Official websites use. Share sensitive information only on official, secure websites. The role and timing of whole or stereotaxic brain radiotherapy BR in patients with advanced non-small cell lung cancer aNSCLC and asymptomatic brain metastases aBMs are not well established. Primary endpoint was progression-free survival PFS , secondary endpoints were overall survival OS , global, extra-cerebral and cerebral objective response rate ORR , toxicity, and quality of life [ClinicalTrials.
The trial was stopped early because of slow recruitment. Keywords: bevacizumab, cerebral metastasis, management, non-small—cell lung cancer, pemetrexed, radiotherapy. Moreover, the incidence of BMs at diagnosis seems to be increasing, 2 partly because of the more widespread use of brain magnetic resonance imaging MRI.
Most of these patients are not included in clinical trials that lead to the marketing of new therapeutics, chemotherapies, targeted therapies targeting anti-programmed cell death protein-1 PD-1 or its ligand-1 PD-L1 , for first- or second-line or more treatments. Furthermore, very few trials have been dedicated exclusively to patients with BMs. The quality of life QOL and prognosis for these patients are poorer than for those without BMs at diagnosis.
Management of these patients has not been clearly codified and BM management varies widely in Europe 5 ; it is often complex to avoid functional and cognitive deterioration and to control extra-cerebral disease. In this context, for NSCLC patients with aBMs and in good general condition, eligible for platin-based chemotherapy, the role and the timing of brain radiotherapy BR , WBRT, or stereotaxic radiotherapy, have not yet been established clearly.
The randomization and treatment plan are shown in Figure 1. Randomization and treatment schedule. M, C, ASS BR arm: initial BR followed by cisplatin-pemetrexed chemotherapy combined with bevacizumab for eligible patients; ChT arm: cisplatin-pemetrexed ChT combined with bevacizumab for eligible patients with BR only at cerebral disease progression. Eligible patients were assigned randomly to receive either first-line BR followed by chemotherapy BR arm or first-line of the same chemotherapy and BR only if clinical or radiological cerebral progression ChT arm.
