Introduction. Brain metastasis is a poor prognostic marker in lung cancer. However it is not known whether amongst patients with EGFR mutation those with brain metastases have a worse outcome. Methods. We compared the survival outcomes between EGFR mutation positive patients with and without brain metastases. In this retrospective analysis of prospective database of all metastatic lung cancer patients at our centre between July 2009 and December 2012, patients were treated with either combination chemotherapy or oral TKI. All patients with brain metastases received whole brain radiation. Kaplan Meier method was used for survival analysis and compared using log rank test. Results. 101 patients with EGFR mutated, metastatic lung cancer were studied. Fourteen had brain metastases and 87 did not. The common EGFR mutations were exon 19 deletion (61.3%) and exon 21 L858R mutation (28.7%). Overall response was 64% in extracranial metastasis group as compared to 50% in brain metastasis group. There was a significant worsening of median OS in the patients with brain metastases (11.6 months) compared with only extracranial metastases (18.7 months), . Conclusion. Amongst patients with EGFR mutant NSCLC, the presence of brain metastases leads to a worse outcome as compared to patients with extracranial metastases alone. 1. Introduction Metastatic lung cancer is one of the leading causes of cancer mortality worldwide. The presence of brain metastasis confers an even worse prognosis [1]. The median survival amongst patients with adenocarcinoma of the lung with brain metastasis in one of the early reports was around 73 days [1]. Whole brain radiotherapy (WBRT) improves median survival to 4–6 months [2, 3]. Non-small cell lung cancer (NSCLC) patients with brain metastases who have activating mutations of epidermal growth factor receptor (EGFR) tend to do significantly better as compared to those with wild type EGFR (median survival of 12.9 months as compared to 3.1 months) [4], when treated with oral tyrosine kinase inhibitors (TKIs) and cranial irradiation. EGFR mutation positivity is a good prognostic marker and patients with EGFR mutant lung cancer tend to have a longer survival. However, patients with EGFR mutated NSCLC have a predilection to develop brain metastases. The incidence of EGFR mutation positivity among patients with brain metastases is higher, ranging from 44 to 63%, as compared to the usually described 10% incidence of EGFR mutation in all patients diagnosed with NSCLC [5]. Although the development of brain metastases in general predicts for a poor
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