Validation of the ALK-Brain Prognostic Index for patients with ALK-rearranged lung cancer and brain metastases

• Verfasst von: Zerdes, Ioannis [VerfasserIn]
• Verfasst von: Kamali, C. [VerfasserIn]
• Verfasst von: Koulouris, A. [VerfasserIn]
• Verfasst von: El Sayed, Mei [VerfasserIn]
• Verfasst von: Schnorbach, Johannes [VerfasserIn]
• Verfasst von: Christopoulos, Petros [VerfasserIn]
• Verfasst von: Tsakonas, G. [VerfasserIn]
• Titel: Validation of the ALK-Brain Prognostic Index for patients with ALK-rearranged lung cancer and brain metastases
• Verf.angabe: I. Zerdes, C. Kamali, A. Koulouris, M. Elsayed, J. Schnorbach, P. Christopoulos, & G. Tsakonas
• E-Jahr: 2023
• Jahr: 20 November 2023
• Umfang: 7 S.
• Fussnoten: Gesehen am 08.05.2024
• Titel Quelle: Enthalten in: ESMO open
• Ort Quelle: London : BMJ, 2016
• Jahr Quelle: 2023
• Band/Heft Quelle: 8(2023), 6, Artikel-ID 102069, Seite 1-7
• ISSN Quelle: 2059-7029
• DOI: doi:10.1016/j.esmoop.2023.102069
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: ALK-BPI
• Sach-SW: brain metastases
• Sach-SW: non-small-cell lung cancer
• Sach-SW: prognosis
• K10plus-PPN: 1888146591

Abstract

Background - Brain metastases (BMs) are a key challenge in the management of anaplastic lymphoma kinase-rearranged non-small-cell lung cancer (ALK+ NSCLC), but prognostic scores are complicated or rely on data before the era of tyrosine kinase inhibitors (TKIs). This study aimed to validate the novel ALK-Brain Prognostic Index (ALK-BPI), which was originally proposed based on 44 TKI-treated ALK+ NSCLC patients from Karolinska University Hospital, using an external clinical cohort. - Patients and methods - TKI-treated ALK+ NSCLC patients with BM from Heidelberg (n = 82, cohort 1) were retrospectively analyzed alone and together with the original Karolinska cohort (n = 126, cohort 2). Cox regression models were used to determine the association of clinical variables and scores with overall survival (OS) after BM diagnosis (BM-related OS). - Results - Both cohorts showed a similar median age (58 years), roughly balanced sex distributions (52%-56% females), and Eastern Cooperative Oncology Group performance status (PS) 0-2 for most patients (87%-92%) at the time of BM development, which were present already at initial diagnosis in 36%-38% of the patients. Most patients had received next-generation ALK inhibitors (54%-63%), while 55%-56% of patients did not receive any radiotherapy. The ALK-BPI identified poor-risk patients (i.e. featuring ≥ 2/3 risk factors: PS > 2, male sex, development of BM after initial diagnosis) with a significantly shorter BM-related OS than other patients in both cohorts: 32/82 in cohort 1 with 21.3 versus 62.2 months in median [hazard ratio (HR) = 2.5, P < 0.001]; 59/126 in cohort 2 with 23.1 versus 67.2 months in median (HR = 2.6, P < 0.001). The five-parameter Lung-molGPA score did not achieve statistical significance and/or clear prognostic separation in all four groups, while the Disease-Specific Graded Prognostic Assessment score did not show consistent results. - Conclusions - The ALK-BPI is a reliable tool for easy prognostic dichotomization of TKI-treated ALK+ NSCLC patients with BM in daily clinical practice, without the complexity of previous models.