180P Incidence of brain metastases (BM) in newly diagnosed stage IV NSCLC during COVID-19

Abstract

Background: Reduced diagnostic procedures and late presentation during COVID19 may lead to late diagnosis of NSCLC. De novo BM may thus be more common during COVID19. Baseline incidence of BM in asymptomatic patients (pts) needs to be defined. Methods: Consecutive pts with stage IV NSCLC referred to Royal Marsden Hospital between Jun-Nov 2020 were included. Prospectively collected data were analysed descriptively. Results: Of 172 pts, 95 (55%) underwent brain imaging, 77 (45%) did not. More pts with brain imaging had good ECOG and received systemic therapy compared to those without brain imaging (table). 37/95 (39%) pts had BM on imaging. In pts with BM, 65% had BM symptoms, 35% did not. 12/27 (44%) pts with 1–5 BM were asymptomatic compared to 1/10 (10%) pts with ≥6 BM (p = 0.07). 32/95 (34%) pts with brain imaging had BM symptoms; of which 24 (66%) had BM confirmed on imaging. However, 13/63 (21%) asymptomatic pts also had BM detected on imaging. 10/37 (27%) pts with BM received stereotactic radiosurgery, of which 5 were asymptomatic. Of the remaining 27 pts with BM, 12 received TKI alone, 1 was monitored, 4 received palliative radiotherapy, 8 were unfit for treatment, 2 died. 11/37 (30%) pts with BM did not receive systemic therapy. Table 180PCharacteristicsBrain imaging N = 95 N (%)No brain imaging N = 77 N (%)AgeMedian (range)70 (34–95)74 (47–91)SmokingNever20 (21%)12 (16%)Ex/current74 (78%)51 (66%)NA1 (1%)14 (18%)ECOG016 (17%)5 (6%)1–268 (72%)37 (48%)3–411 (11%)27 (35%)NA0 (0%)8 (10%)SubtypeAdenocarcinoma68 (72%)45 (58%)Squamous cell11 (12%)12 (16%)Other11 (11%)4 (5%)NA5 (5%)16 (21%)MolecularVariant detected52 (55%)25 (32%)No variant28 (29%)31 (40%)NA15 (16%)21 (27%)BM symptomsYes32 (34%)4 (5%)*Not for active treatment.No63 (66%)60 (78%)NA013 (17%)Systemic therapyNA0 (0%)2 (3%)Yes64 (67%)32 (42%)No31 (33%)43 (56%)Poor ECOG Pt wishes Died Surgery/radiotherapy only Monitor17 4 5 3 228 2 12 0 1* Not for active treatment. Open table in a new tab Conclusions: The incidence of de novo BM was high in pts with stage 4 NSCLC during COVID19 (39%), higher than historical rates (25%). Many pts with BM were asymptomatic (35%). Brain imaging should be considered in all pts with a new diagnosis of stage 4 NSCLC. Whether early diagnosis and treatment of BM affects survival will need to be explored. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: W. Cui: Research grant/Funding (self): Breast Cancer Trials group; Research grant/Funding (self): Australian Government Research Training scholarship. C. Milner-Watts: Honoraria (self): AstraZeneca. A.R. Minchom: Honoraria (self), Advisory/Consultancy: Janssen Pharmaceutica; Honoraria (self), Advisory/Consultancy: Merck Pharmaceuticals; Honoraria (self): Novartis Oncology; Honoraria (self): Bayer Pharmaceuticals; Honoraria (self): Faron Pharmaceuticals; Travel/Accommodation/Expenses: LOXO oncology. S. Popat: Honoraria (self), Advisory/Consultancy: AstraZeneca; Honoraria (self), Advisory/Consultancy: Roche; Honoraria (self), Advisory/Consultancy: Boehringer Ingelheim; Honoraria (self), Advisory/Consultancy: Pfizer; Honoraria (self), Advisory/Consultancy: Novartis; Honoraria (self), Advisory/Consultancy: Takeda; Honoraria (self), Advisory/Consultancy: BMS; Honoraria (self), Advisory/Consultancy: MSD; Honoraria (self), Advisory/Consultancy: EMD Serono; Honoraria (self), Advisory/Consultancy: Guardant Health; Honoraria (self), Advisory/Consultancy: Bayer; Honoraria (self), Advisory/Consultancy: Blueprint; Honoraria (self), Advisory/Consultancy: Daiichi Sankyo; Honoraria (self), Advisory/Consultancy: Janssen; Honoraria (self), Advisory/Consultancy: GSK; Honoraria (self), Advisory/Consultancy: BeiGene; Honoraria (self), Advisory/Consultancy: Incyte; Honoraria (self), Advisory/Consultancy: Eli Lilly; Honoraria (self), Advisory/Consultancy: Amgen. M.E.R. O'Brien: Advisory/Consultancy: MSD; Advisory/Consultancy: AbbVie; Advisory/Consultancy: Roche; Advisory/Consultancy: Pierre Fabre; Advisory/Consultancy: BMS. All other authors have declared no conflicts of interest.