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Recommended first-line management of asymptomatic brain metastases from EGFR mutant and ALK positive non-small cell lung cancer varies significantly according to specialty: an international survey of clinical practice

BACKGROUND: The role for radiotherapy or surgery in the upfront management of brain metastases (BrM) in epidermal growth factor receptor mutant (EGFRm) or anaplastic lymphoma kinase translocation positive (ALK+) non-small cell lung cancer (NSCLC) is uncertain because of a lack of prospective evidenc...

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Autores principales: Fong, Chin Heng, Meti, Nicholas, Kruser, Timothy, Weiss, Jessica, Liu, Zhihui Amy, Takami, Hirokazu, Narita, Yoshitaka, de Moraes, Fabio Ynoe, Dasgupta, Archya, Ong, Choo Khoon, Yang, James C. H., Lee, Jih Hsiang, Kosyak, Natalya, Pavlakis, Nicholas, Kongkham, Paul, Doherty, Mark, Leighl, Natasha B., Shultz, David B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482634/
https://www.ncbi.nlm.nih.gov/pubmed/37691657
http://dx.doi.org/10.21037/jtd-22-697
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author Fong, Chin Heng
Meti, Nicholas
Kruser, Timothy
Weiss, Jessica
Liu, Zhihui Amy
Takami, Hirokazu
Narita, Yoshitaka
de Moraes, Fabio Ynoe
Dasgupta, Archya
Ong, Choo Khoon
Yang, James C. H.
Lee, Jih Hsiang
Kosyak, Natalya
Pavlakis, Nicholas
Kongkham, Paul
Doherty, Mark
Leighl, Natasha B.
Shultz, David B.
author_facet Fong, Chin Heng
Meti, Nicholas
Kruser, Timothy
Weiss, Jessica
Liu, Zhihui Amy
Takami, Hirokazu
Narita, Yoshitaka
de Moraes, Fabio Ynoe
Dasgupta, Archya
Ong, Choo Khoon
Yang, James C. H.
Lee, Jih Hsiang
Kosyak, Natalya
Pavlakis, Nicholas
Kongkham, Paul
Doherty, Mark
Leighl, Natasha B.
Shultz, David B.
author_sort Fong, Chin Heng
collection PubMed
description BACKGROUND: The role for radiotherapy or surgery in the upfront management of brain metastases (BrM) in epidermal growth factor receptor mutant (EGFRm) or anaplastic lymphoma kinase translocation positive (ALK+) non-small cell lung cancer (NSCLC) is uncertain because of a lack of prospective evidence supporting tyrosine kinase inhibitor (TKI) monotherapy. Further understanding of practice heterogeneity is necessary to guide collaborative efforts in establishing guideline recommendations. METHODS: We conducted an international survey among medical (MO), clinical (CO), and radiation oncologists (RO), as well as neurosurgeons (NS), of treatment recommendations for asymptomatic BrM (in non-eloquent regions) EGFRm or ALK+ NSCLC patients according to specific clinical scenarios. We grouped and compared treatment recommendations according to specialty. Responses were summarized using counts and percentages and analyzed using the Fisher exact test. RESULTS: A total of 449 surveys were included in the final analysis: 48 CO, 85 MO, 60 NS, and 256 RO. MO and CO were significantly more likely than RO and NS to recommend first-line TKI monotherapy, regardless of the number and/or size of asymptomatic BrM (in non-eloquent regions). Radiotherapy in addition to TKI as first-line management was preferred by all specialties for patients with ≥4 BrM. NS recommended surgical resection more often than other specialties for BrM measuring >2 cm. CONCLUSIONS: Recommendations for the management of BrM from EGFRm or ALK+ NSCLC vary significantly according to oncology sub-specialties. Development of multidisciplinary guidelines and further research on establishing optimal treatment strategies is warranted.
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spelling pubmed-104826342023-09-08 Recommended first-line management of asymptomatic brain metastases from EGFR mutant and ALK positive non-small cell lung cancer varies significantly according to specialty: an international survey of clinical practice Fong, Chin Heng Meti, Nicholas Kruser, Timothy Weiss, Jessica Liu, Zhihui Amy Takami, Hirokazu Narita, Yoshitaka de Moraes, Fabio Ynoe Dasgupta, Archya Ong, Choo Khoon Yang, James C. H. Lee, Jih Hsiang Kosyak, Natalya Pavlakis, Nicholas Kongkham, Paul Doherty, Mark Leighl, Natasha B. Shultz, David B. J Thorac Dis Original Article BACKGROUND: The role for radiotherapy or surgery in the upfront management of brain metastases (BrM) in epidermal growth factor receptor mutant (EGFRm) or anaplastic lymphoma kinase translocation positive (ALK+) non-small cell lung cancer (NSCLC) is uncertain because of a lack of prospective evidence supporting tyrosine kinase inhibitor (TKI) monotherapy. Further understanding of practice heterogeneity is necessary to guide collaborative efforts in establishing guideline recommendations. METHODS: We conducted an international survey among medical (MO), clinical (CO), and radiation oncologists (RO), as well as neurosurgeons (NS), of treatment recommendations for asymptomatic BrM (in non-eloquent regions) EGFRm or ALK+ NSCLC patients according to specific clinical scenarios. We grouped and compared treatment recommendations according to specialty. Responses were summarized using counts and percentages and analyzed using the Fisher exact test. RESULTS: A total of 449 surveys were included in the final analysis: 48 CO, 85 MO, 60 NS, and 256 RO. MO and CO were significantly more likely than RO and NS to recommend first-line TKI monotherapy, regardless of the number and/or size of asymptomatic BrM (in non-eloquent regions). Radiotherapy in addition to TKI as first-line management was preferred by all specialties for patients with ≥4 BrM. NS recommended surgical resection more often than other specialties for BrM measuring >2 cm. CONCLUSIONS: Recommendations for the management of BrM from EGFRm or ALK+ NSCLC vary significantly according to oncology sub-specialties. Development of multidisciplinary guidelines and further research on establishing optimal treatment strategies is warranted. AME Publishing Company 2023-08-14 2023-08-31 /pmc/articles/PMC10482634/ /pubmed/37691657 http://dx.doi.org/10.21037/jtd-22-697 Text en 2023 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Fong, Chin Heng
Meti, Nicholas
Kruser, Timothy
Weiss, Jessica
Liu, Zhihui Amy
Takami, Hirokazu
Narita, Yoshitaka
de Moraes, Fabio Ynoe
Dasgupta, Archya
Ong, Choo Khoon
Yang, James C. H.
Lee, Jih Hsiang
Kosyak, Natalya
Pavlakis, Nicholas
Kongkham, Paul
Doherty, Mark
Leighl, Natasha B.
Shultz, David B.
Recommended first-line management of asymptomatic brain metastases from EGFR mutant and ALK positive non-small cell lung cancer varies significantly according to specialty: an international survey of clinical practice
title Recommended first-line management of asymptomatic brain metastases from EGFR mutant and ALK positive non-small cell lung cancer varies significantly according to specialty: an international survey of clinical practice
title_full Recommended first-line management of asymptomatic brain metastases from EGFR mutant and ALK positive non-small cell lung cancer varies significantly according to specialty: an international survey of clinical practice
title_fullStr Recommended first-line management of asymptomatic brain metastases from EGFR mutant and ALK positive non-small cell lung cancer varies significantly according to specialty: an international survey of clinical practice
title_full_unstemmed Recommended first-line management of asymptomatic brain metastases from EGFR mutant and ALK positive non-small cell lung cancer varies significantly according to specialty: an international survey of clinical practice
title_short Recommended first-line management of asymptomatic brain metastases from EGFR mutant and ALK positive non-small cell lung cancer varies significantly according to specialty: an international survey of clinical practice
title_sort recommended first-line management of asymptomatic brain metastases from egfr mutant and alk positive non-small cell lung cancer varies significantly according to specialty: an international survey of clinical practice
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482634/
https://www.ncbi.nlm.nih.gov/pubmed/37691657
http://dx.doi.org/10.21037/jtd-22-697
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