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K.M. Kerr



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    P1.18 - Poster Session 1 - Pathology (ID 175)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pathology
    • Presentations: 1
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      P1.18-014 - An analysis of mRNA and long non-coding RNA (lncRNA) expression during the progression from pre-invasive lesions (PL) to invasive squamous cell carcinoma (SqCC) of the bronchus. (ID 2251)

      09:30 - 16:30  |  Author(s): K.M. Kerr

      • Abstract

      Background
      Lung cancer is a common disease, with a poor 5-year survival rate often attributed to late diagnosis where curative treatment is uncommon. SqCC account for ~40% of non-small cell lung cancer (NSCLC) that possess a clinically detectable preinvasive phase. Intervention following early diagnosis of NSCLC using low-dose CT and autofluorescence bronchoscopy can significantly reduce mortality. PL are histological changes of bronchial epithelium that can be classified into squamous metaplasia (M), mild dysplasia (MID), moderate dysplasia (MOD), severe dysplasia (SD), carcinoma in-situ (CIS). They are found with varying prevalence, in high-risk cohorts such as smokers or individuals exposed to occupational carcinogens. MID and MOD are more frequently identified but only a minority progress to a SqCC. SD and CIS more commonly progress to SqCC but this is not universal.

      Methods
      The natural history of PL is not sufficiently understood. In order to address this, we have used exon arrays to profile mRNA and lncRNA levels in total RNA samples derived from formalin fixed wax embedded bronchial biopsies subject to laser microdissection. Three thoracic pathologists (KK, JG, LJ) reviewed all biopsies and agreed the morphological classification. We will report changes in differential expression of mRNA and lncRNA levels when we compare the transcriptome profiles of 5 categories of PL (M, miD, moD, sD, CIS) and 2 categories of SqCC (node negative and node positive), with those of matched normal bronchial epithelial cells. We believe this analysis provides an unprecedented insight into the molecular events that drive progression towards invasive malignancy, and may aid the identification of novel tools for the management of early squamous cell lung cancer.

      Results
      not applicable

      Conclusion
      not applicable

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    P1.20 - Poster Session 1 - Early Detection and Screening (ID 172)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P1.20-004 - UK lung Cancer Screening trial (UKLS): Base line data (ID 1796)

      09:30 - 16:30  |  Author(s): K.M. Kerr

      • Abstract

      Background
      Lung Cancer causes over 35,000 UK deaths per year: early detection by CT screening has been shown to reduce mortality in the USA by 20%.

      Methods
      UKLS is a pilot randomised controlled trial, screening individuals at a high risk of developing lung cancer (>5% over 5yrs) with low-dose CT. UKLS is population-based, approaching people of 50-75yrs identified through local primary care records and using a validated lung cancer risk prediction model to identify high risk individuals from the target group (Raji Annals of Int. Med 2012). We report observations made from the initial recruitment to the trial. 250,000 individuals were approached in Liverpool and Cambridgeshire, 30% responded positively to the first questionnaire. 4000 individuals were recruited and randomised to receive either a low-dose CT scan or usual care. All CTs were double read according to UKLS protocol. Nodules were reported as category 1, 2, 3 or 4 depending on size and volume (Baldwin et al. Thorax 2011). Participants with category 4 nodules (>500mm3) were referred to the lung cancer multi-disciplinary team (MDT) for further workup. Individuals with a category 3 nodule (50-500 mm3) underwent a repeat CT within 3 months, whereas category 2 nodules (15-50mm3) were followed up at 12 months. The trial is currently in follow-up and some participants are still in the 3 and 12 month phases.

      Results
      1991 high risk UKLS participants underwent baseline CT by June 2013. 1044/1991(52.4%) individuals had nodules requiring further imaging or work-up. 79/1991 (4.0%) had nodules which required referral to the MDT clinics at the pilot sites for further workup. At this time 31/1991(1.6%) had a prevalent lung cancer. 27/31 lung cancers (87.1%) were non-small cell lung cancer and 25/31 lung cancers (80.6%) were Stage I or II (based on pathological staging or clinical staging where the pathology staging was not available).

      Conclusion
      UKLS has already demonstrated 1.6% prevalence, utilising the LLP risk prediction model to identify high risk individuals, which compares favourably with the NELSON and other European trials. The Pilot UKLS is due to provide an interim report in 2014.

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    P1.21 - Poster Session 1 - Diagnosis and Staging (ID 169)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P1.21-002 - A survey of EGFR mutation frequency and testing practices in Asia Pacific (ID 1213)

      09:30 - 16:30  |  Author(s): K.M. Kerr

      • Abstract

      Background
      The efficacy of EGFR TKIs in EGFR mutation-positive NSCLC patients has led to a need for accurate, timely EGFR mutation testing worldwide. Although EGFR mutation testing has been adopted by many laboratories in Asia, accurate data are lacking on the proportion of NSCLC patients tested in each country, and the most commonly used testing methods. The objectives are to investigate the practice of EGFR mutation analysis in Asian Pacific countries and document the prevalence of routine testing in this population.

      Methods
      This is a retrospective database survey of records from NSCLC patients tested for EGFR mutations from 1 January 2011 to 1 January 2012 at participating sites across the Asia Pacific region. The majority of eligible hospitals/laboratories that participated had performed ≥ 100 EGFR mutation tests during that period. Accessible patient records were used to complete an online questionnaire, with data being stored in a central database. Primary objectives were to determine the number of NSCLC patients tested for EGFR mutations and the rate of EGFR mutation positivity: overall, by histological subtype, and by demography. Other variables included the number of NSCLC cases diagnosed, EGFR mutation testing methods used, and tumour sample characteristics and processing. The proportion of EGFR mutation-positive patients and 95% CI were calculated; other variables will be summarized descriptively. An interim analysis has been conducted using data collected from more than 18,000 newly diagnosed NSCLC patients at 29 sites.

      Results
      The data from surveyed sites indicates that the overall proportion of NSCLC patients tested for EGFR mutations was 31.9% (95% CI 31.2-32.6%), with an EGFR mutation positivity rate of 40.2% (95% CI 39.1-41.4%) overall, ranging from 28.7% to 53.4% (Table). Additional data on demographic and histological subgroups and current testing practices (methods, sample types, sample preparation) will be presented. [*: Wilson score confidence interval. **: Note that the sites from Vietnam (one site) and Philippines (one site) did not test ≥ 100 patients. N.D.: No data.]

      Table: Proportion of Patients Tested and EGFR Mutation Rates at Participating Sites
      Country Total number of newly diagnosed NSCLC patients Proportion of patients tested, % (95% CI*) EGFR mutation positivity, % (95% CI*)
      Total 18,050 31.9 (31.2-32.6) 40.2 (39.1-41.4)
      Japan 2,379 64.8 (62.9-66.7) 30.2 (28.0-32.6)
      China 12,086 18.3 (17.6-19.0) 38.1 (36.3-39.9)
      Taiwan 2,530 52.9 (50.9-54.8) 53.4 (50.7-56.0)
      Hong Kong 399 31.1 (26.7-35.8) 49.2 (40.6-57.9)
      Malaysia 357 98.6 (96.8-99.4) 45.7 (40.6-51.0)
      Thailand 249 57.8 (51.6-63.8) 45.1 (40.6-49.8)
      Vietnam** 50 100.0 (92.9-100.0) 36.0 (24.1-49.9)
      Philippines** N.D. Not Known 38.9 (29.5-49.2)
      Indonesia N.D. Not Known 28.7 (20.8-38.2)

      Conclusion
      The data collected in this survey indicate that, in 2011, testing practices varied widely across the region, despite the well-known high incidence of the mutation. The data provide an insight into these practices and provide a reference platform on which to compare and build on for the future of EGFR mutation testing and molecular diagnosis of NSCLC in Asia Pacific.

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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-052 - Symptoms and early diagnosis of lung cancer. (ID 3443)

      09:30 - 16:30  |  Author(s): K.M. Kerr

      • Abstract

      Background
      In the UK, the 5-year survival for lung cancer patients is less than 10%. One of the reasons contributing to this poor survival is the late stage at diagnosis, with approximately 80% of patients presenting with unresectable disease. CT screening of high risk patients may be effective but is expensive and still under investigation in clinical trials. Symptom-driven investigations may be more likely to detect advanced than early disease. We present data of the presenting symptom type and duration in patients diagnosed at an early, potentially curable stage.

      Methods
      Data from available casenotes of patients with resected non-small cell lung cancer were extracted by one data manager (NP) to study the main presenting symptom, other tumour-related symptoms, duration (where documented), smoking history and stage of disease. All patients were treated in a single institution between 2003 and 2008.

      Results
      105 patients’ details are included. 54 were male; age range 40-83 years, mean 67 years. Chest X-ray was abnormal in 103/105 patients. Smoking status was recorded in 83 (79%) cases. Three were never smokers. At time of diagnosis, 32 patients were still smoking and 17 had just quit. Of those who had stopped previously, 7 did so < 5 years before diagnosis, 5 at >5 < 10 years and 19 > 10 years before diagnosis. Pack year estimates were available in 91 patients and ranged from 5 to 180 (mean 40). Tumour stage at resection was 1a in 28, 1b in 29, IIa in 19, IIb in 15 and IIIa in 14. 25 patients had no symptoms (25%). The most common major presenting symptoms are in Table 1. Pre-diagnosis duration of symptoms was recorded in 67 patients (84%). 31 (39%) had >1 symptom.

      Dominant symptom No of patients Duration in months (mean)
      Cough 25 1-24 (3)
      +haemoptysis 10 0.5-6 (1)
      Lower respiratory infections 10 0.5-36 (3)
      Dyspnoea 10 0.25-12 (1)
      Chest/arm pain 9 2 hours – 4months (1)
      Weight loss 4 3-6
      Other 12 1-12 (2)
      None 25 -

      Conclusion
      CXR was abnormal in the majority of these patients with early tumours. The mean time to presentation with a dominant symptom was short. Almost a quarter of patients were asymptomatic and picked up as an icidental finding.The challenge to identify lung cancer patients early, at a curable stage, continues.