BM are frequent in NSCLC patients (pts) but management can vary.
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.
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.
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
Legal entity responsible for the study
EORTC Lung Cancer Group
All authors have declared no conflicts of interest.