363, 1.287, and 1.004, respectively). CNS metastasis did not affect PS at relapse. Subsequent treatment, mainly consisting of EGFR -tyrosine kinase inhibitors (TKIs), could be equally given in patients with or without CNS metastasis (96% vs. 94%). Overall survival after relapse was equivalent between patients with and without CNS metastasis. The efficacy of conventional adjuvant chemotherapy may be limited in patients with lung adenocarcinoma harboring EGFR mutations. CNS metastasis is likely to be found in practice before deterioration in PS, and may have little negative impact on compliance with subsequent EGFR -TKIs and survival after relapse. In this era of adjuvant TKI therapy, further prospective observational studies are desirable to elucidate the optimal management of CNS metastasis. • Adjuvant chemotherapy may increase the rate of relapse on central nervous system. • Adjuvant chemotherapy may have limited effect on lung cancer harboring EGFR mutations. • Central nervous system metastasis is found before deterioration in performance status. • Central nervous system metastasis may have little impact on treatment after relapse. • Central nervous system metastasis has little impact on survival after relapse. [ABSTRACT FROM AUTHOR]