Tyrosine Kinase Inhibitors With and Without Up-Front Stereotactic Radiosurgery for Brain Metastases From EGFR and ALK Oncogene–Driven Non–Small Cell Lung Cancer (TURBO-NSCLC)

For people with non-small cell lung cancer (NSCLC) that has specific genetic changes—known as EGFR mutations or ALK rearrangements—targeted drugs called tyrosine kinase inhibitors (TKIs) can be very effective. Advanced TKIs like osimertinib and alectinib travel throughout the body and can even enter the brain to fight cancer cells that have spread there (brain metastases).

While TKIs work well on their own, doctors wanted to know if adding a targeted form of radiation—called stereotactic radiosurgery (SRS)—before starting TKI treatment would lead to better results. SRS delivers precise, high-dose radiation directly to brain tumors while protecting nearby healthy tissue.

A study called TURBO-NSCLC looked at 317 patients who had EGFR- or ALK-positive lung cancer that had spread to the brain. Researchers compared patients treated with TKIs alone against those who received both up-front SRS and TKIs.

The study found that adding up-front SRS significantly improved brain tumor control and delayed the time it took for cancer in the brain to progress. While overall survival rates were similar between both groups, patients with larger brain tumors (1 centimeter or larger) gained the greatest benefit from combining SRS with TKIs.

This research suggests that for patients with EGFR- or ALK-driven lung cancer and larger brain tumors, receiving radiosurgery alongside targeted therapy can offer better, longer-lasting control of cancer in the brain.