Please join BTOG today Registration is free BTOG’s Mission is to support and educate health care professionals, creating a professional community to exchange ideas, information and innovation and to foster the development of research. The overall aim is to represent the needs of patients and improve their outcomes. Please join BTOG today Registration is free Website: www.btog.org Email: info@btog.org @BTOGORG

BTOG Educational Events 2018/2019 BTOG Stage III Lung Cancer Essential Update 2018 23rd November 2018 – London BTOG 2019 - 17th Annual BTOG Conference 2019 23rd to 25th January 2019 – Dublin BTOG and Mesothelioma UK – Mesothelioma Essential Update 2019 March 2019 (TBC) – London BTOG Thoracic Oncology Course 2019 13th and 14th May 2019 - Leicester

ASCO 2018 update: Early lung cancer and radical radiotherapy Dr Jason Lester

Immunotherapy

Presented By Greg Durm at 2018 ASCO Annual Meeting Phase II Trial of Concurrent Chemoradiation with Consolidation Pembrolizumab in Patients with Unresectable Stage III NSCLC Multicentre US trial Presented By Greg Durm at 2018 ASCO Annual Meeting

Background: Stage III Unresectable NSCLC Presented By Greg Durm at 2018 ASCO Annual Meeting

Radiation May Prime for an Immune Response Presented By Greg Durm at 2018 ASCO Annual Meeting

Presented By Greg Durm at 2018 ASCO Annual Meeting Consolidation Pembrolizumab Following CCRT for Unresectable Stage III NSCLC: LUN 14-179 Presented By Greg Durm at 2018 ASCO Annual Meeting

Patient and Disease Characteristics Presented By Greg Durm at 2018 ASCO Annual Meeting

Presented By Greg Durm at 2018 ASCO Annual Meeting Pneumonitis Presented By Greg Durm at 2018 ASCO Annual Meeting

Time to Metastatic Disease or Death Presented By Greg Durm at 2018 ASCO Annual Meeting

Progression Free Survival Presented By Greg Durm at 2018 ASCO Annual Meeting

Presented By Greg Durm at 2018 ASCO Annual Meeting Conclusions Presented By Greg Durm at 2018 ASCO Annual Meeting

Nivolumab concurrent with chemoradiotherapy in locally advanced NSCLC – a phase 2 trial Abstract 8510 Dutch

Study design

Selected toxicity

Pneumonitis

Authors’ conclusions

Durvalumab

Efficacy of Consolidation Pembrolizumab Presented By Greg Durm at 2018 ASCO Annual Meeting

Immunotherapy Consolidation immunotherapy after chemoradiotherapy seems manageable Radiotherapy detail lacking – is immunotherapy making up for ‘bad’ RT?

Immunotherapy Concurrent Nivolumab feasible Grade 3-5 pneumonitis: Concurrent/adjuvant nivolumab 10.3% Adjuvant pembrolizumab 6.5% Adjuvant Durvalumab 3.4% No Survival data

Presented By Greg Durm at 2018 ASCO Annual Meeting Future Directions Presented By Greg Durm at 2018 ASCO Annual Meeting

Early Detection

Aim To detect early (lung) cancer using a blood test Analysis of cell-free DNA from blood is already used to help choose targeted therapies (e.g. the Cobas EGFR mutation test) in patients with advanced disease

About the study Has enrolled more than 12,000 of the planned 15,000 participants (70% with cancer, 30% without cancer) This report is from the first pre-planned sub-study: three prototype sequencing assays were performed on blood samples from approximately 1,700 participants Twenty different cancer types across all stages were included in the sub-study

About the study 127 people with stage I-IV lung cancer included Three assays were designed to detect cancer-defining signals in the blood: Targeted sequencing to detect non-inherited (somatic) mutations Whole-genome sequencing (WGS) to detect somatic gene copy number changes Whole-genome bisulfite sequencing (WGBS) of cfDNA to detect abnormal cfDNA methylation patterns (epigenetic changes)

Among the 127 participants with lung cancer, the biologic signal for lung cancer was comparable across the assays, and the signal increased with cancer stage. At 98% specificity, the WGBS assay detected 41% of early stage (stage I-IIIA) lung cancers and 89% of late-stage (stage IIIB-IV) cancers. The WGS assay was similarly effective, detecting 38% of early-stage cancers and 87% of late-stage cancers, whereas the targeted assay detected 51% of early-stage cancers and 89% of late- stage cancers. Initial results showed that all three prototype assays could detect lung cancer with a low rate of false positive findings (a false positive occurs when the test suggests a person has cancer when there is no cancer). Of the 580 control samples (from people without cancer at study enrollment) in the sub-study, five (<1%) had a cancer-like signal across all three assays. Of those five participants, two were subsequently diagnosed with cancer (one with stage III ovarian cancer, and one with stage II endometrial cancer), highlighting the potential for such a test to identify early stage cancers.

“We’re one step closer to being able to detect early lung cancer from a simple blood test. While there’s still a way to go before cell-free DNA from blood can be used for cancer detection on a broad scale, this research serves as a building block for the development of future tests,”

Cigarette price, smoking behaviors, and lung cancer mortality in Indiana Abstract 6559

Increasing tobacco costs have been proven to be one of the most effective interventions of decreasing tobacco use. The relationship between tobacco cost and lung cancer mortality has not been as well established. We investigated the relationship of cigarette price with smoking prevalence, cigarette consumption, and lung cancer incidence and mortality in Indiana and nationally

We obtained average cigarette pack prices, cigarette pack sales, smoking prevalence, and lung cancer incidence and mortality rates in Indiana and nationally from 1995-2015. Average cigarette pack prices were inflation adjusted to 2015 then assessed for Pearson correlation coefficient (r) with cigarette pack sales, smoking prevalence, and lung cancer incidence and mortality. Cigarette price was also correlated with smoking prevalence among state-level characteristics that included gender, age, ethnicity, education, and income.

From 1995 to 2015, average cigarette pack price in Indiana rose from $2.29 to $5.41. Increasing cigarette price in Indiana was associated with: decreasing cigarette consumption decreasing overall smoking prevalence decreasing lung cancer mortality

Increasing tobacco taxes and subsequent increasing cigarette prices were associated with decreased smoking prevalence, cigarette consumption, and lung cancer mortality in Indiana. Lower socioeconomic populations in Indiana may not be as price-responsive as similar populations nationally. Policies aimed at increasing tobacco prices should prioritize diverting revenues towards health programs and tobacco-cessation initiatives for lower-income individuals.

The population-based impact of adjuvant chemotherapy (CTx) on outcomes in AJCC6 stage IB non-small cell lung cancer (NSCLC) Abstract 8523

Stereotactic radiotherapy

Long-term survival comparison of stereotactic radiotherapy versus surgery for elderly patients with clinical stage T1-T2 non-small cell lung cancer Abstract 8511 Indianapolis. There are several matched-paired analysis reports of comparing the long-term outcome between Stereotactic Body Radiation Therapy (SBRT) and surgical resection. Most of them are small series. This study aimed to compare the long-term overall survival (OS) after SBRT and surgery from a single medical center with surgery performed with the same group of surgeons.

Methods Cancer registry data 2005-2015 Patients with clinical staged T1 and T2 N0 disease treated with either primary surgery or SBRT Only patients elder than 65 years Matched analysis

Results 774 patients 508 patients with surgery and 266 patients with SBRT The median age was 73 years (range: 65-96 years) 50% were male 67% had T1 disease

The median OS and survival rates at one-, three- and five years were 81 months (95%CI:66-92), 85%, 70% and 58% after surgery, and 37 months (95%CI:28-46), 83%, 50% and 29% after SBRT, respectively (log-rank p< 0.001). This matched analysis, representing the largest one in the literature, demonstrated that patients treated with surgery have significantly better long-term survival than that of SBRT in elderly patients. This result varies from some of previous reports showing similar survival between SBRT and surgery. Prospective randomized study is needed to determine whether SBRT can present as an alternative for operable patients.

Authors’ conclusions The largest published matched analysis Patients treated with surgery had significantly better long-term survival than those treated with SBRT This result varies from some of previous reports showing similar survival between SBRT and surgery Prospective randomized study is needed

Abstract 8512

What next?

Summary Immunotherapy Early lung cancer SABR Integrating immunotherapy with concurrent chemoradiotherapy is relatively safe and appears to be effective Early lung cancer Low dose CT screening may not be the UK solution Blood screening showing promise but early days Most effective strategy is smoking prevention SABR Lack of robust prospective data on SABR vs surgery Current evidence suggests surgery remains the standard of care

Please join BTOG today Registration is free BTOG’s Mission is to support and educate health care professionals, creating a professional community to exchange ideas, information and innovation and to foster the development of research. The overall aim is to represent the needs of patients and improve their outcomes. Please join BTOG today Registration is free Website: www.btog.org Email: info@btog.org @BTOGORG

BTOG Educational Events 2018/2019 BTOG Stage III Lung Cancer Essential Update 2018 23rd November 2018 – London BTOG 2019 - 17th Annual BTOG Conference 2019 23rd to 25th January 2019 – Dublin BTOG and Mesothelioma UK – Mesothelioma Essential Update 2019 March 2019 (TBC) – London BTOG Thoracic Oncology Course 2019 13th and 14th May 2019 - Leicester