Aim: To define high tumor burden (HTB) in non-small-cell lung cancer. Methods: A total of five oncologists initiated the project, selecting 66 participants, and elaborated a questionnaire with 26 statements using the Delphi method with a 9-point Likert scale of agreement. Results: Factors with moderate strength of consensus were identified, including a sum of the longest diameter of lesions ≥10 cm, elevated Lactate dehydrogenase, hepatic involvement, lymphangitis carcinomatosis, brain involvement unapproachable with local techniques and pericardial effusion. There was a consensus against increases in tumor markers and asymptomatic brain involvement being related to HTB. HTB was considered a relevant factor for treatment selection supporting the choice of combination regimens versus immunotherapy only. Conclusion: In this Delphi study, experts defined several factors associated with HTB in non-small cell lung cancer.

Tweetable abstract

High tumor burden is an undefined concept in non-small-cell lung cancer. This research is a Delphi survey among Spanish oncologists focused on a consensus on this concept that could help oncologists define the best treatment option in the first-line setting.

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Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 19, No. 14

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History

Received 14 October 2022

Accepted 26 April 2023

Published online 12 May 2023

Published in print May 2023

Information

Keywords

Acknowledgments

The authors thank the oncologist participants in this project: P Garrido, J Corral Jaime, JL González Larriba, L Paz-Ares, J de Castro, A Calles, F de Asis, OJ Vidal, M Guirado, R García Campelo, A Sánchez Hernández, A Collazo Lorduy, JA Macías Cerrolaza, RM Álvarez, R Álvarez, B Losada Cila, JM Trigo Pérez, C Aguado de la Rosa, B Jiménez, J Baena Espinar, A del Barrio, C García Girón, P Cruz, C Bayona Antón, I Sullivan, R Gómez Diaz, R López Castro, LE Chara Velasco, B Hernández Marín, J Garde Noguera, MP Diz Tarin, JM Sánchez Torres, Y Lage Alfranca, V Calvo de Juan, M Dorta Suárez, C Pangua, S Cerezo González, E Carcereny Costa, I Gil Bazo, DV Baz, AL Ortega Granados, P Lianes Barragán, JC Villa Guzmán, A Velasategui, F Navarro, S Falagán Martínez and ME Olmedo.

Financial & competing interests disclosure

The authors wish to thank A Pedromingo (Bio-Estadística, Madrid, Spain) for statistical analysis and F Rico-Villademoros (Cociente SL, Madrid, Spain) for editorial assistance; their participation was funded by Fundación Hospital Infanta Sofía-Hospital de Henares. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

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