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John Kirkpatrick Field



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    OA 15 - Diagnostic Radiology, Staging and Screening for Lung Cancer II (ID 684)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Radiology/Staging/Screening
    • Presentations: 1
    • Now Available
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      OA 15.09 - Discussant - OA 15.06, OA 15.07, OA 15.08 (Now Available) (ID 10836)

      15:55 - 16:10  |  Presenting Author(s): John Kirkpatrick Field

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P2.13 - Radiology/Staging/Screening (ID 714)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      P2.13-025 - Selecting the Risk Cut off for the LLP Model (ID 9519)

      09:30 - 09:30  |  Author(s): John Kirkpatrick Field

      • Abstract

      Background:
      The application of risk prediction models for the selection of individuals for lung cancer (LC) screening requires risk thresholds to distinguish between individuals eligible and ineligible for screening. However, little is known about the performance of risk prediction models across different risk thresholds. The UKLS trial utilised the Liverpool Lung Project risk model (LLP~v2~) with a risk threshold of 5% for 5-year LC incidence as the selection criteria in the trial. The UKLS yielded a 1.7% LC detection rate at baseline, which was higher than the NLST or NELSON trials. This study evaluates the performance of different risk thresholds for the selection of individuals for lung cancer screening utilising the LLP~v2~ model.

      Method:
      The performance of the LLP~v2~ risk model to predict 5-year LC incidence was evaluated in ever-smokers from the PLCO. The sensitivity (the proportion of LC in the total population that occur within those selected for screening), specificity (the proportion of individuals excluded from screening which do not develop LC), and proportion of individuals eligible for screening was assessed across a wide range of risk thresholds. In addition, the trade-off between the sensitivity and the proportion of individuals eligible for screening was assessed.

      Result:
      Applying low risk thresholds yielded high sensitivities, at the cost of low specificities and higher ratios of persons eligible per LC included within the eligible population. For example, a LLP~v2~ risk threshold of 1.0% would yield a sensitivity of 91.5% at the cost of a specificity of 37.2% and a ratio of 39 eligible individuals per LC. In contrast, a LLP~v2~ risk threshold of 5.0% would only yield a sensitivity of 36.5%, but had a specificity of 88.8% and a ratio of 18 eligible individuals per LC. A LLP~v2~ risk threshold of 2.03% yielded a similar sensitivity, but higher specificity and a more favourable ratio of eligible individuals per LC compared to the NLST criteria. LLP~v2~ risk thresholds between 2.0-3.0% may provide an advantageous balance between sensitivity and the ratio of eligible individuals per LC.

      Conclusion:
      The level of the risk threshold applied to select individuals for screening has an inverse relationship between the efficacy and efficiency of LC screening. Implementing LC screening programs which use risk prediction models to determine screening eligibility require further assessment of the trade-off between these aspects with regards to the long-term benefits, harms and cost-effectiveness to ascertain the optimal risk threshold.

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    WS 01 - IASLC Supporting the Implementation of Quality Assured Global CT Screening Workshop (By Invitation Only) (ID 632)

    • Event: WCLC 2017
    • Type: Workshop
    • Track: Radiology/Staging/Screening
    • Presentations: 4
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      WS 01.01 - Welcome and Aims of Workshop (ID 10613)

      08:30 - 08:40  |  Presenting Author(s): John Kirkpatrick Field

      • Abstract
      • Slides

      Abstract:
      On October 14th, the Fifth IASLC Strategic Screening Workshop will be held in Yokohama Convention Center with the following objectives: 1.) provide the state of art methodology for undertaking lung CT cancer screening, 2.) provide discussions and recommendations around implementation, which will have impact on all health services, 3.) develop a resource toolkit to support national screening implementation efforts when based on current knowledge and international expectations, 4.) propose recommendation for the IASLC Executive Committee to consider regarding how they can support leadership in this forefront area of lung cancer for the Association, 5.) produce a document outlining the summary status from this workshop. The IASLC has been a robust supporter of research and progress with lung cancer screening especially working to integrate tobacco control and cessation measures with low dose CT-based early detection efforts in high risk populations. As the world’s leading multi-disciplinary lung cancer care professional society and with the quality of the lung cancer screening process fundamentally linked to the proper coordination of all of the health professionals required for this service, IASLC has a critical role in facilitating rapid progress for this validated approach to reducing lung cancer mortality. This Workshop brings leading experts in screening from across the world to discuss best practices as well as to consider new collaborations to advance best practice. In light of the great demand from the IASLC membership, we have also organized a second screening forum for October 14, which is a Symposium on Advances in Lung Cancer CT Screening. In this forum, a number of international leaders will present their experiences with aspects of CT screening process. These presentations are more in-depth than in the Workshop forum but still providing ample time for interaction with the attendees. The intention is to provide the membership with a comprehensive emersion into the rapidly moving field of lung cancer screening. This is a new, complex and demanding service. Implementing a high quality screening process while maintaining low cost can be done, but many institutions have benefitted from a collaborative approach to share institutional practices. The goal of the current IASLC Workshop and Symposium is to encourage and facilitate such collaborative interactions.

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      WS 01.02 - Session 1 (ID 10640)

      08:40 - 08:40  |  Presenting Author(s): John Kirkpatrick Field

      • Abstract
      • Slides

      Abstract not provided

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      WS 01.24 - Designs of Possible Biomarkers for Future Screening Programs? (ID 10665)

      13:41 - 13:49  |  Presenting Author(s): John Kirkpatrick Field

      • Abstract
      • Slides

      Abstract:
      The integration of biomarkers into lung cancer CT screening programmes remains an ‘unfulfilled promise’ in lung cancer research. There are two specific areas that biomarkers could contribute: (i) identification of high risk individuals for future Lung cancer CT screening programmes (ii) management of CT detected ‘indeterminate’ nodules (Figure 1). Figure1. Potential for the integration of biomarkers into Lung cancer CT screening programmes Figure 1 The choice of potential risk biomarkers has been recently reviewed by Atwater & Massion (1), however, the major issue is that none of the candidate biomarkers have been shown to have any impact on the reduction of cancer mortality. The question is whether we have been undertaking the correct design to identify such a molecular biomarker, which will need to add significant worth to the current risk models based on lifestyle and medical history or to the developing image-based “radiomic” biomarkers. Many diagnostic biomarkers have been described, but often these have not been designed to work alongside Lung cancer CT screening. Lung cancer risk prediction models based on epidemiological parameters and history of lung disease have made a major contribution to how we select participants for lung cancer screening trials, the two risk modes which have been used in recent lung cancer screening trials are the LLPv2 (2) (UKLS) and the PLCO2012 (3) used in the Pan Canadian trial. However, no biomarkers or genetic susceptibility markers have made any impact on these risk prediction models to date(4). The recent new set of SNPs identified in the Lung cancer OncoArray publication (5) may provide a new research avenue. Also utilising the Cancer Genome Atlas (TCGA) project dataset, 8 SNPs were found to be significantly associated with lung cancer risk ( P 0.05) in both discovery and validation phases (6). Some biomarker modalities, e.g. breath testing and liquid biopsies for microRNA (miRNA) or circulating tumour DNA (ctDNA) could impact either on risk models for selection or for managing nodules. The advent of Breath tests for early lung cancer detection has come of age and has demonstrated potential by Owlstone Medical who are in discussion with the NHS to roll out the device across GP surgeries in the UK in 2017, based on the results of the PAN Cancer Clinical trial. [https://www.owlstonemedical.com/]. It will be important to assess how best to integrate such GP-based tests with wider screening programmes. Early lung cancer breath tests recently reviewed (7) (8). A major effort is currently been undertaken in ctDNA, the presence of cell free DNA in either plasma or serum has been described in multiple publications, however the presence of ctDNA in early disease remains elusive (9) and ctDNA is more likely to be employed in nodule management. However, circulating protein biomarkers have a more established history in lung cancer diagnosis (10) (11). The management of CT scan detected indeterminate nodules presents a major issue to the clinicians managing these patients, a number of nodule risk models have been developed, based on the characteristics of the nodules with specific epidemiological criteria (12) and pulmonary management guideline have been drawn up (13). A range of other models have been recently reviewed (14). This is now considered the forefront area of molecular biomarker research, could potentially make an enormous contribution to the management of indeterminate nodules. Liquid biopsies for microRNA (miRNA) have diagnostic and prognostic potential for CT screen detected cancers (15) (16) and may impact of nodule management (17). Pomising new research into the evaluation of tumor-derived exosomal miRNA using next-generation sequencing as a diagnostic maker for early disease has also been developed (18) (19). Circulating miRNA may also be used to improve risk models including clinical factors, imaging and serum protein levels (20). One challenge for validation and evaluation of the required molecular and imaging biomarkers is the availability of low dose CT scan data and related samples, especially in countries that have not yet instigated national screening programmes. This may be met in part by current initiatives to establish registry studies and to make imaging data available as currently been planned in the IASLC CCTRR project, but a parallel effort for access to associated minimally invasive samples (e.g. plasma and serum) would be welcomed. References 1. T. Atwater, P. P. Massion, Ann Transl Med 4, 158 (2016). 2. J. K. Field et al., Health Technol Assess 20, 1-146 (2016). 3. C. M. Tammemagi et al., J Natl Cancer Inst 103, 1058-1068 (2011). 4. M. W. Marcus et al., Int J Oncol 49, 361-370 (2016). 5. J. D. McKay et al., Nat Genet 49, 1126-1132 (2017). 6. Y. Zhang et al., Ann Oncol, (2017). 7. S. A. Hayes et al., J Breath Res 10, 034001 (2016). 8. I. Taivans et al. Expert Rev Anticancer Ther 14, 121-123 (2014). 9. C. Perez-Ramirez et al., Liquid biopsy in early stage lung cancer. Transl Lung Cancer Res 5, 517-524 (2016). 10. C. E. Hirales Casillas et al., Future Oncol 10, 1501-1513 (2014). 11. X. Wang et al., Oncotarget 8, 45345-45355 (2017). 12. A. McWilliams et al., CT. N Engl J Med 369, 910-919 (2013). 13. G. British Thoracic Society Pulmonary Nodule Guideline Development. (2016), vol. 2017. 14. J. K. Field et al. Transl Lung Cancer Res 6, 35-41 (2017). 15. M. Boeri et al.,. Proc Natl Acad Sci U S A 108, 3713-3718 (2011). 16. S. Sestini et al., Oncotarget 6, 32868-32877 (2015). 17. J. Shen et al., BMC Cancer 11, 374 (2011). 18. X. Jin et al., Clin Cancer Res, (2017). 19. Y. Lin et al., Int J Cancer, (2017). 20. Li et al. World J Surg Oncol 15, 107 (2017).



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      WS 01.38 - Session 6: What Priorities and Recommendations Should the IASLC Executive Focus On: How They Can Support Leadership in this Area of Lung Cancer (Round Table Discussion) (ID 10683)

      16:20 - 18:00  |  Presenting Author(s): John Kirkpatrick Field

      • Abstract

      Abstract not provided

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    WS 02 - IASLC Symposium on the Advances in Lung Cancer CT Screening (Ticketed Session SOLD OUT) (ID 631)

    • Event: WCLC 2017
    • Type: Symposium
    • Track: Radiology/Staging/Screening
    • Presentations: 1
    • Now Available
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      WS 02.09 - Lung Cancer Guidelines (Now Available) (ID 10624)

      12:00 - 13:00  |  Presenting Author(s): John Kirkpatrick Field

      • Abstract
      • Presentation

      Abstract not provided

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.