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T. Herrmann
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ORAL 16 - Clinical Care of Lung Cancer and Advanced Biopsies (ID 115)
- Event: WCLC 2015
- Type: Oral Session
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:J.W. Neal, Q. Zhou
- Coordinates: 9/08/2015, 10:45 - 12:15, Mile High Ballroom 2a-3b
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ORAL16.03 - Acceptability of NSCLC, NOS in Advanced Disease: An Assessment of US Oncologists, Pulmonologists and Pathologists (ID 1255)
10:45 - 12:15 | Author(s): T. Herrmann
- Abstract
- Presentation
Background:
In 2011 the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology issued a recommendation to classify patients with advanced NSCLC into specific histological and molecular subtypes and minimize the diagnosis of not otherwise specified (NOS) subtype. The objective of this study was to define the rate of NOS subtype being observed in practice as well as the NSCLC care team’s knowledge and beliefs about a diagnosis of NOS subtype in advanced-stage disease.
Methods:
A series of 5 questions were developed to identify the incidence of NOS subtype being observed in the community as well as relevant care team knowledge gaps and beliefs that may influence the findings. The case vignettes and questions and were based on current standards of care and evidence-base in the treatment of advanced NSCLC. The questions were made available online to healthcare providers either through a survey or as part of 2 certified medical education activities; without monetary compensation or charge. Confidentiality of survey respondents was maintained and responses were de-identified and aggregated prior to analyses. The series of 5 questions was launched in both formats in December 2014 and participant responses were collected over the following 4 months.
Results:
In total, 553 oncologists, pathologists and pulmonologists answered all 5 questions. Oncologists who responded to the questions on average saw about 6-10 patients with suspected or diagnosed NSCLC per month while pathologists and pulmonologists were more likely to see 1-5 per month. Almost 60% of oncologists, pathologists and pulmonologists stated that the incidence of NOS subtype should occur in less than 5% of all cases. Yet, 28% of participating oncologists, 37% of pathologists, and 40% of pulmonologists would find a diagnosis of NSCLC, NOS acceptable. Moreover, 45% of oncologists and 64% of pulmonologists stated that 11% or more of their patients are reported as having a diagnosis of NSCLC, NOS. Reasons for acceptability of NOS subtype differed between clinicians; with more pulmonologists stating it is always acceptable while pathologists and oncologists were more likely to cite age or smoking status, respectively. When asked what contributes to this belief a majority of oncologists and pathologists cited an inability to obtain adequate tissue while pulmonologists were more likely to state that subtyping was unnecessary to prescribe the appropriate therapy (30%) or it was a result of system barriers (25%).
Conclusion:
Despite recommendations from key organizations the incidence of NSCLC, NOS many members of the care team continue to accept a diagnosis of NOS in their patients. Our findings demonstrate a pressing need for additional education of the multidisciplinary care team involved in the diagnosis of advanced NSCLC so as to ensure appropriate diagnosis and treatment.
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-004 - Oncologists' Comprehension and Beliefs Surrounding Cancer Immunotherapy in Advanced NSCLC (ID 1267)
09:30 - 17:00 | Author(s): T. Herrmann
- Abstract
Background:
Advanced NSCLC is now recognized as an immune-modifiable disease, and with the approval of the first PD-1 inhibitor, immune checkpoint inhibitors represent a new standard of care for patients with previously treated squamous cell lung cancer. The objective of this study was to evaluate oncologists’ familiarity with cancer immunotherapy in the context of advanced NSCLC and the impact of an educational curriculum on narrowing gaps in clinical practices.
Methods:
An expert panel of oncologists identified educational gaps in the area of cancer immunotherapy. A series of 9 CME online activities were developed, 2 of which centered on advanced NSCLC and are the focus of this study. Interactivity questions allowed learners to self-report their familiarity with immunotherapy concepts in the management of advanced NSCLC, while case vignette and knowledge-based questions were constructed around evidence-based medicine. Confidentiality of survey respondents was maintained and responses were de-identified and aggregated prior to all analyses.
Results:
1368 oncologists participated in the 2 activities on advanced NSCLC. As seen in the table below participation in the education activities resulted in numerous improvements in knowledge and competence as seen in the table below. Despite improvements, several important gaps remained. Only70% of oncologists comprehend that a tumor may increase in size or new lesions appear during initial therapy with an immune checkpoint inhibitor. In addition, about half of oncologists still had difficulty grasping how immune checkpoints downregulate T cell responses. Finally, oncologists still had difficulty identifying the unique side effect profile associated with immune checkpoint inhibitors. In addition, 55% of oncologists reported they were not comfortable with managing side effects associated with these agents.Table
% answered correctly % answered correctly Pre-Activity Post-Activity Comprehension of Basic Immunology Interaction of TCR with MHC-peptide complex and co-stimulatory receptors CD28/CD80 and CD86 52% 69% Which does not represent a role of an immune checkpoint in the adaptive immune response: CTLA-4 binds to CD28, augmenting T-cell activation 50% 57% Knowledge of Immune System’s Role in Response to Cancer T cell infiltration and decreased risk of recurrence 69% 76% Disease progression on an immune checkpoint inhibitor 65% 71% Efficacy, Safety, Limitations of Immune Checkpoint Inhibitors Limitations PD-L1 as a biomarker 26% 70% Durability of response 5% 30% Unique side effect profile 41% 59%
Conclusion:
The study evaluated oncologists’ familiarity with cancer immunotherapy in advanced NSCLC and demonstrated the necessity of developing targeted educational interventions for improving the knowledge and practice patterns of oncologists. Additional education is needed to continue to improve clinicians’ competence in the use of cancer immunotherapies in the management of NSCLC.
