Treatment preferences for epidermal growth factor receptor mutation-positive non-small cell lung cancer with brain metastasis: a large-scale survey from Chinese oncologists

Background: Radiotherapy combined with tyrosine kinase inhibitor (TKI) has drawn extensive attention as a treatment regimen for patients with epithelial growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) with brain metastases (BMs). However, the optimal regimens and treatment sequence remain unknown. This study sought to investigate the opinions of Chinese oncologists toward the regimen selection and therapeutic timing for patients with EGFR-mutated NSCLC with BMs. Methods: A survey was developed by the expert group of the Specialty Committee of Lung Cancer of the Chinese Anti-Cancer Association. Between January and March 2018, the survey was distributed in online and paper forms to oncologists working in departments that may receive patients with NSCLC with BMs. Results: The survey was completed by 1,000 oncologists. When selecting a patient's therapeutic regimen, respondents were most likely to consider the benefit to overall survival (32%), followed by the benefit to progression-free survival (18%) and quality of life (17%). Radiotherapy combined with EGFR-TKI agents is the leading regimen over monotherapy (46-58%), with rates increasing in patients with neurological symptoms and a higher number of intracranial metastases. For patients with 1-3 BMs, stereotactic radiosurgery (SRS) with TKI was the preferred regimen. For patients with >3 BMs, whole-brain radiotherapy with TKI was the preferred regimen in accordance with the preference towards meningeal BM. Conclusions: Radiotherapy combined with EGFR-TKI agents is the preferred regimen among Chinese oncologists for the treatment of patients with EGFR mutation-positive NSCLC with BMs. BM number and type may influence the selection of radiotherapy regimen. Randomized controlled trials could be helpful in addressing current disputes regarding treatment regimens.