Updated Prognostic Tool Could Guide NSCLC Treatment in Patients With Brain Mets

An updated prognostic tool incorporating gene alteration data could help guide clinical management of patients with non–small-cell lung cancer (NSCLC) and brain metastases, according to a new analysis.

“With the recent advent of molecularly targeted therapies and immunotherapies, survival from lung cancer continues to improve,” wrote study authors led by Paul W. Sperduto, MD, of the University of Minnesota. “Patients are thus at greater risk for developing late sequelae of the disease, such as brain metastases.”

The Diagnosis-Specific Grade Prognostic Assessment was developed based on patients diagnosed between 1985 and 2005, and includes four factors: patient age, Karnofsky performance status, extracranial metastases, and number of brain metastases. The new analysis included 2,186 NSCLC patients (1,521 adenocarcinomas and 665 non-adenocarcinomas) diagnosed more recently, from 2006 through 2014, to understand if other factors could further refine prognostic assessment. The results were published online ahead of print in JAMA Oncology.

The analysis found that the same original four factors remain prognostic. Also, positive findings for EGFR and ALK were independently prognostic, and were added to the new tool, dubbed Lung-molGPA; factors with bigger effect sizes were given higher weight, and thus the highest possible score remains 4.0, the same as with the Diagnosis-Specific Grade Prognostic Assessment.

Among adenocarcinoma patients, patients with a score of 3.5–4.0 (4% of patients) had a median survival of 46.8 months. Those with a score of 0.0–1.0, meanwhile, had a median survival of only 6.9 months. Among non-adenocarcinoma patients, in whom gene mutation status is rarely tested, patients with a score of 2.5–3.5 had a median survival of 12.8 months and those with the lowest scores had a median survival of 5.3 months.

“The Lung-molGPA is a user-friendly tool that may facilitate clinical decision-making and better design and stratification for future clinical trials in this heterogeneous patient population,” the authors concluded.

In an accompanying editorial, John H. Suh, MD, of the Cleveland Clinic, wrote that the use of prognostic indices that incorporate biology can not only help guide treatment in NSCLC patients with brain metastases but also provide realistic expectations for patients and physicians.

“Ultimately, we must move beyond prognostic factors and develop predictive markers of survival, quality of life, neurocognitive function, and toxic effects that will further our understanding of brain metastases and aid in the development of personalized therapies that make a meaningful difference,” he wrote.