Multidisciplinary expert opinion on the treatment consensus for patients with EGFR mutated NSCLC with brain metastases

Ponce, Santiago; Bruna, Jordi; Juan, Óscar; López, Rafael García-Foncillas; Navarro, Alejandro; Ortega, Ana Laura; Puente, Javier; Verger, E.; Bartolome, A.; Nadal, Ernest

doi:10.1016/j.critrevonc.2019.03.017

Cited by 8 publications

(6 citation statements)

References 142 publications

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“…With the discovery of targetable mutations (e.g., EGFR) and increased implementation of SRS, the recognition of the heterogeneity in the disease course of NSCLC with and without brain metastases has grown. 50 The focal treatment of brain metastases with SRS and WBRT may be prevented or delayed in patients with targetable mutations, whereas brain metastases that are multiple and without targetable mutations may still require WBRT. 51 These treatment modalities have different side effects 20 and may have different psychological and neuropsychological consequences.…”

Section: Discussionmentioning

confidence: 99%

Death Anxiety in Patients With Metastatic Non-Small Cell Lung Cancer With and Without Brain Metastases

Eggen

Reyners

Shen

et al. 2020

Journal of Pain and Symptom Management

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Section: Discussionmentioning

confidence: 99%

Death Anxiety in Patients With Metastatic Non-Small Cell Lung Cancer With and Without Brain Metastases

Eggen

Reyners

Shen

et al. 2020

Journal of Pain and Symptom Management

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“…The characteristics of the CPGs are summarized in Table 1. Seven CPGs were established for SCLC (10-16), 20 for NSCLC (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), and 22 for lung cancer regardless of histological subtype . The number of published CPGs increased every year, with a total of 22 CPGs published in 2020.…”

Section: Characteristics Of Selected Guidelinesmentioning

confidence: 99%

Evaluation of the reporting quality of clinical practice guidelines on lung cancer using the RIGHT checklist

Yang¹,

Lü²,

Ma³

et al. 2021

Transl Lung Cancer Res

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Background: In recent years, the number of clinical practice guidelines (CPGs) for lung cancer has increased, but the quality of these guidelines has not been systematically assessed so far. Our aim was to assess the reporting quality of CPGs on lung cancer published since 2018 using the International Reporting Items for Practice Guidelines in Health Care (RIGHT) instrument. Methods:We systematically searched the major electronic literature databases, guideline databases and medical society websites from January 2018 to November 2020 to identify all CPGs for small cell and nonsmall cell lung cancer (NSCLC). The search and extraction were completed using standardized forms.The quality of included guidelines was evaluated using the RIGHT statement. We present the results descriptively, including a stratification by selected determinants.Results: A total of 49 CPGs were included. The mean proportion across the guidelines of the 22 items of the RIGHT checklist that were appropriately reported was 57.9%. The items most common to be poorly reported were quality assurance (item 17) and description of the role of funders (item 18b), both of which were reported in only one guideline. The proportions of items within each of the seven domains of the RIGHT checklist that were correctly reported were Basic information 75.9%; background 83.2%; evidence 44.5%; recommendations 55.4%; review and quality assurance 12.2%; funding and declaration and management of interests 42.9%; and other information 38.1%. The reporting quality of guidelines did not differ between publication years. CPGs published in journals with impact factor >30 tended to be best reported. Conclusions:Our results revealed that reporting in CPGs for lung cancer is suboptimal. Particularly the declaration of funding and quality assurance are poorly reported in recent CPGs on lung cancer.

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“…The current treatment options for managing BMs include surgical resection, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS), either alone or combined with SM, such as chemotherapy or targeted therapy ( 7 ). Thus far, increasing numbers of studies have shown that SM has excellent efficacy for BMs, especially with the emergence of tyrosine kinase inhibitors (TKIs) that target epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK); patients with BMs who harbored these gene mutations thus have opportunities to forego local treatment to the brain in early days ( 8 ). Brain radiotherapy is a standard treatment for BMs, and various studies have explored the best sequence in which radiotherapy and SM should be administered in the context of newly diagnosed BMs ( 9 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

Treatment Patterns and Survival Outcomes of Non-Small Cell Lung Cancer Patients Initially Diagnosed With Brain Metastases in Real-World Clinical Practice

et al. 2020

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Background This study aimed to comprehensively analyze the characteristics, treatment patterns, and survival outcomes of non-small-cell lung cancer (NSCLC) patients initially diagnosed with brain metastases (BMs) in real-world practice. Methods We enrolled NSCLC patients initially diagnosed with BMs between Jan 2004 and Jan 2018 in our institution. Patient demographics, treatment modalities, and survival outcomes were then analyzed. Brain localized treatment (BLT) included early brain radiotherapy (EBR), deferred brain radiotherapy (DBR), and surgery. Results A total of 954 patients were identified. Concerning initial treatment, 525 patients (55.0%) received systemic medication (SM)+BLT, 400 patients (41.9%) received SM only, and 29 patients received BLT only (3.0%). SM+BLT cohort was associated with longer median overall survival (mOS) than the SM only and the BLT only cohorts both in epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)-negative/unknown patients (15.3 months, 95% confidence interval [CI], 14.2–16.4; 11.1 months, 9.0–13.2; 7.0 months, 5.4–8.6; p<0.001) and in EGFR/ALK-positive patients (33.7 months, 28.5–38.9; 22.1 months, 17.8–26.4; 4.0 months, 3.6–4.4; p < 0.001). As for timing of radiotherapy, SM+EBR (14.1 months, 12.7–15.5) was associated with inferior mOS than SM+DBR (19.4 months, 14.2–24.6) in EGFR/ALK-negative/unknown patients. No significant difference was found in EGFR/ALK-positive patients (28.3 months, 19.1–37.5; 33.3 months, 28.1–38.5). Patients in the EGFR/ALK-negative/unknown cohort treated with first-line pemetrexed with platinum (PP) (15.8 months, 14.0–17.6, p<0.001) had longer mOS than those received non-PP regimens (13.1 months, 11.6–14.6). However, no difference was observed among EGFR/ALK-positive patients who were treated with tyrosine kinase inhibitors (TKIs) (29.5 months, 21.1–37.9; p = 0.140), PP (27.2 months, 21.6–32.8) and non-PP regimens (25.0 months, 16.0–34.0). Conclusions Our study confirmed that the use of SM+BLT is associated with superior mOS than those treated with SM only and BLT only. SM+DBR might be a better radiotherapeutic strategy for this patient population. EGFR/ALK-negative/unknown patients showed a survival benefit with PP treatment.

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Multidisciplinary expert opinion on the treatment consensus for patients with EGFR mutated NSCLC with brain metastases

Cited by 8 publications

References 142 publications

Death Anxiety in Patients With Metastatic Non-Small Cell Lung Cancer With and Without Brain Metastases

Death Anxiety in Patients With Metastatic Non-Small Cell Lung Cancer With and Without Brain Metastases

Evaluation of the reporting quality of clinical practice guidelines on lung cancer using the RIGHT checklist

Treatment Patterns and Survival Outcomes of Non-Small Cell Lung Cancer Patients Initially Diagnosed With Brain Metastases in Real-World Clinical Practice

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