Patients with non-small cell lung cancer (NSCLC) may see improved survival predictions as a result of a new prognostic tool that includes EGFR and ALK gene alterations data, according to an analysis published in JAMA Oncology.
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A previously developed prognostic tool used to guide clinical decision making for patients with NSCLC is the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA), which takes into account patient age, Karnofsky Performance Status, extracranial metastases, and number of brain metastases. However, a recent study showed that patients with EGFR and ALK alterations have a markedly improved survival versus those without these gene alterations.
In order to incorporate data on EGFR and ALK gene alterations into prognosis for patients with NSCLC and brain metastases, researchers developed an update to DS-GPA, called Lung-molGPA. The new prognostic index was developed based on data from a retrospective database analysis that included 2186 patients with NSCLC (adenocarcinoma, n=1,521; nonadenocarcinoma, n=665) between 2006 and 2014. The original four factors used in the DS-GPA index were again found to be significant prognostic factors. For patients with adenocarcinoma, the two new factors, EGFR and ALK alterations, were also significant prognostic factors. Median survival for all patients with NSCLC and brain metastases was 12 months, and median survival for patients with adenocarcinoma was 15.2 months.
Patients were scored from 0 to 4 based on the presence of these factors, with higher scores corresponding to better prognosis. Only 65 patients with adenocarcinoma received Lung-molGPA scores of 3.5 to 4.0, but their median survival was 46.8 months. Of the 161 original patients with adenocarcinoma and nonadenocarcinoma to score 3.5 to 4.0 using the DS-GPA tool, the median survival was only 14.8 months.
The researchers, led by Paul W. Sperduto , MD, MSS, Gamma Knife Center, University of Minnesota, Waconia, MN, noted that the study was limited due to its retrospective nature and inherent selection bias of patients.
“To improve the value and outcomes of available treatments, patients with poor prognoses, ie, low Lung-molGPA scores, should be offered different therapies than those with good prognoses, who will most likely benefit from the more expensive and aggressive treatment approaches,” wrote, said John H Suh, MD, chairman of the department of radiation oncology at the Brain Tumor and Neuro-Oncology Center at Cleveland Clinic, in an invited commentary.
