Efficacy of Molecular-targeted Agents in Vertebral Metastasis Management in Non-small Cell Lung Cancer

Background/Aim: The effect of modern molecular-targeted agents (MTAs), on vertebral metastases in non-small cell lung cancer (NSCLC) remains inadequately characterized. We investigated the local control effects of MTAs on vertebral metastases in patients with NSCLC.

Patients and Methods: We retrospectively analyzed 307 vertebral metastases in 85 patients with NSCLC, treated between 2019 and 2021. Patients were categorized based on prior systemic therapy exposure (19 with vs. 66 without) and the type of first-line therapy administered (32 MTA vs. 34 non-MTAs). Multivariate analyses were performed for the vertebral progression-free period (vPFP) and overall survival (OS) using a Cox proportional hazards model with propensity scores as covariates. p-Value correction for multiple pairwise comparisons was performed using the Bonferroni method.

Results: In treatment-naïve patients, MTAs presented superior outcomes compared with non-MTAs [1-year vPFP: 93.6% vs. 85.1%, p=0.02; 1-year overall survival (OS): 90.3% vs. 60.9%, p=0.004]. Patients without prior systemic therapy had significantly better outcomes than previously treated patients (1-year vPFP: 89.5% vs. 49.1%, p<0.001; 1-year OS: 75.2% vs. 34.2%, p=0.011). The multivariate analysis identified prior systemic therapy as a significant predictor of poor outcomes [vPFP: hazard ratio (HR)=6.78, p<0.001; OS: HR=2.13, p=0.030].

Conclusion: Modern systemic therapies, particularly MTAs, present significant efficacy in controlling vertebral metastases in patients with NSCLC without prior systemic therapy. Deferring local treatments may be feasible in patients without prior systemic therapy, whereas those who develop vertebral metastases after treatment may require additional treatment.