The Role of Brain Radiotherapy in Patients With Asymptomatic Brain Metastasis in the Era of Targeted Therapy for NSCLC

Study Overview
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Brief Summary
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Brain metastasis is the most common neurological complication in tumor patients, and lung cancer is the most common tumor with brain metastasis. The prognosis of patients with non-small cell lung cancer with brain metastasis is poor. If not treated, the median survival time was about 1 month, the median survival time for steroid therapy was about 2 to 3 months, and the median survival time for patients receiving whole brain radiotherapy was about 3 to 6 months. Studies have shown that the incidence of brain metastasis is not only related to tumor size, N stage and tumor cell type, but also more likely to occur in NSCLC patients with sensitive gene mutation. With the rapid development of NSCLC molecular targeted therapy and precise radiotherapy, the new main therapeutic methods for NSCLC brain metastasis in recent years include stereotactic radiotherapy for (SRT),. Based on intensity modulated technique, simultaneous modulated accelerated radiation therapy for Brain(SMART-Brain) and molecular targeted therapy were carried out. However, at present, the best treatment choice for NSCLC brain metastasis, especially for asymptomatic brain metastasis patients, is still controversial. The choice and combined application mode of individualized treatment for different patients is still a problem to be explored. Based on the synergistic effect of radiotherapy and molecular targeted therapy on the basis of cell and molecule, The purpose of this study was to prospectively compare the efficacy of radiotherapy combined with targeted therapy and targeted therapy alone in patients with asymptomatic NSCLC brain metastasis with gene sensitive mutations, and subgroup analysis of different molecular targets and mutation sites. It is expected that this study will provide a basis for optimizing the curative effect of patients with NSCLC brain metastasis.

Detailed Description
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This is a randomized phase II clinical trial. The objective of the study is to assess efficacy and safety of brain radiotherapy combined with targeted therapy and simple targeted therapy in patients with asymptomatic NSCLC brain metastasis with gene sensitive mutation. Patients were randomized with equal allocation to Molecular targeted therapy alone or with brain radiotherapy. Study therapy continued until disease progression, unacceptable adverse event, or withdrawal of consent

Official Title
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A Randomized Phase II Trial of Brain Radiotherapy Combined With Targeted Therapy in Patients With Asymptomatic NSCLC Brain Metastasis With Gene Sensitive Mutation

Conditions
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Non Small Cell Lung Cancer, Brain Metastases

Intervention / Treatment
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* Drug: molecular targeted therapies
* Radiation: Brain Radiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Histology confirmed that it was non-small cell lung cancer; EGFR, ALK or ROS1 gene detection showed sensitive gene mutation, and patients were willing to receive targeted therapy; brain MRI confirmed brain metastasis; asymptomatic or symptomatic brain metastasis could be controlled by glucocorticoid; PS score 0-1; no brain radiotherapy or targeted therapy before entering the group; there was no history of malignant tumor and no serious medical diseases; Laboratory examination: White blood cell count ≥ 4 *10^9/L, neutrophil count ≥ 2.0 *10^9, platelet count ≥ 100 *10^9, hemoglobin ≥ 10 g / L, liver and kidney function and ECG were normal; the pregnancy test was negative within 3 days before entering the group, and agreed to use medically effective contraceptives during the experiment; sign informed consent form. Exclusion Criteria: Small cell lung cancer was confirmed by pathology; other malignant tumors (unless PFS ≥ 3 years, except non-black skin cancer); were treated with brain radiotherapy or targeted therapy before; those with other potentially serious diseases (congestive heart failure, transmural myocardial infarction, admission with severe acute bacterial or fungal infection, COPD or other respiratory diseases that affect treatment, etc.), Taking into account that the study may exacerbate or fail to control the disease; severe immunosuppressive diseases, such as AIDS; pregnant women, lactating women or women of childbearing age who do not agree with the use of effective contraception in the trial; Intracranial metastasis with obvious symptoms or symptoms that can not be relieved by glucocorticoid alone

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: molecular targeted therapy group<br>Molecular targeted therapy(according to the results of gene detection, targeted drugs were selected, such as EGFR mutation using the first generation of EGFR-TKI,ALK or ROS1 mutation using the first generation of ALK inhibitors) | Drug: molecular targeted therapies<br>* if EGFR mutation is positive, (gefitinib, ecotinib, erlotinib）or ALK/ROS-1 positive（Crizotinib）<br>* Other names: Targeted Molecular Therapies;|
| Experimental: Brain Radiotherapy and molecular targeted therapy group<br>Brain Radiotherapy (stereotactic radiotherapy was used for 1-3 intracranial lesions, and simultaneous modulated accelerated radiation therapy for Brain(SMART-Brain )was used for more than 3 intracranial lesions);Molecular targeted therapy(according to the results of gene detection, targeted drugs were selected, such as EGFR mutation using the first generation of EGFR-TKI,ALK or ROS1 mutation using the first generation of ALK inhibitors) | Drug: molecular targeted therapies<br>* if EGFR mutation is positive, (gefitinib, ecotinib, erlotinib）or ALK/ROS-1 positive（Crizotinib）<br>* Other names: Targeted Molecular Therapies;Radiation: Brain Radiotherapy<br>* SRS was used for 1-3 intracranial lesions, and simultaneous modulated accelerated radiation therapy for Brain(SMART-Brain)was used for more than 3 intracranial lesions<br>* Other names: simultaneous modulated accelerated radiation therapy for Brain,SMART-Brain;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intracranial progression-free survival,iPFS-LM | Time from BM diagnosis to the first documentation of intracranial lesion progression or death with documented intracranial progression | Every 6 weeks up to 2 years | 
| Objective Response Rate,ORR | ORR, proportion of patients with a best overall response of complete response or partial response (CR+PR) | 1 month after treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progress Free Survival rate,PFS | The period from the start of treatment to the progression or death of a patient | Every 6 weeks up to 2 years | 
| Median Survival Time,MST | the cumulative survival rate is 0.5, the corresponding survival time means that only 50% of the individuals can live through this time. | Every 6 weeks up to 2 years | 
| adverse events | Number of patients with adverse events (AEs) as a measure of safety and tolerability | Every 6 weeks up to 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Non Small Cell Lung Cancer, Brain Metastases