The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer

Peters, Solange; Bexelius, Christin; Munk, Veronica C.; Leighl, Natasha B.

doi:10.1016/j.ctrv.2016.03.009

Cited by 220 publications

(162 citation statements)

References 63 publications

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Section: Discussionmentioning

confidence: 99%

“…Brain metastases are related with a generally poor prognosis, low quality of life and high economic burden, which varies depending on the treatment option38. Although whole-brain radiation therapy is the standard treatment for brain metastases, stereotactic radiosurgery is widely used in limited brain disease38. Prophylactic cranial irradiation showed a survival benefit and decreased incidence of brain metastasis in small cell lung cancer cases39, however there was no survival benefit in NSCLC12.…”

Section: Discussionmentioning

confidence: 99%

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Baseline neutrophil–lymphocyte ratio is associated with baseline and subsequent presence of brain metastases in advanced non-small-cell lung cancer

Koh

Choi

Ahn

et al. 2016

Sci Rep

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We examined the predictive value of neutrophil–lymphocyte ratio (NLR) by examining their association with the baseline presence and subsequent development of brain metastases in patients with stage IV non-small cell lung cancer (NSCLC). We examined the predictive value of NLR for brain metastasis in 260 stage IV NSCLC. Logistic regression models and competing risk analysis were used to determine the association of NLR with baseline and subsequent presence of brain metastases. Multivariate analysis reveals that patients with high NLR (≥4.95) had significantly more brain metastases at diagnosis than those with low NLR (Odds Ratio = 2.59, P = 0.01). In patients who had no baseline brain metastasis, competing risks analysis revealed that patients with high NLR showed higher cumulative incidence of subsequent brain metastases, compared to those with low NLR (P = 0.017). A high NLR was associated with the baseline presence or the subsequent development of brain metastases, particularly in the group with adenocarcinoma (P = 0.013 and P = 0.044, respectively). Furthermore, an increase in NLR during treatment was associated with subsequent brain metastases (P = 0.004). The NLR is an independent predictive factor for the baseline presence of brain metastases and subsequent brain metastases in stage IV NSCLC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Baseline neutrophil–lymphocyte ratio is associated with baseline and subsequent presence of brain metastases in advanced non-small-cell lung cancer

Koh

Choi

Ahn

et al. 2016

Sci Rep

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“…In our opinion, supra-tentorial asymptomatic brain metastases should not be considered exclusion criteria for immune checkpoint inhibitor treatment. The risk of brain metastases increases over time owing to the prolonged survival of patients with advanced NSCLC [25]. Therefore, further investigations are needed to determine optimal treatment combinations with brain radiotherapy, sequences of treatment, and safety [26].…”

Section: Anti-pd-1 Antibodies As Single Agent In Patients With Pd-l1-mentioning

confidence: 99%

Successes and failures: what did we learn from recent first-line treatment immunotherapy trials in non-small cell lung cancer?

Remón

Besse

Soria

2017

BMC Med

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The immune checkpoint inhibitors have significantly modified the therapeutic landscape of advanced non-small cell lung cancer in second-line and, more recently, first-line settings. Because of the superior outcome with pembrolizumab as an upfront strategy, PD-L1 status should now be considered a new reflex biomarker for guiding first-line treatment in patients with advanced non-small cell lung cancer. Improved responses have also been reported with the combination of immune checkpoint inhibitors and chemotherapy as the first-line treatment; however, this strategy has not yet been validated by phase III trial data and its interplay with PD-L1 status still requires clarification.In this manuscript we review the contradictory results of recent phase III trials with immune checkpoint inhibitors in the first-line setting, the potential reasons for discrepancies, and some of the remaining open questions related to the positioning of immune checkpoint inhibitors in the first-line setting of non-small cell lung cancer.

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“…The incidence of CNS metastases seems to have further increased over the last years (4), possibly due to a more widespread use of magnetic resonance imaging (MRI) leading to early diagnosis (5), and to the improved efficacy of systemic therapies in controlling extracranial disease and prolonging survival, therefore allowing CNS micro-metastases to grow and become clinically evident (6). Unfortunately, the development of CNS metastases has a negative impact on quality of life, resource utilization and survival of patients with NSCLC (7).…”

Section: Introductionmentioning

confidence: 99%

State of the art of chemotherapy for the treatment of central nervous system metastases from non-small cell lung cancer

Inno¹,

Noia²,

D’Argento³

et al. 2016

Transl. Lung Cancer Res.

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Chemotherapy is the mainstay of treatment of advanced non-small cell lung cancer (NSCLC) without molecular drivers. Despite a low penetration of central nervous system (CNS), chemotherapy drugs demonstrated encouraging activity against CNS metastases from NSCLC. Based on the available data, chemotherapy should be considered as an important part of the multidisciplinary treatment of CNS metastases. Particularly, platinum-based regimens represent the most active combinations and pemetrexed is associated with a meaningful clinical benefit for patients with non-squamous histology. How to integrate chemotherapy and radiotherapy for newly diagnosed brain metastases (BMs) is still debated. Although flawed by some limitations, the available evidence suggests a role for upfront chemotherapy for the treatment of NSCLC patients with synchronous, asymptomatic BMs, thus allowing a delay of radiotherapy. Despite the introduction of modern and more effective chemotherapy, however, the prognosis of NSCLC patients with CNS metastases remains poor, especially for those with progressive BMs or leptomeningeal carcinomatosis (LC).

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The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer

Cited by 220 publications

References 63 publications

Baseline neutrophil–lymphocyte ratio is associated with baseline and subsequent presence of brain metastases in advanced non-small-cell lung cancer

Baseline neutrophil–lymphocyte ratio is associated with baseline and subsequent presence of brain metastases in advanced non-small-cell lung cancer

Successes and failures: what did we learn from recent first-line treatment immunotherapy trials in non-small cell lung cancer?

State of the art of chemotherapy for the treatment of central nervous system metastases from non-small cell lung cancer

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