A new prognostic model for lung cancer with brain metastases uses histology, mutations, number of metastases, performance status, and age to accurately predict survival outcomes in patients, according to research published in Radiation Oncology (published online June 26, 2017; doi:10.1186/s13014-017-0844-6).
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Prognostic tools have long been used to support clinical decision making and to stratify participants in prospective clinical trials for lung cancer. These trials have validated recursive partitioning analysis (RPA) and graded prognostic assessment (GPA) as predictive scores. However, prognostic tools are in need of constant update to reflect unique biological features of different primary tumors, especially lung cancer. A refined score that integrates EGFR and ALK molecular features (Lung-molGPA) has recently been developed by a North American collaborative group.
Norwegian and German researchers led by Carsten Nieder, department of oncology and palliative medicine, Nordland Hospital (Norway), conducted a retrospective study to validate Lung-molGPA in an independent European patient population. A total of 269 patients were sampled who were treated with individualized approaches that included brain radiation therapy. Data regarding age, extracranial spread, number of brain metastases, performance status, histology, EGFR mutations, and ALK alterations were collected at baseline and included in calculating the Lung-molGPA score.
Researchers hypothesized that a validated score would gain wide acceptance and could replace the RPA and GPA scores.
Researchers categorized patients into four prognostic strata: 0-1 point (n = 110 patients; 41%), 1.5-2 points (n = 109 patients; 41%), 2.5-3 points (n = 42 patients; 16%), and 3.5-4 points (n = 8 patients; 3%). Points were given based on favorable prognostic features, indicating that most patients in this sample had unfavorable prognostic features.
Median survival of patients in the sample was 5.4 months. The Lung-molGPA score predicted survival in patients with adenocarcinoma or non-adenocarcinoma histology; median survival was 3.0, 6.2, 14.7 and 25.0 months in the 4 different prognostic strata for adenocarcinoma and 2.4, 5.5 and 12.5 months in the 3 different prognostic strata for non-adenocarcinoma.
The most significant inference taken from the study, researchers concluded, was that Lung-molGPA accurately reflected the prognostic impact of baseline characteristics in lung cancer with brain metastases. This score offers an improvement of the widely-adopted RPA and GPA scores.—Zachary Bessette
