Radiation therapy plus osimertinib <i>vs</i> osimertinib alone in epidermal growth factor receptor mutated non-small cell lung cancer: A systematic review

BACKGROUND: About 25%-40% of people with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) experience brain metastases, which cause major challenges in their treatment. There continues to be no agreement on the ideal method for using EGFR- tyrosine kinase inhibitors (TKIs) and radiotherapy in management. AIM: To systematically assess how effective and safe EGFR-TKIs are when used together with or without radiotherapy in people with EGFR mutation and brain metastases. METHODS: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a complete literature search was initiated. We selected studies of two designs: Randomized trials and observational studies, which focused on therapies like EGFR-TKIs, radiotherapy, or approaches that combine both. Results for primary outcomes focused on how long people lived without the cancer spreading, whether the brain tumor shrank, and how safe the treatment was. RESULTS: Ten randomized controlled trials and 17 observational studies, totaling 14955 patients, met the inclusion criteria. Osimertinib and similar third-generation EGFR-TKIs performed better in the brain, helping patients with central nervous system (CNS) responses of 60% to 91%. Treatment involving combined EGFR-TKI medicine and radiotherapy worked better for local control and survival than EGFR-TKI treatment alone, mainly in patients with less than three brain metastases, ECOG 0-2, and moderate to severe neurological symptoms. Cognitive function was preserved better in those who received stereotactic radiosurgery and EGFR-TKIs than in those who had whole-brain radiation therapy. CONCLUSION: , moderate to severe neurological symptoms).