Author of

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  P3.11 - Poster Session 3 - NSCLC Novel Therapies (ID 211)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P3.11-024 - <strong>QUARTZ</strong><br /><strong>Quality of Life after Treatment for Brain Metastases from Non-Small Cell Lung Cancer: An update on the UK Medical Research Council QUARTZ trial.</strong> (ID 2154)

    09:30 - 09:30  |  Author(s): E. McColl
    • Abstract

    Background
    Approximately one third of all non-small cell lung cancer (NSCLC) patients will develop brain metastases. The majority of such patients are inoperable with a very poor prognosis, and for several decades the standard treatment has been a combination of steroids and whole brain radiotherapy (WBRT). However, little evidence exists to support this approach, and there is continuing debate over the use of WBRT. The diversity of clinical opinion and patient preference makes this a challenging question to address.

    Methods
    The multi-centre randomised QUARTZ trial assesses whether optimal supportive care including steroids (OSC) is a viable alternative to the current standard of OSC plus WBRT, in terms of duration and quality of life (QoL). The primary endpoint of Quality Adjusted Life Years (QALYs) reflects that both quality and duration of survival are important. Disease status, symptoms and QoL data are collected weekly. The impact of the disease and treatment on carers is also being assessed. A total of 534 patients is required to exclude a detriment in terms of QALYs of >1 week with OSC (from 5 weeks with OCS plus WBRT), and the aim was to recruit this number in three years.

    Results
    After four years, only 188 patients had been recruited and a decision was taken to present the interim results to participating clinicians. Interim data (from the first 151 QUARTZ patients)[1] provided no strong evidence that omitting WBRT was detrimental in terms of survival or QoL and there were no clear differences in steroid usage or toxicity. By June 2013 QUARTZ has recruited 438 patients (82%) and 336 carers from 78 UK and Australian centres. Data collection is excellent with 98% of forms returned.

    Conclusion
    Patients with brain metastases (and others approaching end of life) represent a difficult group to study, as they often have different priorities regarding treatment options, but it is vital that we obtain the highest quality evidence possible in order to best guide treatment. QUARTZ has demonstrated that good trial design (weekly phone assessments, using QALYs as the primary endpoint, releasing interim results, etc) makes it possible to conduct successful clinical trials in this challenging patient population in order to answer important clinical questions. The interim results have reassured QUARTZ Investigators that omitting WBRT does not appear to lead to any detrimental effect in terms of either length or QoL, and have proved very useful when discussing the trial with potential patients. Although molecular targeted agents can extend treatment options for some patients, QUARTZ remains an important trial, which will define the use of WBRT and may impact on practice worldwide. We estimate completing recruitment during Summer 2014. Recruitment rates remain constant with many centres demonstrating successful recruitment to QUARTZ. Acknowledgements Thank you to all the patients and their carers for participating in the trial and the recruiting centres for their hard work in recruiting patients and helping to achieve the high standard of data collection. QUARTZ is supported by Cancer Research UK (CRUK/07/001). References 1. Langley RE et al. Clin Oncol (R Coll Radiol) 2013;25(3):e23-30.