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L. Petruželka
Moderator of
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OA04 - Epidemiology and Prevention of Lung Cancer (ID 370)
- Event: WCLC 2016
- Type: Oral Session
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 8
- Moderators:L. Petruželka, S. Shastri
- Coordinates: 12/05/2016, 11:00 - 12:30, Schubert 4
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OA04.01 - Educational and Wealth Inequalities in Tobacco Use among Men and Women in 54 Low-And-Middle-Income Countries (ID 3910)
11:00 - 11:10 | Author(s): C.T. Sreeramareddy, S. Haprper, L. Ernstsen
- Abstract
- Presentation
Background:
To support health policies and place monitoring systems to tackle socio-economic inequalities in tobacco use in low-and-middle-income countries (LMIC) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in low-and-middle income countries.
Methods:
We analyzed DHS data on tobacco use collected in 54 countries. We calculated weighted prevalence estimates of current tobacco use (any type of tobacco) in each country for five wealth groups and four educational groups. We calculated both absolute and relative measures of inequality, i.e., the Slope Index of Inequality (SII) and Relative Index of Inequality (RII), which take into account the distribution of prevalence across all wealth and education groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification.
Results:
Male tobacco use among was highest in Bangladesh (70.3%) lowest in Sao Tome (7.4%); whereas female tobacco use highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men educational inequalities varied widely between countries but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83-4.61) in LICs, 1.99 (95% CI 1.66-2.38) in lMIC, and 1.82 (95% CI 1.24-2.67) in uMIC. Wealth inequalities among men varied less between countries but both RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05-2.88) in LICs, 1.84 (95% CI 1.54-2.21) in lMICs, and 1.67 (95% CI 1.15-2.42) in uMIC. For educational inequalities among women, the RII varied much more than SII varied between the countries, and aggregate RII was 14.49 (95% CI 8.87-23.68) in LICs, 3.05 (95% CI 1.44-6.47) in lMIC and 1.58 (95% CI 0.33-7.56) in uMIC. Wealth inequalities among women showed a pattern similar to that of men: the RII was 5.88 (95% CI 3.91- 8.85) in LICs, 1.76 (95% CI 0.80 -3.85) in lMIC, and 0.39 (95% CI 0.09 -1.64) in uMIC. In contrast to men, among women the SII was pro-rich (higher smoking among the more advantaged) in 13 of the 52 countries (7 of 23 lMIC and 5 of 7 uMIC).
Conclusion:
Our results confirm that socio-economic inequalities tobacco use exist in LMIC, varied widely between the countries, and were much wider in the lowest income countries. These findings are important for better understanding and tackling of socio-economic inequalities in health in LMIC.
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OA04.02 - Smoking Behavior in Patients with Early Stage Non-Small Cell Lung Cancer: A Report from ECOG-ACRIN 1505 Trial (ID 5385)
11:10 - 11:20 | Author(s): S.S. Ramalingam, S.E. Dahlberg, H. Wakelee, S.M. Keller, W.J. Tester, D.R. Gandara, S.L. Graziano, A. Adjei, C.A. Butts, J. Schiller
- Abstract
- Presentation
Background:
Approximately 85% of lung cancer is related to cigarette smoking. Smoking cessation has been reported to benefit patients even after the diagnosis of lung cancer. We studied the smoking behavior of patients with lung cancer in a phase 3 study for early stage lung cancer.
Methods:
The ECOG-ACRIN 1505 study enrolled patients with stages IB, II and IIIA non-small cell lung cancer (NSCLC) after they had undergone surgical resection. It was designed to evaluate whether the addition of bevacizumab would improve survival relative to cisplatin-based chemotherapy alone. Studying the correlation between smoking status and outcome was a secondary endpoint. Patients completed a questionnaire about their smoking habits at baseline, 3, 6, 9 and 12 months after study entry.
Results:
Out of 1501 patients enrolled, 99%, 90%, 85%, 82% and 80% responded to the questionnaire at baseline, 3, 6, 9 and 12 months respectively. Nearly 90% reported having smoking during their lifetime. At study entry, 12% reported ongoing smoking. The median age patients started smoking was 17 years and the median age at which they quit smoking was 55 years. The median number of cigarettes smoked per day was 20. Approximately 4% smoked cigars (median number 2/day). Of the 40% that reported smoking after the diagnosis of lung cancer, only 15% reported smoking at 12 months. At 12 months after study entry, among those who continued to smoke, 79% reported smoking fewer cigarettes/day, whereas 11% smoked more cigarettes. When asked about the number of cigarettes smoked at 12 mos, 63% reported smoking fewer than 10 cigarettes/day. The incidence of grades 3-5 toxicity was 76% in smokers versus 69% in non-smokers (p=0.06). There were no differences in dose reductions for chemotherapy (P=0.55) or bevacizumab (P=0.90) between smokers and non-smokers. The median number of chemotherapy cycles were nearly identical for smokers and never-smokers. The disease-free survival (DFS) and OS for smokers relative to never-smokers were 0.97 (P=0.83) and 1.54 (P=0.01) respectively.
Conclusion:
This is the first comprehensive, prospective report of smoking habits of patients with lung cancer. There were a high rate of smoking cessation and reduction in number of cigarettes smoked, that was maintained at 12m after study entry. Toxicity and DFS did not differ significantly between smokers and never-smokers, though overall survival was more favorable with the never-smokers. Study was coordinated by ECOG-ACRIN (Robert L. Comis, M.D., Chair) and supported in part by Public Health Service Grants CA180820, CA180888, CA180821, & CA180863.
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OA04.03 - Preliminary Results of a Low Cost Intervention to Improve Tobacco Cessation Practices within a Large University Health System (ID 4599)
11:20 - 11:30 | Author(s): M.K. Hamby, A. Nix, J. Tobi, K. Rysso, D. Arenberg
- Abstract
- Presentation
Background:
Tobacco cessation is critical for both population and individual health, and especially so in the context of a lung cancer screening program. Our institution initiated formal lung caner screening in 2013. In preparation for this we audited randomly selected clinic visits to assess adherence to published tobacco cessation guidelines. Our findings in that study prompted us to initiate a systematic multi-step program to improve tobacco practices from assessing tobacco use to presribing pharmacotherapy, and referral to tobacco cessation counselors.
Methods:
The project included four separate but related interventions; 1) Inviting clinic directors to send a clinic staff member of their choice for formal training in a specialize Tobacco treatment Specialist (TTS) course. 2) Generating monthly reports showng completeless of tobacco history (Current/Former/Never), pack-years recording, and (for former smokers) quit dates, use of pharmacotherapy for current smokers, and referrals for either tobacco cessation or formal lung cancer screening. 3) Providing monthly feedback to clinic directors comparing their performance to others in the project, and 4) Initiation of an electronic Best Practice Alert prompt for smokers including links to a Lung Cancer Screening Questionaire & decision aid and referral to Tobacco Counselor.
Results:
This University Health System is affiliated with over 150 satellite clinical sites. 20 sites delivering mostly adult primary care were invited to participate. Individuals from 14 sites completed TTS training. Initial assessment of tobacco use (Current/Former/Never) was excellent (>99%) across all clinical sites, including those who did not particpate in TTS training. However, pack-years were recorded on average less that 40% of the time and quit dates for former smokers were recorded less than 30% of the time at baseline. After training clinic staff in the TTS course, and regular ongoing feedback to clinical directors, we observed a significant initial increase in accurate recording of pack-years and quit dates (two points of emphasis) for all sites involved in the project, as well as referals to tobacco counselling. Over this time, unfortunately we did not detect an increase in the rate of prescription of tobacco pharmacotherapy. The There was a gradual increase in the the number of referrals for lung cancer screening Cts increased from an average of 30 per month to an average of over 70.
Conclusion:
This project to disseminate the skills of a TTS training course to clinics within a large University Health System has led to modest improvements in overall practices and demonstrated areas where additional improvements are needed.
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OA04.04 - Discussant for OA04.01, OA04.02, OA04.03 (ID 6943)
11:30 - 11:45 | Author(s): G. Lopes
- Abstract
- Presentation
Abstract not provided
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OA04.05 - Chronic Inflammation, NSAIDS and the Risk of Lung Cancer Death (Abstract under Embargo until December 5, 7:00 CET) (ID 6166)
11:45 - 11:55 | Author(s): M. Bittoni, D.P. Carbone, R. Harris
- Abstract
- Presentation
Background:
Chronic inflammation appears to heighten the risk of lung cancer and, reciprocally, agents that reduce inflammation have been found to reduce this risk. Nevertheless, few prospective studies have examined associations between lung cancer and the intake of nonsteroidal anti-inflammatory drugs (NSAIDs). In the current study, we examined associations between fatal lung cancer and NSAIDs using prospective data from the Third National Health and Nutrition Examination Study.
Methods:
Baseline data on smoking, NSAIDs and other lifestyle variables were collected for 10,735 participants during 1988-1994, and cause-specific mortality status was ascertained through probabilistic record matching using the National Death Index through 2006. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) to quantify associations between NSAID use and lung cancer death, with adjustment for current smoking and other variables.
Results:
During 18 years of follow-up, 269 individuals died from lung cancer of which 252 (93.6%) reported a history of cigarette smoking. Since all but 17 of the 269 fatal lung cancer cases occurred among current or former smokers, estimates of NSAID effects were ascertained from a sub-cohort of 5,882 individuals who reported a history of past or current cigarette smoking. Multivariate regression models revealed that regular use of ibuprofen reduced the risk of lung cancer death by 48% (HR=0.52, 95% CI=0.33-0.82, P<0.01). Main effects of other compounds tested (aspirin or acetaminophen) were not statistically significant.
Conclusion:
Prospective data from NHANES III showed that among adults with a history of past or current smoking, ibuprofen intake was associated with a substantial (48%) reduction in the risk of dying from lung cancer. Effects of aspirin and acetaminophen were not statistically significant. These results suggest that regular use of certain NSAIDs may be beneficial for high-risk subgroups of smokers as a lung cancer prevention strategy.
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OA04.06 - Examining Pleiotropic Associations of Genetic Risk Variants for Chronic Obstructive Pulmonary Disease with Lung Cancer Risk (ID 5225)
11:55 - 12:05 | Author(s): L.C. Sakoda, K.K. Thai, N.H. Roubinian, C. Iribarren, C.A. Schaefer, N. Risch, L.A. Habel, C.P. Quesenberry Jr., E. Jorgenson
- Abstract
- Presentation
Background:
Tobacco smoke is the primary cause of chronic obstructive pulmonary disease (COPD) and lung cancer, and among smokers, COPD is associated with increased lung cancer risk. However, fewer than 30% of smokers are diagnosed with either disease, suggesting that genetic factors also influence the pathogenesis of both diseases. Despite the plausibility for shared genetic predisposition, knowledge about pleiotropy between COPD and lung cancer is limited.
Methods:
Using the Genetic Epidemiology Research on Adult Health and Aging cohort established at Kaiser Permanente Northern California (KPNC), an integrated healthcare system, we examined non-Hispanic white smokers aged ≥40 years diagnosed with lung cancer (n=489), including those with COPD (n=243) or without COPD (n=174), and neither disease (n=26,553) through January 31, 2014. Those with lung cancer were identified from KPNC Cancer Registry data. Those with COPD were identified from electronic health record data, requiring at least one hospitalization with a principal discharge diagnosis or two outpatient visits with a diagnosis of chronic bronchitis, emphysema, or COPD (ICD-9 codes: 491.*, 492.*, 496.*). We examined 16 single nucleotide polymorphisms (SNPs) in 10 risk loci identified previously for COPD or airflow obstruction by genome-wide association studies (1q41, 4q22.1, 4q31.21, 5q32, 6p21.32, 11q22, 14q32, 15q25.1, 16p11.2, 19q13) for their associations with lung cancer risk, overall and stratified by COPD. SNPs were examined individually and also jointly as an unweighted 16-SNP risk score. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusted for age, sex, pack-years of smoking, and principal components of genetic ancestry.
Results:
Only two SNPs at 15q25.1, a risk locus also known for lung cancer and nicotine dependence, were associated with overall lung cancer risk: rs8034191 (per-allele OR=1.22, 95% CI: 1.07-1.39, p=0.003) and rs12914385 (per-allele OR=1.23; 95% CI: 1.08-1.40, p=0.002). In stratified analyses, associations were marginally stronger for lung cancer without COPD (rs8034191: OR=1.36, 95% CI: 1.09-1.69; rs12914385: OR=1.24, 95% CI: 1.00-1.54) than lung cancer with COPD (rs8034191: OR=1.09, 95% CI: 0.90-1.31; rs12914385: OR=1.17, 95% CI: 0.97-1.40). The 16-SNP risk score was suggestively associated with overall lung cancer risk (highest vs. lowest quintile: OR=1.31, 95% CI: 0.97-1.76), with the magnitude of association somewhat stronger for lung cancer with COPD (OR=1.28, 95% CI: 0.84-1.97) than without COPD (OR=1.16, 95% CI: 0.72-1.88).
Conclusion:
Our preliminary results provide minimal evidence of pleiotropic associations of identified genetic variants for COPD with lung cancer risk, although analyses are limited by the number of lung cancer patients examined.
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OA04.07 - Clinical Characteristics of Lung Adenocarcinoma in the Young: Results from the Genomics of Young Lung Cancer Study (ID 5578)
12:05 - 12:15 | Author(s): B.J. Gitlitz, A.H. Wu, M. Bittoni, B.J. Addario, A.L. Sable-Hunt, M.B. Jennings, S. Novello, T. Vavala, R. Chen, D. Morosini, G.R. Oxnard, S..L. Park
- Abstract
- Presentation
Background:
Background: Lung cancer is increasingly recognized as a heterogeneous disease comprised of genomically defined subtypes with distinct targetable genomic alterations. However, it is unknown whether established lung cancer risk factors differ between these genomically distinct subtypes. In this study of the genomics of young lung cancer (GoYLC), we present preliminary results of lifestyle risk factors by specific genomic alteration to better characterize lung cancer in the young.
Methods:
Methods: Beginning in July of 2014, patients diagnosed with a bronchogenic lung cancer under the age of 40 were recruited to the GoYLC study. Informed consent was obtained in-person and virtually (online), allowing patients to participate globally, regardless of proximity to study sites (https://www.openmednet.org/site/alcmi-goyl). To date, this study has accrued a total of 101 cases, of which 85 are adenocarcinoma (AC). Stage 4 AC is the focus of this analysis.
Results:
Results: Among the 63 stage 4 AC cases, the most common genomic alterations were ALK rearrangements (n=28; 44% of stage 4 AC cases) and EGFR mutations (n=17; 27%) while the other genomic alterations (n=18; 29%) include ROS1, BRCA2, HER2, P53, RET and ATM. The prevalence of active smoking and/or exposure to passive smoking was highest among those with ALK (64%), intermediate for those with EGFR (47%) and lowest for those with other genomic alterations (39%). However, the prevalence of only active smoking was lowest among those with ALK (28%), followed by EGFR (35%) and highest for those with other genomic alterations (39%). The majority of patients with ALK rearrangements or EGFR mutations reported no family history of lung cancer (82% and 88%, respectively), compared with 67% among those with other genomic alterations.
Conclusion:
Conclusion: These preliminary results suggest that lifestyle characteristics and family history in young lung cancer patients may differ by genomic alteration. Passive smoke exposure was more prevalent among those with ALK rearrangements or EGFR mutations. Those with other genomic alterations, albeit, a heterogeneous group, were least likely to be exposed to passive smoking and more likely to be active smokers. We are continuing to enroll participants and are expanding the epidemiologic characterization to all study patients to evaluate if risk factors also differ by tumor stage and histology (Data to be presented). Importantly, this analysis lays the groundwork for the development of our more comprehensive epidemiology of young lung cancer study that may identify potential lifestyle and environmental risk factors related to specific genomic alterations.
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OA04.08 - Discussant for OA04.05, OA04.06, OA04.07 (ID 6989)
12:15 - 12:30 | Author(s): R. Ulmeanu
- Abstract
- Presentation
Abstract not provided
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Author of
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MA09 - Immunotherapy Combinations (ID 390)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Chemotherapy/Targeted Therapy/Immunotherapy
- Presentations: 1
- Moderators:M. Sebastian, E.B. Garon
- Coordinates: 12/06/2016, 14:20 - 15:50, Strauss 2
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MA09.08 - Discussant for MA09.05, MA09.06, MA09.07 (ID 7048)
15:08 - 15:20 | Author(s): L. Petruželka
- Abstract
- Presentation
Abstract not provided
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MTE27 - Treatment of Lung Cancer Patients with Poor Performance Status (Ticketed Session) (ID 320)
- Event: WCLC 2016
- Type: Meet the Expert Session (Ticketed Session)
- Track: Chemotherapy/Targeted Therapy/Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 07:30 - 08:30, Lehar 1-2
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MTE27.02 - Treatment of Lung Cancer Patients with Poor Performance Status (ID 6589)
08:00 - 08:30 | Author(s): L. Petruželka
- Abstract
- Presentation
Abstract not provided
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-011 - Management of Non-Small-Cell Lung Cancer (NSCLC) Stage III Patients in Central European Countries (ID 4608)
14:30 - 14:30 | Author(s): L. Petruželka
- Abstract
Background:
The aim of the study is to determine the actual standard management of patients with stage III NSCLC in Central European centres/countries. The project is a multicentre, prospective, non-interventional registry.
Methods:
After ethical committee approval and signed informed consent, the data about diagnostic and therapeutic procedures of consecutive patients diagnosed with stage III NSCLC (UICC7) were collected in web-based registry organised by the IBA MUNI, Brno, Czech Republic.
Results:
With cut-off 30 June 2016, 509 patients from 7 countries/16 centres were enrolled, median number of patients per centre being 23 (range 6-99). There were 163 (32%) women and 37 (7%) never smokers. Performance status distribution was as follows: ECOG 0, 1, 2 and 3 in 29%, 56%, 12% and 3%, respectively. Squamous cancer was found in 52%, adenocarcinoma in 39%, not otherwise specified in 5% and others in 4% of cases. Genetic mutations were examined in 119 (23%) patients, predominantly EGFR in 111 subjects with 10 (8%) positive findings, while the ALK mutation in 64 patients with no positive finding. Regular staging procedures were X-Ray scan (97%), chest CT (96%) and bronchoscopy (89%). Staging was completed by abdominal CT in 66% of patients, abdominal US in 29%, PET/CT in 22%, bone scan in 17% and brain CT or MRI in 13%, respectively. Stage IIIA was found in 59% and stage IIIB in 41% of patients. N2/N3 nodes were diagnosed in 60%/22% of patients. Pathological mediastinal lymph-node positivity was confirmed in 109 (21%) patients (6% EBUS, 0.2% VATS, 1% mediastinoscopy, 1% transbronchial biopsy and 13% surgery). Median time from diagnosis to first treatment was 23 days (range 0–321). Treatment procedures were: surgery 138 (27%), chest radiotherapy 246 (48%) and chemotherapy 409 (80%) of subjects, respectively. Chemotherapy as only modality was given in 136 (27%) of patients. Surgery was combined with radiation in 6 cases, with chemotherapy in 79 (16%) cases and with both chemotherapy and radiotherapy in 37 (7%) patients. Chemotherapy plus radiotherapy was given in 159 (31%) patients including concurrent chemoradiotherapy in 67 (13%) cases. At the time of cut-off, 64% patients were alive, median survival time was not reached, and the 1-year estimated survival rate was 71%.
Conclusion:
The most prevalent histology was squamous cancer. Histopathological examination of mediastinal lymph-nodes was done in 21% of patients, mostly during surgery. Majority of patients (55%) were treated with combination therapy. Palliative chemotherapy only was given in 27% of patients. Survival data are not mature.
