Should erlotinib be coadministered with whole-brain radiotherapy in patients with brain metastases and non-small-cell lung cancer?

摘要

To the Editor: Welsh et al conducted a bicentric single-arm phase II study of whole-brain radiotherapy (WBRT) administered concurrently with erlotinib and followed by erlotinib maintenance therapy for patients with a good performance status and any number of brain metastases (BM) and non-small-cell cancer (NSCLC). Patients were naive to erlotinib therapy but may have undergone prestudy BM-directed treatment (stereotactic radiotherapy [SRT] or surgery). Primary outcome was overall survival (OS) that was contrasted with a historical comparator group. Several comments are warranted. The finding of no exaggerated neurotoxicity with concurrent WBRT and erlotinib is not surprising, given the similar finding in two studies of erlotinib combined with radiotherapy and temozolomide in newly diagnosed glioblastoma. However, and remarkably, the treatment-related neurotoxicity reported comprised only headache and dizziness. This paucity of toxidty is in contrast with most studies ofWBRT for BM. Additionally, some of the current study authors have eloquently characterized the neurocognitive toxicity ofWBRT and, although sequential neurocognitive studies were performed in the current study, there is no reference to radiation/treatment-associated injury as measured by a prespecified neurocognitive battery.