# Evaluating the efficacy and safety of Anlotinib in conjunction with stereotactic radiosurgery for small cell lung cancer patients with brain metastases

## TL;DR

Combining Anlotinib with stereotactic radiosurgery improves outcomes for small cell lung cancer patients with brain metastases.

## Contribution

This study demonstrates that Anlotinib combined with SRT reduces brain necrosis and improves survival in SCLC patients with brain metastases.

## Key findings

- Anlotinib combined with SRT significantly improves intracranial hypertension relief compared to SRT alone.
- The combination treatment reduces radiation-induced brain necrosis and improves progression-free survival.
- Adverse reactions from Anlotinib are low and mostly mild.

## Abstract

Small cell lung cancer (SCLC) is characterized by its aggressive nature and high propensity for brain metastases. This study investigates the clinical efficacy and safety profile of Anlotinib in combination with Stereotactic Radiotherapy (SRT) for treating brain metastases in patients with small cell lung cancer (SCLC).

This research included 98 SCLC brain metastasis patients treated at Chengde Central Hospital from October 2020 to January 2024. The patients were categorized into a combined treatment group (CTG) (n = 45) and a Simple SRT group (SSG)(n = 53). The CTG (58 lesions) received Anlotinib with brain SRS, while the SSG (67 lesions) underwent only brain SRS. We compared the rates of intracranial hypertension relief, intracranial lesion treatment efficacy, radiation-induced brain necrosis, intracranial progression-free survival, and overall survival between the groups. Additionally, Anlotinib usage and adverse reactions in the CTG were documented.

Intracranial hypertension relief was significantly higher in the CTG at 80.0% (36/45) compared to 11.3% (6/53) in the SSG (p < 0.001). Radiation-induced brain necrosis occurred in 3.4% (2/58) of the CTG, markedly less than the 20.9% (14/67) in the SSG, indicating a significant difference (χ2 = 8.479, p = 0.004). Effective intracranial lesion treatment rates were 86.7% (39/45) in the CTG and 62.3% (33/53) in the SSG, with a notable difference (χ2 = 7.951, p = 0.047). The median intracranial progression-free survival was 7.8 months in the CTG vs. 4.8 months in the SSG (p < 0.0001). Median overall survival times were 11.3 months for the CTG and 7.8 months for the SSG (p = 0.3506). The duration of Anlotinib treatment in the CTG was 6 (6, 18) weeks. Adverse reactions included Grade I hypertension in three patients and Grade I hand-foot skin reactions in two patients, with a drug-related adverse reaction rate of 11.1% (5/45).

Anlotinib combined with SRT significantly alleviates brain edema, reduces the incidence of radiation-induced brain necrosis, enhances intracranial progression-free survival, and demonstrates a low adverse reaction rate.