Chad Rusthoven
@Chad_Rusthoven
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New in @JCO_ASCO. TURBO-NSCLC study of CNS-active TKI +\- SRS for brain mets from EGFR & ALK NSCLC. SRS assoc w/⬆️ local control (multivar HR 0.3) & time to CNS prog (HR 0.63). No diff in OS. Greater benefits w/SRS observed for pts w/large mets (>=1 cm).
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Thank you @QuadShotNews for highlighting our recent article in @JAMAOnc on the combination of SRS with CNS-active TKIs for brain metastases from EGFR and ALK driven NSCLC. @pike_lab @MSK_RadOnc @MSKCancerCenter @CUCancerCenter
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RT @NRGonc: FRIDAY! Tune in to our podcast for info on NRG-CC009, an active, accruing NRG study comparing hippocampal avoidant WBRT+memanti….
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RT @pike_lab: I’m pleased to share our summary of the clinical evidence on the use of TKIs and SRS in EGFR or ALK+ NSCLC! We need better bi….
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RT @JAMAOnc: The management of brain metastases in EGFR-variant and ALK-positive NSCLC patients remains uncertain, with evidence suggesting….
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RT @JCO_ASCO: Tyrosine Kinase Inhibitors With and Without Up-Front. Stereotactic Radiosurgery for #BrainMetastases From EGFR and ALK Oncoge….
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RT @gbanna74: In view of TURBO-NSCLC study results, would you offer TKIs + SRS in EGFR/ALK+ve NSCLC patients? @OncoAlert @OncoViews @OncBro….
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RT @MSKCancerCenter: A new multi-institution study from @pike_lab and colleagues in @JCO_ASCO finds adding up-front stereotactic radiosurge….
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RT @JoeChangMD: Any role of up-front SRS in lung pts with brain Mets and EGFR or ALK targetable mutations who is receiving the 3th generati….
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RT @MSK_RadOnc: 🧠⚡️🫁☢️New in @JCO_ASCO from @pike_lab @Chad_Rusthoven: The addition of up-front #radiation #SRS to CNS-penetrant #TKI ⬆️tim….
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Also want to mention my gratitude for the opportunity to work on this study w/ outstanding collaborator & lead author Luke Pike (@pike_lab), @EmilyAnnMiao, & 7 center TURBO-NSCLC team @TejasPatilMD @brandon_imber @TonyWangMD @njmyall1 @nickthomasmed @joshuapalmermd @BK_radiation.
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If SRS (upfront or early consolidation) is indicated for larger or higher risk mets & TKI alone is a reasonable option for small, low risk mets (likely to disappear with TKI), this still leaves a vast gray area where either option may be considered. MultiD eval remains essential.
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Re latter scenario, a prior study from our group reported fav results w/upfront CNS-active TKI alone for high volume mets, termed “CNS Downstaging”. IMHO, though not eval’d in TURBO, study of “consolidative SRS” after initial TKI is relevant & warranted.
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TURBO won’t be the final word on this imp topic, but does suggest caution re blanket omission of SRS. Pts w/large, high risk mets likely benefit from early SRS. Conversely, pts w/numerous small mets may have ⬆️ QOL from upfront TKI alone (avoiding possible WBRT) & close follow up.
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Also notable, there were no sig differences observed in OS, suggesting effective salvage therapy for the increased CNS progression events with TKI alone. And the CNS control benefits of SRS were observed at the cost of ~10% rate of symptomatic necrosis with SRS.
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The observation of increased benefits with upfront SRS in TURBO in pts w/ larger (>=1 cm) brain mets may also provide some useful information regarding pt selection for early integration of SRS.
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While, IMO, results do not imply a one-size-fits-all approach, TURBO does characterize the tradeoffs assoc w & wo upfront SRS. Given increasing use of TKI alone, notable that local & overall CNS control ⬆️ w/SRS, which can be clinically important in pts w/higher risk brain mets.
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