2017_SBRT_Course Book

Brain mets in patients with driver mutations

Magnuson JCO 2016

Retrospective multi-institution study: n=351

EGFR- TKI N=131

Brain mets

WBI N=120

SRS N=100

n < 5

64% 27% 72%

< 1cm

66% 35% 44%

asympto matic

88% 49% 51%

Ø Upfront SRS in small & asymptomatic brain mets improves OS

07.09.17 ESTRO SBRT COURSE 2017 - Matthias Guckenberger

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Brain mets in patients with driver mutations Randomized Japanese study of Crizotibib vs Alectinib in FL 14 – 28% with brain metastases

Primary EP PFS

100

80

60

NR

Overall With BM

40

PFS (%)

20

10.2 months

0

HR 0.24 HR 0.08

0 1

3

6

9

12

15

18

21

24

27

Time (months)

No. of patientsat risk Alectinib Crizotinib

103 104

103 102

93 86

76 65

49 40

36 21

27 14

9 4

1

Nokihara ASCO 2016

Ø Excellent PFS in patients treated with Alectinib Ø Role or radiotherapy in drugs with goof BBB penetration?

07.09.17 ESTRO SBRT COURSE 2017 - Matthias Guckenberger

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