Patients with ALK-rearranged non-small cell lung cancer (NSCLC) and brain metastasis treated with stereotactic radiosurgery (SRS) and/or whole-brain radiotherapy (WBRT) and tyrosine kinase inhibitors (TKIs) have prolonged survival, a recent study published online ahead of print in the Journal of Clinical Oncology has shown.1

For the study, a team of researchers led by Joseph N. Contessa, MD, PhD, associate professor of Therapeutic Radiology and Pharmacology at Yale University School of Medicine, sought to identify prognostic factors and assess outcomes for patients with ALK­-rearranged NSCLC and brain metastasis.

Researchers analyzed data from 90 patients with brain metastasis from ALK-rearranged NSCLC treated at six institutions. Of those, 84 received SRS or WBRT to the brain and 86 received treatment with a TKI.

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Results showed that after development of brain metastases, median overall survival was 49.5 months (95% CI: 29.0 – not reached) and median intracranial progression-free survival was 11.9 months (95% CI: 10.1 – 18.2).

Researchers found that absence of extracranial metastases, a Karnofsky performance score 90 or higher, and no history of TKI therapy prior to brain metastasis development were significantly associated with improved survival. There was no significant different in survival between patients treated with SRS vs those treated with WBRT.

The findings suggest that interventions to control intracranial metastatic disease are of significant importance.

“The refinement of prognosis for this molecular subtype of NSCLC identifies a population of patients likely to benefit from first-line SRS, close CNS observation, and treatment of emergent CNS disease,” the authors conclude.1


1. Johung KL, Yeh N, Desai NB, et al. Extended survival and prognostic factors for patients with ALK-rearranged non–small-cell lung cancer and brain metastasis [published online ahead of print on October 5, 2015]. J Clin Oncol. doi: 10.1200/JCO.2015.62.0138.