High tumor burden in patients with non-small-cell lung cancer: a Delphi survey among Spanish oncologists

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 LDH, 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 abstractHigh 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.