Lung-molGPA Aids NSCLC Brain Metastases Prognosis, Decision-Making

EGFR and ALK mutation status have been added into a non-small-cell lung cancer brain metastases predictive tool

medwireNews: Incorporating genetic markers into a prognostic score for patients with non-small-cell lung cancer (NSCLC) brain metastases improves the ability to predict length of survival, research suggests.

Paul Sperduto, from the University of Minnesota in Waconia, USA, and co-workers looked at the impact of adding genetic or molecular biomarkers into the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA), which was originally based on age, Karnofsky Performance Status, the presence of extracranial metastases and number of brain metastases.

To create the updated Lung-molGPA, the team examined data from 2186 patients treated for newly diagnosed NSCLC brain metastases between 2006 and 2014, including 1521 cases of adenocarcinoma and 665 of nonadenocarcinoma.

Adenocarcinoma patient prognosis was significantly linked to the original four factors plus EGFR and ALK mutation status, all of which were designated a score of between 0.5 and 1.0 points.

Median overall survival of adenocarcinoma patients was 15.2 months but this varied significantly with Lung-molGPA result, from 6.9 months for a score of 0.0–1.0, to 13.7 months for a score of 1.5–2.0, and 26.5 months for a score of 2.5–3.0. The 4% of patients who scored the maximum 3.5–4.0 on the Lung-molGPA result had a median OS of almost 4 years, at 46.8 months.

As mutation status was not routinely tested in the nonadenocarcinoma patients, these individuals could score a maximum of 3.0 points in the Lung-molGPA, the researchers note. Median OS was 9.2 months in this group and again significantly differed between patients with a score of 0.0–1.0, 1.5–2.5 and 2.5–3.0, at 5.3, 9.8 and 12.8 months, respectively.

“The Lung-molGPA is a user-friendly tool that may facilitate clinical decision making and better design and stratification for future clinical trials in this heterogeneous patient population”, the authors write in JAMA Oncology.

In an accompanying invited commentary, John Suh, from the Cleveland Clinic in Ohio, USA, recommends that “[t]o improve the value and outcomes of available treatments, patients with poor prognosis, ie, low Lung-molGPA scores, should be offered different therapies than those with good prognosis, who will most likely benefit from the more expensive and aggressive treatment approaches.”

He emphasizes: “Given the ongoing debate regarding the optimal management strategy for patients with brain metastases, it is paramount that all patients be evaluated in a multidisciplinary setting to determine the most appropriate treatment approach while we await results of the ongoing clinical trials.”

References

Sperduto PW, Yang TJ, Beal K, et al. Estimating survival in patients with lung cancer and brain metastases. An update of the Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA). JAMA Oncol; Advance online publication 17 November 2016. doi:10.1001/jamaoncol.2016.3834

Suh JH. Association of molecular marker status with graded prognostic assessment of lung cancer with brain metastases. JAMA Oncol; Advance online publication 17 November 2016. doi:10.1001/jamaoncol.2016.3818

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