94 Outcome of patients with metastatic lung cancer presenting with synchronous brain metastases – A single centre; 5 year retrospective analysis
TL;DR
There was so significant difference in number of patients receiving local brain treatment based on PDL1 and molecular genetic status that Prospective randomised clinical trials are needed to test the utility of upfront local intracranial treatments in this cohort.
Abstract
Metastatic non-small cell lung cancer (NSCLC) with synchronous brain metastases (BM) impacts prognosis and therapeutic considerations. Up to 20% patients with NSCLC may develop BM. Clinical trials of whole brain radiotherapy (WBRT), neurosurgical resection and stereotactic radiosurgery outdate the recent advances in systemic therapy for NSCLC. Retrospective data was collected on all patients with NSCLC who presented with synchronous BM between 2017-2022. This included demographics, histological sub-type, programme death ligand-1 (PDL-1) status, genetic markers, types of intracranial treatments, primary cancer treatment, progression and survival. 200 patients were identified. Mean age was 65 years; median performance status was 1. Most common histological subtype was adenocarcinoma (82%); 14 patients had a targetable genetic mutation. PDL-1 status was >50%, 1-49%, and <1% in 78, 37, and 39 patients respectively. Median overall survival (OS) was 6.7 months. Median OS varied according to the type of NSCLC treatment patients received; it was 27, 15.4, 14.7, 7.6, and 2.9 months in patients treated with tyrosine kinase inhibitor (TKI), radical intent thoracic treatments, immunotherapy, chemotherapy, and best supportive care respectively. Median OS was 34, 14.7, 13.9, 6.2, and 4.8 months in patients who received multimodality treatment, neurosurgery, SRS, WBRT, and BSC respectively. There was so significant difference in number of patients receiving local brain treatment based on PDL1 and molecular genetic status. The management of synchronous BM in patients with NSCLC poses a clinical conundrum. SRS, neurosurgical resection both offer survival advantage in patients receiving TKIs, immunotherapy, or radical treatment for the primary lung cancer whilst WBRT and chemotherapy have a limited impact. Prospective randomised clinical trials are needed to test the utility of upfront local intracranial treatments in this cohort.