EORTC survey on 1st line management of patients with oncogene driven, advanced NSCLC and brain metastases

Brain metastases (BMs) are a frequent complication in patients with oncogene driven non-small cell lung cancer (NSCLC). To obtain a better insight into the current treatment patterns for these patients, the EORTC performed a large survey in a panel of European medical and radiation oncologists. In this video, Prof Mariana Brandao shares the key results of this survey as presented during the 2025 annual WCLC meeting.

The online survey was distributed among EORTC and ESTRO members between June 2023 and July 2024 with questions addressing treatment access and preferences for 10 different oncogenes (EGFR, ALK, ROS1, RET, MET, KRAS, HER2, EGFRex20, NTRK, BRAF). In total, 166 participants filled in the survey, including 57% of medical oncologists and 41% of radiation oncologist. 

Access to TT differed across oncogenes, with the highest access (~98%) for agents targeting EGFR and ALK and the lowest access for TT against NTRK and HER2 (~60%). Overall, the preferred treatment for asymptomatic BMs consisted of TT (68.8%) while it was local therapy (42.9%) in case of symptomatic BMs. Interestingly, differences were also observed between specialities, with a higher level of confidence in TT among medical oncologists vs. radiation oncologists (74% vs. 54.2% for asymptomatic and 29% vs. 10% for symptomatic BMs). Furthermore, also the type of the oncogene influenced the preference for TT, both in patients with symptomatic and asymptomatic BMs. In addition, the survey revealed that almost half of the participants do not give TT concurrently with cranial radiotherapy. 

In brief, this survey shows that the management of BMs differs between symptomatic and asymptomatic patient, but also between oncogenes and across specialities. Research efforts should be directed to improve evidence-based decision-making via dedicated clinical trials and/or prospective data collection.