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Emily Stone



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    OA10 - The Slow Pandemic – Tobacco Control in the Prevention of Lung Cancer (ID 170)

    • Event: WCLC 2020
    • Type: Oral
    • Track: Risk Reduction and Tobacco Control
    • Presentations: 1
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      OA10.01 - Chair (ID 4151)

      10:30 - 11:30  |  Presenting Author(s): Emily Stone

      • Abstract

      Abstract not provided

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    P41 - Screening and Early Detection - Lung Cancer Screening Programmes (ID 176)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P41.07 - Lung Cancer Screening: What is the State of the Evidence about Implementation? (ID 720)

      00:00 - 00:00  |  Author(s): Emily Stone

      • Abstract
      • Slides

      Introduction

      Lung cancer remains the leading cause of cancer death worldwide. Low dose computed tomography (LDCT) screening in high-risk populations can reduce lung cancer specific mortality as demonstrated in two landmark trials. Little is known about whether implementation of a high-risk LDCT screening program would be feasible in the Australian setting. The aim of this research was to critically review the literature about the core implementation components that would facilitate a targeted LDCT screening program in Australia.

      Methods

      Best practice methods for a rapid review were used; a PICO statement, inclusion and exclusion criteria were developed. The search strategy executed in Medline, PsychInfo and Embase selected relevant articles published between 1 January 2009 and 8 August 2019; an update was undertaken to January 2020.

      Results

      Title and abstract citations were screened (n=1559); full text review was undertaken for 8 systematic reviews and 70 original studies. High-risk LDCT screening is effective in reducing mortality and the benefits of screening outweigh harms. LDCT screening in European and North American settings appeared to be cost-effective but evidence for Australia was limited. As no systematic reviews address the core components of LDCT screening programs necessary for implementation, we synthesized data from randomised controlled trials, cohort studies, real-world program evaluations and policy documents to develop a taxonomy of core components for implementation. These elements were: 1. Identification of the high-risk population for recruitment, eligibility, selection and referral; 2. Educating the public, people at high risk and healthcare providers - including increased awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making; 3. Identifying the components necessary for health services to deliver a screening program, which are summarised across the a) planning phase inclusive of human resources to coordinate the program, electronic data systems that integrate medical records and linking to an established national registry, b) Implementation phase, which is inclusive of human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants and, c) the monitoring and evaluation phase inclusive of monitoring outcomes, radiological reporting, compliance with established standards and quality assurance; 4. Reporting data and research, including audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening; and 5. Incorporating smoking cessation interventions into LDCT screening programs.

      We identified barriers and facilitators to implementation through detailed review of real-world program evaluations (n=40). The most significant barriers were evident in the identification of the high-risk population, particularly with regards to recruitment and eligibility criteria. There is little evidence about whether high-risk LDCT screening would be acceptable to the Australian population particularly for ‘hard-to-reach’ communities that include Aboriginal and Torres Strait Islander peoples, communities that are culturally and linguistically diverse or face socio-economic deprivation, or in regional, rural and remote communities.

      Conclusion

      The feasibility of a targeted LDCT screening program in Australia requires a stronger evidence base about implementation and cost-effectiveness. These findings are internationally relevant. We propose a work program to explore and generate new evidence that will facilitate implementation.

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    P60 - Tumor Biology and Systems Biology - Basic and Translational Science - Immune Bio (ID 198)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Tumor Biology and Systems Biology - Basic and Translational Science
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P60.01 - Single-Cell Transcriptomics to Assess Response to Immunotherapy in Advanced Lung Cancer ex-vivo:  Developing a Functional Predictive Assay (ID 881)

      00:00 - 00:00  |  Author(s): Emily Stone

      • Abstract
      • Slides

      Introduction

      Treatment with immunotherapy (IO) has lead to improvements in survival for patients with advanced lung cancer (ALC) but robust predictive biomarkers remain elusive. Single cell genomics provides an opportunity to study cellular profiles in exceptional detail. Novel transcriptomic (scRNA-seq) including VDJ sequencing, allow evaluation of cellular responses to IO in real-time, providing an opportunity for a predictive test.

      Methods

      Fine needle aspirates taken from patients with ALC are exposed to IO or control invitro. Cells are collected, captured and sequenced using the 5’ VDJ kit (10X Genomics). Cellular subtypes are delineated and phenotyped using Seurat software. Comparisons between the control and treated conditions are conducted. Immunoactivation is measure and correlated with patient response.

      Results

      4/21 samples have been sequenced. ~5000 cells are sequenced per capture. Cell clustering demonstrates the innate and adaptive immune system and ~10 cancer subtypes per sample. Figure 1 shows diverse cell populations seen. Within the CD8 t-cell population, 3 distinct cytotoxic t-cell subsets are identified; fully functional, pre-exhausted and exhausted.

      umap lung cancer and stroma copy.jpg

      Figure 1

      Conclusion

      Using scRNA-seq with VDJ sequencing, the functional capacity of effector cells can be ascertained within the tumour microenvironment and immune cell responses to immunotherapy can be measured. Single cell sequencing has the potential to be used as a functional, predictive assay for treatment with IO.

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