Cancer Control (May 2025)

Therapeutic Outcomes of Osimertinib in EGFR – Mutant Non-Small Cell Lung Cancer With Brain Metastases: Results From a Retrospective Study at Vietnam National Cancer Hospital

  • Thi Nhu Hoa Nguyen MD,
  • Quang Le Van,
  • Phuong Nguyen Thi Bich MD,
  • Hau Tran Thi MD,
  • Van Tai Nguyen PhD,
  • The Dao Minh MD,
  • Lien Nguyen Duc PhD,
  • Duong Phan Thanh MD,
  • Lam Ngo Le MD,
  • Chu Nguyen Van,
  • Hoang Nguyen Cong PhD,
  • Duc Nguyen Dinh MD,
  • Hung Kien Do

DOI
https://doi.org/10.1177/10732748251348429
Journal volume & issue
Vol. 32

Abstract

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Introduction This study aimed to evaluate the therapeutic effect of osimertinib and further to compare the results of osimertinib plus brain radiation vs. osimertinib monotherapy in advanced EGFR-mutant non-small cell lung cancer (NSCLC) patients with brain metastases (BMs). Methods A retrospective study was conducted involving 62 advanced EGFR-mutant NSCLC patients with BMs who were treated with first-line osimertinib at the Vietnam National Cancer Hospital between April 2019 and December 2023. Patients were categorised in two treatment groups: (1) osimertinib alone (33 patients) and (2) osimertinib combined with locoregional therapy, including stereotactic radiosurgery or whole-brain radiotherapy (29 patients). Endpoints included objective response rate (ORR), central nervous system response rate (CNS-ORR), progression-free survival (PFS), overall survival (OS). Results The systemic ORR was 91.9% and the disease-control rate (DCR) was 96.8%. The CNS-ORR was 91.9% and the CNS-DCR was 100%. The median PFS and median OS achieved were 24.5 and 35.2 months, respectively. There was no significant difference in outcomes between patients in either treatment group with respect to CNS-ORR ( P = 1.0), mean best percentage change from baseline in CNS target lesion size ( P = .376), median PFS ( P = .656), intracranial progression-free survival (iPFS) ( P = .706), or OS ( P = .734). The occurrence of any-grade adverse events (AEs) did not differ significantly between the two treatment groups ( P = .762). However, in the osimertinib plus brain radiation cohort, 3/29 (10.3%) patients experienced radiotherapy-related AEs (2 cases of brain necrosis, 1 case of leukoencephalopathy), which consisted of one case of grade 3 brain radiation necrosis. Conclusion Osimertinib shows favorable real-world outcomes in improving PFS, OS, and CNS-ORR in advanced EGFR-mutant NSCLC Vietnamese patients with BMs, with no clear additional benefit from combining with brain radiotherapy.