“High Tumor Burden” in Metastatic Non-Small Cell Lung Cancer: Defining the Concept

Abstract

Oliver Higuera Gómez,1 Amaia Moreno Paul,2 Ana Laura Ortega Granados,3 Silverio Ros Martínez,4 Diego Pérez Parente,5 Pedro Ruiz Gracia,5 Lucía Sáenz Cuervo-Arango,6 Laia Vilà7 1Department of Medical Oncology, La Paz University Hospital, Madrid, Spain; 2Medical Oncology Department, Galdakao University Hospital, Galdakao, Spain; 3Medical Oncology Department, Hospital of Jaen, Jaen, Spain; 4Medical Oncology, Virgen de la Arrixaca University Hospital, Murcia, Spain; 5Lung Cancer, Medical Affairs Department, Roche Farma S.A, Madrid, Spain; 6Lung Cancer, Marketing Department, Roche Farma S.A, Madrid, Spain; 7Medical Oncology Department, Parc Taulí University Hospital, Sabadell, SpainCorrespondence: Oliver Higuera GómezDepartment of Medical Oncology, La Paz University Hospital, Paseo de la Castellana, 261, Madrid, 28046, SpainTel [phone]Email [email protected]: Identifying patient characteristics that define a worse disease prognosis or “high tumor burden” (HTB) status is essential for clinical decision-making and treatment selection in metastatic non-small cell lung cancer (mNSCLC). We aimed to define this concept based on the experience of oncologists in clinical practice.Patients and Methods: A representative sample of Spanish experts was selected and asked to complete an online survey regarding the definition of HTB according to their personal experience.Results: HTB was identified by the oncologists (N = 81) as one of the principle factors influencing first-line treatment decision-making. According to the experts, HTB is mainly defined by the number of metastatic lesions (n = 45, 56%), location (n = 34, 42%), tumor size (sum of diameters of target lesions; n = 26, 32%) and liver involvement (n = 24, 30). High lactate dehydrogenase (LDH) levels were also associated with HTB. Almost half of respondents (n = 33, 41%) believed that one metastatic lesion was sufficient to consider a patient as presenting HTB, 72% (n = 58) considered that two were necessary and 99% (n = 80) three. Liver (n = 76, 100%) followed by brain (n = 65, 86%) were the main metastatic sites associated with HTB. Tumor size ranging from 6 cm to 10 cm as well as high LDH levels (three times the upper limit) defined the concept for 82% (n = 62) and 100% (n = 76) of oncologists, respectively.Conclusion: In the real-world setting, according to experts, HTB is defined by the number of metastatic lesions, location of metastases, tumor size and by high LDH levels. Given the relevance of this concept, efforts should be made to unify its definition and to further explore its potential as a prognostic factor for mNSCLC patients.Keywords: non-small cell lung cancer, “high tumor burden”, number of metastases, tumor size, metastatic locations, lactate dehydrogenase

Keywords

• non-small cell lung cancer
• “high tumor burden”
• number of metastases
• tumor size
• metastatic locations
• lactate dehydrogenase