Survival in Patients With Brain Metastases: Limited or Stable Extracranial Disease

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In a systematic review and meta-analysis reported in JAMA Network Open, Li et al found that patients with intracranial metastatic disease in the context of limited or stable extracranial disease (IMD-SE) secondary to any primary cancer had improved overall survival vs those with intracranial metastatic disease in the setting of progressive extracranial disease (IMD-PE).

Study Details

A total of 68 studies with data on 5,325 patients with IMD-SE (defined as intracranial metastatic disease with two or fewer extracranial metastatic sites) and 1,466 patients with IMD-PE (intracranial metastatic disease with unstable, disseminated extracranial disease, or not fulfilling criteria for IMD-SE) were included in the analysis. Patients had received no prior second-line chemotherapy or second-line brain-directed therapy.

Most studies of single-type primary cancers were in non–small cell lung cancer (NSCLC); 25 studies included multiple primary cancers. Median follow-up in the studies ranged from 4.7 to 102 months.

Key Findings

IMD-SE was associated with significantly improved overall survival vs IMD-PE (hazard ratio [HR] = 0.52, 95% confidence interval [CI] = 0.39–0.70). Weighted median overall survival estimates were 17.9 months (95% CI = 16.4–22.0 months) in the IMD-SE group vs 8.0 months (95% CI = 7.2–12.8 months) in the IMD-PE group.

IMD-SE was associated with significantly better intracranial progression-free survival vs IMD-PE (HR = 0.63, 95% CI = 0.52–0.76). Weighted intracranial progression-free survival estimates were 13.6 months (95% CI = 5.0–13.6 months) in the IMD-SE group vs 5.5 months (95% CI = 1.9–5.5 months) in the IMD-PE group.

Overall, the pooled median overall survival among patients with IMD-SE was 20.9 months (95% CI = 16.35–25.98 months), including 20.2 months (95% CI = 10.43–38.20 months) in patients with breast cancer and 27.5 months (95% CI = 18.27–49.66 months) in patients with NSCLC.

The investigators concluded, “In this systematic review and meta-analysis of patients with IMD-SE, limited systemic disease was associated with improved overall survival and intracranial progression-free survival. Future prospective trials should aim to collect granular information on the extent of extracranial disease to identify drivers of mortality and optimal treatment strategies in patients with brain metastases.”

Sunit Das, MD, PhD, of the Division of Neurosurgery, Department of Surgery, University of Toronto, is the corresponding author for the JAMA Network Open article.

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