Should optimal supportive care alone be the standard of care for brain metastases patients from non-small cell lung cancer, who are not eligible for radiosurgery or surgery?

The Quality of Life after Treatment for Brain Metastases (QUARTZ) trial was a non-inferiority, phase III randomized trial comparing optimal supportive care (OSC) including dexamethasone versus OSC including dexamethasone and whole brain radiotherapy (WBRT). In this trial, 538 patients were recruited from 69 United Kingdom and three Australian centres. The primary outcome was quality-adjusted life-years (QALYs), generated from overall survival and patient completed EuroQOL EQ-5D questionnaires. The mean QALYs was 46.4 days for the OSC and WBRT arm versus 41.7 days for the OSC arm, with a mean difference of 4.7 days (90% CI: −12.7 to 3.3 days). In addition, there was no difference in overall survival (hazard ratio 1.06, 95% CI: 0.90–1.26), overall quality of life or dexamethasone use between the two groups (1).