Which sequence of treatment should be given first – local or systemic treatment for patients with non-small cell lung cancer and brain metastases?

This study evaluated which sequence of treatment should be given first, local or systemic (whole-body) treatment for patients with non-small cell lung cancer (NSCLC) and brain metastases (BMs). The data showed that systemic treatment followed by local treatment was associated with longer survival for patients with NSCLC and BM.

NSCLC is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. Treatment for NSCLC includes chemotherapy, radiotherapy, and surgical removal of tumors. In 20-40% of cases, NSCLC spreads from the lung to the brain (brain metastases, BM). There are few effective treatment options for NSCLC BM.

The most common treatment of lung cancer BM involves both local and systemic therapy. Local therapy such as radiation and surgery targets specific sites. Systemic therapy such as chemotherapy, immunotherapy, or targeted therapy spreads through the whole body. Tyrosine kinase inhibitors (TKIs) are a type of targeted therapy that blocks certain proteins that are responsible for many cell functions in the body. TKIs have been shown to improve survival outcomes in patients with NSCLC and BM. However, which sequence of treatment (local followed by systemic or systemic followed by local) provides the most clinical benefit in patients with NSCLC and BM is not known.

This study involved 160 patients with NSCLC and BM. Patients underwent both local (radiotherapy or brain surgery) and systemic treatment (chemotherapy and TKI drugs).

Patients who received more than 3 cycles of chemotherapy, stereotactic radiosurgery (high dose of radiation targeting a specific site from different angles), and TKI drugs all had longer survival.

Local treatment followed by systemic therapy was associated with shorter survival compared to systemic therapy followed by local treatment.

Local treatment that began within 1 week of the diagnosis of BM was associated with shorter survival.

This study concluded that systemic treatment followed by local treatment was associated with longer survival for patients with NSCLC and BM.

This study looked back in time at medical records. This study only included patients treated at 2 different institutions in China. Side effects associated with brain radiotherapy were not evaluated.