As if COVID-19 hasn’t claimed enough victims around the world, a United Kingdom research group has found another detrimental repercussion of the pandemic.
Their study concluded that the incidence of de novo brain metastases has been higher among patients with stage 4 NSCLC during the COVID19 era (39%) compared with historical rates (25%).
In a poster presentation during the European Lung Cancer Virtual Congress 2021 (abstract 180P), the authors explained that two of the by-products of the pandemic have been reduced rates of diagnostic procedures and late disease presentation, both of which may lead to late diagnosis of NSCLC.
“De novo brain metastases may thus be more common during COVID-19,” they wrote. The researchers also noted the need to define the baseline incidence of brain metastases in asymptomatic NSCLC patients.
To help address these questions, the investigators enrolled 172 consecutive patients who presented to the Royal Marsden Hospital in London between June and November 2020, all of whom had stage IV NSCLC. A total of 95 patients (55%) underwent brain imaging, while the remaining 77 (45%) did not. Data were collected prospectively and analyzed descriptively.
According to principal investigator Wanyuan Cui, MB BS, a Medical Oncologist at the institution, 89% of patients who had brain imaging were Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1-2, compared with only 42% of their counterparts who did not undergo brain imaging. What's more, while 67% of patients who underwent brain imaging received systemic therapy, only 42% of those who had no brain imaging received systemic therapy.
Thirty-seven of 95 patients who underwent brain imaging were found to have brain metastases. Of these, only 65% were symptomatic symptoms. A total of 27 patients had between one and five brain metastases, 12 of whom (44%) were asymptomatic. By comparison, 10 patients had at least six brain metastases, only one of which (10%) was asymptomatic (p=0.07).
Looking at the data another way, the researchers found that only 32 of the 95 patients (34%) who underwent brain imaging actually had symptoms of brain metastases. Of these, 24 (66%) had brain metastases confirmed on imaging. Interestingly, however, 13 of 63 asymptomatic patients (21%) also had brain metastases detected on imaging.
Of the 37 patients who had brain metastases, 10 (27%) underwent stereotactic radiosurgery; five of these individuals were asymptomatic. Among the remaining 27 patients with brain metastases, 12 received tyrosine kinase inhibitors alone, four received palliative radiotherapy, and one was monitored. Eight individuals were deemed to be unfit for treatment, and two patients died. Eleven of the 37 patients (30%) with brain metastases did not receive systemic therapy, the result of poor ECOG performance status in 17 individuals and patient wishes in the other four.
Mortality outcomes were assessed in February 2021, after a median follow-up period of 6.2 months. At that point, 57 patients (33%) had died. Among patients who underwent baseline brain imaging, no statistically significant difference was found in terms of in survival between those with brain metastases and those without (hazard ratio 1.38; p=0.37). In patients with brain metastases, there was no statistically significant difference in survival between those who were symptomatic and their counterparts had no symproms (HR 0.46; p=0.14). Finally, the investigators found no differences in survival between patients who did and did not have baseline brain imaging (HR 0.85; p=0.56).
These results, the researchers concluded, demonstrate that the incidence of brain metastases has been greater in NSCLC patients COVID19 than historical data demonstrate (25%).
“Brain imaging should be considered in all patients with a new diagnosis of stage 4 NSCLC,” the authors wrote. “Whether early diagnosis and treatment of brain metastases affects survival will need to be explored.”