Lung cancer (Amsterdam, Netherlands) · 2025
Overall survival in patients with non-small cell lung cancer and leptomeningeal metastases: Data from the Dutch cancer Registry.
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Huijs Jarno W J, Ogliari Francesca R, Damhuis Ronald A M, Jongbloed Mandy, Broen Martinus P G, Anten Monique H M E, Brandsma Dieta, Degens Juliette H R J, De Ruysscher Dirk K M, Hendriks Lizza E L
Аннотация
BACKGROUND: Leptomeningeal metastases (LM) at initial diagnosis are a rare manifestation in patients with non-small cell lung cancer (NSCLC), historically associated with poor survival and limited treatment options. With the introduction of immune checkpoint inhibitors (ICIs) and next-generation targeted therapies, treatment opportunities have expanded, but real-world data on patients with LM remain scarce.
MATERIALS AND METHODS: A retrospective cohort study of all patients with NSCLC and baseline LM registered in the Netherlands Cancer Registry between 01-01-2017 and 31-12-2023 was performed. Demographics, disease characteristics, treatment patterns, and survival outcomes were analyzed. Primary endpoint was overall survival (OS). Cox regression analyses were performed to assess prognostic factors.
RESULTS: A total of 259 patients were identified: 133 (51.4 %) received best supportive care (BSC), 27 (10.4 %) chemotherapy-only, 59 (22.8 %) (chemo-)ICI, and 40 (15.4 %) targeted therapy. At diagnosis, 44.8 % of patients had a WHO performance status of 0-1, 47.1 % were male, and 55.2 % were aged over 65 years. Almost all patients (91.5 %) had non-squamous histology. Median OS for BSC, chemotherapy, (chemo-)ICI, and targeted therapy was 1.3 months (95 % CI: 1.0-1.5), 8.0 months (95 % CI: 4.8-11.3), 8.3 months (95 % CI: 5.2-11.3), and 20.5 months (95 % CI: 16.7-24.3), respectively. Multivariable analysis revealed treatment group, cranial radiotherapy, and number of metastatic organs as independent predictors of OS. Targeted therapy provided the most favorable outcomes.
CONCLUSION: Systemic therapies can substantially improve survival in patients with NSCLC with LM at diagnosis and should therefore no longer be considered an automatic exclusion criterion for active treatment.
MATERIALS AND METHODS: A retrospective cohort study of all patients with NSCLC and baseline LM registered in the Netherlands Cancer Registry between 01-01-2017 and 31-12-2023 was performed. Demographics, disease characteristics, treatment patterns, and survival outcomes were analyzed. Primary endpoint was overall survival (OS). Cox regression analyses were performed to assess prognostic factors.
RESULTS: A total of 259 patients were identified: 133 (51.4 %) received best supportive care (BSC), 27 (10.4 %) chemotherapy-only, 59 (22.8 %) (chemo-)ICI, and 40 (15.4 %) targeted therapy. At diagnosis, 44.8 % of patients had a WHO performance status of 0-1, 47.1 % were male, and 55.2 % were aged over 65 years. Almost all patients (91.5 %) had non-squamous histology. Median OS for BSC, chemotherapy, (chemo-)ICI, and targeted therapy was 1.3 months (95 % CI: 1.0-1.5), 8.0 months (95 % CI: 4.8-11.3), 8.3 months (95 % CI: 5.2-11.3), and 20.5 months (95 % CI: 16.7-24.3), respectively. Multivariable analysis revealed treatment group, cranial radiotherapy, and number of metastatic organs as independent predictors of OS. Targeted therapy provided the most favorable outcomes.
CONCLUSION: Systemic therapies can substantially improve survival in patients with NSCLC with LM at diagnosis and should therefore no longer be considered an automatic exclusion criterion for active treatment.