Virtual Library

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    MA18 - Modelling, Decision-Making and Population-Based Outcomes (ID 920)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 11
    • Moderators:
    • Coordinates: 9/25/2018, 13:30 - 15:00, Room 201 F
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      MA18.01 - Non-Small Cell Lung Cancer Risk Assessment with Artificial Neural Networks (ID 13532)

      13:30 - 13:35  |  Presenting Author(s): Tafadzwa Lawrence Chaunzwa  |  Author(s): Yiwen Xu, David C Christiani, Andrea Shafer, Nancy Diao, Michael Lanuti, Raymond Mak, Hugo Aerts

      • Abstract
      • Presentation
      • Slides

      Background

      Lung cancer is a heterogeneous disease with many clinically important subtypes. Given the complexity of classification, there is room for innovative risk assessment tools to help ascertain prognosis and management. In this work we tested an Artificial Neural Network (ANN) to stratify patients into clinically significant low and high risk categories.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      CT imaging, survival, and cancer staging data was extracted for a sample of 311 patients with Stage-I (n = 186) and Stage-II (n = 125) non-small cell lung cancer (NSCLC) from the comprehensive Boston Lung Cancer Survival (BLCS) cohort. Median follow-up from time of diagnosis was 3.5 years, with 86% 2-year survival. A deep convolutional neural network pretrained on ImageNet was used, with fine-tuning of the last convolutional layers, dense layers, and softmax for stratification. Inputs of this model were 50 x 50 mm2 image patches. Training was performed on 182 labeled CT scans (112 Stage-I and 70 Stage-II). 46 cases were used for initial cross-validation, with an independent test set of 83 cases. The median prediction probability from the ANN was used as a cutoff to divide patients into low and high risk groups.

      4c3880bb027f159e801041b1021e88e8 Result

      The model was able to perform classification of cancer stage on the heterogeneous test set (AUC = 0.73, p< 0.0005). The test set was split evenly into low risk (n = 42) and high risk (n= 41) groups based on model predictions. There was statistically significant separation in the Kaplan Meier-estimates for survivorship in the two stratified groups (p < 0.02).

      ialsc_figure.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      ANNs can be effective tools for quantitative risk stratification in NSCLC. In addition to the potential for real-time clinical decision support, ANNs may also help create new paradigms in lung cancer risk assessment. The models have the capacity to perform suprahuman computations, which can help meet future demands of clinical practice, given expanding digital-imaging volumes.

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      MA18.03 - How in the Real World Are Lung Cancer Patients Treated? The Ontario, Canada Experience (ID 13772)

      13:35 - 13:40  |  Presenting Author(s): William Kenneth Evans  |  Author(s): William Flanagan, Cindy Gauvreau, Phongsack Manivong, Saima Memon, Natalie Fitzgerald, John R Goffin, Rochelle Garner, Edwin Khoo, Nicole Mittmann

      • Abstract
      • Presentation
      • Slides

      Background

      Clinical trials define treatment recommendations but how patients are actually treated in the real world is poorly understood. The Canadian Partnership Against Cancer has developed a model of lung cancer (LC) management (OncoSim-lung) based on clinical trials data and expert advice. To credibly project the future clinical and economic impacts of cancer control measures using OncoSim, the model has been refined using real-world data.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Treatment data by histology and stage were extracted from the Ontario Cancer Registry for LC cohorts diagnosed in 2010 and 2013. All incident cases that satisfied the IARC rule of a new primary were included. Missing or unknown stage cases were excluded. Clinical pathways were validated by oncologists from different disciplines across Canada.

      4c3880bb027f159e801041b1021e88e8 Result

      The 2013 cohort included 8,086 staged LC: NSCLC (n=7,143) Stage I 18.7%, II 8%, III/IIIa 11.4%, IIIb 4.9% IV 56.8%; SCLC (n= 943) limited 67.7%, extensive 32.3%. Of 1340 stage I NSCLC patients, 61% underwent surgery; 39% had no surgery and one third of these had no active treatment (NAT). 55% of those not receiving surgery underwent radical radiotherapy and 6% had palliative radiotherapy. Of 579 patients with stage II NSCLC, 60% underwent surgery and 47% of these received adjuvant chemotherapy; 40% had no surgery and 22% of these had NAT. Radical radiotherapy, radiotherapy plus chemotherapy or palliative radiotherapy were given in 33%, 19% and 18% of non-surgical cases, respectively. Of 813 stage III/IIIa patients, only 26% underwent surgery, 41% of whom received adjuvant chemotherapy or postoperative radical radiotherapy (16%); 13% received trimodality treatment. Of the 75% of Stage III not receiving surgery, 26% had NAT and 21% had palliative radiotherapy alone. Of those receiving active treatment, 20% received combined chemo +radiotherapy and 13% each had chemotherapy alone or radical radiotherapy alone. Of 356 stage IIIb patients, 17% had NAT, 28% received palliative radiotherapy and only 30% had chemo + radical radiotherapy. 18% had chemo alone. Of 4055 stage IV NSCLC, 47% had NAT, 24% received chemotherapy alone and 23% had palliative radiotherapy only. Of those who received first-line chemotherapy (n= 1059), 47% received second line chemotherapy and of those, 37% received third line therapy.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Compared to prior expert opinion, there was a higher use of radiotherapy for early stage disease, a lower frequency of chemo-radiotherapy in Stage III disease and a higher frequency of NAT across all stages of disease.

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      MA18.04 - Discussant - MA 18.01, MA 18.03 (ID 14651)

      13:40 - 13:55  |  Presenting Author(s): Shalini K Vinod

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA18.05 - Characteristics and Long-Term OS of Non-Small Cell Lung Cancer Patients Receiving EGFR Tyrosine Kinase Inhibitor Treatment (ID 13197)

      13:55 - 14:00  |  Presenting Author(s): Michael Bergqvist  |  Author(s): Helene Nordahl Christensen, Fredrik Wiklund, Stefan Bergström

      • Abstract
      • Presentation
      • Slides

      Background

      Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are important therapeutic agents in treatment of EGFR mutation-positive non-small cell lung cancer (NSCLC) patients. However, long-term follow-up and knowledge of clinical factors and TKI treatment patterns, which may be associated with longer OS, remains unclear. Using nationwide registry data, the aim was to investigate survival, prognostic factors for OS, and first line TKI treatment pattern of stage IIIB/IV NSCLC patients in Sweden.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      In this cohort study, data on all patients diagnosed with stage IIIB-IV NSCLC during 2010—2015 from the nationwide Cancer Registry of Sweden were linked with data on dispensed EGFR-TKI drugs, comorbidity, and mortality data from Swedish national health registries. OS was defined as the interval from date of diagnosis until date of death. Survival rates were estimated using the Kaplan-Meier method. Assessment of predictive factors for OS was performed in multivariable Cox regression.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 9,992 stage IIIB/IV NSCLC patients (mean age 70 years, female 49%), 1419 (14%) received first-line TKI treatment. Overall, 59% of TKI treated patients (median age 68 years) were female, 44% had at least one comorbidity, 85% had adenocarcinoma, and 89% were stage IV. Median follow-up time was 15 months and median OS was 16 months; 1- and 3-years survival rates were 62% and 15%, respectively. Predictors of longer OS were younger age at diagnosis, adenocarcinoma, less advanced clinical stage, and less comorbid disease. Furthermore, patients included in the end of the period had a longer OS compared to earlier. TKI treatment switching/re-challenging, as well as prolonged TKI treatment, also predicted longer OS.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This is the first nationwide study on NSCLC patients receiving first-line EGFR TKIs in routine clinical practice in Sweden. In addition to the reported prolonged TKI treatment length and TKI switching/re-challenging during the observation period, improvements and extension of EGFR testing targeting the appropriate NSCLC patient population may further have contributed to the observed relatively long overall survival.

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      MA18.06 - Patterns of Lung Cancer Care in the United States: Developments and Disparities (ID 11991)

      14:00 - 14:05  |  Presenting Author(s): Erik Ferdinand Blom  |  Author(s): Kevin ten Haaf, Douglas Arenberg, Harry J De Koning

      • Abstract
      • Presentation
      • Slides

      Background

      The level of adherence to lung cancer treatment guidelines is unclear. The aims of this current study were to provide an overview of current patterns of lung cancer care in the United States and to identify possible disparities in receiving standard of care.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using the National Cancer Database, we evaluated the first course therapy of 468,422 lung cancer cases diagnosed between 2010-2014. We used a series of multivariate logistic regression models to identify relationships between patient, tumor, and health care provider characteristics and receiving predefined stage-specific standards of care.

      4c3880bb027f159e801041b1021e88e8 Result

      Most common treatments were surgery only (15.2%), radiotherapy only (12.8%), chemotherapy only (13.5%), and radiotherapy and chemotherapy (26.2%). 22.1% of subjects received no treatment. Between 2010-2014, the use of Video-Assisted Thoracoscopic Surgery among surgically treated cases increased from 24.6% to 42.3%, while the rate of conversions to open surgery decreased from 18.3% to 10.4%. Among stage IA non-small cell lung cancer patients treated with thoracic radiotherapy, the use of Stereotactic Body Radiotherapy increased from 53.4% to 73.0%. Overall, only 63.3% of subjects received standard of care. Receiving surgery for early-stage non-small cell lung cancer was less likely with increasing age (for those 80 and over: odds ratio [OR], 0.08; 95% confidence interval [95%CI], 0.07-0.09), for non-Hispanic Blacks (OR, 0.59; 95%CI, 0.57-0.62), and for squamous cell histology (OR, 0.46; 95%CI, 0.45-0.47). These disparities were also present in other stages.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Particularly elderly lung cancer patients, non-Hispanic Blacks, and those with squamous cell histology are less likely to receive standard of care. These disparities may have consequences for lung cancer screening, as the effectiveness depends on adequate treatment of lung cancer.

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      • Abstract
      • Presentation
      • Slides

      Background

      Continued smoking after a LC diagnosis is associated with poorer cancer outcomes including increased risk of treatment-related side-effects, reduced treatment efficacy and poorer prognosis. Smoking cessation is an integral part of LC survivorship by improving both cancer and non-cancer outcomes. To enhance survivorship education, clinicians should understand patient awareness of the harms of continued smoking.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      LC survivors from Princess Margaret Cancer Centre, Toronto (2014-2017) were surveyed with respect to self-awareness of the harms of continued smoking on cancer-related outcomes. Univariable and multivariable logistic regression models assessed factors associated with awareness and whether awareness was associated with cessation among current smokers at diagnosis.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 553 patients, 181 were lifetime never-smokers. Among those smoking during the peri-diagnosis period (n=177), 65% quit after diagnosis. Among all, few patients were aware that smoking negatively impacts treatment-related outcomes [complications from cancer surgery (only 41% aware), radiation side-effects (30%), quality-of-life on chemotherapy (44%) and treatment efficacy (36%)]; half were aware that smoking negatively impacts cancer prognosis (51% aware) and risk of developing second primaries (50%). Compared to ex-smokers/never-smokers at diagnosis, current smokers at diagnosis were less aware of the impact of smoking on radiation side-effects (22% vs 31% aware, P=0.01), prognosis (44% vs 55%, P=0.02) and risk of second primaries (42% vs 55%, P=0.007). Among sociodemographic variables, only those speaking English at home were consistently found more likely unaware that smoking negatively impacts these outcomes (ORs=1.52-2.20, P<0.04). Patients with early stage disease were more likely unaware that smoking negative impacts radiation side-effects (OR=1.60, 95%CI[1.09-2.35], P=0.02); while patients on curative treatment (OR=1.53[1.08-2.17], P=0.02) and those exposed to second-hand smoke (SHS) were more likely unaware that smoking impacts quality-of-life on chemotherapy (OR=1.64[1.05-2.58], P=0.03). Exposure to SHS, treatment intent and stage were not associated with awareness of impact on prognosis or second primaries (P>0.11). Among smokers in the peri-diagnosis period, awareness of the impact of smoking on surgical complications (aOR=2.09 [0.96-4.54], P=0.06), quality-of-life while receiving chemotherapy (aOR=2.60[1.17-5.79], P=0.02) and on treatment efficacy (aOR =2.24[0.97-5.20], P=0.06) were each associated with subsequent quitting, adjusted for marital status, pack-years, self-rated health and SHS exposure.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Many LC patients are unaware of the harms of continued smoking on cancer outcomes, particularly those smoking at diagnosis. Awareness of some of these outcomes was associated with subsequent tobacco cessation. Patient education on the health benefits of smoking cessation may increase quit rates and improve outcomes for LC patients.

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      MA18.08 - Discussant - MA 18.05, MA 18.06, MA 18.07 (ID 14652)

      14:10 - 14:25  |  Presenting Author(s): Vera Hirsh

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA18.09 - Predictors of Health Utility Scores (HUS) in Advanced EGFR-Mutated NSCLC. (ID 13087)

      14:25 - 14:30  |  Presenting Author(s): Shirley Xue Jiang  |  Author(s): Manjusha Hurry, Katrina Hueniken, M Catherine Brown, Mindy Liang, Devalben Patel, Catherine Labbe, Lawson Eng, Hiten Naik, Penelope Bradbury, Natasha B Leighl, Frances A Shepherd, Wei Xu, Geoffrey Liu, Ryan N. Walton, Grainne M O'Kane

      • Abstract
      • Presentation
      • Slides

      Background

      Advanced NSCLC patients with EGFR mutations (EGFRm) are currently treated with first - to third-generation tyrosine kinase inhibitors (TKIs). In the advanced setting, quality of life is an important goal; we therefore evaluated determinants of HUS in this population.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      In a prospective, observational study, patients with advanced EGFRm NSCLC completed EQ-5D surveys at outpatient visits generating HUS (range 0-1). Patients were allowed to enrol at any point in their disease course. Baseline clinical characteristics and outcome data were extracted from chart review. Patient imaging was reviewed and health states (stable/progressing) at each encounter recorded. Univariable analyses conducted using ANOVA and multivariable regression analyses with generalized estimating equations identified factors associated with HUS.

      4c3880bb027f159e801041b1021e88e8 Result

      From November 2014 to July 2017, 782 encounters (follow-up visits) were collected for 244 patients. Median age at first encounter was 64 years (range:29-96); 54% were female and 54% Asian. Median time from diagnosis of stage IV NSCLC to first encounter was 23 months (range:0-67). The median number of HUS collected per patient was 2 (range:1-14). For patients with multiple visits the median time between completed questionnaires was 1.8 months (1-18). 105 patients (43%) presented with or developed brain metastases during the study period. In a univariable analysis, regardless of treatment line, mean HUS (mHUS) on osimertinib was 0.85 (standard deviation (SD):0.15) (n=33 patients; 114 encounters) compared to mHUS=0.80 (SD:0.17) on gefitinib (n=147, 351 encounters); mHUS=0.72 (SD:0.16) on chemotherapy (n=32, 76 encounters); and mHUS=0.79 (SD=0.15) on other TKIs (n=49, 133 encounters); p<0.001. In a multivariable analysis, disease progression (p=0.04) and ECOG performance status >0 (p<0.001) were associated with lower HUS. In contrast, treatment with osimertinib (when compared to a reference group of first-generation TKIs, gefitinib/erlotinib) was associated with improved HUS (p=0.01), while line of therapy and number of metastatic sites of disease were not associated with HUS. In addition, brain metastases had no significant impact on HUS (p=0.33).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Progressive disease and worse performance status associate with lower HUS in patients with EGFRm NSCLC. Patients treated with osimertinib had the highest HUS when compared with a reference group of first-generation EGFR TKIs regardless of line of therapy. These results may help in the choice of EGFR-TKI, especially in patients with a poor performance status.

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      MA18.10 - Evolving Immunotherapy Practice Patterns in Advanced NSCLC: Analysis of an Online Treatment Decision Tool (ID 13848)

      14:30 - 14:35  |  Presenting Author(s): David R. Gandara  |  Author(s): Timothy A Quill, Martin J. Edelman, Suresh S. Ramalingam, Heather A Wakelee, Howard West, Kevin L Obholz

      • Abstract
      • Presentation
      • Slides

      Background

      Checkpoint immunotherapy (IO) is revolutionizing NSCLC therapy. We have previously published results of an online decision support tool designed to provide clinicians with education and expert guidance (Chow et al: JTO 2015). Here we report an analysis of a recently updated version of this online tool, capturing the impact of emerging IO options.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From June 2016 to July 2017, the NSCLC decision tool was updated to incorporate new treatment options for 280 different case scenarios. Briefly, oncologists entered patient and disease characteristics and then their planned treatment into the tool. Afterwards recommendations from 5 lung cancer experts were provided for that specific patient scenario.

      4c3880bb027f159e801041b1021e88e8 Result

      This analysis includes 1481 individual cases entered by 863 practicing oncologists between June 2016 and April 2018 (USA 19%, Europe 33%, Rest of World 48%). During this time, treatment choices for EGFR and ALK cancers by oncologists closely resemble those of experts. After approval of 1st-line pembrolizumab for patients with high PD-L1 expression, oncologists recommended pembrolizumab less often than experts (67% vs 95%). In the 2nd-line setting following platinum chemotherapy, both tumor histology and PD-L1 expression level impacted treatment recommendations (see Table). For PD-L1 expression < 1%, recommendations between oncologists and experts differed substantially.

      Second-line setting after platinum chemotherapy
      Participants' Treatment Choice Experts' Treatment Choice
      2016 2017 2016 2017
      Nonsquamous
      PD-L1 (1%)

      54% IO

      34% CT

      (n = 35)

      79% IO

      15% CT

      (n = 47)

      100% IO

      85% IO

      15% CT

      PD-L1 (< 1%)

      28% IO

      65% CT

      (n = 104)

      49% IO

      41% CT

      (n = 63)

      40% IO

      55% CT

      75% IO

      25% CT

      Squamous
      PD-L1 (1%)

      62% IO

      25% CT

      (n = 24)

      74% IO

      4% CT

      (n = 23)

      100% IO

      100% IO

      PD-L1 (< 1%)

      28% IO

      65% CT

      (n = 74)

      38% IO

      40% CT

      (n = 45)

      85% IO

      15% CT

      80% IO

      20% CT

      8eea62084ca7e541d918e823422bd82e Conclusion

      This updated analysis of an online NSCLC decision-making tool integrates recent changes to the treatment landscape in 2017, capturing emerging patterns in IO therapy. Compared to earlier versions, practicing oncologist’s choice of 1st-line EGFR- and ALK- targeted therapy more closely tracked with experts during this period, while selection of IO differs from expert recommendations. A detailed analysis of expert versus online user data will be presented.

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      MA18.11 - Implementing a Comprehensive National Audit of Lung Cancer Surgery: The English Lung Cancer Clinical Outcomes Publication (LCCOP) Project (ID 12090)

      14:35 - 14:40  |  Presenting Author(s): Doug West  |  Author(s): Richard Page, Neal Navani, Susan V Harden, Aamir Khakwani, Richard Hubbard, Paul Beckett

      • Abstract
      • Presentation
      • Slides

      Background

      We report the establishment of a national audit of outcomes after lung cancer resection (LCCOP) in the English National Health Service (NHS), a government healthcare system providing the great majority of lung cancer surgery. LCCOP is a compulsory audit commissioned by NHS England.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Unusually, for a surgical audit, data is initially obtained from the cancer registry, and matched to national Hospital Episode Data (HES), before local validation by clinical teams. After case mix adjustment, unit level survival rates at 30, 60 and 90 days, and length-of-stay data are published online and in an annual report. The first annual report was released in 2014.

      Survival is adjusted for age, sex, performance status, stage, laterality, FEV1 percentage, comorbidity and socioeconomic status

      4c3880bb027f159e801041b1021e88e8 Result

      The number of resections rose by 21% between 2015-2017 (4892 to 5936). Median annual activity per surgeon rose from 30 to 49 cases between 2014-2017, a 63% increase. In 2015 survival at 30, 90 and 365 days was 98.1%, 96.3% and 87.9% respectively. Median length of stay was 6 days (IQR 4-9).

      In 2015, 43.9% of lobectomies were completed by VATS, 4.3% were started VATS and completed by open surgery and 0.7% completed by robotics.

      Adjusted 90 day survival by surgical unit: 2017 report (2015 data)

      90 day 2017(15).png

      8eea62084ca7e541d918e823422bd82e Conclusion

      Using routinely collected NHS activity data for surgical audit is feasible, and reduces the data collection burden for hospital teams. Clinical validation remains important to correct discrepancies. Surgical activity has risen significantly. Increases in individual surgeon case volume may reflect increasing subspecialisation. Significant inter-provider variation remains, particularly in length of stay.

      More lung cancer surgery is being done in the English NHS. Surgeons are increasingly subspecialising, with higher case volumes. Local variation remains, particularly around length of stay. A mixed model of routinely collected data with local validation appears acceptable to clinical units.

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      MA18.12 - Discussant - MA 18.09, MA 18.10, MA 18.11 (ID 14653)

      14:40 - 14:55  |  Presenting Author(s): Martin R Stockler

      • Abstract
      • Presentation
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      Abstract not provided

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    MS08 - Lung Cancer in the Real World (ID 787)

    • Event: WCLC 2018
    • Type: Mini Symposium
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 5
    • Moderators:
    • Coordinates: 9/24/2018, 13:30 - 15:00, Room 201 F
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      MS08.01 - How Can Real World Data Improve Clinical Evidence Generation and Impact Regulatory Bodies - European Perspective (ID 11432)

      13:30 - 13:45  |  Presenting Author(s): Yolande Lievens

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MS08.02 - How Can Real World Data Improve Clinical Evidence Generation and Impact Regulatory Bodies – US Perspective (ID 14624)

      13:45 - 14:00  |  Presenting Author(s): Gideon Blumenthal

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MS08.03 - Sources of Real World Data: Research Designs, Statistical Modelling and Quality Assurance Requirements (ID 11433)

      14:00 - 14:15  |  Presenting Author(s): Mary W. Redman

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MS08.04 - The ASCO Perspective (ID 11434)

      14:15 - 14:30  |  Presenting Author(s): Bruce E Johnson

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      MS08.05 - The ESTRO Perspective (ID 11435)

      14:30 - 14:45  |  Presenting Author(s): Umberto Ricardi

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    MS13 - Novel Mediators of Lung Cancer Metastasis (ID 792)

    • Event: WCLC 2018
    • Type: Mini Symposium
    • Track: Biology
    • Presentations: 5
    • Moderators:
    • Coordinates: 9/25/2018, 10:30 - 12:00, Room 201 F
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      MS13.01 - Liquid Biopsy-mediated Identification of Metastatic Variants (ID 11453)

      10:30 - 10:45  |  Presenting Author(s): Philip Christopher Mack

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      MS13.02 - Capicua Inactivation Drives Lung Cancer Metastasis (ID 11454)

      10:45 - 11:00  |  Presenting Author(s): Trever G Bivona

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      MS13.03 - Ubiquilin as a Novel Mediator of Lung Cancer Invasion and Metastasis (ID 11455)

      11:00 - 11:15  |  Presenting Author(s): Levi J. Beverly

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      Abstract not provided

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      MS13.04 - Tracking the Evolution of Non-Small-Cell Lung Cancer (ID 11456)

      11:15 - 11:30  |  Presenting Author(s): Charles Swanton  |  Author(s):

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      MS13.05 - Discussant (ID 11457)

      11:30 - 11:45  |  Presenting Author(s): David Beer

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      Abstract not provided

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    MTE07 - Management of Pleural Recurrence (Ticketed Session) (ID 817)

    • Event: WCLC 2018
    • Type: Meet the Expert Session
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/24/2018, 07:00 - 08:00, Room 201 F
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      MTE07.02 - From Surgical Perspective (ID 11559)

      07:00 - 07:30  |  Presenting Author(s): Robert J Korst

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      Abstract not provided

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      MTE07.01 - From Radiation Oncology Perspective (ID 11558)

      07:30 - 08:00  |  Presenting Author(s): Andreas Rimner

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      Abstract not provided

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    MTE18 - Case-Based Management of Patients with Inadequate Tissue for Molecular Tests (Ticketed Session) (ID 828)

    • Event: WCLC 2018
    • Type: Meet the Expert Session
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 07:00 - 08:00, Room 201 F
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      MTE18.01 - Case-Based Management of Patients with Inadequate Tissue for Molecular Tests (ID 11577)

      07:00 - 08:00  |  Presenting Author(s): Benjamin P Levy, Adrian Sacher

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      Abstract not provided

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    MTE28 - Lessons from the Past-What I Would Not Do Again in Diagnostic and Therapeutic IP (Ticketed Session) (ID 838)

    • Event: WCLC 2018
    • Type: Meet the Expert Session
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/26/2018, 07:00 - 08:00, Room 201 F
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      MTE28.01 - Lessons from the Past-What I Would Not Do Again in Diagnostic and Therapeutic IP (ID 11595)

      07:00 - 07:30  |  Presenting Author(s): Navneet Singh  |  Author(s): Inderpaul S Sehgal

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      Abstract not provided

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      MTE28.02 - Lessons from the Past-What I Would Not Do Again in Diagnostic and Therapeutic IP (ID 14696)

      07:30 - 08:00  |  Presenting Author(s): Jason S Agulnik

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    OA04 - Improving Access and Outcomes in Lung Cancer Management (ID 898)

    • Event: WCLC 2018
    • Type: Oral Abstract Session
    • Track: Nursing and Allied Professionals
    • Presentations: 8
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 201 F
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      OA04.01 - What is the Cost of a Strong Evidence for the Treatment of Advanced Non-Small Cell Lung Cancer? (ID 14410)

      10:30 - 10:40  |  Presenting Author(s): Pedro Aguiar Jr  |  Author(s): Barbara Gutierres, Barbara Dourado, Alanda Alves, Carmelia Maria Noia Barreto, Gilberto de Lima Lopes, Auro Del Giglio

      • Abstract
      • Presentation
      • Slides

      Background

      Evidence-based medicine was developed to guide medical decisions based upon the strongest scientific evidence available in the literature. However, large randomized clinical trials are expensive. In addition, new antineoplastic drugs development is also extremely expensive. Therefore, we hypothesized that the strongest evidence available nowadays comes from studies developed by the pharmaceutical industry.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We carried out a search on network databases for studies published between 2014 and 2017. We included only experimental studies that assessed the treatment for advanced or metastatic non-small cell lung cancer. All included studies were divided into two groups: studies funded by pharmaceutical industry and studies funded by other sources. The primary end point was to compare the evidence strength of each group. Secondary end points were to compare other aspects, such as the number of patients included by each group of studies and the number of innovative drugs studied by each group of studies.

      4c3880bb027f159e801041b1021e88e8 Result

      We found 1,502 studies and included 299 studies (154 sponsored by pharmaceutical industry and 145 funded by other sources). 52,988 patients were included in all studies (36,455 in studies sponsored by industry and 16,533 in studies with other funding sources; p < 0.001). The studies funded by pharmaceutical industry had the stronger evidence compared with studies with other sources of funding (p = 0.005). Moreover, studies sponsored by pharmaceutical industry studied more innovative therapies (72.4% versus 48.9%; p < 0.001) and had a higher proportion of open access manuscript (60.8% versus 43.9%; p = 0.004). Results are summarized in the table.

      Parameter Industry Sponsored P value

      Yes

      154 (100%)

      No

      145 (100%)
      Number of patients 36,455 16,533 <0.001
      Mean N of patients 236.7 115.6
      Line First 110 (71.4%) 94 (64.8%) 0.220
      Second or more 44 (28.6%) 51 (35.2%)
      Biomarker Yes 55 (35.9%) 55 (37.9%) 0.723
      No 98 (64.1%) 90 (62.1%)
      Innovative Tx Yes 110 (72.4%) 69 (48.9%) <0.001
      No 42 (27.6%) 71 (51.1%)
      Phase I 20 (13%) 25 (17.2%) 0.409
      II 101 (65.6%) 97 (66.9%)
      III 32 (20.8%) 21 (14.5%)
      IV 1 (0.6%) 2 (1.4%)
      Evidence Level 1 0 (0%) 1 (0.7%) 0.005
      2 76 (49.4%) 52 (35.9%)
      3 78 (50.6%) 87 (60%)
      4 0 (0%) 5 (3.4%)
      Experimental Yes 35 (47.3%) 26 (50%) 0.765
      Superiority No 39 (52.7%) 26 (50%)
      Open Access Yes 93 (60.8%) 61 (43.9%) 0.004
      Article No 60 (39.2%) 78 (56.1%)

      8eea62084ca7e541d918e823422bd82e Conclusion

      Studies funded by pharmaceutical industry had stronger evidence, tested more innovative therapies, and were more accessible to the readers compared with studies developed with other sources of funding. These findings may alert oncology cooperative groups to the need of more studies with more evidence strength.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      OA04.02 - Demographic, Psychosocial, and Behavioral Associations with Cancer Screening Among a Homeless Population (ID 11252)

      10:40 - 10:50  |  Presenting Author(s): Lovoria B Williams  |  Author(s): Stephen W Looney, Thomas Joshua, Amber McCall, Martha S Tingen

      • Abstract
      • Presentation
      • Slides

      Background

      Although cancer incidence and mortality is declining, cancer remains among the leading causes of death worldwide. Research shows that cancer morbidity and mortality can be reduced by early detection. Yet, both cancer risks and screening behavior remain understudied in the United States homeless population. Lung cancer is the deadliest of cancers. Given the recent lung cancer screening guideline, it is especially important to assess population-based awareness of the screening recommendation among the homeless population, a population known to have higher cancer risk behaviors and lower cancer screening rates.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Researchers conducted a cross-sectional survey of homeless individuals (n =201) who attended a 1-day community event. Eligible study participants were English-speaking adults, aged 21 and above. Willing participants completed a 1-page 33 item paper survey. The analysis describes the demographic, psychosocial, and behavioral associations with cancer screenings and knowledge of the lung cancer screening recommendation.

      4c3880bb027f159e801041b1021e88e8 Result

      Participants’ mean age was 51.7 years (SD 13.6); the group was largely African American (77.3%) and male (67.9%). Despite higher cancer risk behaviors, knowledge of lung cancer screening and general participation rates for cancer screenings were below national benchmarks. Among women, the breast and cervical cancer screening rates were 46.5% and 85.1%. Among men, the prostate cancer screening rate was 34.2%. Among all participants, the colon cancer-screening rate was 44%. Cancer risk behaviors were higher than national rates and lung cancer screening knowledge was low (23.0%). Some cancer screening behaviors were associated with age, income, health status, obesity, tobacco use, and physical activity level.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The associations of screening with modifiable risk factors such as smoking, physical activity and obesity suggests that relevant behavior change interventions are necessary among this high-risk population. Given the barriers to screening of poverty-stricken individuals, such as lack of transportation and access, nurses must not only educate patients on lung cancer screening, they must assist with identifying payment resources and care navigation. Moreover, nurses must be educated on the ambiguity and inconsistency among evidenced-based screening guidelines and be prepared to engage patients in shared decision-making that weighs the recommendations with the patient’s individual cancer risks. To improve cancer survival among disparate populations, sustained community outreach is necessary to increase awareness of screening recommendations, identify high-risk individuals, and navigate them to resources. It is imperative that resources are provided to support relevant behavior change interventions, such as tobacco cessation in this high-risk population.

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      OA04.03 - The Role of Comprehensive Genomic Profiling in the Community Setting  (ID 13559)

      10:50 - 11:00  |  Presenting Author(s): Kimberly Ann Rohan

      • Abstract
      • Presentation
      • Slides

      Background

      Comprehensive Genomic Profiling (CGP) is biomarker information to helo match patients to approved targeted therapies, immunotherapies, and clinical trials. This information can assist practitioners in caring for patients with solid tumors in decision making. Nurses play a key role in educating paitnets on how the testing is done, what information it will provide and how that information will be used in clinical practice.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A retrospective analysis was done on the results of Comprehensive Genomic Profiling (Foundation One) on paitents that were tested in our practice from 2014-2017. The Edward Cancer Center is a community hospital based cancer center in the western suburbs of Chicago. The practice has 7 oncologists and 4 Advanced Practice Nurses. The practice saw approximately 650 new cases of cancer last year. It is rare that a patient presents with Comprehensive Genomic Profining (CGP). Our center ordered CGP on 46 patients with a cancer diagnosis after discussion with their primary oncologist. Each case was reviewed for number of genomic alterations identified, treatment associated with potential for clinical trial benefit, therapies associated with lack of response and the clinical decisions that were made based on the findings.

      4c3880bb027f159e801041b1021e88e8 Result

      Of the 46 charts reviewed: 263 genomic alterations were identified, 172 therapies were associated with potential clinical benefit and 11 therapies associated with lack of response. Of these patients, 6 (13%) were referred to clinical trial and 12 (26%) resulted in change in therapy. Of the lung cancer patients, 2 (6%) were referred to clinical trial and 11 (34%) resulted in change in therapy.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Comprehesive Genomic Profiling is a useful tool in identifying patients in the community setting for clinical trial enrollement. 6-13% exceeds the national clinical trial enrollment. The results also assist in directing patient care and in directing change of therapy to more targeted therapies or continuation of current therapy. There were 4 (8.5%) patients that opted to stop care and enroll in hospice care based on the CGP lresults.

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      OA04.04 - Discussant - OA 04.01, OA 04.02, OA 04.03 (ID 14552)

      11:00 - 11:15  |  Presenting Author(s): Jhanelle Elaine Gray

      • Abstract
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      Abstract not provided

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      OA04.05 - An Early Rehabilitation Intervention for Enhancing Oxygenation From Lung Cancer Surgery (ID 11990)

      11:15 - 11:25  |  Presenting Author(s): Wei Ling Hsiao

      • Abstract
      • Presentation
      • Slides

      Background

      The purpose of this study is to test the effects of an early rehabilitation intervention on oxygenation, postoperative complications, and recovery from lung cancer surgery.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The study uses an experimental design. Ninety patients scheduled for lung cancer surgeries was recruited from thoracic surgery units of a medical center in Taiwan. Patients were randomly assigned to the intervention or the control group. The intervention includes a 5-day postoperative in-hospital rehabilitation from post op day 1. The main components of the rehabilitation were aerobic and strength exercises as well as breathing training by using an incentive spirometry. Peripheral capillary oxygen saturation (SpO2) was measured in the morning of the preoperative day and of the 4 consecutive days from postoperative day one to four by using the Nellcor™ OxiMax N-65 Portable Pulse Oximeter. The SpO2/FiO2 (S/F) ratio was then calculated to assess patients’ oxygenation. Data on postoperative pulmonary compilations and durations of chest tube drainage were collected from the patients’ charts.

      4c3880bb027f159e801041b1021e88e8 Result

      The patients’ demographics and baseline measures were equivalent between groups. Results of GEE showed a significant group by time interaction effect on S/F ratio. As for the parameter estimates, from postoperative day 1 to day 4, the S/F ratio improvement in the intervention group was 74.49 (Wald X2 = 46.42, p<0.001) more than in the control group. Result of Chi-square test showed that the number of postoperative lung complications in the intervention group (n =1) was significantly less (X2 = 8.39, p = 0.004) than it in the control group (n =10). Result of t- test showed that the duration of chest tube drainage in the intervention group (2.00±1.00 days) was significantly shorter (t =-2.32, p = 0.022) than it in the control group (2.56±1.25 days).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The study results support the effects of the early rehabilitation intervention on enhancing oxygenation, preventing complications, and promoting recovery from lung cancer surgery as indicated by shortened the duration of chest tube drainage. Surgery to remove the cancer is one of the primary treatment options for non-small cell lung cancer. However, lung cancer surgery may result in decreasing lung capacity and expansion; therefore, increase risks for postoperative pulmonary complications. Pulmonary rehabilitation designed to enhance lung expansion and ventilation may help to reduce postoperative lung complications and promote patients’ recovery from lung cancer surgery.

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      OA04.06 - Perceptions of Non-Participation in a Rehabilitation Intervention After Surgery for Non-Small Cell Lung Cancer (ID 12058)

      11:25 - 11:35  |  Presenting Author(s): Mai Nanna Schoenau  |  Author(s): Malene Missel

      • Abstract
      • Presentation
      • Slides

      Background

      Patients with non-small lung cancer (NSCLC) are difficult to engage in clinical trials. Few studies have examined in-depth why these patients refuse to participate. In a Danish randomized clinical trial; ’Postoperative rehabilitation in operable lung cancer patients (PROLUCA)’ only 32% of eligible participants consented to participate in the trial. The purpose of this qualitative study was therefore to explore perceptions, considerations and barriers of non-participation in PROLUCA.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This study was inspired by Reflective Life Research as developed by Dahlberg et al. as a descriptive and interpretive phenomenological research approach. Participants are patients who declined to participate in PROLUCA (non-participants). They were purposefully sampled and recruited from the group of patients who were found to be eligible for the exercise intervention but who declined to participate. Data were collected though telephone interviews. Openness, curiosity and sensitivity played an important role in carrying out the interviews. Analysis was performed according to Reflective Life Research.

      4c3880bb027f159e801041b1021e88e8 Result

      Fifteen non-participants consented to participate in qualitative interviews. Nine men and six women with a mean age of 68 years (range 48-84) were included. Mean time since surgery was 21 month (range 12-28). Five patients were working and ten were retired, eleven patients lived with a partner.

      The analysis revealed three essential themes referred to the patients’ experiences of being ‘Between healthy life and good life’, ‘Under the influence of society’ and their experiences of ‘Health and rehabilitation as a personal responsibility’. Perceptions of non-participation in rehabilitation after surgery for lung cancer are moderated between freedom and necessity. Patients experience ambivalence between a wish to participate in rehabilitation and not having the energy to participate. Patients refused to participate due to daily life priorities and lack of motivation which furthermore is related to social and interpersonal relationships. The patients exercise history is also essential in declining participation. Additionally the patients are under influence of norms and health perceptions from the society.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Patients’ perception of "the good life" was fundamental for accepting or declining participation in a rehabilitation intervention study. Consideration and barriers of non-participation was influenced by norms from the society, motivation, priorities, exercise history, social and interpersonal relations.

      This study has contributed with a sensitive awareness of why patients following lung cancer surgery might refuse participating in rehabilitation. This knowledge can be taken into consideration in the planning of future clinical trials with lung cancer patients.

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      OA04.07 - Early Initiated Postoperative Rehabilitation Reduces Fatigue in Patients with Operable Lung Cancer: A Randomized Trial (ID 13733)

      11:35 - 11:45  |  Presenting Author(s): Morten Quist  |  Author(s): Maja Schick Sommer, Jette Vibe-Petersen, Maja Stærkind Bohlbro, Seppo W Langer, Klaus Richter Larsen, Karen Trier, Merete Christensen, Paul Frost Clementsen, Malene Missel, Carsten Henriksen, Kristina Poulsen, Henning Langberg, Jesper Holst Pedersen

      • Abstract
      • Presentation
      • Slides

      Background

      Surgical tolerability and perioperative risk of complications are correlated with high age, smoking history, comorbidities, low cardiorespiratory fitness (VO2peak) and low functional capacity, which paradoxically are characteristics describing the average patient with lung cancer. Little is known about the optimal amount and timing of exercise strain in concern of the operation wound and with regard improvement of physical function and quality of life (QOL). On this background, we decided to investigate the effect of early vs. late initiated postoperative rehabilitation in patients with operable lung cancer on exercise capacity, functional capacity, muscle strength, and QOL.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The study was designed as a two-armed randomized controlled trial with randomization to either early initiated postoperative rehabilitation (14 days after surgery (ERG)) or a control arm with late initiated postoperative rehabilitation (14 weeks after surgery (LRG)). The primary endpoint was a change in maximum oxygen consumption (VO2peak) from baseline to post intervention 26 weeks following lung resection. Fatigue was measured with EORTC QLQ C30 LC13.

      4c3880bb027f159e801041b1021e88e8 Result

      From April 2013 to June 2016, 582 patients with operable NSCLC were screened for eligibility. With 119 patients randomized in the early rehabilitation group (ERG) (68 females, 51 males; median age 65), and 116 randomized to late rehabilitation group (LRG) (62 females, 54 males; median age 65) the recruitment rate was 52.6%. There was a non-significant decrease in VO2peak in both ERG and LRG from baseline to 26 weeks and no significant difference between ERG and LRG (p=0.9269). There was a significant decrease from baseline to 14 weeks in both ERG (p=0.027) and LRG (p<0.001) and a significant difference between groups (p=0.0018). There was a non-significant increase from 14 weeks to 26 weeks in ERG (p=0.464) and a significant increase from 14 weeks to 26 weeks in LRG (p<0.001) and a significant difference between the two groups (p=0.0003). We found no significant differences in QOL but we found a significant difference between ERG and LRG from baseline to 14 weeks in fatigue level in favour of ERG.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This is the first randomized controlled trial to investigate the effects of early vs. late initiated postoperative rehabilitation in patients with lung cancer. There is no difference in the commencement (early vs. late) of a postoperative exercise program for patients with lung cancer on exercise capacity. But to reduce fatigue patients should be recommended to initiate early exercise programs.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      OA04.08 - Discussant - OA 04.05, OA 04.06, OA 04.07 (ID 14553)

      11:45 - 12:00  |  Presenting Author(s): Pippa Labuc

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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