3331 - Impact of neurological symptom burden on the survival prognosis in a real-life cohort of patients with non-small cell lung cancer brain metastases

Background

The high efficacy of targeted treatments in a- to oligosymptomatic non-small cell lung cancer (NSCLC) brain metastases (BM) revived the long discussion on BM screening. Therefore, we aimed to investigate the prognostic impact of symptomatic burden in patients with newly NSCLC BM in a large real-life cohort.

Methods

Patients with newly diagnosed NSCLC BM were identified from the Vienna Brain Metastasis Registry.

Results

1531 patients (male 57.4%, female 42.3%; median age 62 years) were available for further analysis. Neurological symptoms including neurological deficits (952/153; 62.2%), symptoms of increased intracranial pressure (456/153; 29.8%) and epileptic seizures (199/1531; 13.0%) were evident in 1125/1531 (73.5%) patients. Oligo-to asymptomatic BM were significantly more frequently observed in patients with synchronous diagnosis of BM and NSCLC (p < 0.001). Patients with oligo- to asymptomatic BM presented with a longer median overall survival after diagnosis of BM compared to patients with symptomatic BM (11 vs. 7 months; p < 0.001). In detail, presence of increased intracranial pressure and seizures showed no impact on survival prognosis (p > 0.05), while the median overall survival was significantly longer in patients without neurological deficits (11 vs. 7 months; p < 0.001): memory disorders (6 vs. 8 months; p > 0.05), ataxia (7 vs. 8; p = 0.041) and vertigo (6 vs. 9; p = 0.007). In multivariate analysis with DS-GPA (HR 1.41; 95% CI 1.33-1.50; p < 0.001), the presence of neurological symptoms was independently associated with survival prognosis from diagnosis of BM (HR 1.19; 95% CI 1.05-1.36; p = 0.007). Interestingly, the prognostic impact of neurological symptoms was more pronounced in patients with lower DS-GPA class II-IV (class II: 15 vs. 11; p = 0.002, class III: 10 vs. 6; p < 0.001, class IV: 6 vs. 3; p = 0.018) compared to patients with DS-GPA class I (19 vs. 14; p = 0.230).

Conclusions

Presence of neurological symptoms presented with a strong and independent association with survival prognosis from diagnosis of BM especially in patients with lower DS-GPA and should be further evaluated for inclusion in the prognostic assessment of patients with newly diagnosed NSCLC BM.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M. Preusser: Research grant / Funding (self): Böhringer-Ingelheim; Honoraria (institution), Advisory / Consultancy, Research grant / Funding (self): GlaxoSmithKline; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self): Merck Sharp & Dome; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self): Roche; Honoraria (self), Advisory / Consultancy: Bristol-Myers Squibb; Honoraria (self), Advisory / Consultancy: Novartis; Honoraria (self), Advisory / Consultancy: Gerson Lehrman Group; Honoraria (self), Advisory / Consultancy: CMC Contrast; Honoraria (self), Advisory / Consultancy: Mundipharma; Honoraria (self), Advisory / Consultancy: AstraZeneca; Honoraria (self), Advisory / Consultancy: AbbVie; Honoraria (self), Advisory / Consultancy: Lilly; Honoraria (self), Advisory / Consultancy: Medahead; Honoraria (self), Advisory / Consultancy: Daiichi Sankyo. A.S. Berghoff: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Daiichi Sankyo; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self), Travel / Accommodation / Expenses: Roche; Honoraria (self), Advisory / Consultancy: Bristol-Meyers Squibb; Honoraria (self), Advisory / Consultancy: Merck; Travel / Accommodation / Expenses: Amgen; Travel / Accommodation / Expenses: AbbVie. All other authors have declared no conflicts of interest.