Abstract 175P
Background
Patients with non-small cell lung cancer (NSCLC) often have brain metastases (BM) which are associated with reduced quality of life (QoL). Local therapies for BM include surgery, stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT). In the era of precision oncology, targeted therapy may allow deferral of upfront local therapies for EGFR/ ALK-positive BM. This study aimed to assess and compare the QoL of NSCLC BM patients undergoing different local therapies.
Methods
Patients diagnosed with advanced NSCLC with BM after March 2021 from seven public oncology centres in Hong Kong were included. Data on local therapies for BM were collected. QoL assessments were conducted at baseline and at 3, 6, 9 and 12 months (m) using validated EORTC QLQ-C30 and EQ-5D-5L questionnaires.
Results
A total of 124 advanced NSCLC patients with BM were recruited and 102 of them had at least 3m follow-up. For patients who did not undergo any local therapy (n=35), 83% received targeted therapy. They showed significant improvement in emotional functioning (EF) at 3, 6 and 9m and social functioning (SF) at 3m. Patients undergoing surgery (n=25) showed significant improvement in role functioning (RF), EF and fatigue from 3m to 6m. SRS (n=12) and WBRT (n=30) showed no significant difference in QoL over time. Compared to patients not undergoing any local therapy, those receiving surgery had lower RF (mean difference (MD) -22.2, p=0.03), EF (MD -14.2, p=0.04), cognitive functioning (MD -21.1, p=0.01), SF (MD -21.1, p=0.02) and more pain (MD 19.9, p=0.03) at 3m; while those undergoing WBRT had worse global health status at 3 and 6m (MD -14.2, p=0.04; MD -20.2, p=0.05, respectively), physical functioning (MD -27.6, p=0.002), SF (MD -22.8, p=0.02), more nausea and vomiting (MD 16.5, p=0.03), lower QOL in terms of EQVAS (MD -17.6, p=0.003) and utility score (MD -0.4, p=0.01) at 3m. Patients receiving surgery experienced more pain (MD 26.3, p=0.04) and WBRT had more nausea and vomiting (MD 19.4, p=0.05) than SRS at 3m.
Conclusions
Deferral of local therapies for BM in selected patients appears to have a better QoL than WBRT and surgery at 3m. However, QoL of patients undergoing surgery would improve gradually after 3m.
Legal entity responsible for the study
The University of Hong Kong.
Funding
Roche Hong Kong Limited.
Disclosure
All authors have declared no conflicts of interest.