Scientific Program

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    S01 - This is a test

    • Type: Highlight of the Day Session
    • Track:
    • Moderators:
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    IASLC Foundation Walk supported by Lung Cancer Canada (Ticketed Event)

    • Type: Networking Opportunity
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    • Moderators:
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      Registration Opens

      07:00 - 08:00

      • Abstract

      Abstract not provided

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      Shotgun Start

      08:00 - 09:30

      • Abstract

      Abstract not provided

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      Celebration and Breakfast/Snacks

      09:30 - 11:00

      • Abstract

      Abstract not provided

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    This is a test

    • Type: Educational Session
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    • Moderators:
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    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session)

    • Type: Symposium
    • Track: Screening and Early Detection
    • Moderators:
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      S01.01 - Breakfast

      07:00 - 07:30

      • Abstract

      Abstract not provided

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      S01.02 - Introductions & Welcome

      07:30 - 07:35

      • Abstract

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      S01.03 - Session I: The Backbone to our Knowledge on Lung Cancer Screening

      07:35 - 07:35

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      Abstract not provided

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      S01.04 - Lung Cancer Screening: 1999 to Date – What Have We Learnt?

      07:35 - 07:50  |  Presenting Author(s): David F Yankelevitz

      • Abstract

      Abstract

      In 1999, ELCAP published their initial results from baseline screening. It found that in a cohort of 1000 participants approximately 85% of the cancers could be diagnosed as clinical Stage I, and that compared with chest radiography found many more of the cancers. In a subsequent study the expanded I-ELCAP found that the long term survival as a measure of cure rate approached 80%. The publicity associated with this initial study was quite large and led to the initiation of several other trials including the NLST. The NLST published their results in 2011 and based this, screening was endorsed by insurers in the US and now other countries are similarly following suit. However, despite the positive result of the NLST, and reimbursement from insurers, screening has had extremely limited uptake in the US, with only approximately 2% of those eligible (among a restricted population) are being screened. Thus, we face a situation where the most common cancer killer has been studied in the most expensive screening trial ever performed which had a positive result, insurers are reimbursing for it, and few people are having it done.

      With lung cancer screening being touted as a major breakthrough in the war on cancer the question naturally arises as to why it is not being performed more frequently. There have been many reasons to explain the poor uptake, ranging from merely a slow start but expected steady increase, lack of awareness by the clinician or potential screenee, obstacles such as the shard decision making requirement, too many potential harms, and lack of significant benefits.

      This lack of perceived significant benefit is perhaps the most important aspect, since without a substantial benefit, even if the harms were minimized, why would anyone get screened and why would a clinician recommend it. It seems that this is clearly influencing the decision not to be screened as many experts and even guideline organizations consider the benefits to not be sufficient enough so as to recommend the screening. Even CMS considered the balance of the risks and benefits so tenuous that they took the unique step of requiring a shared decision making process to be included as necessary for reimbursement so that a person could balance the risks and benefits.

      It is this aspect of benefit that needs to be considered more carefully when explaining it to a potential screenee. Current decision aids, which are required as part of a shared decision making process, in the US and Canada rely almost exclusively on the NLST result and attempt to convert its findings into more visual aids. However, in translating those NLST results, it needs to be understood that they were highly dependent on the design parameters of the study itself, namely 3 rounds of screening and 6.5 years of follow-up. When these parameters change so do the benefits. In the US, current recommendations for screening include annual screening over the period of eligibility for the participant (although for Canada it is restricted to 3 years). Under the circumstance of continued annual screening, the reduction in mortality begins to approach the estimated cure rate for the cancer. It is this feature of cure rate that is really what is most important to any person interested in being screened, and it is substantially higher than the mortality reduction seen in a randomized trial where by necessity the mortality reduction is diluted by the time interval after screening has stopped and cancers are still being followed, and also by not including those cancers that are relatively slow growing and cured as a result of early treatment but not counted towards the mortality reduction because the trial has concluded before their counterpart in the control arm has died. Based on these considerations, it is possible to have a cancer that is 100% curable when screen detected, yet the trial may only show a 20% (or even lower) mortality reduction. Thus, there is inherently no incompatibility between the 80% cure rate seen in the I-ELCAP compared with the 20% mortality reduction seen in the NLST. The simple conversion of the 20% mortality reduction found in NLST into a cure rate as is so commonly done when explaining the benefit to a person interested in screening is highly misleading. The cure rate, which is the clinically relevant feature, is higher. This coupled with the way in which harms are currently expressed, based again almost solely on those NLST results has the effect of amplifying harms at the same time the benefits are being underestimated and surely affect the perception of overall value of CT screening both for physicians as well as people who might be interested.

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      S01.05 - Discussion

      07:50 - 08:00

      • Abstract

      Abstract not provided

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      S01.06 - Session II: Future Integration of Biomarkers in the Selection of High Risk Individuals for Lung Cancer Screening

      08:00 - 08:00

      • Abstract

      Abstract not provided

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      S01.07 - The U19 Plans for Integration of Biomarkers into Future Lung Cancer Screening

      08:00 - 08:50  |  Presenting Author(s): Rayjean J. Hung, Paul Brennan, Christopher Ian Amos

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      Abstract not provided

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      S01.08 - Discussion

      08:50 - 09:00

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      Abstract not provided

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      S01.09 - Session III: European Strategy for the Implementation of Lung Cancer Screening

      09:00 - 09:00

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      Abstract not provided

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      S01.10 - EU Position Statement on Lung Cancer Screening

      09:00 - 09:20  |  Presenting Author(s): Matthijs Oudkerk

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      Abstract not provided

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      S01.11 - Discussion

      09:20 - 09:30

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      S01.12 - Coffee Break

      09:30 - 09:50

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      Abstract not provided

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      S01.13 - Session IV: Lung Cancer Screening Requires Infra-Structural Organisation and an Integrated Smoking Cessation Plan

      09:50 - 09:50

      • Abstract

      Abstract not provided

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      S01.14 - Coordination of the Lung Cancer CT Screening Experience

      09:50 - 10:05  |  Presenting Author(s): Joelle Thirsk Fathi

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      Abstract not provided

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      S01.15 - Integration of Smoking Cessation into Lung Cancer Screening

      10:05 - 10:20  |  Presenting Author(s): Kate Brain

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      Abstract not provided

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      S01.16 - Discussion

      10:20 - 10:30

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      Abstract not provided

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      S01.17 - Session V: Panel Discussion: Next Steps for Lung Screening?

      10:30 - 11:30  |  Presenting Author(s): Claudia I Henschke, Kwun M Fong, Motoyasu Sagawa, Matthew Eric Callister, Nasser Altorki, Bruce Pyenson, Andrea Katalin Borondy Kitts

      • Abstract

      Abstract not provided

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      S01.18 - IASLC Leads the International Collaboration on Data Sharing (IASLC- ELIC-CCTRR)

      11:30 - 11:50  |  Presenting Author(s): John Kirkpatrick Field, James L Mulshine

      • Abstract

      Abstract not provided

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      S01.19 - Discussion

      11:50 - 12:00

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      S01.20 - Networking Lunch

      12:00 - 12:00

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      Abstract not provided

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    JCSE01 - Perspectives for Lung Cancer Early Detection

    • Type: Joint IASLC/CSCO/CAALC Session
    • Track: Screening and Early Detection
    • Moderators:
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      JCSE01.01 - Breakfast and Poster Viewing

      07:30 - 08:00

      • Abstract

      Abstract not provided

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      JCSE01.02 - Necessity for Early Detection in Lung Cancer and Initial Attempts for Early Detection

      08:00 - 08:20  |  Presenting Author(s): Annette Maree McWilliams

      • Abstract

      Abstract not provided

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      JCSE01.03 - CT Screening for Early Detection (NLST, UKLS, NELSON, ITALUNG, DANTE, Others)

      08:20 - 08:40  |  Presenting Author(s): Matthijs Oudkerk

      • Abstract

      Abstract not provided

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      JCSE01.04 - Risk Modeling for the Early Detection of Tin Miner Lung Cancer in China

      08:40 - 09:00  |  Presenting Author(s): You-lin 13910410711 Qiao

      • Abstract

      Abstract not provided

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      JCSE01.05 - Biomarkers and Liquid Biopsy for Early Detection of Lung Cancer

      09:00 - 09:20  |  Presenting Author(s): K.C. Allen Chan

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      Abstract not provided

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      JCSE01.06 - Incorporating Artificial Intelligence for Early Detection of Lung Cancer

      09:20 - 09:40  |  Presenting Author(s): Jie Hu

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      Abstract not provided

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      JCSE01.07 - Discussion

      09:40 - 09:50

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      Abstract not provided

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      JCSE01.08 - Coffee Break and Poster Viewing

      09:50 - 10:15

      • Abstract

      Abstract not provided

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      JCSE01.09 - Cluster Trial: Ph2 Biomarker-Integrated Study of Single Agent Alpelisib, Capmatinib, Ceritinib and Binimetinib in advNSCLC

      10:15 - 10:25  |  Presenting Author(s): Qing Zhou  |  Author(s): Yi-Long Wu, Xu-Chao Zhang, Hai-Yan Tu, Bin Gan, Bin-Chao Wang, Chong-Rui Xu, Hua-Jun Chen, Ming-ying Zheng, Zhen Wang, Xiao-Yan Bai, Yue-Li Sun, Andrea Myers, Xueting Lv, Yajnaseni Chakraborti, Sylvia Zhao, Jin -Ji Yang

      • Abstract

      Background
      Several genetically altered signaling pathways have been profiled in NSCLC, enabling advanced management of NSCLC using targeted therapies. This study investigated the therapeutic spectrum of NSCLC with uncommon molecular alterations by allocating patients to treatment arms based on molecular aberrations; targeted therapies alpelisib (PI3Kαi), capmatinib (METi), ceritinib (ALKi), and binimetinib (MEKi) were evaluated.The study was based on the umbrella design. Key objectives: investigate feasibility of using one trial for different agents based on biomarker-integrated analysis, assess anti-tumor activity, characterize safety, tolerability and PK profiles of individual agents. Key eligibility criteria: age ≥18 years; ECOG PS ≤2; failed prior treatment/unsuitable for chemotherapy. Documentation of locally determined molecular alterations before treatment allocation was required (alpelisib, 350 mg QD: PIK3CA mutation/amplification; capmatinib, 400 mg BID (tablet): MET IHC overexpression/amplification; ceritinib, 750 mg QD: ALK or ROS1 rearrangement; binimetinib, 45 mg BID: KRAS, NRAS or BRAF mutation).Sixty-six patients with advNSCLC were enrolled (median age 58 years; 65.2% male: alpelisib, n=2; capmatinib, n=16; ceritinib, n=26; binimetinib, n=22). As of Feb 28, 2018, 10 patients in ceritinib and 2 in binimetinib arms were ongoing. Twenty-four patients had confirmed partial responses (36.4%): alpelisib, 0%; capmatinib, 18.8%; ceritinib, 73.1%; binimetinib, 9.1% (Figure). Longest mPFS (14.4 months) was in ceritinib arm. Among the most common treatment-related AEs: alpelisib: malaise, hyperglycemia, dysgeusia; capmatinib: nausea, anemia, peripheral edema, decreased appetite; ceritinib: diarrhea, vomiting, ALT/AST elevation; binimetinib: mouth ulceration, AST, blood CPK increased, rash. Most AEs were grade 1/2.

      abstract #1.jpg

      Objective responses/tumor shrinkage were observed in the study; highest ORR and mPFS were observed with ceritinib, although patient numbers differed between arms. All treatments were well tolerated; no new safety signals were observed. This study demonstrated the feasibility of an umbrella trial and importance of precision medicine in the management of advNSCLC with uncommon molecular alterations.

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      JCSE01.10 - A Ph3 Study of Niraparib as Maintenance Therapy in 1L Platinum Responsive Extensive Disease Small Cell Lung Cancer Patients

      10:25 - 10:35  |  Presenting Author(s): Shun Lu  |  Author(s): Liyan Jiang, Xinghao Ai, Junling Li, Xiaorong Dong, Dan Zhang, Qi Liu

      • Abstract

      Background
      Small cell lung cancer (SCLC) accounts for 15% of lung cancer, characterized by early dissemination and rapid development of chemo-resistant disease after platinum response (60-80%). Less than 2% of extensive disease SCLC (ED-SCLC) patients survive 5 years. The bi-allelic loss or inactivation of TP53 and RB1 is common in SCLC, the poly(ADP-ribose) polymerase-1 (PARP-1), a critical DNA damage repair enzyme, is highly expressed in SCLC, and SCLC is sensitive to platinum based chemotherapy, suggesting that the defect in DNA damage repair pathways plays an important role in SCLC. ZL2306/ Niraparib is a highly selective PARP-1/2 inhibitor which was exclusively licensed for development in China by Zai Laboratory from TESARO. In SCLC PDX model, niraparib demonstrated anti-tumor activities as monotherapy. In addition, niraparib demonstrated promising tumor growth inhibition in maintenance post platinum treatment in platinum sensitive SCLC PDX models. Clinically, in phase III NOVA study, niraparib demonstrated clear clinical benefit as maintenance treatment by significantly extending progression free survival in all platinum-sensitive recurrent ovarian cancer patients regardless gBRCA or HRD status which led to the approval by FDA and EMA in ovarian cancer. It is suggested that niraparib maintenance therapy could provide potential clinical benefit in platinum responsive SCLC. ZL-2306-005 is a randomized double-blind multi-center phase 3 study to evaluate the efficacy and safety of niraparib versus placebo as maintenance therapy in ED-SCLC patients who have had responses to platinum based chemotherapy.Approximately 590 Chinese patients with histologically or cytologically confirmed ED-SCLC who have achieved either complete response or partial response to their platinum based chemotherapy to their newly diagnosed disease will be randomized (2:1) to 2 groups, receiving either ZL-2306 or placebo in ZL-2306-005 study. Patients need to complete 4 cycles of etoposide + cisplatin/ carboplatin. All patients will be stratified by gender, LDH level and history of prophylactic cranial irradiation. ZL-2306 will be started with 300mg PO QD for patients with a baseline body weight ≥77 kg and a baseline platelet count ≥150,000/μL, or 200 mg PO QD for patients with a baseline body weight <77 kg or a baseline platelet count <150,000/μL based on RADAR analysis in NOVA study. Patients will remain on treatment until disease progression or intolerable toxicity. The co-primary endpoints are PFS assessed by independent central radiologic review and OS; the secondary endpoints are PFS assessed by investigator, CFI, QoL, safety and tolerability.

      Section not applicable

      Section not applicable

      a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.11 - Dynamic ctDNA Monitoring Revealed Novel Resistance Mechanisms and Response Predictors of Osimertinib Treatment in East Asian NSCLC Patients

      10:35 - 10:45  |  Presenting Author(s): Jianhua Chang  |  Author(s): Zhihuang Hu, Dongmei Ji, Shannon Chuai, Weina Shen, Junning Cao, Jialei Wang, Xianghua Wu

      • Abstract

      Background

      Advanced NSCLC patients, harboring EGFR T790M, exhibit marked diversity in tumor behavior and response to AZD9291, yet a discriminable molecular profile remains elusive. In addition, although EGFRC797S was involved in 30% of AZD9291 resistance cases in Western patients, mechanisms for the rest patients remain unclear, especially for the East Asian population. We utilized circulating tumor DNA (ctDNA) profiling to conduct dynamic monitoring in patients undergoing AZD9291, thus characterizing mutational heterogeneity and genomic evolution.

      Longitudinal plasma samples were collected before, during and post of the AZD9291 treatment in Chinese NSCLC patients with acquired T790M mutation. A ctDNA panel, spanning 160KB of human genome, was used to perform capture-based targeted sequencing that comprises critical exons and introns of 168 genes. The EGFR mutation abundance and dynamic changes of allele fraction (AF) were analyzed with progression-free survival (PFS) after AZD9291 treatment.

      A total of 61 samples were collected longitudinally from 14 patients, of which 9 have experienced progressive disease (PD). Six patients exhibited a rebound of ctDNA prior to radiographic PD, suggesting the potential of ctDNA in early detection of PD. Several acquired mutations were detected with the AZD9291 resistance, including newly identified EGFR G796S, L792H/F/R/V, V802F, V843I mutations, expect for the previously reported RB1 and EGFR C797S, L718Q mutations. Patients with a higher ratio of T790M and EGFRactivating mutation at baseline had a significantly longer PFS (9.6m vs 4.5m, p=0.008). A lower ratio of EGFRactivating mutation AF compared to baseline at first follow-up was significantly correlated with a longer PFS (8.5m vs 5.0m, p=0.027). Furthermore, patients harboring other known driver mutations in addition to T790M at baseline had an inferior PFS (4.9m vs 7.8m, P=0.039).

      Several novel resistance mechanisms were identified by ctDNA monitoring in the East Asian patients treated with AZD9291. Relative AF of T790M, changes of AF after treatment and the presence of concurrent driver mutations at baseline could predict clinical benefit of AZD9291 treatment.

      a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.12 - Discussant Oral Abstracts

      10:45 - 11:00  |  Presenting Author(s): Daniel S.W. Tan

      • Abstract

      Abstract not provided

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      JCSE01.13 - Discussant Poster Abstracts

      11:00 - 11:15  |  Presenting Author(s): Bob T. Li

      • Abstract

      Abstract not provided

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      JCSE01.14 - Effects of Neoadjuvant Chemotherapy on the Expression of Programmed Death Ligand-1 and Tumor Infiltrating Lymphocytes in Lung Cancer Tissues

      11:15 - 11:15  |  Presenting Author(s): Xu Wang  |  Author(s): Wenyu Sun, Kewei Ma

      • Abstract

      Background
      Immune checkpoints programmed death 1(PD1)and its ligand PD-L1,PD-L2 pathways can mediate negative synergistic stimulation signals.Immunotherapy combined with chemotherapy can increase the objective response rate of cancer patients,but the mechanism of combination therapy is not clear.This study aims to analyze the changes of PD-L1,PD-L2 in lung cancer tissues and the changes of TILs ( CD4+,CD8+,CD28+,and CD56+ lymphocytes ) surrounding the tumor before and after neoadjuvant chemotherapy(platinum-based),in order to provide a theoretical basis for relevant clinical studies.Tumor samples were obtained from 26 patients who confirmed primary lung cancer before and after NAC from 2009 to 2016 in the First Hospital of Jilin University. The expression of PD-L1, PD-L2 in lung cancer specimens were assessed by IHC. 5%,10%,20%,30%,50% expression thresholds were used to define PD-L1, PD-L2 positive status, respectively. Of 16 patients ( since the biopsy tissue specimens were limited, only 16 cases of biopsy and postoperative tissue specimens were collected), the expression of TILs around the tumor before and after NAC were assessed by IHC. We analyze the changes of PD-L1 and PD-L2 in lung cancer tissues before and after NAC, the correlation between the changes of PD-L1 in lung cancer tissues and tumor shrink rate, the interval from the end of NAC to operation, pathological type, gender and smoking status. Of 16 patients, the changes of TILs around the tumor before and after NAC were also evaluated. P<0.05 was considered statistically significant.

      1. When using 5%, 10%, and 20% as expression threshold to define PD-L1 positive status, PD-L1 was up-regulated after NAC (P=0.008,P=0.016,P=0.016). However, there were no obviously statistical significance about the expression of PD-L1 when using 30%, 50% expression threshold. The expression of PD-L2 were not show any statistical significance before and after NAC.

      2. Of 16 patients, the expression of CD4+, CD8+ and CD28+ lymphocytes increased after NAC (P=0.014,P=0.038,P=0.021), whereas the change of CD56+ lymphocytes was not statistical significant.

      3. There were no significant difference between the changes of PD-L1 and tumor shrink rate, interval from the end of NAC to operation, pathological type, gender and smoking status .

      1. NAC up-regulates the expression of PD-L1 in lung cancer tissues when the expression thresholds are 5%, 10%, and 20%.

      2. NAC up-regulates the expression of CD4+, CD8+, and CD28+ lymphocytes.

      3. No correlation exists between the variation of PD-L1 and tumor shrink rate, interval from the end of NAC to operation, pathological type, gender and smoking status.

      a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.15 - Molecular Characteristics of ALK Primary Point Mutations Non-Small-Cell Lung Cancer in Chinese Patients

      11:15 - 11:15  |  Presenting Author(s): Chunwei Xu  |  Author(s): Jinhuo Lai, Wenxian Wang, Quxia Zhang, Wu Zhuang, Yunjian Huang, Youcai Zhu, Yanping Chen, Gang Chen, Meiyu Fang, Tang Feng Lv, Yong Song

      • Abstract

      Background
      Anaplastic lymphoma kinase (ALK) gene rearrangements have been identified in lung cancer at 3-7% frequency, thus representing an important subset of genetic lesions that drive oncogenesis in this disease. While the genetic locus of ALK primary point mutations NSCLC patients is unclear. The aim of this study is to investigate mutations and prognosis of NSCLC harboring ALK primary point mutations.

      A total of 339 patients with non-small-cell lung cancer were recruited between July 2012 and December 2015. The status of ALK primary point mutation and other genes were detected by next generation sequencing.


      ALK gene primary point mutation rate was 8.55% (29/339) in non-small cell lung cancer, including V163L (3 patients), F921Gfs*16 (2 patients), K1416N (2 patients), A585T (2 patients), P1442Q (1 patient), A348T (1 patient), K1525E (1 patient), S737L (1 patient), P115L (1 patient), Q515E (1 patient), E314D (1 patient), R395H (1 patient), S1219F (1 patient), S341G (1 patient), P1543S (1 patient), G129V (1 patient), Q167H (1 patient), L550F (1 patient), T1012M (1 patient), D302Y (1 patient), H755Q (1 patient), H331Q (1 patient), G1474E (1 patient) and E119D (1 patient), and median overall survival (OS) for these patients was 20.0 months. Among them, 27 patients with co-occurring mutations had a median OS of 20.0 months, and median OS of the 2 patients without complex mutations was 8.5 months. Statistically significant difference was found between the two groups (P=0.02). Briefly, patients with (n=8) or without (n=21) co-occurring EGFR mutations had a median OS of 24.0 months and 20.0 months respectively (P=0.73); patients with (n=21) or without (n=8) co-occurring TP53 mutations had a median OS of 20.0 months and 17.0 months respectively (P=0.83).

      EGFR and TP53 gene accompanied may have less correlation with ALK primary point mutation in NSCLC patients. Results of ongoing studies will provide a platform for further research to offer individualized therapy with the purpose of improving outcomes. a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.16 - Positive Correlation Between Whole Genomic Copy Number Variant Scoring and the Grading System in Lung Non-Mucinous Invasive Adenocarcinoma 

      11:15 - 11:15  |  Presenting Author(s): Zheng Wang  |  Author(s): Shenglei Li, Lin Zhang, Lei He, Di Cui, Chenglong Liu, Yuyan Gong, Bi Liu, Xiaoyu Li, Wang Wu, David Cram, Dongge Liu

      • Abstract

      Background
      Grading systems of Lung adenocarcinoma have been proposed by Sica and Kadota in stage I tumors,but the predominant architectural subtypes grading system is applicable for resection samples mostly. The correlation between the histological subtypes and grading with whole genomic copy number variation(WGCNV) is unknown, and was investigated in lung non-mucinous invasive adenocarcinoma (LNMIA) at this study.The predominant histological subtype from 58 resection specimens of LNMIA and 20 para-cancerous lung tissues were collected by laser microdissection from HE staining FrameSlides PEN-Membrane slides.7 of 58 specimens,two predominant subtypes in one cancerous nodule were collected simultaneously. Whole genome amplification followed by high-throughput sequencing was used to deteted WGCNV with the para-cancerous lung tissues as normal reference set and WGCNV was scored by a particular formula.
      abstract #1.jpgabstract #2.jpg

      The letters above the figure show the results of Chi-squared test, and same letters mean no significant difference.

      WGCNV median scores of 5 histological subtypes of LNMIA with three tiered architectural grades are shown in Table1. The WGCNV scores have a positive correlation with either histological subtypes and architectural grading system (Figure1 A and B). The differences of WGCNV scores are detected betweem two predominant subtypes in one cancerous nodule.

      GWCNV scores display a positive correlation with three tiered architectural grading system and may has a potential value to predict prognosis in LNMIA. a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.17 - Weekly Nab-Paclitaxel Plus Carboplatin as Neoadjuvant Therapy for IIIA-N2 Lung Squamous Cell Carcinoma: A Prospective Phase II Study

      11:15 - 11:15  |  Presenting Author(s): Changli Wang  |  Author(s): Yu Zhang, Jian Quan Zhu, Dongsheng Yue, Xiaoliang Zhao, qiang Zhang, Hui Chen

      • Abstract

      Background
      To evaluate the safety and antitumor activity of weekly nab-paclitaxel combined with carboplatin in patients with advanced stage IIIA-N2 NSCLC patients with squamous histologyFrom April 2015 to August 2017, 36 treatment-naive, pathologically diagnosed IIIA-N2 lung squamous cell carcinoma patients were enrolled and given two cycles of weekly nab-paclitaxel (100mg/m2, day1,8,15 of a 21-day cycle) plus Carboplatin (AUC = 5 at day 1, q3w) as neoadjuvant therapy. Then resectability was assessed and surgery was performed for resectable lesions. Post-operative adjuvant chemotherapy regimens is the combination of Nab-paclitaxel (100mg/m2, qw x 6) and carboplatin (AUC 5, Q3W x 2) for patients with PD, adjuvant chemotherapy regimen will be changed. The primary objective is the safety and efficacy, and the secondary objectives are quality of life and the role of prognostic biomarker SPARC.

      Of 36 patients, 3 stopped treatment due to patient decision. 33 were finally evaluated and 1 is still on treatment. Significant tumor volume shrinkage was seen in some patients after the neoadjuvant therapy. 66.7% patients achieved partial response (PR), 21.2% patients achieved stable disease (SD). Disease control (PR +SD) rate was 87.9%. Finally, 23 patients underwent surgical resection, the respectability rate was 69.7%. 12.1% occurred disease progress and failed to achieve resection, including 3 with local progress and 1 with pulmonary metastatic nodule; Among 22 PR pts, 4 failed to achieve resection, in which 1 was due to heart function, the other 3 due to personal unwillingness. 2 of 7 with stable disease failed to achieve resection; the pathological improvement in T stage and N stage before and after treatment was 81.8% (18/22) and 50% (11/22) respectively. The major adverse event was neutropenia (grade I and II) and no serious AE was found.

      Nab-paclitaxel in combination with Carboplatin showed promising ORR rate and resection rate in of IIIA-N2 lung squamous cell carcinoma. The regimen could be a new chemo option as the neoadjuvant treatment. PFS and OS data will be reported after follow up completing.

      a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.18 - A Multicenter Survey of One Year Survival Among Chinese Patients with Advanced Nonsquamous Non-Small Cell Lung Cancer (CTONG1506)

      11:15 - 11:15  |  Presenting Author(s): Qing Zhou  |  Author(s): Ping Yu, Yong Song, Xin Zhang, Gongyan Chen, Yi Ping Zhang, Jianhua Chen, Zhuang Yu, Yi Hu, Xia Song, Diansheng Zhong, Guosheng Feng, Lulu Yang, Lujing Zhan, Luan Di Yao, Yun Chen, Yue Gao, Yi-Long Wu

      • Abstract

      Background
      Previous results of CTONG1506 study showed that gene aberration test rate was increasing in Chinese NSCLC patients and first-line treatment was standardized accordingly. This survey further described one year survival of patients with different gene aberration status and under different first-line treatments.

      CTONG1506 was a two-year series cross-sectional study. Patients with advanced nonsquamous NSCLC who were admitted from August 2015 to March 2016 and who received first-line anti-cancer treatment at one of 12 tertiary hospitals across China were included. Data extracted from medical charts were entered into medical record abstraction forms, which were collated for analysis. Survival information was collected one year after patients were admitted to hospital. One year survival rate and its 95% confidence interval were analysed by Kaplan-Meier method.

      A total of 707 patients were analysed, with mean age of 57 years and 56.7% were male. Among the 487 patients who had survival data, 192 were EGFR- mutation positive (86 mutated in exon 19 [one year survival rate 0.90, 95% CI: 0.81-0.94] and 88 mutated in exon 21 [one year survival rate 0.84, 95% CI: 0.75-0.90]), 27 patients were ALK positive and 164 patients were EGFR and ALK wild type. Most EGFRmutation positive patients (128/192) received tyrosine kinase inhibitors (TKIs) as first-line treatment and most EGFR wild type patients (155/175) received first-line chemotherapy (Chemo). Pemetrexed was the most common non-platinum chemotherapy-backbone agent (120/155) in platinum doublet regimens. One year survival rates are shown in the table.

      abstract 12337 ctogn1506 one-year survival.png

      This national-wide real world study of tertiary hospitals in China revealed that a majority of (>75%) advanced nonsquamous NSCLC patients survived more than one year and was comparable to well-controlled clinical trial results, indicating survival benefits by gene aberration status guided standard of care. This result may be further validated by our on-going two-year survey.

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      JCSE01.19 - ALTER-0303 Study: Tumor Mutation Index (TMI) For Clinical Response to Anlotinib in Advanced NSCLC Patients at 3rd Line

      11:15 - 11:15  |  Presenting Author(s): Baohui Han  |  Author(s): Jun Lu, Wei Zhang, Bo Yan, Lele Zhang, Jie Qian, Bo Zhang, Shuyuan Wang

      • Abstract

      Background

      Anlotinib is an effective multi-targeted receptor tyrosin kinase inhibitor (TKI) for refractory advanced Non-Small Cell Lung Cancer (NSCLC) therapy at 3rd line. ALTER-0303 clinical trial has been revealed that Anlotinib significantly prolongs progression free survival (PFS; Anlotinib: 5.37 months vs Placebo: 1.40 months) and overall survival (OS; Anlotinib: 9.63 months vs Placebo: 6.30 months) with the objective response rate (ORR) of 9.18% and the disease control rate (DCR) of 80.95%. Here, we sought to understand the gene mutation determinants for clinical response to Anlotinib via next generation sequencing (NGS) upon cell-free DNA (cfDNA) and circulating tumor DNA (ctDNA) at baseline.

      Totally 437 advanced NSCLC patients enrolled in ALTER-0303 study, and 294 patients received Anlotinib therapy. Of the 294 patients, 80 patients were analyzed in the present study. Capture-based targeted ultradeep sequencing was performed to obtain germline and somatic mutations in cfDNA and ctDNA. Response analyses upon discovery cohort (n = 62) and validation cohort (n = 80) were performed by use of germline and somatic (G+S) mutation burden, somatic mutation burden, nonsynonymous mutation burden, and unfavorable mutation score (UMS), respectively. Based on the above independent biomarkers and their subtype factors, tumor mutation index (TMI) was developed, and then used for response analysis.

      Our data indicated that the patients harbouring less mutations are better response to Anlotinib therapy (G+S muatation burden, cutoff = 4000, Median PFS: 210 days vs 127 days, p = 0.0056; somatic mutation burden, cutoff = 800, Median PFS: 210 days vs 130 days; p = 0.0052; nonsynonymous mutation burden, cutoff = 50, Median PFS: 209 days vs 130 days; p = 0.0155; UMS, cutoff = 1, Median PFS: 210 days vs 131 days; p = 0.0016). TMI is an effective biomarker for Anlotinib responsive stratification (Median PFS: 210 days vs 126 days; p= 0.0008; AUC = 0.76, 95% CI: 0.62 to 0.89) upon discovery cohort and validation cohort (Median PFS: 210 days vs 127 days; p = 0.0006). Lastly, integrative analysis of TMI and IDH1 mutation suggested a more promising result for Anlotinib responsive stratification upon validation cohort (Median PFS: 244 days vs 87 days; p < 0.0001; AUC = 0.90, 95% CI: 0.82 to 0.97).This study provide a biomarker of TMI to stratify Anlotinib underlying responders, that may improve clinical outcome for Anlotinib therapy on refractory advanced NSCLC patients at 3rd line. Clinical trial information: NCT02388919. a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.20 - Outcome in Small Cell Lung Cancer Patients with Cerebral Recurrence After Prior Prophylactic Cranial Irradiation 

      11:15 - 11:15  |  Presenting Author(s): Lei Zhao  |  Author(s): Jindong Guo, Xuwei Cai, Xiaolong Fu

      • Abstract

      Background
      Prophylactic cranial irradiation (PCI) is a standard therapy for both limited small cell lung cancer (SCLC) and extensive SCLC patients with good responses to first-line treatment. The aim of this study was to examine outcomes in SCLC patients in a single institution who underwent cerebral recurrence after prior PCI.

      We retrospectively examined the medical records of 219 consecutive SCLC patients who had initially received PCI(25 Gray in 10 fractions) between June 2007 to June 2017. Data were analyzed with regard to age, sex, smoking status, treatment, disease stage, data of PCI, time to cerebral recurrence, site of cerebral recurrence, re-irradiation after cerebral recurrence and time to death. Survival was estimated by the Kaplan-Meier method. Multivariate analyses were performed by the log-rank and Cox’s proportional hazard model test.

      Of the 219 patients undergoing PCI, 180(82.2%) were LD-SCLC and 39(17.8%) were ED-SCLC. The median age was 59 years and the median follow-up time was 23.7 months. The median overall survival (OS) of all patients from the time of diagnosis was 39.0 months (95%CI, 29.6–48.4), in LD-SCLC it was 47.0 months (95%CI, 35.4–58.6), and in ED-SCLC it was 19.0 months (95%CI, 17.0–21.0). The difference was statistically significant with P=0.000.

      Forty-six patients (21.0%) were diagnosed with cerebral recurrence. 30(65.2%) of these presented with oligometastatic disease and 16(34.8%) had non-oligometastatic disease. Cox multivariate analysis identified disease stage (P=0.043) was the only significantly favorable prognostic factor for cerebral recurrence. The median survival time from PCI was 21.0 months (95%CI, 12.5–29.5), in oligmetastatic disease it was 35.0 months (95%CI, 19.0–51.0), and in non-oligometastatic disease it was 16.0 months (95%CI, 12.1–19.9). The difference was statistically significant with P=0.007. Meanwhile, the median time from PCI to cerebral recurrence was 11.0 months (95%CI, 9.5–12.5), in oligmetastatic disease it was 11.0 months (95%CI, 6.7–15.3), and in non-oligometastatic disease it was 10.0 months (95%CI, 8.4–11.6). There was no statistical significance between the two.

      Among forty-six patients with cerebral recurrence, 34 patients underwent re-irradiation using either Re-WBRT (11patients, 23.9%) or SRS /SRT (23patients, 50.0%), another 12 patients (26.1%) did not accept radiotherapy to brain. The median survival time from cerebral recurrence was 10 months (95%CI, 4.1-16.0) for re-irradiation and 4 months (95%CI, 2.3-5.8) for no radiotherapy group, respectively. The difference was statistically significant with P=0.000.

      PCI remains standard therapy for SCLC patients with good responses to first-line treatment. Cerebral recurrence is inevitable, however, cerebral re-irradiation after recurrence is proven to be beneficial for survival.


      a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.21 - Different Responses to Osimertinib in Primary and Acquired EGFR T790M-Mutant NSCLC Patients

      11:15 - 11:15  |  Presenting Author(s): Shuyuan Wang  |  Author(s): Bo Zhang, Baohui Han

      • Abstract

      Background
      Primary EGFR T790M could be occasionally identified by routine molecular testing in tyrosine kinase inhibitor TKI-naive non-small cell lung cancer (NSCLC) patients. This study was aimed to compare clinical characteristics of primary and acquired T790M mutations and their responses to Osimertinib in NSCLC patients.
      We collected clinical characteristics of patients diagnosed with epidermal growth factor receptor (EGFR) mutation from 2012 to 2017 in Shanghai Chest Hospital. For patients with primary and acquired T790M mutations, the responses to Osimertinib were analyzed.Primary T790M was identified in 1.03% (61/5900) of TKI-naive patients. Acquired T790M was detected in 45.50% (96/211) of TKI-treated patients. T790M always coexisted with sensitizing EGFR mutations. Primary T790M was always coexisted with 21L858R (45/61) whereas acquired T790M was coexisted with 19del (61/96). Among them, 18 patients with primary T790M mutation acquired Osimertinib and 75 patients with acquired T790M mutation received Osimertinib. The median progression-free survival (mPFS) of Osimertinib in primary T790M group was greatly longer than that in acquired T790M group (18.0 months:95% CI:15.0-21.0 VS 10.0months:95% CI:8.3-11.7, P=0.016). The DCR of both groups were 89.3% and 100%. In primary T790M group, the mPFS of concomitant occurrence of 20 T790M and 21 L858R or 19del were 15.7m and 24.0 m, respectively. In acquired T790M group, the mPFS of concomitant occurrence of 20 T790M and 21 L858R or 19del were 11.0m and 10.0m, respectively.

      Primary and acquired T790M-mutation patients showed different molecular characteristics. Both of them may respond to Osimertinib. However, primary T790M patients showed greater survival benefits from Osimertinib than acquired T790M patients.

      a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.22 - Differential Molecular Mechanisms Associated with Dramatic and Gradual Progression in NSCLC Patients with Intrathoracic Dissemination

      11:15 - 11:15  |  Presenting Author(s): Ying Chen  |  Author(s): Bao Hua, Wei Li, Chao Zhang, Wen-Fang Tang, Ao Wang, Xue Wu, Jing-Hua Chen, Jian Su, Yang W. Shao, Yi-Long Wu, Wen-Zhao Zhong

      • Abstract

      Background
      Lung cancer is a highly heterogeneous disease with diverse clinical outcomes. The pleural cavity is a frequent metastasis site of proximal lung cancer. Better understanding of its underlining molecular mechanisms associated with dramatic and gradual progression of pleural metastasis in patients with non-small cell lung cancer (NSCLC) is essential for prognosis, intervention and new therapy development.We performed whole-exome sequencing (WES) of matched primary lung adenocarcinoma and pleural metastatic tumors from 26 lung cancer patients with dramatic progression (DP, n=13) or gradual progression (GP, n=13). Somatic alterations at both genome-wide level and gene level were detected. Kaplan-Meier survival analysis and multivariate Cox regression models were applied to analyze the association between different somatic alterations and clinical parameters.We first analyzed the differences in somatic alterations between AP and RP group in the primary tumors, and identified higher somatic copy number alteration (SCNA) level in DP group compared to GP group, which is significantly (p=0.016) associated with poorer progression-free survival (PFS). More specifically, patients with chromosome 18q loss in the primary tumor showed a trend (p=0.107) towards poorer PFS. PTEN (p=0.002) and GNAS (p=0.002) mutations are enriched in the primary tumors of DP group, and are associated with poorer PFS. Furthermore, pleural metastatic tumors harbor a relatively higher level of mutation burden (p=0.105) and significantly increased SCNA (p=0.035) compared to the primary tumors.NSCLC patients in the attenuated progression group have more stable genomes. High level of genomic instability, GNAS and PTENmutations, as well as chromosome 18q loss are associated with rapid progression. a9ded1e5ce5d75814730bb4caaf49419

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      JCSE01.22a - Tislelizumab Combined With Chemotherapy as First-Line Treatment in Chinese Patients With Advanced Lung Cancer

      11:15 - 11:15  |  Presenting Author(s): Jie Wang  |  Author(s): Jun Zhao, Zhijie Wang, Zhiyong Ma, Jiuwei Cui, Yongqian Shu, Zhe Liu, Ying Cheng, Shiang Jiin Leaw, Jian Li, Fan Xia

      • Abstract

      Abstract not provided

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      JCSE01.23 - Closing Remarks

      11:15 - 11:15

      • Abstract

      Abstract not provided

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    S01 - This is a test

    • Type: Educational Session
    • Track: Advocacy
    • Moderators:
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    WS01 - Cancer Genomics Workshop (Ticketed Session)

    • Type: Workshop
    • Track:
    • Moderators:
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      WS01.01 - Introduction to the Workshop

      08:00 - 08:15

      • Abstract

      Abstract not provided

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      WS01.02 - Exercise 1: Cancer Gene Panels: Methods and Application

      08:15 - 09:30

      • Abstract

      Abstract not provided

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      WS01.03 - Break

      09:30 - 09:45

      • Abstract

      Abstract not provided

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      WS01.04 - Exercise 2: Cancer Gene Panels: Result Interpretation and Clinical Utility

      09:45 - 11:00

      • Abstract

      Abstract not provided

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      WS01.05 - Questions/Panel Discussion

      11:00 - 11:15

      • Abstract

      Abstract not provided

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    WS02 - Mesothelioma Workshop

    • Type: Workshop
    • Track: Mesothelioma
    • Moderators:
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      WS02.01 - Session 1: Surgery for Mesothelioma

      08:00 - 08:00  |  Presenting Author(s): Harvey Pass

      • Abstract

      Abstract not provided

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      WS02.02 - What Are the Most Important Unmet Needs in the Surgical Management of Mesothelioma?

      08:00 - 08:15  |  Presenting Author(s): Valerie W Rusch

      • Abstract

      Abstract not provided

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      WS02.03 - Who Are the High Risk Patients for Surgical Failure in Mesothelioma?

      08:15 - 08:30  |  Presenting Author(s): Harvey Pass

      • Abstract

      Abstract not provided

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      WS02.04 - SMART, Where It Is Going

      08:30 - 08:45  |  Presenting Author(s): Marc De Perrot

      • Abstract

      Abstract not provided

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      WS02.05 - Reliability of MM Diagnosis and Role of BAP1 Staining

      08:45 - 09:00  |  Presenting Author(s): Francoise Galateau-Salle

      • Abstract

      Abstract not provided

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      WS02.06 - Q&A

      09:00 - 09:05

      • Abstract

      Abstract not provided

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      WS02.07 - Session 2: Immunotherapy in Mesothelioma

      09:05 - 09:05  |  Presenting Author(s): Paul Baas

      • Abstract

      Abstract not provided

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      WS02.08 - The Microenvironment and Mesothelioma

      09:05 - 09:20  |  Presenting Author(s): Prasad S. Adusumilli

      • Abstract

      Abstract not provided

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      WS02.09 - PDL-1 and Mesothelioma

      09:20 - 09:35  |  Presenting Author(s): Raphael Bueno

      • Abstract

      Abstract not provided

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      WS02.10 - An Overview of Present and Future Immunotherapy Trials in Mesothelioma: Progress and Problems

      09:35 - 09:50  |  Presenting Author(s): Aaron S. Mansfield

      • Abstract

      Abstract not provided

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      WS02.11 - Window of Opportunity Immunotherapy Trials in Mesothelioma: Design and Translation

      09:50 - 10:05  |  Presenting Author(s): Anne S. Tsao

      • Abstract

      Abstract not provided

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      WS02.12 - Q&A

      10:05 - 10:10

      • Abstract

      Abstract not provided

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      WS02.13 - Session 3: Transcriptome Changes and Mutations in Mesothelioma - Somatic, Germline, BAP1 and more

      10:10 - 10:10  |  Presenting Author(s): David Mark Jablons

      • Abstract

      Abstract not provided

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      WS02.14 - BAP1 Mutations: Mechanisms and Significance

      10:10 - 10:25  |  Presenting Author(s): Michele Carbone

      • Abstract

      Abstract not provided

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      WS02.15 - Novel Approaches for Targeting BAP1

      10:25 - 10:40  |  Presenting Author(s): Marjorie G. Zauderer

      • Abstract

      Abstract not provided

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      WS02.16 - Genome-wide Silencing Screen in Mesothelioma Cells Reveals that Loss of Function of BAP1 Induces Chemoresistance to Ribonucleotide Reductase Inhibition: Implication for Therapy

      10:40 - 10:55  |  Presenting Author(s): Emanuela Felley-Bosco

      • Abstract

      Abstract not provided

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      WS02.17 - A Subset of Mesotheliomas with Improved Survival Occurring in Carriers of BAP1 and of other Germline Mutations

      10:55 - 11:10  |  Presenting Author(s): Haining Yang

      • Abstract

      Abstract not provided

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      WS02.18 - Q&A

      11:10 - 11:15

      • Abstract

      Abstract not provided

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    WS03 - Endoscopic Diagnosis and Staging of Lung Cancer – Interventional Pulmonology Hands-On Workshop (Ticketed Session)

    • Type: Workshop
    • Track: Interventional Diagnostics/Pulmonology
    • Moderators:
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      WS03.01 - Welcome and Introduction

      08:00 - 08:10

      • Abstract

      Abstract not provided

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      WS03.02 - EBUS-TBNA – Role in Invasive Mediastinal Staging

      08:10 - 08:30  |  Presenting Author(s): Kazuhiro Yasufuku

      • Abstract

      Abstract not provided

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      WS03.03 - Combined EBUS/EUS Mediastinal Staging

      08:30 - 08:50  |  Presenting Author(s): Waël C. Hanna

      • Abstract

      Abstract not provided

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      WS03.04 - Radial Probe EBUS – Methods and Results

      08:50 - 09:10  |  Presenting Author(s): Kasia Czarnecka-Kujawa

      • Abstract

      Abstract not provided

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      WS03.05 - Navigational Bronchoscopy

      09:10 - 09:30  |  Presenting Author(s): Laura Donahoe

      • Abstract

      Abstract not provided

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      WS03.06 - Hands-On Session on 4 stations

      09:30 - 11:30

      • Abstract

      Abstract not provided

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    WS04 - Roche Scientific Symposium: Clinical Decision Support for Management of Lung Cancer Patients and Future Directions in the Era of Precision Medicine (Sign Up Required) (Not IASLC CME Accredited)

    • Type: Workshop
    • Track:
    • Moderators:
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      WS04.01 - Welcome & Introduction

      08:00 - 08:15

      • Abstract

      Abstract not provided

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      WS04.02 - Protein-based Biomarkers as Tools to Support Clinical Decision Making for Lung Cancer Patients with Results from the Laboratory

      08:15 - 08:45  |  Presenting Author(s): Rafael Molina

      • Abstract

      Abstract not provided

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      WS04.03 - Using Immunohistochemistry in Differential Diagnosis and Predictive Assessment of Lung Cancer

      08:45 - 09:15  |  Presenting Author(s): Mark Kockx

      • Abstract

      Abstract not provided

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      WS04.04 - Clinical Utility of Liquid Biopsy to EGFR Mutation Detection in NSCL

      09:15 - 09:45  |  Presenting Author(s): Adrian Sacher

      • Abstract

      Abstract not provided

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      WS04.05 - Break

      09:45 - 10:00

      • Abstract

      Abstract not provided

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      WS04.06 - Circulating Tumor DNA: Solid Tumor MRD Detection and Potential Clinical Utility

      10:00 - 10:30  |  Presenting Author(s): Aadel Chaudhuri

      • Abstract

      Abstract not provided

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      WS04.07 - University of Missouri’s Experience with the NAVIFY Tumor Board Solution in HemOnc Tumor Board

      10:30 - 11:00  |  Presenting Author(s): Richard Hammer

      • Abstract

      Abstract not provided

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      WS04.08 - Panel Discussion

      11:00 - 11:30

      • Abstract

      Abstract not provided