Antonin Levy1, Corinne Faivre-Finn2, Baktiar Hasan3, Eleonora De Maio3, Anna S Berghoff4, Nicolas Girard5, Laurent Greillier6, Sylvie Lantuéjoul7, Mary O'Brien8, Martin Reck9, Anne-Marie C Dingemans10, Silvia Novello11, Thierry Berghmans12, Benjamin Besse13, Lizza Hendriks14. 1. Department of Radiation Oncology, Gustave Roussy, Institut d'Oncologie Thoracique (IOT), INSERM U1030 Molecular Radiotherapy, Université Paris-Saclay, F-94805, Villejuif, France; Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France. Electronic address: antonin.levy@gustaveroussy.fr. 2. Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre (MCRC), University of Manchester, Manchester, UK. 3. European Organisation for Research and Treatment of Cancer, Brussels, Belgium. 4. Department of Medicine I and Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. 5. Department of Medical Oncology, Institut Curie, Paris, France. 6. Multidisciplinary Oncology and Therapeutic Innovations, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France. 7. Department of Biopathology, Centre Léon Bérard UNICANCER, Lyon, Université Grenoble Alpes, INSERM U1209/CNRS 5309 Institute for Advanced Biosciences, Grenoble France. 8. Department of Medicine, Royal Marsden NHS Foundation Trust, London, UK. 9. LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany. 10. Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands. 11. Oncology Department, University of Turin, AOU San Luigi, Orbassano (TO), Italy. 12. Department of Intensive Care and Oncological Emergencies & Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium. 13. Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France; Department of Medical Oncology, Gustave Roussy, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France. 14. Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands. Electronic address: lizza.hendriks@mumc.nl.
Abstract
BACKGROUND: Brain metastases (BM) are frequent in non-small cell lung cancer (NSCLC) patients, but there is a lack of evidence-based management of this patient group. We aimed to capture a snapshot of routine BM management in Europe to identify relevant research questions for future clinical trials. METHODS: An EORTC Lung Cancer Group (LCG) online survey containing questions on NSCLC BM screening and treatment was distributed between 16/02/17 and 15/06/17 to worldwide EORTC LCG members, and through several European scientific societies in the thoracic oncology field. RESULTS: A total of 462 European physician responses (394 institutions) were analysed (radiation oncologist: 53% [n = 247], pulmonologist: 26% [n = 119], medical oncologist: 18% [n = 84]; 84% with >5 years' experience in NSCLC). Italy (18%, n = 85), Netherlands (15%, n = 68), UK (14%, n = 66), and France (12%, n = 55) contributed most. 393 physicians (85%) screened neurologically asymptomatic patients for BM at diagnosis (52% using magnetic resonance imaging). Most often screened patients were those with a driver mutation (MUT+; 51%, n = 234), stage III (63%, n = 289), and IV (43%, n = 199). 158 physicians (34%) used a prognostic classification to guide initial treatment decisions, and in 50%, lowest prognostic-score threshold to receive treatment differed between MUT+ and non-driver mutation (MUT-) patients. MUT+ patients with >4 BM were more likely to receive stereotactic radiosurgery (SRS) compared with MUT- (27% versus. 21%; p < 0.01). Most physicians (90%) had access to SRS. After single BM surgery, 50% systematically prescribed SRS or WBRT, and 45% only in case of incomplete resection. The preferred treatment in neurologically asymptomatic treatment-naive patients diagnosed with >5 BM was systemic treatment (79%). Of all, 45%/49% physicians stated that all tyrosine kinase inhibitors and immune checkpoint blockers were discontinued (timing varied) during SRS/WBRT, respectively. Drugs most often continued during SRS/WBRT were erlotinib (44%/40%), gefitinib (39%/34%), afatinib (29%/25%), crizotinib (33%/26%) and anti-PD-(L)-1 (28%/22%). CONCLUSION: BM management is highly variable in Europe: screening is not uniform, prognostic classifications are not often used and MUT+ NSCLC patients generally receive more intensive local treatment. Prospective assessment of BM management in MUT+ NSCLC patients is required.
BACKGROUND:Brain metastases (BM) are frequent in non-small cell lung cancer (NSCLC) patients, but there is a lack of evidence-based management of this patient group. We aimed to capture a snapshot of routine BM management in Europe to identify relevant research questions for future clinical trials. METHODS: An EORTC Lung Cancer Group (LCG) online survey containing questions on NSCLC BM screening and treatment was distributed between 16/02/17 and 15/06/17 to worldwide EORTC LCG members, and through several European scientific societies in the thoracic oncology field. RESULTS: A total of 462 European physician responses (394 institutions) were analysed (radiation oncologist: 53% [n = 247], pulmonologist: 26% [n = 119], medical oncologist: 18% [n = 84]; 84% with >5 years' experience in NSCLC). Italy (18%, n = 85), Netherlands (15%, n = 68), UK (14%, n = 66), and France (12%, n = 55) contributed most. 393 physicians (85%) screened neurologically asymptomatic patients for BM at diagnosis (52% using magnetic resonance imaging). Most often screened patients were those with a driver mutation (MUT+; 51%, n = 234), stage III (63%, n = 289), and IV (43%, n = 199). 158 physicians (34%) used a prognostic classification to guide initial treatment decisions, and in 50%, lowest prognostic-score threshold to receive treatment differed between MUT+ and non-driver mutation (MUT-) patients. MUT+ patients with >4 BM were more likely to receive stereotactic radiosurgery (SRS) compared with MUT- (27% versus. 21%; p < 0.01). Most physicians (90%) had access to SRS. After single BM surgery, 50% systematically prescribed SRS or WBRT, and 45% only in case of incomplete resection. The preferred treatment in neurologically asymptomatic treatment-naive patients diagnosed with >5 BM was systemic treatment (79%). Of all, 45%/49% physicians stated that all tyrosine kinase inhibitors and immune checkpoint blockers were discontinued (timing varied) during SRS/WBRT, respectively. Drugs most often continued during SRS/WBRT were erlotinib (44%/40%), gefitinib (39%/34%), afatinib (29%/25%), crizotinib (33%/26%) and anti-PD-(L)-1 (28%/22%). CONCLUSION: BM management is highly variable in Europe: screening is not uniform, prognostic classifications are not often used and MUT+ NSCLCpatients generally receive more intensive local treatment. Prospective assessment of BM management in MUT+ NSCLCpatients is required.
Authors: Pierre-Yves Borius; Jean Régis; Alexandre Carpentier; Michel Kalamarides; Charles Ambroise Valery; Igor Latorzeff Journal: Cancer Metastasis Rev Date: 2021-01-04 Impact factor: 9.264
Authors: L M Füreder; G Widhalm; B Gatterbauer; K Dieckmann; J A Hainfellner; R Bartsch; C C Zielinski; M Preusser; A S Berghoff Journal: Clin Exp Metastasis Date: 2018-11-12 Impact factor: 5.150
Authors: Gokoulakrichenane Loganadane; Frédéric Dhermain; Guillaume Louvel; Paul Kauv; Eric Deutsch; Cécile Le Péchoux; Antonin Levy Journal: Front Oncol Date: 2018-09-05 Impact factor: 6.244