Addition of SRS to TKIs for TKI-Naïve EGFR, ALK NSCLC Patients With BM Is Not Associated With Improvements in Survival

Background: Brain metastases (BM) occur within 3 years in 40% to 60% of non–small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor ( EGFR ) mutations and anaplastic lymphoma kinase ( ALK ) gene rearrangements. Newer tyrosine kinase inhibitors (TKIs) cross the blood–brain barrier and can be used as sole treatment for BM. The role of stereotactic radiosurgery (SRS) with newer TKIs is unclear. Objective: To evaluate the effect of adding SRS to TKIs for TKI-naïve +EGFR and +ALK NSCLC patients with BM. Design: Multi-institutional, retrospective cohort study. Methods: Records of TKI-naive +EGFR and +ALK NSCLC patients with BM were analyzed. To be included in the combined TKI-SRS group, the SRS had to be delivered within 8 weeks of initiating central nervous system (CNS)-penetrating TKI therapy. Primary end points were CNS progression and overall survival (OS). Results: From 2013 to 2022, there were 317 eligible patients, 200 in the TKI-only group and 117 in the TKI-S more...