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

Oliver Higuera Gómez; Amaia Moreno Paul; Ana Laura Ortega Granados; Silverio Ros Martínez; Diego Pérez Parente; Pedro Ruiz Gracia; Lucía Sáenz Cuervo-Arango; Laia Vilà

doi:10.2147/CMAR.S302928

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

Cancer Manag Res. 2021 Jun 14:13:4665-4670. doi: 10.2147/CMAR.S302928. eCollection 2021.

Authors

Oliver Higuera Gómez¹, Amaia Moreno Paul², Ana Laura Ortega Granados³, Silverio Ros Martínez⁴, Diego Pérez Parente⁵, Pedro Ruiz Gracia⁵, Lucía Sáenz Cuervo-Arango⁶, Laia Vilà⁷

Affiliations

¹ Department of Medical Oncology, La Paz University Hospital, Madrid, Spain.
² Medical Oncology Department, Galdakao University Hospital, Galdakao, Spain.
³ Medical Oncology Department, Hospital of Jaen, Jaen, Spain.
⁴ Medical Oncology, Virgen de la Arrixaca University Hospital, Murcia, Spain.
⁵ Lung Cancer, Medical Affairs Department, Roche Farma S.A, Madrid, Spain.
⁶ Lung Cancer, Marketing Department, Roche Farma S.A, Madrid, Spain.
⁷ Medical Oncology Department, Parc Taulí University Hospital, Sabadell, Spain.

Abstract

Purpose: 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: lactate dehydrogenase; metastatic locations; non-small cell lung cancer; number of metastases; tumor size; “high tumor burden”.

Grants and funding

This work was sponsored by Roche Farma S.A., Spain. Qualified researchers may request access to individual patient level data through the clinical study data request platform (https://vivli.org/). Further details on Roche’s criteria for eligible studies are available here (https://vivli.org/members/ourmembers/). For further details on Roche’s Global Policy on the Sharing of Clinical Information and how to request access to related clinical study documents, see here: https://www.roche.com/research_and_development/who_we_are_how_we_work/clinical_trials/our_commitment_to_data_sharing.htm.