A Comparison Between First-, Second- and Third-Generation Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients with Non-Small-Cell Lung Cancer and Brain Metastases

Patients with non-small-cell lung cancer (NSCLC), harboring Epidermal Growth FactorReceptor (EGFR) mutations, are more susceptible to brain metastases (BM). Comparisons of theefficacy of different-generation EGFR-tyrosine kinase inhibitors (TKI) on BMs from NSCLC arecurrently limited. We identified studies comparing different EGFR-TKIs for NSCLC through Pubmedliterature search and selected those with neurological outcome data. By two retrospective analyses,Erlotinib showed longer neurological time-to-progression (30 months vs. 15.8 months, P = 0.024)and reduced the risk of central nervous system (CNS) progression (Hazard Ratio (HR) 0.25; 95% CI,0.08–0.81; P = 0.021) compared to Gefitinib. In a phase 2b randomized trial, 16% of patients with BMshad a similar Progression Free Survival (PFS) (HR 0.76, 95% CI 0.41–1.44) or Overall Survival (OS)(HR 1.16, 95% CI 0.61–2.21) with Afatinib versus Gefitinib; a lower risk of developing subsequent BMswith Afatinib than Gefitinib (HR 0.49; 95% CI 0.34–0.71; P < 0.001) was reported by a retrospectivestudy. A randomized phase 3 trial proved that patients with BMs treated with Osimertinib hadlonger PFS (HR 0.47, 95% CI 0.30–0.74) and OS (HR 0.79, 95% CI 0.61–1.01) than with Gefitinib, andlower incidence of CNS progression (6% vs. 15%, respectively). Although there is limited evidence,differences in CNS activity may exist between EGFR-TKIs