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Background <p>Optimal first-line treatment for epidermal growth factor receptor (EGFR) mutant NSCLC with brain metastases (BMs) has not been fully defined. We aimed to compare different first-line tyrosine kinase inhibitor (TKI) combination therapies and monotherapy for these patients in a real-world setting, especially in the era of 3rd generation TKIs.</p> Methods <p>Patients with EGFR-mutant NSCLC and BMs receiving first-line EGFR-TKIs from 2019 to 2023 were retrospectively reviewed (<i>n</i> = 150): TKI alone (<i>n</i> = 73), TKI plus brain radiation (TKI + BRT, <i>n</i> = 25), TKI plus bevacizumab (TKI + BEV, <i>n</i> = 38) and TKI plus chemotherapy (TKI + CT, <i>n</i> = 14). Intracranial progression-free survival (iPFS), PFS, overall survival (OS), responses and adverse events of each group were compared and survival beneficial population were explored.</p> Results <p>Among enrolled patients, majority (70.7%) received 3rd generation EGFR-TKIs and 29.3% received 1st /2nd generation drugs. The median iPFS of TKI alone group was significantly inferior than those in TKI + BRT, TKI + BEV and TKI + CT groups (22.1 vs. 32.9 months vs. not reached [NR] vs. NR, <i>p</i> = 0.001). The median PFS and OS were 11.1 and 40.1 months, 18.9 and 67.1 months, 16.5 and 38.8 months, 39.8 and 79.8 months, respectively, with TKI alone, TKI + BRT, TKI + BEV and TKI + CT (PFS, <i>p</i> = 0.014; OS, <i>p</i> = 0.015). The combination therapies brought iPFS and PFS benefits over TKI alone regardless of TKI generations. A linear correlation was demonstrated between iPFS and OS (R<sup>2</sup> = 0.508, <i>p</i> &lt; 0.001). Multivariate analysis revealed that the addition of BRT (HR = 0.375, 95%CI, 0.176–0.802, <i>p</i> = 0.011) or bevacizumab (HR = 0.294, 95%CI, 0.141–0.611, <i>p</i> = 0.001) significantly reduced intracranial progression risk. Whereas, the combinations of TKI and RT (HR = 0.326, 95%CI, 0.128–0.834, <i>p</i> = 0.019) or chemotherapy (HR = 0.083, 95%CI, 0.010–0.666, <i>p</i> = 0.019) were independent factors for favorable OS. No significant difference on survival or toxicity was observed among the three combination therapies.</p> Conclusion <p>EGFR-TKI combination therapies improved iPFS, PFS and OS than TKI monotherapy for patients with EGFR-mutant NSCLC and BMs irrespective of TKI generation or combination strategy.</p>

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EGFR-TKI monotherapy versus combination therapy as first-line treatment for EGFR-mutant NSCLC with brain metastases: a real-world comparison analysis

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  • 发表日期：

    2026年5月20日

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  • Fei Qi,
  • Yuzhu Chen,
  • Yi Han,
  • Peng Jiang,
  • Siyu Lei,
  • Xingyu Du,
  • Yuan Gao,
  • Fan Zhang,
  • Juan Du,
  • Hongxia Li,
  • Tongmei Zhang

摘要

Background

Optimal first-line treatment for epidermal growth factor receptor (EGFR) mutant NSCLC with brain metastases (BMs) has not been fully defined. We aimed to compare different first-line tyrosine kinase inhibitor (TKI) combination therapies and monotherapy for these patients in a real-world setting, especially in the era of 3rd generation TKIs.

Methods

Patients with EGFR-mutant NSCLC and BMs receiving first-line EGFR-TKIs from 2019 to 2023 were retrospectively reviewed (n = 150): TKI alone (n = 73), TKI plus brain radiation (TKI + BRT, n = 25), TKI plus bevacizumab (TKI + BEV, n = 38) and TKI plus chemotherapy (TKI + CT, n = 14). Intracranial progression-free survival (iPFS), PFS, overall survival (OS), responses and adverse events of each group were compared and survival beneficial population were explored.

Results

Among enrolled patients, majority (70.7%) received 3rd generation EGFR-TKIs and 29.3% received 1st /2nd generation drugs. The median iPFS of TKI alone group was significantly inferior than those in TKI + BRT, TKI + BEV and TKI + CT groups (22.1 vs. 32.9 months vs. not reached [NR] vs. NR, p = 0.001). The median PFS and OS were 11.1 and 40.1 months, 18.9 and 67.1 months, 16.5 and 38.8 months, 39.8 and 79.8 months, respectively, with TKI alone, TKI + BRT, TKI + BEV and TKI + CT (PFS, p = 0.014; OS, p = 0.015). The combination therapies brought iPFS and PFS benefits over TKI alone regardless of TKI generations. A linear correlation was demonstrated between iPFS and OS (R2 = 0.508, p < 0.001). Multivariate analysis revealed that the addition of BRT (HR = 0.375, 95%CI, 0.176–0.802, p = 0.011) or bevacizumab (HR = 0.294, 95%CI, 0.141–0.611, p = 0.001) significantly reduced intracranial progression risk. Whereas, the combinations of TKI and RT (HR = 0.326, 95%CI, 0.128–0.834, p = 0.019) or chemotherapy (HR = 0.083, 95%CI, 0.010–0.666, p = 0.019) were independent factors for favorable OS. No significant difference on survival or toxicity was observed among the three combination therapies.

Conclusion

EGFR-TKI combination therapies improved iPFS, PFS and OS than TKI monotherapy for patients with EGFR-mutant NSCLC and BMs irrespective of TKI generation or combination strategy.