Author of

• 10984

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  P1.22 - Poster Session 1 - Epidemiology, Etiology (ID 166)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10992

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    P1.22-008 - Identifying evidence-practice gaps in lung cancer and priority setting with clinicians in NSW, Australia. (ID 2518)

    09:30 - 09:30  |  Author(s): E. Stone
    • Abstract

    Background
    Implementation Science has emerged over the past 20 years to highlight a fundamental problem in health care: that knowledge about optimal care is not applied in clinical practice. A ‘gap analysis’ is an initial research activity undertaken when quantifying the gap between existing knowledge and clinical practice. The purpose of this presentation is to describe outcomes of a gap analysis conducted in lung cancer and priority setting focus groups held with oncology health professionals. This research is being conducted by Sydney Catalyst, a Translational Cancer Research Centre that brings together teams of clinicians and researchers from more than 20 member organisations across NSW, Australia, for the purpose of facilitating rapid translation of scientific evidence into clinical practice and policy.

    Methods
    A systematic approach was used to examine the evidence across the lung cancer patient journey. Data sources included international and national clinical practice guidelines, systematic reviews and meta-analyses, and research from peer reviewed publications, including population-based patterns of care studies and data linkage studies. We also conducted a descriptive analysis of data from clinical cancer registries and administrative databases used in the local setting of Sydney and regional NSW, Australia, to determine what gaps were locally relevant. All data sources were reviewed and synthesised to create the list of evidence-practice gaps. The gaps are presently being tested in three focus groups in urban and regional cancer services in NSW, Australia. Focus group participants include specialists in lung and thoracic oncology, medical, nursing, allied health and supportive care health professionals. The purpose of these focus groups is to conduct a priority setting exercise, where clinicians can rate the relevance of gaps to the local context and agree on which gaps should first be addressed in any subsequent research projects.

    Results
    Seven evidence-practice gaps were identified across the patient journey (from initial presentation and diagnosis through to palliative care). We analysed 2008 data from one local hospital for all lung cancer patients (N=329) and found that local patterns of care appear to be consistent with those previously observed in a NSW patterns of care study. This assists in demonstrating that gaps identified at the population level are also present in local health care settings and strengthens a rationale for developing collaborative lung cancer specific research projects that engage clinicians and researchers. The analysis and outcomes of focus groups will be presented, along with a critical appraisal of the gap analysis methodology and show how this approach in lung cancer is relevant to other tumour groups and health conditions.

    Conclusion
    A gap analysis enables researchers and clinicians to identify where deficiencies exist between published research evidence and optimal patient care. By drawing together and synthesizing data from multiple sources of evidence, identifying gaps and setting priorities with local health professionals, we believe we can address the goal of more rapidly translating evidence into practice.

• 11745

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  P2.11 - Poster Session 2 - NSCLC Novel Therapies (ID 209)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11753

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    P2.11-008 - High Proportion of Unusual EGFR Mutations in an Australian Population of Non-Squamous NSCLC (ID 935)

    09:30 - 09:30  |  Author(s): E. Stone
    • Abstract

    Background
    EGFR mutations have previously been reported in 10-15% of non-squamous NSCLC in European populations. The rate of mutations and the proportion of mutations considered to be classical activating, known to confer resistance or unusual is yet to be determined in the Australian population. The influence of unusual mutations on disease progression is not yet clear.

    Methods
    We conducted a retrospective audit of cases of non-squamous NSCLC lung cancer presenting to two metropolitan multidisciplinary teams in Sydney, Australia. All had EGFR testing conducted between October 2010-March 2013. EGFR mutations were identified using PCR and DNA sequencing.

    Results
    134 patient samples were tested for EGFR mutation. Samples were obtained by surgical resection (n=50), FNA (n=31), Core Biopsy (n=31), pleural fluid aspirate (n=3) and EBUS FNA (19). Of these, 32 (24%) were positive for an EGFR mutation. 23/32 had classical activating mutations, with 16/32 Exon 19 deletions and 7/32 Exon 21 L858 substitutions. 4/32 had non-activating/resistance mutations, with 3 exon 20 insertions and 1 exon 20 T790M (L858 + T790M complex de novo mutation). The remaining 6/32 had unusual mutations (1 Exon 20 ala 767-Val769 duplication, 1 Exon 21 p. Pro848Leu, 2 Exon 18 p. G719x, 1 exon 20 S761, D770 insertion and 1 exon 20 deletion V774 insertion). 72 patients in the cohort were female. 8 were Asian, 8 were Pacific Islander, 1 was Indian and 15 were Caucasian. Smoking history was confirmed in all cases. 18/32 were non-smokers, 3/32 were Asian and 24/32 were female. Of the patients with EGFR mutation positive tumours, 16/32 received TKI as first-line therapy, 5/32 received TKI as second-line therapy, 6/32 did not receive TKI and 5/32 were lost to follow-up in other institutions. Of the 6 who did not receive TKI, 5 cases were early-stage treated surgically; the other case received palliative radiotherapy but co-morbidity prevented TKI therapy. Information regarding disease progression was available in 20/32 cases. Of these cases 11/20 had classical activating mutations, were treated with EGFR TKI and, to date have a mean (SD) progression free survival (PFS) of 315 (± 208) d. Those with other mutations had a PFS of 117 (±86) d. This difference was statistically significant at p<0.01(Mantel-Cox).

    Conclusion
    EGFR mutations occur more commonly in an Australian population of non-squamous NSCLC than previously reported in European populations. Most in this series have classical activating mutations. Almost one third of this series had a mutation other than classically activating and in all of these cases the PFS was significantly reduced. We report six unusual mutations of unclear clinical significance, which are also associated with poor PFS.