Researchers updated a prognostic tool to assess survival in patients with lung cancer and brain metastases by adding new data of genetic and molecular changes in tumors. The updated tool, called Lung-molGPA, can aid clinicians in making personalized treatment decisions, and may also be used to stratify patients in clinical trials.
The study, “Estimating Survival in Patients With Lung Cancer and Brain Metastases—An Update of the Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA),” was published in the journal JAMA Oncology.
Researchers at Minneapolis Radiation Oncology in Minnesota analyzed data from 2,186 patients with non-small-cell lung cancer (NSCLC) and newly detected brain metastases. Data on the molecular features of the group’s tumors — which consisted of 1,521 adenocarcinomas and 665 non-adenocarcinomas — was extracted from a database registering patients from U.S. cancer centers.
The older assessment — called the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) — was based on data from 1985 to 2005. It included four factors that together predicted survival in this patient group: age, Karnofsky Performance Status (a tool assessing the general impairment of patients), the presence of non-brain metastases, and the number of brain metastases.
This time, researchers assessed data from patients diagnosed from 2006 and 2014. The surveyed factors were tested for their ability to predict survival, and researchers used analyses to compare the predictive ability of various classes of factors separately in patients with adenocarcinoma and cancer of non-adenocarcinoma type.
In addition to the four original factors, researchers added two more: changes in the ALK and EGFR genes in patients with adenocarcinoma. In patients with cancer that was not of adenocarcinoma type, mutations were not assessed on a routine basis.
The median survival in this more recent group was 12 months. But looking only at those with adenocarcinoma and Lung-molGPA scores of 3.5 to 4, the survival was far better — nearly four years.
This is better than the median survival of seven months seen in the group providing data for the earlier version of the assessment. Researchers believe that better treatments allow lung cancer patients to survive longer. But a longer survival also means an increased risk of the cancer spreading to the brain.