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.