Journal article
Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient
Journal of clinical oncology, Vol.38(32), pp.3773-3784
11/10/2020
DOI: 10.1200/JCO.20.01255
PMCID: PMC7655019
PMID: 32931399
Abstract
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.
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.
Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (
< .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.
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).
Details
- Title: Subtitle
- Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient
- Creators
- Paul W Sperduto - Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, Minneapolis, MN.Shane Mesko - The University of Texas MD Anderson Cancer CenterJing Li - The University of Texas MD Anderson Cancer CenterDaniel Cagney - Dana-Farber Cancer InstituteAyal Aizer - Dana-Farber Cancer InstituteNancy U Lin - Dana-Farber Cancer Institute, Boston, MAEric Nesbit - Northwestern Univ, Chicago, IL;Tim J Kruser - Northwestern Univ, Chicago, IL;Jason Chan - University of California, San FranciscoSteve Braunstein - University of California, San FranciscoJessica Lee - Duke UniversityJohn P Kirkpatrick - Duke UniversityWill Breen - Mayo Clinic, Rochester, MNPaul D Brown - Mayo Clinic Rochester, MNDiana Shi - Massachusetts General HospitalHelen A Shih - Massachusetts General HospitalHany Soliman - Sunnybrook Health Science CentreArjun Sahgal - Sunnybrook Health Science CentreRyan Shanley - University of MinnesotaWilliam A Sperduto - Duke UniversityEmil Lou - University of MinnesotaAshlyn Everett - University of Alabama at BirminghamDrexell H Boggs - University of Alabama at BirminghamLaura Masucci - Centre Hospitalier de l’Université de MontréalDavid Roberge - Centre Hospitalier de l’Université de MontréalJill Remick - University of Maryland, BaltimoreKristin Plichta - University of IowaJohn M Buatti - University of IowaSupriya Jain - University of Colorado Anschutz Medical CampusLaurie E Gaspar - University of Colorado DenverCheng-Chia Wu - Columbia UniversityTony J C Wang - Columbia UniversityJohn Bryant - Miami Cancer Institute, Miami, FL.Michael Chuong - Miami Cancer Institute, Miami, FL.Yi An - Yale UniversityVeronica Chiang - Yale UniversityToshimichi Nakano - University of Niigata, Niigata, Japan.Hidefumi Aoyama - Hokkaido UniversityMinesh P Mehta - Miami Cancer Institute, Miami, FL.
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.38(32), pp.3773-3784
- DOI
- 10.1200/JCO.20.01255
- PMID
- 32931399
- PMCID
- PMC7655019
- NLM abbreviation
- J Clin Oncol
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Grant note
- P30 CA077598 / NCI NIH HHS UL1 TR002494 / NCATS NIH HHS
- Language
- English
- Date published
- 11/10/2020
- Academic Unit
- Radiation Oncology; Neurosurgery; Otolaryngology
- Record Identifier
- 9984304038402771
Metrics
17 Record Views