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Amy Moore



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    MA19 - Looking at PROs in Greater Detail - What Patients Actually Want and Expect (ID 147)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      MA19.05 - Improving Lung Cancer Outcomes and Quality in the US Community Setting with the Creation of Lung Cancer Centers of Excellence Program (Now Available) (ID 1939)

      11:30 - 13:00  |  Presenting Author(s): Amy Moore

      • Abstract
      • Presentation
      • Slides

      Background

      The Addario Lung Cancer Foundation community hospital Centers of Excellence (COE) Program encourages community cancer centers in the US to implement ‘best practices’ across the lung cancer care continuum, including provision of coordinated, multidisciplinary care. By comparing performance metrics within and outside the network of COEs, the program seeks to ensure that lung cancer patients (pts) receive the highest quality of care in their local area whilst also enabling COE hospitals to gain insights that facilitate the rapid implementation of quality improvement cycles.

      Method

      The Impact Study was launched to conduct a comprehensive comparative analysis of COE member and non-member institutions across numerous quantitative and qualitative metrics from within the lung cancer care continuum. The 2018 analysis included 17 COE sites and 19 non-COE community hospitals representing approximately 5,000 pts in each cohort. The COE Impact study captured pts’ demographic and clinical information as well as performance metrics from early stage screening through late stage diagnosis and all aspects of pts’ care.

      Result

      Variable

      COE

      Non-COE

      P value

      # Cancer centers/hospitals

      17

      19

      Answers collected by nurse navigator

      41%

      100%

      <0.001

      Average # of hospital beds

      565

      342

      0.104

      Average # of lung cancer pts/institution

      497

      470

      0.968

      Lung cancer screening program

      94%

      42%

      0.001

      Endoscopic Bronchoscopy Ultrasound (EBUS)

      23%

      16%

      0.323

      Screening of pts for clinical trials

      81%

      35%

      <0.001

      Race: Caucasians

      81%

      37%

      <0.001

      Pathologist in tumor boards

      100%

      67%

      0.012

      ER visits the first 4 months of therapy

      14%

      32%

      0.022

      Molecular testing of pts with metastatic disease

      81%

      48%

      0.001

      Next generation sequencing

      58%

      22%

      0.009

      Conclusion

      Improved structure and processes of care delivery at COE hospitals may translate into improved quality of care, outcomes, and patient experiences. The Lung Cancer COE program, now including 38 community cancer centers encompassing 12,000 lung cancer patients, plans to conduct this study annually with prospective, longitudinal data collection for future trend analyses as a means of facilitating continuous quality improvement in community-level lung cancer care.

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    P1.14 - Targeted Therapy (ID 182)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.14-04 - Final Results of the Prospective Genomics of Young Lung Cancer (GYLC), an Addario Lung Cancer Medical Institute Study (ID 427)

      09:45 - 18:00  |  Author(s): Amy Moore

      • Abstract

      Background

      We hypothesized that young age at lung cancer diagnosis is a clinical characteristic associated with a higher likelihood for having a driver mutation. Our goals were to identify a genomically enriched subtype of lung cancer, facilitate delivery of targeted therapy and lay groundwork for studies of heritable and environmental lung cancer risk factors.

      Method

      Eligible subjects had a diagnosis of bronchogenic lung cancer < 40 years old. We included a website to allow for virtual consenting and remote participation from anywhere in the world. An integrated data and biorepository allowed for completion of study activities and routing of specimens. We defined seven genes of interest based on the Lung Cancer Mutational Consortium (LCMC): EGFR, KRAS, HER2, BRAF, ALK, ROS1, RET. We hypothesized that the prevalence of targetable alterations in these genes would be greater in our population compared to the LCMC and powered our study to detect an increase from 35% to 50%. Subjects with advanced adenocarcinoma who were not tested for all seven genes or who were wild type for all seven underwent additional genomic profiling using Foundation Medicine testing.

      Result

      We accrued 133 participants from July 2014 to June 2017. Notably, 44% entered the trial via the website. The mean age at diagnosis was 34 (range 16 to 39) and 57% were female; 77% were stage 4 at diagnosis and the majority had adenocarcinoma (86%). Of the 115 patients with adenocarcinoma, 83.5% were stage 4 and the focus of the comparison to the LCMC cohort. A targetable mutation was identified in 85.4%, with 76% harboring a combined ALK (38.5%), EGFR (31.3%), or ROS1 (6.3%) mutation. Of 14 patients who underwent on-protocol testing, a targetable driver was identified in eight (57%), including two with a RET rearrangement, two with ERBB2 mutations, two with MET amplification, one with an ALK rearrangement with a prior negative FISH and one with a novel EGFR-RAD fusion previously tested negative for EGFR.

      Conclusion

      We have described a genomically distinct subset of NSCLC in patients < age 40. Those with stage 4 adenocarcinoma must undergo comprehensive genomic testing to identify a targetable driver. The extremely high rate of driver mutations particularly in ALK supports the need for an Epidemiology of YLC study. Additionally, use of remote consenting and the Addario Lung Cancer Foundation's advocacy enabled rapid accrual of this rare cohort (<1%) and has laid the foundation for innovative research partnerships with other rare oncogene-driven patient groups.

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      P1.14-29 - Disrupting the Paradigm: Partnering with Oncogene-Focused Patient Groups to Propel Research (ID 1498)

      09:45 - 18:00  |  Author(s): Amy Moore

      • Abstract
      • Slides

      Background

      Genomic alterations drive more than 60% of adenocarcinoma cases of non-small cell lung cancer (NSCLC). About 20% of cases will have an oncogenic driver (EGFR, ALK, ROS1, BRAF, NTRK, etc.) that can be treated with approved targeted therapy drugs, and more (RET, Exon 20 insertions, etc.) have clinical trial options. Patients and caregivers dealing with these cancers have organized globally into oncogene-focused groups (“Groups”—see Table 1) and are building partnerships that seek to provide support, increase awareness and education, accelerate and fund research, and improve access to effective diagnosis and treatment.

      table 1 oncgene-focused patient and caregiver groups..png

      Method

      We partnered in a variety of ways to accelerate research. While each Group sets its own research priorities, we’ve found successful collaborative research has the following seven characteristics. It includes patients from the start, in all aspects of the project. It addresses questions meaningful to patients. It develops patient-centered measurements. It accommodates patients’ clinical realities. It leverages social media and patient groups. It shares progress with participants frequently. It makes results rapidly and freely available.

      Result

      These methods have enabled the Groups to collaborate successfully with clinicians, researchers, advocacy organizations, and industry to generate ideas for next steps in research for their disease, forge new studies and clinical trials for a specific oncogenic driver, create new patient-derived models of oncogene-driven cancers to study acquired resistance, develop registry-based studies to collect real-world data, and guide patients to clinical trials.

      Conclusion

      Oncogene-focused patient-caregiver groups are creating new paradigms across the research continuum. They have demonstrated that their partnerships with advocacy organizations, clinicians, researchers, and industry, can increase available patient-derived models, patient data, and specimens among geographically distributed, oncogene-driven cancer populations.

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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-23 - Rates of Support and Care Offerings Among Patients in an Advocacy Organization Sponsored Lung Cancer Patient Registry (ID 2683)

      10:15 - 18:15  |  Author(s): Amy Moore

      • Abstract

      Background

      We conducted a survey of lung cancer patients and caregivers in the United States in 2015 and 2016 that identified gaps in access to supportive care and patient education. An additional survey of patients and caregivers in 2016 revealed low rates of molecular testing among lung cancer patients despite being recommended by clinical guidelines. In order to gauge how much progress has been made in addressing these gaps, we looked at self-reported rates among participants in a lung cancer patient registry founded by a patient advocacy organization, the GO2 Foundation for Lung Cancer.

      Method

      The Lung Cancer Registry, supported by the GO2 Foundation for Lung Cancer, and partners The American Lung Association and The International Association for Lung Cancer, collects self-reported data from lung cancer patients and caregivers through an online interface on a variety of topics related to patients’ lung cancer diagnoses and care experiences. For this study, we analyzed data collected from 939 registry participants between November 2016 to December 2018 on supportive care, assistance, and molecular testing offerings to patients.

      Result

      The majority of registry participants reported that their doctors had discussed future treatment options beyond their current line of therapy with them (72%) and that care navigation help had been offered to them by a nurse navigator or care coordinator (60%). Additionally, most participants (88%) reported their clinic had provided educational materials related to their diagnosis or treatment. High rates of molecular testing were also reported among registry participants (76%). Testing most commonly occurred at initial diagnosis.

      Conclusion

      Registry participants were offered navigation and patient education resources at high rates. Additionally, molecular testing was offered at high rates occurring early in care. This suggests that significant progress has been made by the lung cancer community in the United States to address previously identified gaps in certain aspects of support and care. However, registry participants represent a highly educated, technology-enabled population, indicating that gaps may still exist and should be looked at further in other demographics such as in rural and lower socio-economic areas where lung cancer is common.