Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient
| Autor: | Daniel N. Cagney, Shane Mesko, Diana D. Shi, Emil Lou, John Bryant, Supriya K. Jain, Hany Soliman, Arjun Sahgal, John P. Kirkpatrick, Eric Nesbit, Kristin A. Plichta, Cheng-Chia Wu, Steve Braunstein, Ashlyn S. Everett, Laurie E. Gaspar, Ryan Shanley, Drexell Hunter Boggs, Laura Masucci, Yi An, Jessica W. Lee, Ayal A. Aizer, Jing Li, William Sperduto, Paul D. Brown, Minesh P. Mehta, William G. Breen, Tim J. Kruser, Toshimichi Nakano, Hidefumi Aoyama, Veronica Chiang, Jill Remick, Paul W. Sperduto, John M. Buatti, Nan Lin, Tony J. C. Wang, Michael D. Chuong, Jason Chan, David Roberge, Helen A. Shih |
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| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine Oncology Cancer Research medicine.medical_specialty Multivariate analysis Clinical Sciences Oncology and Carcinogenesis MEDLINE 03 medical and health sciences Rare Diseases 0302 clinical medicine Neoplasms Internal medicine Original Reports 80 and over medicine Humans In patient Oncology & Carcinogenesis Karnofsky Performance Status Precision Medicine Cancer Aged Proportional Hazards Models Aged 80 and over screening and diagnosis Brain Neoplasms business.industry Proportional hazards model Middle Aged Prognosis Precision medicine Brain Disorders Brain Cancer Clinical trial Detection 030104 developmental biology Multicenter study 030220 oncology & carcinogenesis Multivariate Analysis Female Neoplasm Grading business 4.2 Evaluation of markers and technologies |
| Zdroj: | J Clin Oncol Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol 38, iss 32 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | PURPOSE 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. METHODS 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. RESULTS Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation ( P < .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. CONCLUSION 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). |
| Databáze: | OpenAIRE |
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