P14. Elderly patients with NSCLC with brain mets-need for combined targeted therapy

Background: Non-small cell lung cancer (NSCLC) with brain metastases is usually associated with poor outcomes and survival and about 40-50% of all patients with lung cancer develop brain metastases during the course. The poor outcomes and relapses following WBRT alone indicate a need for new therapeutic options. As some patients with NSCLC have mutations in the epidermal growth factor receptor (EGFR) and treating with WBRT with the anti-EGFR agent erlotinib in patients of NSCLC with brain metastases may benefit the patients in terms of disease regression and possible improvement in quality of life. Temozolomide has been already used alone or in combination with radiotherapy in the treatment of primary brain tumors and there are few studies showing its benefits in metastatic brain with WBRT. In this study we test the feasibility and efficacy of both of the drugs with WBRT.

Material and methods: A total of 12 elderly patients of biopsy proven adenocarcinoma lung with brain metastases (on MRI) were analyzed from July 2010 to March 2012. All the patients were planned for palliative radiation of 30 Gy/10#/2 weeks to local disease with WBRT of 20 Gy/5#/1 week with concurrent Temozolomide@ 75 mg/m² followed by assessment for further therapy after 3 weeks of radiation. All the patients were evaluated 3 weekly for assessment of symptom relief and improvement or progression. After 3 weeks all the patients were started on Erlotinib@ 150 mg, daily and Temozolamide@ 150-200 mg/m², D1-5, 4 weekly.

Results: The patients’ age ranged from 58 to 75 years. All the patients completed the scheduled radiation with oral steroids. Five patients progressed and died between 3 and 10 months. One patient defaulted during the radiation therapy and another after completion of six cycles of oral chemotherapy. Only five patients could complete the 12 cycles of oral chemotherapy with Temozolamide and Erlotinib, 4 weekly. Only one patient needed dose reduction of Erlotinib to 100 mg due to grade III rashes in 3rd cycle. The patients who improved after local and brain RT have shown to tolerate the further oral chemotherapy. These patients are still alive with the metastatic disease.

Conclusions: The combination of Erlotinib with temozolomide appears to be a promising therapy for treating brain metastases in NSCLC in terms of tolerability and efficacy.

Keywords: Non-small cell lung cancer (NSCLC); elderly; brain metastase; therapy