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Srinivas Chilukuri
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P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P09.07 - Oncologists Practices and Perceptions on Management of Brain Metastases from Non-Small Cell Lung Cancers-: A Nationally Representative Survey (ID 2199)
00:00 - 00:00 | Presenting Author(s): Srinivas Chilukuri
- Abstract
Introduction
There is a lack of consensus regarding the role and type of intracranial treatment (ICT) in patients of non-small cell lung cancers (NSCLC) with 1-10 asymptomatic brain metastases with or without driver mutations. We embarked on an online survey to understand the common practices and perceptions among oncologists treating lung cancer across the country.
Methods
Participants of this anonymized online survey included medical and radiation oncologists from all over India. Unique links were electronically mailed from a database populated from professional associations. Descriptive statistical analysis was applied to closed-ended questions, expressed as frequency for categorical variables. Chi-square test and Fisher’s exact test was used for comparisons.
Results
The total number of respondents was 445. Sixty-five percent of the respondents were radiation oncologists while 20% were medical oncologists and the rest were clinical oncologists practicing both specialties. Routine MRI brain was part of the staging investigations for NSCLC patients (asymptomatic for brain metastases) in only 57% of the oncologists, with the rest relying only on whole-body PET scans. For patients of NSCLC with asymptomatic brain metastases (1-10 in number) with known driver mutations, the most preferred choice of initial treatment was ICT followed by tyrosine kinase inhibitors (TKI) among 45% of respondents which was followed by TKI alone (with deferment of WBRT) in 39% and rest preferred concurrent TKI and ICT. 66% of oncologists practicing medical oncology (including clinical oncologists) as compared to only 21% radiation oncologists preferred TKI alone (p<0.05). Although the most preferred choice of TKI for EGFR mutations in the above situation was Osimertinib (57%), only 20% of the patients actually receive it. Amongst the respondents who prefer TKI alone, 63% believed that the choice of ICT was dependent on the TKI received by the patient. Respondents who preferred deferring ICT, would change their approach in the presence of leptomeningeal involvement (74%). For patients with ALK mutations, Crizotinib was the most preferred choice (50%). For patients with asymptomatic brain metastases without known driver mutations, upfront ICT was the primary treatment of choice in 81% of respondents. The most preferred ICT of choice was SRS in 72% of respondents, surgery alone in 30% followed by WBRT with SRS boost in 15%. Cerebrospinal fluid (CSF) analysis was routinely advised in only 57% of asymptomatic patients with imaging-based suspicion of leptomeningeal metastases. In patients of metastatic NSCLC with leptomeningeal metastases, the preferred treatment options were a combination of systemic with intrathecal therapies in 39% and WBRT with systemic/intrathecal therapies in 37% of the respondents.
Conclusion
In view of the wide variations in preferences amongst oncologists regarding intracranial management of brain metastases from NSCLC across the Indian sub-continent, there is a need for prospective research to address this debate. Our survey provides significant information that can act as a suitable benchmark to form uniform practice guidelines.
