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David Raymond Baldwin



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    OA 02 - Mesothelioma: Challenges For New Treatment (ID 653)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Mesothelioma
    • Presentations: 1
    • Now Available
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      OA 02.03 - Prophylactic Irradiation of Tracts (PIT) in Patients with Pleural Mesothelioma: Results of a Multicentre Phase III Trial (Now Available) (ID 7980)

      11:20 - 11:30  |  Author(s): David Raymond Baldwin

      • Abstract
      • Presentation
      • Slides

      Background:
      It has been widespread practice across Europe to irradiate diagnostic or therapeutic chest wall (CW) intervention sites in patients with malignant pleural mesothelioma (MPM) post-procedure - a practice known as prophylactic irradiation of tracts (PIT). This study aims to determine the efficacy of PIT in reducing the incidence of CW metastases following a chest wall procedure in MPM.

      Method:
      In this multicentre phase III randomised controlled trial, MPM patients following a chest wall procedure were randomised 1: 1 to receive PIT (within 42-days of procedure) or no PIT. Large thoracotomies, needle biopsy sites and indwelling pleural catheters were excluded. PIT was delivered at a dose of 21Gy in 3 fractions over 3 consecutive weekdays using a single electron field adapted to maximise coverage of the tract from skin surface to pleura. The primary outcome was the incidence of CW metastases within 6 months from randomisation, assessed in the intention-to-treat population. Stratification factors included epitheloid histology and intention to give chemotherapy. Trial registration number NCT01604005.

      Result:
      375 patients (186 PIT and 189 no PIT) were randomised between 06/2012-12/2015 from 54 UK centres. Comparing PIT vs no PIT, %male patients was 89.8/88.4%, median age 72.8/74.6 years, %ECOG PS (0,1,2) 32.2,56.5,11.3/23.8,56.1,20.1%, %confirmed epithelioid histology 79.6/74.1%, and %with intention to give chemotherapy 71.5/71.4%. The chest wall procedures were VATS (58.1/51.3%), open surgical biopsy (2.7/5.3%), local-anaesthetic-thoracoscopy (26.9/27.0%), chest drain (5.9/8.5%) and others (6.5/7.9%) for the PIT vs no PIT arm respectively. Radiotherapy was received as intended by 181/186 patients in the PIT arm. The proportion of CW metastases by 6 months was 6/186 (3.2%) vs 10/189 (5.3%) for the PIT vs no PIT arm respectively (odds ratio 0.60 [95% CI 0.17-1.86]; p=0.44) and by 12 months 15/186 (8.1%) versus 19/189 (10.1%) respectively (OR=0.79 [95% CI 0.36-1.69];p=0.59). Cumulative incidence of CW metastases at 6months/12 months/24 months was 3.3/8.5/10.0% in the PIT arm vs 5.6/10.9/18.7% in the no PIT arm. Evaluable patients who developed CW metastases reported a mean increase in visual analogue scale pain score of 13.3 (p<0.01) compared to baseline. Skin toxicity was the most common radiotherapy-related adverse event in the PIT arm with 96(51.6%) grade 1, 19(10.2%) grade 2, and 1(0.5%) grade 3 radiation dermatitis (CTCAE V4.0). There were no other grade 3 or higher radiotherapy-related adverse events.

      Conclusion:
      There is no role for the routine use of PIT following diagnostic or therapeutic CW procedures in patients with MPM.

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    P1.05 - Early Stage NSCLC (ID 691)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
    • Now Available
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      P1.05-010 - Curative Treatment Rates for Patients Diagnosed with Early Stage Non-Small Cell Lung Cancer (NSCLC) in England (Now Available) (ID 9889)

      09:30 - 09:30  |  Author(s): David Raymond Baldwin

      • Abstract
      • Slides

      Background:
      Overall survival for lung cancer in England has previously been shown to be improving year on year and to correlate with surgical resection rates (National Lung Cancer Audit (NLCA) 2016 report). Recently the NLCA switched to use anonymised data collected and processed by the National Cancer Registration and Analysis Service (NCRAS) which has allowed linkage of the dataset to other national datasets including the radiotherapy dataset (RTDS), not previously reported. The main aim of this study was to identify a national curative treatment rate for early stage NSCLC and to identify which patient features influence whether a patient receives surgery, radical radiotherapy (RT) or no active treatment.

      Method:
      A cross-sectional analysis was conducted on all English patients diagnosed with stage I-II lung cancer between January 2015 and December 2015. Types of surgery and radical radiotherapy were identified from NCRAS databases including Cancer Outcomes and Services Dataset (COSD), Hospital Episode Statistics (HES) and RTDS databases. Survival was defined from time from treatment until death and Cox regression analysis was used to determine factors associated with survival.

      Result:
      36025 cases of lung cancer were identified in 2015 with 8841 (28%) cases of stage IA-IIB proven or presumed NSCLC. 4560 (51.6%) cases received surgery and 1437 (16.2%) received radical RT creating a combined total of 5997 (67.8%) cases receiving treatment with curative intent. Curative intent treatment varied across cancer networks from 61.6% to 74.4%. Stereotactic Ablative Radiotherapy (SABR) was delivered in 750/1437 (52.2%) radical RT cases, generally for stage I disease, 60/1437 (4.1%) cases received Continuous Hyper-fractionated Accelerated RT (CHART) and 486/1437 (33.8%) cases received 55Gy/20 fractions, a commonly prescribed hypo-fractionated radical RT regime in England. Notably, 2844 (32.2%) patients did not receive treatment with curative intent, receiving either palliative therapy or supportive care only. Lack of treatment with curative intent was associated with increasing age and worsening performance status and varied across networks (25.6% - 38.4%). Updated survival data will be presented.

      Conclusion:
      In England for 2015, the curative treatment rate for stage I and II NSCLC was 67.8%. This means that almost one third of patients did not receive definitive treatment for their early stage lung cancer, ranging from 25.6% to 38.4 % across networks. A NLCA deep dive spotlight audit to identify more details about why these patients did not receive definitive treatment is planned for later this year.

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    P2.06 - Epidemiology/Primary Prevention/Tobacco Control and Cessation (ID 707)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
    • Presentations: 1
    • Now Available
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      P2.06-005 - An Exploration of Attitudes and Barriers to Uptake of Lung Cancer Screening in at Risk Adults in the United Kingdom (Now Available) (ID 9103)

      09:30 - 09:30  |  Presenting Author(s): David Raymond Baldwin

      • Abstract
      • Slides

      Background:
      Lung cancer screening targets a high risk subgroup of the population, comprising current and ex-smokers. There are data to suggest that smokers view screening in a nihilistic way and perceive early detection to be of limited use and, as such, are less likely to consider screening participation. Other screening programmes have also shown markedly reduced uptake in those from the most deprived groups. Smoking rates and lung cancer incidence are highest in more socially deprived areas and lung cancer survival is worst in this group. An understanding of the key barriers to engagement with lung cancer screening is therefore vital prior to implementation of a national screening programme.

      Method:
      Focus groups were established in socially deprived communities within the East Midlands, United Kingdom, using community contacts. The Framework approach was used to analyse data into themes and sub-themes. To supplement these focus groups, questionnaires were developed and purposive sampling used to try to obtain a maximum number of views from a cross-section of the deprived communities. Participants were smokers or ex-smokers aged 40 years or older.

      Result:
      Recruitment to focus groups was very challenging, despite remuneration being offered. In total there were 13 participants and a further 56 people responded to questionnaires. Key barriers to screening participation identified were accessibility, with many participants preferring community-based drop-in sessions, perceived stigma and blame surrounding smoking and fear and nihilism regarding a lung cancer diagnosis. Although many were supportive in principle around the idea of screening, they felt that the way it was presented to them was crucial. Participants emphasised the importance of community engagement and the use of community leaders to talk to those who were eligible for screening in a way that they could understand and thus promote it rather than it coming from a medically qualified individual.

      Conclusion:
      This work gives an insight into some of the ideas and opinions around lung cancer screening and highlights some barriers that need to be addressed prior to implementation of a national screening programme. A combination of practical and emotional barriers, alongside the role of community engagement and education were identified as important. As lung cancer screening will focus on a high-risk group of smokers and ex-smokers, their perception of smoking stigma and blame will need to be addressed in a non-judgemental way and novel education and invitation material may need to be developed, delivered through community approaches, to promote screening in a positive light.

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    P3.05 - Early Stage NSCLC (ID 721)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
    • Now Available
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      P3.05-001 - Breath Analysis for Early Detection of Lung Cancer: The LuCID Study (Now Available) (ID 10067)

      09:30 - 09:30  |  Author(s): David Raymond Baldwin

      • Abstract
      • Slides

      Background:
      There is an urgent need for methods to detect lung cancer earlier. If detected early, over half of lung cancer patients could be cured with existing treatments. Therefore, our greatest opportunity lies in increasing rates of early diagnosis through improved cancer screening. Exhaled breath contains over 1,000 Volatile Organic Compounds (VOCs), which are the products of metabolic activity, hence they directly reflect the current state of cells and represent a valuable source of information about the health of an individual. As the earliest stages of tumour development are characterized by profound changes in cellular metabolic activity, VOCs are potential non-invasive biomarkers for early detection of lung cancer. The LuCID study aims to collect breath samples and evaluate VOCs in exhaled breath as non-invasive biomarkers for early detection of lung cancer.

      Method:
      LuCID is an international multi-centre prospective case-control cohort study (ClinicalTrials.gov ID NCT02612532) currently in progress, evaluating breath VOCs in patients with a clinical suspicion of lung cancer. A clinical suspicion is based on symptoms and/or suspicious finding on incidental imaging. Using tidal breathing, patients breathe into the ReCIVA Breath Sampler for 7 minutes to collect alveolar- and bronchial-enriched breath fractions on stable sorbent tubes for later analysis by Gas Chromatography-Mass Spectrometry and Field Asymmetric Ion Mobility Spectrometry (FAIMS, Owlstone Medical Ltd). A classification algorithm will be constructed from chemical spectral data, and undergo internal and external blinded validation to provide a ROC-curve detailing diagnostic accuracy. The LuCID study has an adaptive trial design, recruiting up to 2,600 patients depending on interim results.

      Result:
      The LuCID study has recruited 980 patients to date from 20 centres (mean age 67.5, SD 12.0). Of patients with completed follow-up (n=802), 33% have histologically confirmed lung cancer (of those with lung cancer: 40% early stage 1a-2b, 60% advanced stage 3a-4). Non Small Cell Lung Cancer (NSCLC) comprised 87% of these cancers, and Small Cell Lung Cancer 9%. NSCLC were further categorized as adenocarcinoma (50%), squamous cell carcinoma (38%), with the remaining 12% belonging to other categories.

      Conclusion:
      The LuCID study is evaluating the analysis of exhaled VOC biomarkers as a new diagnostic modality for early detection of lung cancer. Successful completion of the LuCID study will pave the way for the development of a non-invasive, easy-to-implement test that could markedly improve screening and early detection rates, reducing lung cancer morbidity and mortality.

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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: 2
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      WS 01.09 - Session 2: Radiological Imaging – Quality Assurance and Training (ID 10647)

      09:50 - 09:50  |  Presenting Author(s): David Raymond Baldwin

      • Abstract

      Abstract not provided

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      WS 01.18 - Lung Cancer Indicator Detection Trial (LuCID) (ID 10656)

      11:45 - 12:00  |  Author(s): David Raymond Baldwin

      • Abstract
      • Slides

      Abstract:
      Background There is an urgent need for methods to detect lung cancer earlier. If detected early, over half of lung cancer patients could be cured with existing treatments. Therefore, our greatest opportunity lies in increasing rates of early diagnosis through improved cancer screening. Exhaled breath contains over 1,000 Volatile Organic Compounds ﴾VOCs﴿, which are the products of metabolic activity, hence they directly reflect the current state of cells and represent a valuable source of information about the health of an individual. As the earliest stages of tumour development are characterized by profound changes in cellular metabolic activity, VOCs are potential non‐invasive biomarkers for early detection of lung cancer. The LuCID study aims to collect breath samples and evaluate VOCs in exhaled breath as non‐invasive biomarkers for early detection of lung cancer. Method LuCID is an international multi‐centre prospective case‐control cohort study ﴾ClinicalTrials.gov ID NCT02612532﴿ currently in progress, evaluating breath VOCs in patients with a clinical suspicion of lung cancer. A clinical suspicion is based on symptoms and/or suspicious finding on incidental imaging. Using tidal breathing, patients breathe into the ReCIVA Breath Sampler for 7 minutes to collect alveolar‐ and bronchial enriched breath fractions on stable sorbent tubes for later analysis by Gas Chromatography‐Mass Spectrometry and Field Asymmetric Ion Mobility Spectrometry ﴾FAIMS, Owlstone Medical Ltd﴿. A classification algorithm will be constructed from chemical spectral data, and undergo internal and external blinded validation to provide a ROC‐curve detailing diagnostic accuracy. The LuCID study has an adaptive trial design, recruiting up to 2,600 patients depending on interim results. Figure 1 Results The LuCID study has recruited 980 patients to date from 20 centres ﴾mean age 67.5, SD 12.0﴿. Of patients with completed follow‐up ﴾n=802﴿, 33% have histologically confirmed lung cancer ﴾of those with lung cancer: 40% early stage 1a‐2b, 60% advanced stage 3a‐4﴿. Non Small Cell Lung Cancer ﴾NSCLC﴿ comprised 87% of these cancers, and Small Cell Lung Cancer 9%. NSCLC were further categorized as adenocarcinoma ﴾50%﴿, squamous cell carcinoma ﴾38%﴿, with the remaining 12% belonging to other categories. Most recent data on study progress and results will be presented at the conference. Conclusion The LuCID study is evaluating the analysis of exhaled VOC biomarkers as a new diagnostic modality for early detection of lung cancer. Successful completion of the LuCID study will pave the way for the development of a non‐invasive, easy‐to‐implement test that could markedly improve screening and early detection rates, reducing lung cancer morbidity and mortality.



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