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E. Vallieres



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    P1.03 - Poster Session with Presenters Present (ID 455)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 2
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      P1.03-050 - Outcomes after the Decision to Biopsy: Results from a Nurse Practitioner Run Multidisciplinary Lung Cancer Screening Program (ID 6231)

      14:30 - 15:45  |  Author(s): E. Vallieres

      • Abstract

      Background:
      Lung cancer screening programs are increasing in popularity after results from the National Lung Screening Trial demonstrated improvement in mortality after screening with low dose computed tomography. Current guidelines recommend the availability of multidisciplinary care and evaluation; however, reported outcomes from multidisciplinary team decision making to proceed with diagnostic sampling in lung cancer screening remains sparse.

      Methods:
      A retrospective review of patients enrolled in the Swedish Cancer Institute Lung Cancer Screening Program from January 2013 to March 2016 was performed. The program is run by an independently practicing nurse practitioner, with a multidisciplinary team consisting of radiologists, interventional pulmonologists, and thoracic surgeons. Positive screening results (nodules >6mm) with the potential need to pursue diagnostic sampling were reviewed in a multidisciplinary fashion. Basic demographics and procedural outcomes after the decision to biopsy were obtained.

      Results:
      A total of 516 patients were enrolled within the lung cancer screening program from 2013 – 2016. Nodule(s) >6mm were identified in 164 (31.8%) patients. Subsequently, 25 (4.8%) patients underwent some form of invasive testing. The mean age of this population was 66.2 (SD-6.7) years with 56% (14/25) being female and mean pack years of 50.8 (SD-19.5). Percutaneous needle aspiration (n=11), endoscopic sampling (n=10), and surgical biopsy/resection (n=4) were performed as the first invasive diagnostic procedure. The outcomes of this initial sampling were cancer (n=15), non-diagnostic (n=7), benign (n=2), and infection (n=1). Three patients without an initial diagnosis underwent additional non-surgical biopsy attempts. Overall, surgical resection was performed in twelve patients (6 after previous diagnostic procedure, 2 after previous non-diagnostic procedure, and 4 as initial procedure). Final outcomes were cancer (n=16), non-diagnostic procedure (n=4), non-caseating granulomatous inflammation (n=2), benign diagnosis after wedge resection (n=2), and infection (n=1).

      Conclusion:
      Within a nurse practitioner led, multidisciplinary, lung cancer screening program, a small proportion of patients undergo invasive diagnostic testing, despite a rather high prevalence of potentially actionable nodules. Within the NLST population receiving computed tomography, 6.1% underwent invasive testing with 43% undergoing testing that ultimately did not result in a cancer diagnosis. Within our multidisciplinary program, 4.8% underwent invasive testing with 36% undergoing testing not ultimately resulting in a cancer diagnosis. The utilization of multidisciplinary teams during the biopsy decision-making process may help decrease the number of non-diagnostic procedures. Further research is needed to help identify tools that improve patient selection for invasive testing in lung cancer screening programs.

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      P1.03-051 - Medically Underserved and Geographically Remote Individuals May Be Underrepresented in Current Lung Cancer Screening Programs (ID 6273)

      14:30 - 15:45  |  Author(s): E. Vallieres

      • Abstract
      • Slides

      Background:
      The National Lung Screening Trial demonstrated a 20% reduction in lung cancer mortality and ushered in lung cancer screening (LCS). Study centers included 33 academic, mostly urban-based sites, which may underrepresent low socioeconomic remote populations with minimal health care access. United States Census Bureau 2014 data demonstrated that smoking is concentrated among adults with low income and education, and without private medical insurance; components of medically underserved/shortage area designations. We sought to assess the representation of underserved communities in our hospital-based Lung Cancer Screening Program (LCSP).

      Methods:
      We reviewed individuals referred to our LCSP from 2012-2016, consisting of two separate screening sites located within metropolitan King County, Washington. Each individual’s county and distance from the LCS site was calculated. Individual’s residence designation as a geographic medically underserved/shortage area was determined. Definitions include: medically underserved area [MUA; healthcare resources deficient region], medically underserved population [MUP; area with economic/cultural/linguistic barriers to primary care services], health professional shortage area [HPSA; primary care physician shortage].

      Results:
      We identified 599 referred individuals, median age 64, from 13/39 counties (King County and 12 clustered, surrounding counties). Overall, <20% of the referred population resided in underserved/shortage areas and <55% of the designated geographic underserved/shortage areas in the 13 counties had patient referrals (Table). Of those referred, 85% resided in King County, 17% in a MUA and 65% of the MUAs had patient referrals. Two percent of the referral population resided in a remote county, Clallam, where ≥70% of referred households were in underserved/shortage areas. Figure 1



      Conclusion:
      The majority of individuals referred reside within 10 miles of the LCS site. Less than 20% reside in designated underserved/shortage areas and <55% of underserved/shortage areas are represented. Creative and coordinated approaches, like Telemedicine, will be required to address the potential lack of LCS services in underserved/shortage areas and facilitate individuals remaining in their communities.

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    P1.07 - Poster Session with Presenters Present (ID 459)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: SCLC/Neuroendocrine Tumors
    • Presentations: 1
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      P1.07-019 - Large Cell Neuroendocrine Carcinoma of the Lung: Prognostic Factors of Survival and Recurrence after R0 Surgical Resection (ID 4928)

      14:30 - 15:45  |  Author(s): E. Vallieres

      • Abstract
      • Slides

      Background:
      Large cell neuroendocrine carcinomas (LCNEC) represent approximately 3% of all lung cancers. Due to this rarity, little knowledge exists about their outcome, prognosis or optimal treatment strategy. The objective of this study is to evaluate the outcomes of patients undergoing lung resection for LCNEC to identify the factors affecting survival and recurrence to help refine the optimal treatment strategy.

      Methods:
      We retrospectively reviewed 116 patients who underwent lung resection at 8 centers between 2000-2015. We excluded 18 patients: pNX(3), stage IV(5), R1-2(10). Univariate and multivariate analysis were performed to identify factors influencing disease-specific survival, overall survival and recurrence. The variables included age, gender, smoking habit, previous malignancy, ECOG performance status, symptoms at diagnosis, extent of resection, extent of lymphadenectomy, tumor location, tumor size, pT, pleura invasion, pN, pStage and neo/adjuvant treatments. Kaplan-Meier, Cox regression and ROC curve were used.

      Results:
      A total of 98 patients (M/F:60/38) were analyzed with a median age of 66 years (IQR=58-72). Prior to resection, 11 (11%) received induction therapy. Resections included pneumonectomy (8), bilobectomy (3), lobectomy (76) and sublobar (11) with an associated lymph node sampling (N=52, 55%) and lymphadenectomy (N=43, 45%). Adjuvant therapy was delivered in 28 (30%). Pathologic stages were I (N=40, 41%), II (N=33, 34%) and IIIA (N=25, 25%). Median follow-up was 62 (IQR=19-120) months. The 5-year disease-specific and overall survival rates were 51.6% and 42.7%. On univariate analysis, pT was associated with disease-specific and overall survival (p=0.011, p=0.028). Similarly pT was also associated on multivariate analysis with disease-specific and overall survival (p=0.044, p=0.034). The recurrence rate was 55% (2% local, 10% regional, 32% systemic, 11% not-specified). The median disease-free interval was 16 (IQR=6-80) months. Local-regional recurrence wasn’t associated with any factor on univariate analysis. Systemic recurrence was correlated with tumor size (p=0.002), pT (p=0.003) and pStage (p=0.024) on univariate analysis. Tumor size was an independent prognostic factor of systemic recurrence on multivariate analysis (p=0.001) with a threshold value of 3 cm (AUC=0.712). The 5-year disease-free survival for systemic recurrence in tumors < 3 cm or >3 cm was 75.4% and 37.8% (p=0.001). The 5-year disease-specific survival was 56.7% and 47.3% (p=0.088).

      Conclusion:
      Treatment of LCNEC with predominately surgical resection results in a respectable 5-year survival. However, a high proportion of systemic recurrence occurs. Tumors >3 cm have a higher rate of systemic recurrence and lower rate of survival suggesting that adjuvant chemotherapy may be indicated for completely resected LCNEC >3 cm.

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    P3.02c - Poster Session with Presenters Present (ID 472)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P3.02c-050 - IMpower010: Phase III Study of Atezolizumab vs BSC after Adjuvant Chemotherapy in Patients with Completely Resected NSCLC (ID 6098)

      14:30 - 15:45  |  Author(s): E. Vallieres

      • Abstract

      Background:
      Early-stage non-small cell lung cancer (NSCLC) is treated surgically, but 30%-70% of patients experience post-resection recurrence and succumb to disease. Adjuvant chemotherapy is the standard of care for fully resected NSCLC (stages IB [tumors ≥4 cm]-IIIA), and although cisplatin-based chemotherapy provides some benefit, the 5-year absolute survival benefit is ≈5%, underscoring the unmet need. Atezolizumab is an anti-PD-L1 monoclonal antibody that inhibits PD-L1 from binding to its receptors PD-1 and B7.1, thereby restoring anti-tumor immune response. Atezolizumab monotherapy has demonstrated promising efficacy and tolerable safety in patients with previously-treated advanced NSCLC, with a survival benefit observed across all PD-L1 expression levels. Given the need to improve survival for patients with early-stage NSCLC, IMpower010 (NCT02486718), a global Phase III randomized, open-label trial, has been initiated to compare the efficacy and safety of atezolizumab with best supportive care (BSC), following adjuvant cisplatin-based chemotherapy in patients with resected stage IB (tumors ≥4 cm)-IIIA NSCLC.

      Methods:
      Eligibility criteria include complete tumor resection 4-12 weeks prior to enrollment for pathologic stage IB (tumors ≥4 cm)–IIIA NSCLC. Patients must have adequately recovered from surgery, be eligible to receive cisplatin-based adjuvant chemotherapy and have an ECOG PS 0-1. Exclusion criteria include the presence of other malignancies, use of hormonal cancer or radiation therapy within 5 years, prior chemotherapy, autoimmune disease or exposure to prior immunotherapy. Approximately 1127 patients, regardless of PD-L1 expression status, will be enrolled. Eligible patients will receive up to four 21-day cycles of cisplatin-based chemotherapy (cisplatin [75 mg/m[2] IV, day 1] + either vinorelbine [30 mg/m[2] IV days 1, 8], docetaxel [75 mg/m[2] IV day 1] or gemcitabine [1250 mg/m[2] IV days 1, 8], or pemetrexed [500 mg/m[2] IV day 1; non-squamous NSCLC only]). Adjuvant radiation therapy is not permitted. Following adjuvant treatment, eligible patients will be randomized 1:1 to receive atezolizumab (1200 mg q3w, 16 cycles) or BSC. Stratification factors will include sex, histology (squamous vs non-squamous), extent of disease (stage IB vs II vs IIIA) and PD-L1 expression by IHC (TC, tumor cell; IC, tumor-infiltrating immune cell; TC2/3 [≥5% expressing PD-L1] and any IC vs TC0/1 [<5%] and IC2/3 [≥5%] vs TC0/1and IC0/1 [<5%]). The primary endpoint is disease-free survival, and secondary endpoints include overall survival and safety. Exploratory endpoints include PD-L1 status, immune and tumor related biomarkers before, during and after treatment with atezolizumab and at radiographic disease occurrence or confirmation of new primary NSCLC.

      Results:
      Section not applicable

      Conclusion:
      Section not applicable

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    SC25 - The Role of Surgeons in Multimodality Clinical Trials (ID 349)

    • Event: WCLC 2016
    • Type: Science Session
    • Track: Surgery
    • Presentations: 1
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      SC25.02 - Quality of Resection in Induction and Adjuvant Clinical Trials (ID 6706)

      11:00 - 12:30  |  Author(s): E. Vallieres

      • Abstract
      • Presentation

      Abstract not provided

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