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Changes Of Brain Structure In Patients With Metastatic Non-Small Cell Lung Cancer After Long-Term Target Therapy With Egfr-Tki

FRONTIERS IN ONCOLOGY(2021)

Cited 3|Views28
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Abstract
Purpose: Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy is the routine treatment for patients with metastatic non-small cell lung cancer (NSCLC) harboring positive EGFR mutations. Patients who undergo such treatment have reported cognitive decline during follow-up. This study, therefore, aimed to evaluate brain structural changes in patients receiving EGFR-TKI to increase understanding of this potential symptom.Method: The medical records of 75 patients with metastatic NSCLC (without brain metastasis or other co-morbidities) who received EGFR-TKI therapy from 2010 to 2017 were reviewed. The modified Scheltens Visual Scale and voxel-based morphometry were used to evaluate changes in white matter lesions (WML) and gray matter volume (GMV), respectively.Results: The WML scores were higher at the 12-month [8.65 +/- 3.86; 95% confidence interval (CI), 1.60-2.35; p < 0.001] and 24-month follow-ups (10.11 +/- 3.85; 95% CI, 2.98-3.87; p < 0.001) compared to baseline (6.68 +/- 3.64). At the 24-month follow-up, the visual scores were also significantly higher in younger patients (3.89 +/- 2.04) than in older patients (3.00 +/- 1.78; p = 0.047) and higher in female patients (3.80 +/- 2.04) than in male patients (2.73 +/- 1.56; p = 0.023). Additionally, significant GMV loss was observed in sub-regions of the right occipital lobe (76.71 voxels; 95% CI, 40.740-112.69 voxels), left occipital lobe (93.48 voxels; 95% CI, 37.48-149.47 voxels), and left basal ganglia (37.57 voxels; 95% CI, 21.58-53.57 voxels) (all p < 0.005; cluster-level false discovery rate < 0.05).Conclusions: An increase in WMLs and loss of GMV were observed in patients with metastatic NSCLC undergoing long-term EGFR-TKI treatment. This might reflect an unknown side-effect of EGFR-TKI treatment. Further prospective studies are necessary to confirm our findings.
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Key words
non-small cell lung cancer, epidermal growth factor receptor-tyrosine kinase inhibitor, white matter lesion, gray matter, MRI
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