Genomic Alterations and the Incidence of Brain Metastases in Advanced and Metastatic NSCLC: A Systematic Review and Meta-Analysis.

Autor:	Gillespie CS; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom., Mustafa MA; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom., Richardson GE; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom., Alam AM; Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom., Lee KS; Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom., Hughes DM; Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom., Escriu C; Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom., Zakaria R; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom. Electronic address: rzakaria@liverpool.ac.uk.
Jazyk:	angličtina
Zdroj:	Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer [J Thorac Oncol] 2023 Dec; Vol. 18 (12), pp. 1703-1713. Date of Electronic Publication: 2023 Jun 29.
DOI:	10.1016/j.jtho.2023.06.017
Abstrakt:	Introduction: Brain metastases (BMs) in patients with advanced and metastatic NSCLC are linked to poor prognosis. Identifying genomic alterations associated with BM development could influence screening and determine targeted treatment. We aimed to establish prevalence and incidence in these groups, stratified by genomic alterations. Methods: A systematic review and meta-analysis compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were conducted (PROSPERO identification CRD42022315915). Articles published in MEDLINE, EMBASE, and Cochrane Library between January 2000 and May 2022 were included. Prevalence at diagnosis and incidence of new BM per year were obtained, including patients with EGFR, ALK, KRAS, and other alterations. Pooled incidence rates were calculated using random effects models. Results: A total of 64 unique articles were included (24,784 patients with NSCLC with prevalence data from 45 studies and 9058 patients with NSCLC having incidence data from 40 studies). Pooled BM prevalence at diagnosis was 28.6% (45 studies, 95% confidence interval [CI]: 26.1-31.0), and highest in patients that are ALK-positive (34.9%) or with RET-translocations (32.2%). With a median follow-up of 24 months, the per-year incidence of new BM was 0.13 in the wild-type group (14 studies, 95% CI: 0.11-0.16). Incidence was 0.16 in the EGFR group (16 studies, 95% CI: 0.11-0.21), 0.17 in the ALK group (five studies, 95% CI: 0.10-0.27), 0.10 in the KRAS group (four studies, 95% CI: 0.06-0.17), 0.13 in the ROS1 group (three studies, 95% CI: 0.06-0.28), and 0.12 in the RET group (two studies, 95% CI: 0.08-0.17). Conclusions: Comprehensive meta-analysis indicates a higher prevalence and incidence of BM in patients with certain targetable genomic alterations. This supports brain imaging at staging and follow-up, and the need for targeted therapies with brain penetrance. (Copyright © 2023 International Association for the Study of Lung Cancer. All rights reserved.)
Databáze:	MEDLINE
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