TY - JOUR
T1 - Converging survival trends in non-small cell lung cancer patients with and without brain metastasis receiving state-of-the-art treatment
AU - Averbuch, Itamar
AU - Tschernichovsky, Roi
AU - Yust-Katz, Shlomit
AU - Rotem, Ofer
AU - Limon, Dror
AU - Kurman, Noga
AU - Icht, Oded
AU - Reinhorn, Daniel
AU - Moskovitz, Mor
AU - Hanovich, Ekaterina
AU - Benouaich-Amiel, Alexandra
AU - Siegal, Tali
AU - Zer, Alona
AU - Gal, Omer
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/2
Y1 - 2024/2
N2 - Introduction: Historically, patients with brain metastasis (BM) have been excluded from clinical trials investigating treatments for non-small cell lung cancer (NSCLC) due to their unfavorable prognosis. Advanced treatments have increased survival prospects for NSCLC patients with BM. This study evaluated the life expectancy of NSCLC patients with and without BM in the context of contemporary treatments. Methods: Outcome data were collected for patients with advanced NSCLC attending a tertiary medical center between 2015 and 2020. Patients were stratified according to BM status and compared for overall survival (OS) using log-rank and Cox regression analyses. Results: The cohort included 360 patients with NSCLC of whom 134 (37.2%) had BM. Most (95%) of cases of BM developed within the first two years: 63% at diagnosis, 18% during the first year, 14% during the second year. There was no significant difference in OS between patients without BM and those with BM (median 23.7 vs. 22.3 months, HR = 0.97, p = 0.82); patients with BM and a targetable or non-targetable mutation (40.2 vs. 31.4 months, HR = 0.93, p = 0.84, and 20.7 vs. 19.87 months, HR = 0.95, p = 0.75, respectively); and patients with symptomatic BM (23.7 vs. 19.8 months, HR = 0.95, p = 0.78). Treatment for BM (95% of patients) consisted of stereotactic radiosurgery or tyrosine kinase inhibitors, with corresponding intracranial control rates of 90% and 86%. Conclusion: The results imply that the presence of BM has no impact on the prognosis of NSCLC. The practice of excluding NSCLC patients with BM from clinical trials warrants reconsideration.
AB - Introduction: Historically, patients with brain metastasis (BM) have been excluded from clinical trials investigating treatments for non-small cell lung cancer (NSCLC) due to their unfavorable prognosis. Advanced treatments have increased survival prospects for NSCLC patients with BM. This study evaluated the life expectancy of NSCLC patients with and without BM in the context of contemporary treatments. Methods: Outcome data were collected for patients with advanced NSCLC attending a tertiary medical center between 2015 and 2020. Patients were stratified according to BM status and compared for overall survival (OS) using log-rank and Cox regression analyses. Results: The cohort included 360 patients with NSCLC of whom 134 (37.2%) had BM. Most (95%) of cases of BM developed within the first two years: 63% at diagnosis, 18% during the first year, 14% during the second year. There was no significant difference in OS between patients without BM and those with BM (median 23.7 vs. 22.3 months, HR = 0.97, p = 0.82); patients with BM and a targetable or non-targetable mutation (40.2 vs. 31.4 months, HR = 0.93, p = 0.84, and 20.7 vs. 19.87 months, HR = 0.95, p = 0.75, respectively); and patients with symptomatic BM (23.7 vs. 19.8 months, HR = 0.95, p = 0.78). Treatment for BM (95% of patients) consisted of stereotactic radiosurgery or tyrosine kinase inhibitors, with corresponding intracranial control rates of 90% and 86%. Conclusion: The results imply that the presence of BM has no impact on the prognosis of NSCLC. The practice of excluding NSCLC patients with BM from clinical trials warrants reconsideration.
KW - Brain metastasis
KW - Non small cell lung cancer
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85184389775&partnerID=8YFLogxK
U2 - 10.1007/s11060-024-04562-0
DO - 10.1007/s11060-024-04562-0
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C2 - 38324192
AN - SCOPUS:85184389775
SN - 0167-594X
VL - 166
SP - 461
EP - 469
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 3
ER -