The impact of tyrosine kinase inhibitors on the multimodality treatment of brain metastases from renal cell carcinoma.
OBJECTIVE
This study evaluated the effect of tyrosine kinase inhibitors (TKIs) on the brain metastasis (BM), local control (LC), and overall survival (OS) of patients with renal cell carcinoma (RCC) with BM.


METHODS
A retrospective review of patients with RCC BM was conducted. Eligible patients from 2 eras: pre-TKI, 2002 to 2003 and post-TKI, 2006 to 2007, were identified. Prognostic factors, use, and type of systemic therapy were noted. The timing, number, size, and treatment modality data for each BM were recorded. Use of TKI and BM treatment modality were correlated to LC and OS.


RESULTS
Eighty-one patients with 216 BMs were identified. Thirty-seven patients had BM at diagnosis and the remaining 44 were found to have BM at a later point. Forty-one patients never received a TKI and the remaining 40 received TKIs. Stereotactic radiosurgery, surgery, whole brain radiotherapy, or no local brain treatment was used for 89, 19, 24, and 75 lesions, respectively. The median OS from BM diagnosis was 5.4 months for the whole group: 4.4 versus 6.71 months in the never-TKI versus TKI groups, respectively. Patients who received TKIs post-BM development had a median OS of 23.6 months versus 2.08 and 4.41 months for the patients who received TKIs pre-BM or never-TKI, respectively (P=0.0001). LC was statistically superior in lesions managed with surgery or stereotactic radiosurgery versus the no local therapy.


CONCLUSIONS
In patients with RCC and BM, TKIs are associated with a trend of improved OS, but no significant improvement in LC of BM. They may provide a significant benefit to patients with BM with no prior TKI exposure.
*Department of Radiation Oncology, The Methodist Hospital Departments of †Genitourinary Oncology ‡Radiation Oncology §Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
Jonathan
J
Verma
Eric
E
Jonasch
Pamela K
PK
Allen
Jeffrey S
JS
Weinberg
Nizar
N
Tannir
Eric L
EL
Chang
Anita
A
Mahajan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome
D047428:Protein Kinase Inhibitors; D011505:Protein-Tyrosine Kinases