1. 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:
@BTOGORG

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

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

4. Immunotherapy

5. 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

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

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

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

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

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

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

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

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

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

15. Study design

17. Selected toxicity

18. Pneumonitis

19. Authors’ conclusions

21. Durvalumab

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

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

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

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

26. Early Detection

36. 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

37. 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

38. 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)

39. 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.

40. “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,”

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

42. 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

43. We obtained average cigarette pack prices, cigarette pack sales, smoking prevalence, and lung cancer incidence and mortality rates in Indiana and nationally from Average cigarette pack prices were inflation adjusted to 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.

44. 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

45. 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.

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

51. Stereotactic radiotherapy

52. 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.

53. 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

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

55. 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.

56. 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

57. Abstract 8512

65. What next?

66. 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

67. 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:
@BTOGORG

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