1828P - A cross-sectional study investigating the current diagnostic & therapeutical approaches to bone metastases (BoM) in patients (pts) with non-small cell lung cancer (NSCLC)

Background

This study aims to investigate the current practice in BoM detection and management in pts with NSCLC.

Methods

An anonymous web-mail survey was distributed to Italian oncologists/radiotherapists. The questionnaire, developed after literature revision and reviewed by dedicated experts, included 40 items in 5 sections: i) general and work characteristics, ii) diagnostic, ii) bone-targeted agents (BTA), iii) radiotherapy (RT), iv) supportive care.

Results

A total of 108 clinicians (mean age 41.6y, 52% female, 82% oncologists) completed the questionnaire. The 18F-FDG PET is the preferred diagnostic assessment for skeletal evaluation for both pts with (56.5%) and without (63.0%) BoM at the TC scan, whereas RM (65.7%) and 18F-FDG (60.2%) are preferred in case of suspected bone oligoprogression. The occurrence of skeletal-related events (SRE) (56.5%) and life expectancy (56.5%) are the main parameters clinicians take into consideration to start BTA and the expected response to systemic treatment influences this choice in almost half of participants. About the choice of BTA, renal toxicity is the main factor considered (64.8%) and denosumab the most adopted BTA (64.8%). The onset of clinical symptoms mainly drives the timing of RT in pts with bone oligometastatic disease. Most of the participants do not interrupt systemic treatment during stereotactic RT (65.7%) and consider re-irradiation on progressive BoM at least 6 months after previous RT (60.2%). Overall, 65.0% and 40.0% of participants assess body weight and physical activity in NSCLC pts with BoM, 32.0% and 43.0% recommend oral nutritional supplement or a specific diet, 38% advise pts to increase their exercise levels, while 55.6% are worried exercise may increase the risk of SRE. Pts affected by NSCLC with BoM always/often ask about diet (62.0%), oral nutritional supplement (63.0%), physical activity (55.0%) and daily routine (67.0%).

Conclusions

Detection and management of BoM are crucial in the current era of lung cancer. Although clinicians are largely aware, adherence to BTA recommendations, as well as integration of supportive care still represent areas of improvement.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

AMGEN.

Disclosure

S. Pilotto: Financial Interests, Personal, Invited Speaker: Bristol myers squibb, AstraZeneca, MSD, Roche, AMGEN, Novartis, Takeda, Sanofi; Financial Interests, Personal, Advisory Board: MSD, AMGEN, AstraZeneca, Novartis, Eli Lilly, Sanofi; Non-Financial Interests, Principal Investigator: AstraZeneca, Roche, AMGEN, MSD, Daiichi Sankyo. All other authors have declared no conflicts of interest.