TY - JOUR
T1 - Survival in Patients with Brain Metastases
T2 - Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient
AU - Sperduto, Paul W.
AU - Mesko, Shane
AU - Li, Jing
AU - Cagney, Daniel
AU - Aizer, Ayal
AU - Lin, Nancy U.
AU - Nesbit, Eric
AU - Kruser, Tim J.
AU - Chan, Jason
AU - Braunstein, Steve
AU - Lee, Jessica
AU - Kirkpatrick, John P.
AU - Breen, Will
AU - Brown, Paul D.
AU - Shi, Diana
AU - Shih, Helen A.
AU - Soliman, Hany
AU - Sahgal, Arjun
AU - Shanley, Ryan
AU - Sperduto, William A.
AU - Lou, Emil
AU - Everett, Ashlyn
AU - Boggs, Drexell H.
AU - Masucci, Laura
AU - Roberge, David
AU - Remick, Jill
AU - Plichta, Kristin
AU - Buatti, John M.
AU - Jain, Supriya
AU - Gaspar, Laurie E.
AU - Wu, Cheng Chia
AU - Wang, Tony J.C.
AU - Bryant, John
AU - Chuong, Michael
AU - An, Yi
AU - Chiang, Veronica
AU - Nakano, Toshimichi
AU - Aoyama, Hidefumi
AU - Mehta, Minesh P.
N1 - Publisher Copyright:
Copyright © 2020 American Society of Clinical Oncology. All rights reserved.
PY - 2020/11/10
Y1 - 2020/11/10
N2 - PURPOSE Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility. METHODS A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively. RESULTS Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (P, .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non–small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively. CONCLUSION Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient . 0.50).
AB - PURPOSE Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility. METHODS A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively. RESULTS Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (P, .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non–small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively. CONCLUSION Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient . 0.50).
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U2 - 10.1200/JCO.20.01255
DO - 10.1200/JCO.20.01255
M3 - Article
C2 - 32931399
AN - SCOPUS:85095861087
SN - 0732-183X
VL - 38
SP - 3773
EP - 3784
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 32
ER -