Changing characteristics, treatment approaches and survival of patients with brain metastasis: data from six thousand and thirty-one individuals over an observation period of 30 years

Background: An accurate classification of patients with brain metastases (BMs) is an important foundation to guide individualised treatment decisions and to formulate BM cohorts for modern clinical trials. Methods: Six thousand and thirty-one patients with newly diagnosed BM from different solid tumours treated between 1986 and 2020 were identified from the Vienna Brain Metastasis Registry. Results: A rising fraction of patients presented with asymptomatic BM during the observation period (1986-1999: 20.2% vs 2010-2020: 30.6%; p < 0.001). Especially, oncogene-addicted non-small-cell lung cancer (NSCLC) and BRAF (v-Raf murine sarcoma viral oncogene homolog)-positive melanoma had a higher rate of asymptomatic BM presentation compared with wild-type tumours (p < 0.05). Significant changes of initial BM treatment approaches were observed with a decrease of neurosurgical procedures (1986-1999: 30.8% vs 2010-2020: 19.5%) and an increase of radiation treatments (1986-1999: 65.0% vs 2010-2020: 73.3%) and systemic therapies (1986-1999: 1.0% vs 2010-2020: 2.0%; p < 0.001). Median overall survival (OS) was heterogeneous between primary tumour entities but with an overall increase over the decades (median OS 1986-1999: 5 months vs 2010-2020: 7 months; p Z 0.001). Sur-vival times were longer in patients with oncogene-addicted NSCLC, BRAF-positive mela-noma and hormone receptor-positive breast cancer compared with the other cancer subtypes (p > 0.05). Conclusion: Our data highlight shifting trends in the symptomatic presentation and in treat-ment strategies of patients with BM over the last decades. Entity specific aspects and, in partic-ular, the presence of targetable driver mutation impact the clinical presentation and prognosis. Future BM specific trials need to address the modern composition of BM cohorts and the distinct clinical course of patients with targetable driver mutations. 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

Patient classification is crucial for guiding individualized treatment decisions and forming brain metastases (BMs) cohorts for clinical trials. The study reveals shifting trends in the presentation and treatment strategies of BM patients over the past decades. The presence of targetable driver mutations affects the clinical presentation and prognosis, emphasizing the need to address the modern composition of BM cohorts and the distinct clinical course of patients with targetable driver mutations in future BM-specific trials.