Top Line: Does nitroglycerine improve response to whole brain radiation (WBRT) for patients with non-small cell lung cancer (NSCLC) brain metastases?
The Study: Hypoxia can enhance tumor radioresistance. This randomized phase 2 trial was designed to test whether nitroglycerine during whole brain radiation could improve tumor oxygenation and increase response rate. Ninety-six patients with NSCLC brain mets receiving 30 Gy in 10 fractions whole brain radiation were randomized to transdermal nitroglycerin (NTG) during treatment. NTG consisted of a 36mg transdermal patch (10mg per 24 hours) worn during WBRT. Roughly half of patients (55.3% in the WBRT arm and 44.7% in the WBRT+NTG) had EGFR mutation. Intracranial overall response rate (iORR) was significantly higher with NTG (56.6% v 32.7%), although there was no significant difference in intracranial disease control (91.8% v 97.8%). Among EGFR mutated patients, the iORR rate was doubled with NTG (61.9% v 33.3%). This resulted in improved intracranial progression-free survival (27.7mo v 9.6 mo) and overall PFS, but no difference in overall survival. Patients receiving NTG were more likely to experience headache (27.3%), hypotension (29.5%), and nausea (27.3%).
TBL: This phase 2 trial suggests transdermal nitroglycerin during whole brain radiation for NSCLC brain metastases may improve intracranial response. | Arrieta, Int J Radiat Oncol Biol Phys 2022