DELAYING INTRACRANIAL PROGRESSION IN NSCLC BRAIN METASTASES: CLINICAL AND PATIENT-CENTERED VALUE...
Author(s)
Remi Bonetto, Dr1, Vincent Bourbonne, MD, PhD2, Steve Braunstein, MD, PhD3, Brian Chang, MD4, Steven Chmura, MD, PhD5, Frederic Dhermain, MD6, Rami El Shafie, MD7, Hideyuki Harada, MD8, Hidehito Horinouchi, MD, PhD9, Tetsuya Mitsudomi, MD10, Takeshi Okuda, MD11, Luc Ollivier, MD12, Haley Perlow, MD13, Ramji Rajendran, MD, PhD14, Stefan Rieken, MD7, Scott Soltys, MD15, Marco Stein, MD16, Ken Tatebe, MD17, Jason C. Ye, MD18.
1Private Hospital Clairval, Marseille, France, 2CHU Brest, Brest, France, 3UCSF, San Francisco, CA, USA, 4Parkview Cancer Institute, Fort Wayne, IN, USA, 5University of Chicago, Chicago, IL, USA, 6Gustave Roussy, Villejuif, France, 7University Hospital Munster, Munster, Germany, 8Shizuoka Cancer Center, Nagaizumi, Japan, 9National Cancer Center Hospital, Tokyo, Japan, 10Izumi City General Hospital, Izumi, Japan, 11Kindai University, Higashiosaka, Japan, 12ICO, Nantes, France, 13University Hospitals Seidman Cancer Center, Case Western Reserve University, Beachwood, OH, USA, 14Uropartners LLC, Chicago, IL, USA, 15Stanford University, Stanford, CA, USA, 16University Hospital Giessen, Giessen, Germany, 17Rush University, Chicago, IL, USA, 18Keck School of Medicine of USC, Los Angeles, CA, USA.
1Private Hospital Clairval, Marseille, France, 2CHU Brest, Brest, France, 3UCSF, San Francisco, CA, USA, 4Parkview Cancer Institute, Fort Wayne, IN, USA, 5University of Chicago, Chicago, IL, USA, 6Gustave Roussy, Villejuif, France, 7University Hospital Munster, Munster, Germany, 8Shizuoka Cancer Center, Nagaizumi, Japan, 9National Cancer Center Hospital, Tokyo, Japan, 10Izumi City General Hospital, Izumi, Japan, 11Kindai University, Higashiosaka, Japan, 12ICO, Nantes, France, 13University Hospitals Seidman Cancer Center, Case Western Reserve University, Beachwood, OH, USA, 14Uropartners LLC, Chicago, IL, USA, 15Stanford University, Stanford, CA, USA, 16University Hospital Giessen, Giessen, Germany, 17Rush University, Chicago, IL, USA, 18Keck School of Medicine of USC, Los Angeles, CA, USA.
OBJECTIVES: To assess the clinical and humanistic value of delaying intracranial progression (ICP) in patients with brain metastases from non-small cell lung cancer (NSCLC), focusing on impacts to cognition, independence, and functional outcomes beyond survival.
METHODS: An issues panel was conducted with 19 multidisciplinary experts from the United States, Japan, Germany, and France. Participants included radiation oncologists, medical oncologists, and neurosurgeons. Pre-meeting inputs included a targeted literature review and structured questionnaire. A 3-hour moderated discussion explored clinical, humanistic, and economic domains, including ICP measurement, neurologic function, cognition, treatment pathways, independence, psychological burden, and caregiver impact. Qualitative insights were derived from transcript review and thematic synthesis to identify key themes, areas of agreement, and evidence gaps, informing subsequent Delphi statement development.
RESULTS: Experts consistently identified ICP delay as clinically meaningful, even without overall survival benefit. A substantial delay in ICP was viewed as significant, given its association with preserved neurologic function, maintained cognition, and reduced need for corticosteroids and intensive interventions. ICP was also recognized as a key driver of treatment pathways. Progression prompted increased imaging, escalation to additional local or systemic therapies, and higher healthcare utilization, whereas delaying ICP was associated with longer periods without treatment escalation. Humanistic benefits from ICP delay included reduced scan-related anxiety and helped maintain independence, including the ability to drive and perform daily activities. Loss of independence was viewed as a major inflection point for patients and caregivers. Functional impact varied by lesion location and timing. Despite their importance, cognition, functional status, and psychological burden are rarely measured systematically in routine practice, limiting their incorporation into HEOR and value assessments.
CONCLUSIONS: Delaying ICP preserves function, independence, and cognition. These benefits are meaningful but not captured by traditional endpoints, highlighting the need for more patient-centered measures of value.
METHODS: An issues panel was conducted with 19 multidisciplinary experts from the United States, Japan, Germany, and France. Participants included radiation oncologists, medical oncologists, and neurosurgeons. Pre-meeting inputs included a targeted literature review and structured questionnaire. A 3-hour moderated discussion explored clinical, humanistic, and economic domains, including ICP measurement, neurologic function, cognition, treatment pathways, independence, psychological burden, and caregiver impact. Qualitative insights were derived from transcript review and thematic synthesis to identify key themes, areas of agreement, and evidence gaps, informing subsequent Delphi statement development.
RESULTS: Experts consistently identified ICP delay as clinically meaningful, even without overall survival benefit. A substantial delay in ICP was viewed as significant, given its association with preserved neurologic function, maintained cognition, and reduced need for corticosteroids and intensive interventions. ICP was also recognized as a key driver of treatment pathways. Progression prompted increased imaging, escalation to additional local or systemic therapies, and higher healthcare utilization, whereas delaying ICP was associated with longer periods without treatment escalation. Humanistic benefits from ICP delay included reduced scan-related anxiety and helped maintain independence, including the ability to drive and perform daily activities. Loss of independence was viewed as a major inflection point for patients and caregivers. Functional impact varied by lesion location and timing. Despite their importance, cognition, functional status, and psychological burden are rarely measured systematically in routine practice, limiting their incorporation into HEOR and value assessments.
CONCLUSIONS: Delaying ICP preserves function, independence, and cognition. These benefits are meaningful but not captured by traditional endpoints, highlighting the need for more patient-centered measures of value.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
PCR30
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
SDC: Oncology