Abstract
BackgroundAn accurate classification of patients with brain metastases (BMs) is an important foundation to guide individualised treatment decisions and to formulate BM cohorts for modern clinical trials. MethodsSix thousand and thirty-one patients with newly diagnosed BM from different solid tumours treated between 1986 and 2020 were identified from the Vienna Brain Metastasis Registry. ResultsA rising fraction of patients presented with asymptomatic BM during the observation period (1986–1999: 20.2% vs 2010–2020: 30.6%; p < 0.001). Especially, oncogene-addicted non-small-cell lung cancer (NSCLC) and BRAF (v-Raf murine sarcoma viral oncogene homolog)-positive melanoma had a higher rate of asymptomatic BM presentation compared with wild-type tumours (p < 0.05). Significant changes of initial BM treatment approaches were observed with a decrease of neurosurgical procedures (1986–1999: 30.8% vs 2010–2020: 19.5%) and an increase of radiation treatments (1986–1999: 65.0% vs 2010–2020: 73.3%) and systemic therapies (1986–1999: 1.0% vs 2010–2020: 2.0%; p < 0.001). Median overall survival (OS) was heterogeneous between primary tumour entities but with an overall increase over the decades (median OS 1986–1999: 5 months vs 2010–2020: 7 months; p = 0.001). Survival times were longer in patients with oncogene-addicted NSCLC, BRAF-positive melanoma and hormone receptor-positive breast cancer compared with the other cancer subtypes (p > 0.05). ConclusionOur data highlight shifting trends in the symptomatic presentation and in treatment strategies of patients with BM over the last decades. Entity specific aspects and, in particular, the presence of targetable driver mutation impact the clinical presentation and prognosis. Future BM specific trials need to address the modern composition of BM cohorts and the distinct clinical course of patients with targetable driver mutations.
Highlights
An accurate classification of patients with brain metastases (BMs) is an important foundation to guide individualised treatment decisions and to formulate BM cohorts for modern clinical trials
From 1986 to 2020, a rising fraction of BM owing to lung cancer was observed, whereas the fraction of BM from renal cell carcinoma, colorectal cancer, cancer of unknown primary (CUP) and rare tumour types has decreased over the decades
BMs are still a challenge in clinical oncology as the presentation, clinical course and survival prognosis are highly heterogeneous between individuals
Summary
An accurate classification of patients with brain metastases (BMs) is an important foundation to guide individualised treatment decisions and to formulate BM cohorts for modern clinical trials. Prognostic scores as the graded prognostic assessment (GPA) and the diagnosis-specific (DS) GPAs based on clinical characteristics including age, number of BM, status of extracranial disease and Karnofsky Performance Scale (KPS) have been established to estimate the survival prognosis and to support adjusted treatment decisions [2,3]. These scores are based on clinical study cohorts from the late 80s to the early 2000 posing the question if those cohorts can represent a modern real-life BM population. Further evaluation of these new prognostic scores in modern real-life BM cohorts is needed
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