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e-Poster Display Session

180P - Incidence of brain metastases (BM) in newly diagnosed stage 4 NSCLC during COVID-19


24 Mar 2021


e-Poster Display Session


Wanyuan Cui


Journal of Thoracic Oncology (2021) 16 (suppl_4): S748-S802.


W. Cui1, C. Milner-Watts1, S. Saith1, J. Bhosle1, A.R. Minchom1, M. Davidson1, S. Page1, I. Locke1, N. Yousaf1, S. Popat2, M.E.R. O'Brien3

Author affiliations

  • 1 The Royal Marsden Hospital - NHS Foundation Trust, London/GB
  • 2 The Royal Marsden Hospital - NHS Foundation Trust; Imperial College London; Institute of Cancer Research, London/GB
  • 3 The Royal Marsden Hospital - NHS Foundation Trust; Imperial College London, London/GB

Abstract 180P


Reduced diagnostic procedures and late presentation during COVID19 may lead to late diagnosis of NSCLC. De novo BM may thus be more common during COVID19. Baseline incidence of BM in asymptomatic patients (pts) needs to be defined.


Consecutive pts with stage IV NSCLC referred to Royal Marsden Hospital between Jun-Nov 2020 were included. Prospectively collected data were analysed descriptively.


Of 172 pts, 95 (55%) underwent brain imaging, 77 (45%) did not. More pts with brain imaging had good ECOG and received systemic therapy compared to those without brain imaging (table). 37/95 (39%) pts had BM on imaging. In pts with BM, 65% had BM symptoms, 35% did not. 12/27 (44%) pts with 1–5 BM were asymptomatic compared to 1/10 (10%) pts with ≥6 BM (p = 0.07). 32/95 (34%) pts with brain imaging had BM symptoms; of which 24 (66%) had BM confirmed on imaging. However, 13/63 (21%) asymptomatic pts also had BM detected on imaging. 10/37 (27%) pts with BM received stereotactic radiosurgery, of which 5 were asymptomatic. Of the remaining 27 pts with BM, 12 received TKI alone, 1 was monitored, 4 received palliative radiotherapy, 8 were unfit for treatment, 2 died. 11/37 (30%) pts with BM did not receive systemic therapy.

Table 180P:


Brain imaging N = 95 N (%)No brain imaging N = 77 N (%)
Median (range)70 (34–95)74 (47–91)
Never20 (21%)12 (16%)
Ex/current74 (78%)51 (66%)
NA1 (1%)14 (18%)
016 (17%)5 (6%)
1–268 (72%)37 (48%)
3–411 (11%)27 (35%)
NA0 (0%)8 (10%)
Adenocarcinoma68 (72%)45 (58%)
Squamous cell11 (12%)12 (16%)
Other11 (11%)4 (5%)
NA5 (5%)16 (21%)
Variant detected52 (55%)25 (32%)
No variant28 (29%)31 (40%)
NA15 (16%)21 (27%)
BM symptoms
Yes32 (34%)4 (5%)*
No63 (66%)60 (78%)
NA013 (17%)
Systemic therapy
NA0 (0%)2 (3%)
Yes64 (67%)32 (42%)
No31 (33%)43 (56%)
Poor ECOG Pt wishes Died Surgery/radiotherapy only Monitor17 4 5 3 228 2 12 0 1

*Not for active treatment.


The incidence of de novo BM was high in pts with stage 4 NSCLC during COVID19 (39%), higher than historical rates (25%). Many pts with BM were asymptomatic (35%). Brain imaging should be considered in all pts with a new diagnosis of stage 4 NSCLC. Whether early diagnosis and treatment of BM affects survival will need to be explored.

Legal entity responsible for the study

The authors.


Has not received any funding.


W. Cui: Research grant/Funding (self): Breast Cancer Trials group; Research grant/Funding (self): Australian Government Research Training scholarship. C. Milner-Watts: Honoraria (self): AstraZeneca. A.R. Minchom: Honoraria (self), Advisory/Consultancy: Janssen Pharmaceutica; Honoraria (self), Advisory/Consultancy: Merck Pharmaceuticals; Honoraria (self): Novartis Oncology; Honoraria (self): Bayer Pharmaceuticals; Honoraria (self): Faron Pharmaceuticals; Travel/Accommodation/Expenses: LOXO oncology. S. Popat: Honoraria (self), Advisory/Consultancy: AstraZeneca; Honoraria (self), Advisory/Consultancy: Roche; Honoraria (self), Advisory/Consultancy: Boehringer Ingelheim; Honoraria (self), Advisory/Consultancy: Pfizer; Honoraria (self), Advisory/Consultancy: Novartis; Honoraria (self), Advisory/Consultancy: Takeda; Honoraria (self), Advisory/Consultancy: BMS; Honoraria (self), Advisory/Consultancy: MSD; Honoraria (self), Advisory/Consultancy: EMD Serono; Honoraria (self), Advisory/Consultancy: Guardant Health; Honoraria (self), Advisory/Consultancy: Bayer; Honoraria (self), Advisory/Consultancy: Blueprint; Honoraria (self), Advisory/Consultancy: Daiichi Sankyo; Honoraria (self), Advisory/Consultancy: Janssen; Honoraria (self), Advisory/Consultancy: GSK; Honoraria (self), Advisory/Consultancy: BeiGene; Honoraria (self), Advisory/Consultancy: Incyte; Honoraria (self), Advisory/Consultancy: Eli Lilly; Honoraria (self), Advisory/Consultancy: Amgen. M.E.R. O'Brien: Advisory/Consultancy: MSD; Advisory/Consultancy: AbbVie; Advisory/Consultancy: Roche; Advisory/Consultancy: Pierre Fabre; Advisory/Consultancy: BMS. All other authors have declared no conflicts of interest.

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