Estimating Survival in Patients With Lung Cancer and Brain Metastases

Sperduto, Paul W.; Yang, Tian; Beal, Kathryn; Pan, Hubert Y.; Brown, Paul D.; Bangdiwala, Ananta S; Shanley, Ryan; Yeh, Norman; Gaspar, Laurie E.; Braunstein, Steve; Sneed, Penny K.; Boyle, John; Kirkpatrick, John P.; Mak, Kimberley S.; Shih, Helen A.; Engelman, Alexander; Roberge, David; Arvold, Nils D.; Alexander, Brian M.; Awad, Mark M.; Contessa, Joseph N.; Chiang, Veronica; Hardie, J.; Ma, Daniel; Lou, Emil; Sperduto, William; Mehta, Minesh P.

doi:10.1001/jamaoncol.2016.3834

Cited by 533 publications

(172 citation statements)

References 17 publications

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“…Similar to the general population, ALK mutations were rare in our cohort. However, the importance of accounting for molecular features of NSCLC is highlighted in recent studies arguing for updates to clinical metrics including the GPA [26]. Spertudo and colleagues (2017) propose the lung-mol-GPA, a modified GPA metric that includes ALK and EGFR mutations statuses.…”

Section: Discussionmentioning

confidence: 99%

Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer

et al. 2018

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Purpose Routine brain MRI surveillance frequently diagnoses small, asymptomatic brain metastases from non-small cell lung cancer (NSCLC) that are effectively treated with stereotactic radiosurgery (SRS). A subset of patients, however, may die prior to the onset of symptoms. This study identifies clinical features that distinguish neurologically-asymptomatic NSCLC brain metastases patients that die prior to routine 3 month follow-up after SRS. Methods Retrospective chart review from 2007 to 2017 identified 18 patients with neurologically-asymptomatic NSCLC brain metastases who died < 3 months after SRS. Twenty-eight additional patients meeting criteria and surviving > 6 months after SRS were identified. Clinical factors were examined to determine characteristics correlated with survival using cox proportional hazards and nominal logistic regression models. Logistic regression models using salient factors were trained with 10-fold cross-validation and compared to the graded prognostic assessment (GPA) and score index of radiosurgery (SIR) using the AUC from receiver operant characteristic curves. Results The median survival following SRS was 1.4 and 9.2 months for the < 3 months and > 6 months groups, respectively. Age, number of brain metastases, and Karnofsky performance status were associated with overall survival while gender and interval between primary cancer and first brain metastasis diagnoses were associated with < 3 months and > 6 months survival, respectively. Models using GPA and SIR performed poorly compared to preliminary metrics generated in this study for prognosis of both < 3 months and > 6 months survival. Conclusion Physicians require data to provide high-value, cost-conscious health care. Clinical metrics can screen patients with asymptomatic NSCLC brain metastases likely to die prior to the standard screening interval and observation could be considered.

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Section: Discussionmentioning

confidence: 99%

Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer

et al. 2018

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“…Moreover, it would be of value to evaluate whether advanced imaging techniques or radiomics analyses cannot only discriminate between real progression and pseudoprogression, but also can be predictive for response on ICI. Prognostic scores such as the Recursive Partitioning Analysis (RPA) score, disease specific -Graded Prognostic Assessment (ds-GPA) and the molecular-GPA are validated for NSCLC BM patients but these scores were established before the use of ICI [91][92][93][94]. It would be of interest to validate these scores also for BM patients treated with ICI.…”

Section: Future Directionsmentioning

confidence: 99%

Non-small cell lung cancer brain metastases and the immune system: From brain metastases development to treatment

Rassy

Botticella

Kattan

et al. 2018

Cancer Treatment Reviews

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Brain metastases (BM) are diagnosed frequently in non-small cell lung cancer (NSCLC) patients. Despite the high incidence of BM (up to 40% in unselected patients), patients with untreated and/or unstable BM were excluded from pivotal immune checkpoint inhibitors (ICI) NSCLC trials. Percentage of patients with stable and treated BM in these trials ranged from 9.1 to 14.7% and ICI benefit over chemotherapy was not always demonstrated. Only small trials have been completed that demonstrated ICI efficacy in locally untreated, selected BM patients. With 33%, cranial objective response rate (ORR) was comparable to extracranial ORR and responses were often durable. With the promising survival benefits of ICI, in daily practice also unstable and/or untreated BM patients will often receive treatment with ICI and extrapolating clinical trial data to these patients can be challenging. In this review, we will summarize the preclinical rationale and potential concerns for the use of ICI in BM patients. Furthermore, we will summarize BM subgroup data from the pivotal NSCLC trials, retrospective series, the NSCLC BM specific ICI trials and the use of cranial radiation and ICI. Last, we provide an overview of response measurement criteria and future directions.

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“…In general, predictive models have evolved in recent years. For example, Sperduto et al have published improved versions of their original diagnosis-specific graded prognostic assessment (DS-GPA) [18][19][20]. Berghoff et al used previously underappreciated, inexpensive standard test results to create the now validated LabBM score [22].…”

Section: Discussionmentioning

confidence: 99%

“…Initially, they were heavily based on performance status and extracranial disease extent or control, and not stratified by primary cancer type. More recently, specific tumor characteristics have been integrated, e.g., in the molecular lung cancer score, renal cell cancer score, and melanoma score [18][19][20]. In parallel, it has also been realized that blood biomarkers such as serum lactate dehydrogenase (LDH) and albumin, as well as hemoglobin and C-reactive protein (CRP), may contribute to improved survival prediction models [21].…”

Section: Introductionmentioning

confidence: 99%

LabBM Score and Extracranial Score As New Tools for Predicting Survival in Patients with Brain Metastases Treated with Focal Radiotherapy

Nieder¹,

Yobuta²,

Mannsåker³

2020

Cureus

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Estimating Survival in Patients With Lung Cancer and Brain Metastases

Cited by 533 publications

References 17 publications

Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer

Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer

Non-small cell lung cancer brain metastases and the immune system: From brain metastases development to treatment

LabBM Score and Extracranial Score As New Tools for Predicting Survival in Patients with Brain Metastases Treated with Focal Radiotherapy

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