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Poster display session

3527 - Diversity of brain metastasis (BM) management in non-small cell lung cancer (NSCLC) in Europe (EU): Results of the Young Investigators European Organisation for Research and Treatment of Cancer Lung Cancer Group (YI EORTC LCG) survey

Date

09 Sep 2017

Session

Poster display session

Presenters

Lizza Hendriks

Citation

Annals of Oncology (2017) 28 (suppl_5): v460-v496. 10.1093/annonc/mdx380

Authors

L. Hendriks1, C. Faivre-Finn2, B. Hasan3, E. de Maio4, A. Berghoff5, A. Dingemans1, S. Novello6, T. Berghmans7, B. Besse8, A. Levy9

Author affiliations

  • 1 Pulmonary Diseases, Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL
  • 2 Radiotherapy, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 3 Statistics, EORTC - European Organisation for Research and Treatment of Cancer, 1200 - Brussels/BE
  • 4 Medical Oncology, EORTC - European Organisation for Research and Treatment of Cancer, 1200 - Brussels/BE
  • 5 Department Of Medicine I, Medical University of Vienna, Vienna/AT
  • 6 Department Of Oncology, University of Turin, Torino/IT
  • 7 Oncology, Institute Jules Bordet, 1000 - Brussels/BE
  • 8 Cancer Medicine, Institut de Cancérologie Gustave Roussy, 94805 - Villejuif/FR
  • 9 Radiation Oncology, Institut de Cancérologie Gustave Roussy, 94805 - Villejuif/FR
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Resources

Abstract 3527

Background

BM are frequent in NSCLC patients (pts) but management can vary.

Methods

An online survey containing questions on NSCLC BM screening and treatment (tx) was widely distributed between 16/02/17 and 16/04/17 to all EORTC LCG members, and through several EU societies involved in lung cancer tx.

Results

478 physicians (phys) (radiation oncologist: 51.9%, pulmonologist: 27%, medical oncologist: 15.3%, others: 5.8%; 73.2% with >5 years experience in NSCLC) responded. Italy [17.8%], Netherlands [14.2%], UK [13.0%], and France [11.5%] contributed most. 84.9% screened neurologically asymptomatic pts for BM at diagnosis (49% used MRI). Phys screened stage III (66.9%) and IV (40.8%) most often. 35.4% used a prognostic (p) classification to guide initial tx decisions. In 48.1% lowest p-score threshold to actively treat pts did not differ between driver mutation (MUT+) and non-driver (MUT-) pts. 38.1% used less WBRT in poor prognosis pts based on QUARTZ trial (NCT3826061) results. 88.9% had access to stereotactic radiosurgery (SRS). After single BM surgery, 50.8% systematically prescribe adjuvant SRS or WBRT, and 44.2% only in case of incomplete resection. Preferred tx in neurologically asymptomatic tx-naive pts diagnosed with >5 BM was systemic tx (78.4%). 46.9% stated that WBRT could increase systemic tx efficacy. 44.8/49.8% stated that all tyrosine kinase inhibitors (TKI) and immune checkpoint blockers (IO) were discontinued (timing varied) during SRS/WBRT, respectively. Drugs that were most often continued during SRS-WBRT were erlotinib (44.5-40.1%), gefitinib (38.0-34.0%), afatinib (29.9-25.1%), crizotinib (32.2-26.7%) and IO (PD-(L)-1: 28.4-22.8%), CTLA4: 10-9.8%), because of no perceived safety issues (44.6%) or risk of systemic flare (37.9%). MUT+ pts with > 3 BM were more likely to receive SRS than MUT-. 76% of phys preferred local tx & TKI continuation over a switch to next-line tx in pts with only intracranial progression.

Conclusions

BM management differs: screening is not uniform, p-classifications are not often used, and MUT+ NSCLC pts generally receive more aggressive local tx.

Clinical trial identification

not applicable

Legal entity responsible for the study

EORTC Lung Cancer Group

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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