As part of a multi-institutional effort spanning three countries, Miami Cancer Institute has contributed to groundbreaking analysis that reveals overall median survival for patients with brain metastases has improved over time.
Moreover, the analysis identifies that certain subsets of brain metastases have substantially better survival. This has lead to the creation of an algorithm to estimate patient survival, individualize treatment, and stratify clinical trials. Given the survival improvement and current availability of therapies that can effectively treat brain metastases, these patients should no longer be excluded from clinical trials.
Results of this analysis were recently reported in the Journal of Clinical Oncology, https://doi.org/10.1200/JCO.20.01255 examining a database of 6,984 patients from 18 institutions in the United States, Canada and Japan. Among the key results is that the median survival for brain metastases patients has improved, but varies by subset: lung cancer, 7-47 months; breast cancer, 3-36 months; melanoma, 5-34 months; gastrointestinal cancer, 3-17 months; and renal cancer, 4-35 months. As such, the findings led to the evolution of an algorithm to assess a patient’s survival.
“Our report evaluates the outcomes of patients with brain metastases in the modern era, identifying variables that can predict survival for a given patient,” said Minesh Mehta, M.D., deputy director and chief of radiation oncology at Miami Cancer Institute, as well as senior author of the report. “We’ve found that there are subcategories of patients who have substantially better survival – we’re talking survival in years compared to months. No longer is itappropriate to categorize all patients with brain metastases as having just one outcome.”
Previously, the authors of the report developed and refined a Graded Prognostic Assessment (GPA), a diagnosis-specific index for patients with brain metastases. Those prognostic factors were weighted in proportion to their significance and scaled so that patients with the best or worst prognosis would have a GPA of 4.0 or 0.0, respectively. The new findings gather updated GPAs into a single report to define the eligibility quotient, which would identify patients best suited for clinical trials.
These updated GPAs are now available as a free tool for clinicians to accurately estimate a patient’s survival, individualize treatment and stratify clinical trials and can be accessed at www.brainmetgpa.com.
“No longer does one need to speculate or guess to make a prediction on a brain metastases patient’s survival. Our GPA tool is extremely accurate and helpful in guiding a patient’s decision-making,” said Dr. Mehta. “It allows for a robust and accurate discussion of options between the patient and the clinician in a matter of minutes.”
In the United States alone, an estimated 300,000 patients are diagnosed each year with brain metastases. In the remote past, the average survival for brain metastases patients was poor at only about 3-6 months, and the majority of patients could not effectively be treated with most systemic therapies. It was not uncommon for these patients to be treated in a palliative manner and referred to hospice. With the advent of this new analysis, instead of excluding patients with brain metastases from clinical trials, it is recommended for enrollment to be encouraged and for thetrials to be stratified to ensure appropriate comparisons are made.
“It becomes a self-fulfilling prophecy if we start assuming that brain metastases patients are going to have poor survival and therefore, we don’t enrol them in trials with agents that could be effective for their treatment. Instead, if we recognize that these patients can have better survival and enrol them on these trials, we might in fact identify newer agents that are more effective,” said Dr. Mehta. “What’s important to recognize is that we have to stratify clinical trials because patients with brain metastases have different survival rates. We have to have different categories, which will ultimately balance the arms of clinical trials.”
- For information about clinical trials currently underway at Miami Cancer Institute, please visit: https://cancer.baptisthealth.net/miami-cancer-institute/clinical-trials.
