Incidence of lung cancer brain metastases has increased during COVID-19
Patients with non-small cell lung cancer presented with brain metastases at higher rates during the COVID-19 pandemic compared with historical rates, according to prospective data presented at European Lung Cancer Virtual Congress 2021.
Over a 5-month period in 2020, researchers reported an incidence of new brain metastases of 39% among patients with stage IV NSCLC, compared with historical rates of 25%.
“Due to the delay in diagnostic procedures and later patient presentation, we hypothesized that patients were potentially being diagnosed later with more advanced disease,” Wanyuan Cui, MD, medical oncologist in the department of medicine (lung) at The Royal Marsden Hospital-NHS Foundation Trust in London, told Healio.
“We should consider staging brain imaging in all patients with stage IV non-small cell lung cancer, regardless of presence of symptoms suggestive of brain metastases,” Cui added.
The analysis included 172 consecutive patients with stage IV NSCLC treated at The Royal Marsden Hospital from June to November of 2020. Among them, 95 (55%) underwent brain imaging. These patients tended to be younger (median age, 70 years vs. 74 years), had better ECOG performance status (0, 17% vs. 6%; 1-2, 72% vs. 48%, 3-4, 11% vs. 35%) and were more likely to have received systemic therapy (67% vs. 42%) than those who did not undergo brain imaging.
Among the patients who underwent imaging, 37 (39%) had brain metastases. Of them, 13 (35%) were asymptomatic, a finding Cui described as surprising. Imaging confirmed brain metastases among 24 of 34 patients (66%) who underwent imaging for symptoms.
Forty-four percent of patients who had one to five brain metastases were asymptomatic compared with 10% of patients with six or more brain metastases.
Ten patients with brain metastases, including five who were asymptomatic, underwent stereotactic radiosurgery. Of the remaining 27 patients with brain metastases, 12 received a tyrosine kinase inhibitor alone, four received palliative radiotherapy, eight were deemed unfit for treatment, one was monitored, and two died. Eleven (30%) of the patients with brain metastases received no systemic therapy.
After median follow-up of 6.2 months, 57 (33%) patients had died.
Overall, there was no difference in survival among patients who underwent brain imaging compared with those who did not (HR = 0.85; 95% CI, 0.5-1.46).
Among the group that underwent brain imaging, researchers observed no survival differences among those with vs. without brain metastases (HR = 1.38; 95% CI, 0.72-2.97), nor for those with symptomatic vs. asymptomatic metastases (HR = 0.46; 95% CI, 0.16-1.3).
Cui said the 14 percentage-point increase in brain metastases incidence during the period they examined in 2020, compared with a 25% historical rate, could “potentially” be tied to patients undergoing less frequent monitoring during the COVID-19 pandemic. Further research should evaluate outcomes of patients who are treated early vs. late for asymptomatic brain metastases, she added.
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Cui W, et al. Abstract 180P. Presented at: European Lung Cancer Virtual Congress 2021; March 25-27, 2021.