Health Resource Utilization and CNS Metastases in EGFR-Mutant Advanced NSCLC


Key Points

  • Patients with CNS metastases had increased health source utilization.
  • Researchers noted that use of newer systemic treatment options may reduce or delay the development of CNS metastases and reduce associated utilization.

In a single-center study reported in the Journal of Oncology Practice, Chooback et al found that central nervous system (CNS)  metastases are frequent in patients with EGFR-mutant advanced non­–small cell lung cancer (NSCLC) and are associated with increased health resource utilization. Researchers noted that newer systemic therapies may reduce the incidence of metastases and reduce resource utilization.

Study Details

The study was a retrospective review of data from 499 patients referred to BC Cancer and treated with first- and/or second-generation EGFR tyrosine kinase inhibitors from 2010 to 2015. Overall, 229 patients (46%) had CNS metastases; of them, 39% had metastases at diagnosis, and 61% subsequently developed metastases (61%). CNS metastases were managed with surgery with or without whole-brain radiotherapy (13%), whole-brain radiotherapy alone (73%), stereotactic radiosurgery with or without whole-brain radiotherapy (5%), or no CNS-directed therapy (9%). Health resource utilization was compared for patients with CNS-negative disease and those with CNS metastases from the median time of CNS metastases diagnosis to death or last follow-up (9.1 months) and at 9 months preceding death or last follow-up for the CNS-negative group.

Health Resource Utilization

CNS-negative patients had reduced health resource utilization vs patients who were CNS-positive in the 9 months preceding death or last follow-up, including a lower average number of clinic visits (8.53 vs 12.71, P < .001), hospitalizations (0.43 vs 0.76, P < .001), CNS-imaging investigations (0.52 vs 2.65, P < .001), emergency room visits (0.03 vs 0.14, P = .001), palliative care unit admission (8% vs 10%, P = .64), and hospice admission (3% vs 19%, P < .001).

The investigators concluded, “The incidence of CNS metastases in patients with EGFR mutation is high and associated with increased [health resource utilization]. Prevention or delay of CNS metastases with newer systemic therapy options may translate into lower resource utilization.”

The study was supported by the BC Cancer Foundation, Eleni Skalbania Endowment fund for lung cancer research, and AstraZeneca.

Cheryl Ho, MD, FRCPC, of BC Cancer, Vancouver, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.