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C. Vallejos
Moderator of
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SC17 - Lung Cancer: A Global Cancer with Different Regional Challenges (ID 341)
- Event: WCLC 2016
- Type: Science Session
- Track: Regional Aspects/Health Policy/Public Health
- Presentations: 6
- Moderators:C. Vallejos, P.A. Bunn, Jr.
- Coordinates: 12/06/2016, 14:20 - 15:50, Strauss 1
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SC17.01 - Lung Cancer in Russia: Challenges and Perspectives (ID 6666)
14:20 - 14:35 | Author(s): V. Gorbunova
- Abstract
- Presentation
Abstract:
Background Cancer is set to become a major cause of morbidity and mortality in coming decade in every region of the world.Methods The mortality, morbidity and treatment variants in Russia were evaluated.Results The incidence of lung cancer morbidity in Russia in 2014 numbered 57 685, mortality – 49 730. Standardized index incidence rate demonstrates improvement of men since year 2009. It was 55,0 on 100 000 population in 2009; 49,15 in 2013 and 49,0 in 2014. It means a 10,9% decrease since 2009 to 2014. It takes stable first place in men. In women the same years showed different values: 7,0; 7,17; 7,3 at 2009, 2013 and 2014 years respectively, that means + 4,3%. It takes 10-12 places of all malignant diseases among women. Among men lung cancer is on the first place (26,6%) in mortality rates. A non-interventional, prospective cohort study included 838 patients, average age 58,7; male – 78,4%; female – 21,6%, smokers – 26,5%; ex-smokers – 24,1%, current smokers – 49,4%. Disease stages at diagnosis were: stage I-II – 36,8%; stage III – 37,8%; stage IV – 25,4%. It was squamous-cell carcinoma – 54,3%; adenocarcinoma – 31%; BAR – 6,4%; LCC – 2,9%, adenosquamous carcinoma – 2,3%, other – 3,1%. Proportion of EGFR positive tumors constitutes 10,1% (85/838) pts. Surgery was performed for 393 pts (46,9%). Radiotherapy was administered to 145 pts (17,8%). 370 pts (44,2%) underwent first-line CT and 96 (11,8%) – second-line. The treatment depends on the morphology type of the tumor. We consider four main types NSCLC (AdenoCa and SCC), LCLC and NETs. NETs group included typical and atypical carcinoids, LCNEC, SCLC. We participated in 53 different multicenter international trials in lung cancer, including 930 patients. Outside of these protocols we analyzed 567 pts with advanced NSCLC: 255 pts with squamous cell cancer (SCC) and 250 pts with non-SCC for 1st line chemotherapy (CT). ORR was 20-25% for platinum-duplets, 1-year survival – 27,5-37,5 month. The 1-year survival showed best results in absolute figures with paclitaxel and platinum compounds in SCC and gemcitabine and platinum compounds in non-SCC, but the value was not statistically significant neither for 1-year nor for median survival. For SCLC new combination with irinotecan and platinum compound showed ORR – 55,1% and stabilization of disease in 24,3% of pts.Conclusions Nowadays the treatment approaches to lung cancer in Russia depends from morphological type of tumors, IGC results and needs further investigations.
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SC17.02 - Lung Cancer in China: Challenges and Perspectives (ID 6667)
14:35 - 14:50 | Author(s): L. Zhang
- Abstract
- Presentation
Abstract:
Lung cancer is still the leading cause of cancer death in China. The estimated new lung cancer cases and deaths were 733,300 and 610,200 in 2015, respectively. Non-small cell lung cancer (NSCLC) remains the predominant form of the disease in China, with majority of patients being diagnosed at advanced stages. Thus this presentation will focus on advanced stage NSCLC. Current treatment strategy The current treatment algorithm for wild-type non-squamous and squamous NSCLC were shown in Figure 1 and 2, respectively. Figure 1 Figure 1. Treatment algorithm for non-squamous NSCLC (wild-type) Figure 2 Figure 2. Treatment algorithm for advanced squamous NSCLC For patients with activating EGFR mutations, EGFR-TKIs therapy will be used as front-line therapy. Commercial available EGFR-TKIs in China include Gefitinib, Erlotinib and Icotinib. For patients harbouring an ALK rearrangement, crizotinib will also be considered as first-line treatment. When failed from EGFR-TKIs or ALK-Inhibitor therapy, patients will be treated according to clinical model of disease progression. For patients with asymptomatic progression, continuing EGFR-TKIs or ALK-Inhibitor is recommended. For patients with local progression, EGFR-TKIs or ALK-Inhibitor will also be continued with additional local therapy such as whole brain radiation. However, for patients with aggressive progression, EGFR-TKIs or ALK-Inhibitor will be substituted by chemotherapy. Unfortunately, it is difficult to overcome drug resistance according to molecular mechanism because novel agents such as Osimertinib and Alectinib haven’t been approved by Chinese FDA. Challenge and perspective 1. Genetic alterations assays Genetic alterations are frequent in Chinese NSCLC patients. According to PIONEER study (NCT01185314), which is a prospective molecular epidemiology study in newly diagnosed advanced lung adenocarcinoma, the EGFR active mutation rate is 50.2% in Chinese patient population. The incidence of EGFR mutations in patients who never smoked can be as high as 59.6%. ALK rearrangement is also common in this patient population. In a large cross-sectional study enrolled 1160 NSCLC patients, the incidence of ALK rearrangements is 8.1%. Noteworthy, 44% of patients younger than 30 years old harbor ALK rearrangements. However, genetic alterations test rate used to be low in China. According to a large national survey, the EGFR mutation test rate was only 9.6% in 2011. However, as the turnover time shortens, the testing fee decreases, and ctDNA testing becomes available, the EGFR/ALK assays have turned into routine practice in China. Moreover, NGS platforms detecting panels of mutations are commonly used in some leading centers now. 2. Novel agent availability There is severe delay in the approval for novel agents by Chinese FDA. For instance, Bevacizumab was approved by FDA for treatment of NSCLC in 2006, while it was approved by Chinese FDA 9 years later. To improve availability of novel agents, Chinese oncologists are active in participation in international multi-center clinical trials. In addition, more and more innovative drugs have been developed by domestic pharma industry and entered clinical trials (Table 1). Moreover, Chinese FDA makes new policies to encourage innovative drugs and accelerating new drug application.
Table 1. Innovative drugs from China in clinical trials 3. Lung cancer prevention The incidence rate of lung cancer remains high in China between 2000 and 2011. Factors that have contributed to this issue include tobacco smoking and air pollution. 50% adult Chinese men were current smokers in 2010. In addition, smoking rates in adolescents and young adults are still rising in China. To reduce tobacco use in China, the government enact a strict smoking control law in Beijing in June 2015. However, the air pollution is still a severe problem and needs to be improved urgently. 4. Economic burden There are several factors which have contributed to the heavy economic burden of lung cancer patients in China. First, the residents’ income is still low in China. In 2015, per capita disposable income (one year) was only $3300. Second, the cost of anti-cancer drugs is very high (Crizotinib/cycle $8500, Gefitinib/cycle $2200, Pemetrexed/cycle $3000, and Bevacizumab/cycle $4500). Moreover, only 20% of whole medical expense can be covered by insurance, and majority of targeted drugs can’t be covered.Agent ID Classification Indication Phase Avitinib Mutation selected EGFR-TKI EGFR T790M Mutation Phase I Apatinib VEGFR-TKI Nonsquamous NSCLC in 3L Phase III Famitinib VEGFR-TKI Nonsquamous NSCLC in 3L Phase III Theliatinib EGFR inhibitor EGFR amplification Phase I Volitinib c-MET inhibitor c-MET amplification Phase I SHR-1210 PD-1 antibody NSCLC in 2/3L Phase I
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SC17.03 - Lung Cancer in India: Challenges and Perspectives (ID 6668)
14:50 - 15:05 | Author(s): D. Behera
- Abstract
- Presentation
Abstract:
Lung cancer is the commonest type of cancer in males and the leading cause of cancer death in both sexes world-wide. It is also the commonest in men in India accounting for 11.3% of all new cancers and also is the most common cause of cancer death (13.7%). In contrast to a decline trend in men in developed countries with a plateau for females, in India, the incidence continues to rise for both males and females. Data from the population based cancer registries developed under the National Cancer Registry Program of the Indian Council for Medical Research(ICMR) indicates that there is wide geographical variability in the incidence of this disease in different parts of the country. The highest age adjusted incidence rates of 45 per 100000 population are seen in the North-East region of India and are similar to areas reporting the highest incidence rates in some parts of the US and Europe. In other areas of India, especially the Western region, the age adjusted incidence rates are as low as 2 per 100000 population. The demographic profile including age, gender, stage, histology and even the molecular epidemiology (prevalence of EGFR mutations and ALK rearrangements) varies considerably in different parts of India. However, the overall incidence is much lower than that compared to many western countries. The demographic profile of lung cancer seen in India needs special mention. In the past, a single-centre large series of 1009 patients presenting to our institute from 1977-86 had shown squamous histology to the commonest (34.3%) followed by adenocarcinoma (25.9%) and small cell lung cancer (SCLC; 20.3%). Subsequent analysis of 250 patients presenting to us three decades later (2007-09), we found that the histological pattern was largely unchanged with squamous still being the commonest (34.8%) followed by adenocarcinoma (26.0%) and SCLC (18.4%). The male-female ratio as well as the current/ex-smoker to never-smoker ratio was also similar between the two cohorts. A possible reason for the lack of change in demographic profile of lung cancer was thought to be related to the fact that ‘bidi’ and NOT cigarette is the most common form of tobacco smoking in India. The ratio of bidi to cigarette smoking in India ranges from 2.5:1 to 7.0:1 in different parts of India and unlike cigarette making, there has been no change in the process of bidi manufacturing which is primarily a cottage industry. The other important aspect related to its association of quantified tobacco smoke exposure. The smoking index (SI; number of combined bidis and cigarettes smoked per day multiplied by number of years smoked) has been developed for this purpose. Patients can be categorized as either never-smokers (SI=0), light to moderate smokers (SI=1-300) and heavy smokers (SI≥301). In a cohort of 520 non-small cell lung cancer (NSCLC) patients, we observed that age, gender, histological type and stage differed significantly between the three groups. Never-smokers had significantly more females (52%), were younger (mean age 54.5 years), lesser squamous histology (28%), more advanced stage (IIIB/IV; 92%), more metastatic disease (67.4%) and more extra-thoracic metastases (42%) while group of heavy smokers had more males (98%), were older (mean age 61.2 years), more squamous histology (58%), lesser advanced stage (81%), lesser metastatic disease (39%) and lesser extra-thoracic metastases (17%). We have identified another risk factor in women to be the exposure to Biomass fuel. Majority of patients (approximately 83% of NSCLC histology at our centre) present with advanced stage(IIIB/IV) at the time of diagnosis and are managed non-surgically. Misdiagnosis as tuberculosis and empirical treatment with anti-tubercular drugs prior to referral to higher centre is one of the important causes for delayed diagnosis of this disease in India. Developing and under-developing countries are often constrained with regards to availability of health care and other resources necessary for appropriate management of the health related requirements of their population and this holds true for lung cancer as well. Some of the challenges in resource constrained settings include: · Large population with high population density · Illiteracy and poor health awareness · Sub-optimal economic and infrastructure inputs for health care · Suboptimal ratios of doctor and nurses for population · Overburdened hospitals and health care facilities · Huge burden of TB that hinders differentiation by the primary physician with lung cancer Important issues in resource constrained settings include choosing the platinum agent as well as the non-platinum agent. Decision on dose intensity may also be influenced by similar factors (efficacy, tolerance, toxicity profile and packaging strengths of marketed drugs). A list of some of the important factors influencing decision are shown below.
Dr. D. Behera Senior Professor & Head, Dept. of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh - 160012 (INDIA) Email: [email protected] Select References and suggested reading 1. Behera D, Balamugesh T. Lung cancer in India. Indian J Chest Dis Allied Sci 2004; 46 : 269-81 2. Behera D. Managing lung cancer in developing countries: difficulties and solutions. Indian J Chest Dis Allied Sci 2006; 48: 243-4 3. Jindal SK, Behera D. Clinical spectrum of primary lung cancer: review of Chandigarh experience of 10 years. Lung India 1990; 8: 94-98 4. Singh N, Aggarwal AN, Gupta D, Behera D, Jindal SK. Unchanging clinico-epidemiological profile of lung cancer in North India over three decades. Cancer Epidemiol 2010; 34: 101-4. 5. Behera D, Balamugesh T. Indoor air pollution as a risk factor for lung cancer in women. J Assoc Physicians India 2005; 53: 190-2. 6. Singh N, Aggarwal AN, Gupta D, Behera D, Jindal SK. Quantified smoking status and non-small cell lung cancer stage at presentation: analysis of a North Indian cohort and a systematic review of literature. J Thorac Dis 2012; 4: 474-84. 7. Singh N, Behera D. Lung cancer epidemiology and clinical profile in North India: Similarities and differences with other geographical regions of India. Indian J Cancer 2013; 50: 291 8. Singh N, Aggarwal AN, Behera D. Management of advanced lung cancer in resource constrained settings : a perspective from India. Expert Rev Anticancer Ther 2012: 12: 1479–95. 9. Maturu VN, Singh N, Bal A, Gupta N, Das A, Behera D. Relationship of epidermal growth factor receptor activating mutations with histologic subtyping according to International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society 2011 adenocarcinoma classification and their impact on overall survival. Lung India 2016; 33: 257-66. 10. Bal A, Singh N, Agarwal P, Das A, Behera D. ALK gene rearranged lung adenocarcinomas: molecular genetics and morphology in cohort of patients from North India. APMIS 2016 Aug 8; DOI: 10.1111/apm.12581 [Epub ahead of print]Characteristic Relative importance Disease related Age ++ Gender + Histology +++ Molecular profile of tumor ++ Stage + Performance Status +++ Unrelated to disease Co-morbid illnesses + Socio-economic background/financial constraints +++ Medical reimbursement/insurance issues +++ Wishes of patient/family members ++ Frequency of hospital visits ++
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SC17.04 - Lung Cancer in Latin America: Challenges and Perspectives (ID 6669)
15:05 - 15:20 | Author(s): E. Richardet
- Abstract
- Presentation
Abstract not provided
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SC17.05 - Lung Cancer in Africa: Challenges and Perspectives (ID 6670)
15:20 - 15:35 | Author(s): R.M. Gaafar
- Abstract
- Presentation
Abstract:
Lung cancer has been the most common cancer in the world for several decades. The number of new cases estimated in 2012 is 1.8 million cases (12.9% of the total), 58% of which occurred in the less developed regions. The disease remains as the most common cancer in men worldwide (1.2 million, 16.7% of the total) with the highest estimated rates in Nothern America (33.8%) and Northern Europe (23.7%), a relatively high rate in Eastern Asia (19.2) and the lowest rates in Western and middle Africa (1.1 and 0.8 respectively). In developing countries, lung cancer is the most common cancer among males and the third most common cancer among females. Lung cancer is the most common cause of death from cancer worldwide estimated to be responsible for nearly one in 5 (1.59 million deaths, 19.4% of the total) (1). Temporal analyses reveal that significant reductions in lung cancer mortality have been observed in developed countries due to increased awareness of the harmful effects of smoking , asbestos and other factors The role of early detection is also evident. (2). In contrast, lung cancer incidence and mortality rates have increased in some low and medium resourced countries (3). The regional differences are mainly due to increased tobacco smoking in the developing countries , smoking waterpipe, cannabis or even passive and secondary smoke and in the mean time there is lack of proper tobacco control. There are also occupational risk factors such as asbestos exposure, dust, fumes, nickel ,silica and insecticides and up till now there are areas that have not banned asbestos or succeeded to control occupational and environmental exposure and incidence of mesothelioma is increasing. (4) Many studies have shown that cases have genetic susceptibility to develop lung cancer specially in North Africa. Another important factor specially the Middle East North Africa is the increase in the elderly population that may be attributed to better infection control and improvement of general health care . As life expectancy continues to increase throughout the African continent, the burden of cancer is likely to increase. Given that an estimated 32,640 new lung cancer cases will be seen in Africa in 2015 ( 5) .We have to remember also that cancer diagnosis rate in Africa is relatively low and patients present usually in an advanced stage so underreporting may be another factor . Accordingly, it is essential to know the magnitude of lung cancer in different regions in Africa by having cancer registry for the countries . So, obstacles to the global fight against lung cancer include lack of registry in some parts of Africa, low public awareness of lung cancer and absence of screening for the high risk cases , overburdened treatment centers and insufficient financial support. The ways to combat all these obstacles start by setting strategies for prevention and earlier detection in the low income countries. Public health awareness of the risk factors that cause lung cancer and the importance of avoiding / stopping smoking and banning asbestos should be clear and this is the role of public health authorities, medical journals and public media. The war against tobacco companies should start and everyone should understand the danger of smoking. This is done also by cooperation of scientific organizations of governmental and non governmental organizations. Also, we should reduce air pollution and regulate the occupational exposure of the employees to avoid the appearance of lung cancer and mesothelioma. As for early detection , screening can help in high risk patients and many authorities and NGOs can help to catch the early cases. In the mean time there should be ways to access modern imaging techniques to detect the cancer and use the minimal requirements for diagnosis and care . Accordingly it is essential to set the treatment guidance protocols to facilitate the management of the patients and to educate and train the doctors that should acquire degree granting programs and get certificates in the oncological field. It is mandatory to to lower the cost of health care to encourage the patients to go for treatment and to get the proper care. There should be special dealing for the economic pressure and avoidance of financial toxicities for the patient. The last point that have to be ameliorated in Africa developing countries is research through International collaboration as studying genetic polymorphism and relation to smoking and changing patient concept about drugs received in clinical trials that use new drugs, proper investigations and lower the cost of treatment and may get better outcome. References 1- Globocan 2012 (IARC): Estimated cancer incidence, mortality and prevalence worldwide, section of cancer surveillance 2- Jemal A, Center MM, DeSantis C, Ward EM (2010) Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 19: 1893-1907. 3- Sankaranarayanan R, Jayant K, Brenner H 2011: An overview of cancer survival in Africa, Asia, the Caribean and central America: the case for investment in cancer health services. IARC Sci Publ: 257-291. 4- Gaafar RM, Eldin NH (2005) Epidemic of mesothelioma in Egypt. Lung Cancer 49: S17-S20. 5- Tao Z, Shi A, Lu C, Song T, Zhang Z, etal. 2014: Breast cancer : Epidemiology and Etiology. Cell Biochem Biophysi
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SC17.06 - Lung Cancer in Low and Middle Income Countries: A Comprehensive Cancer Control Approach (ID 7171)
15:35 - 15:50 | Author(s): N. Enwerem-Bromson
- Abstract
- Presentation
Abstract not provided
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Author of
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P1.01 - Poster Session with Presenters Present (ID 453)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.01-050 - Overall Survival in Advanced Lung Cancer Patients Treated at Oncosalud-AUNA (ID 6336)
14:30 - 14:30 | Author(s): C. Vallejos
- Abstract
Background:
Lung cancer still remains as the principal death cause in many regions around the world. Unfortunate, between 60-70% of patients are diagnosed with advanced disease (clinical stage IIIB-IV). We report the overall survival of advanced lung cancer in patients treated at a private institution (Oncosalud – AUNA).
Methods:
We analyzed data of 75 patients with advanced lung cancer and treated at Oncosalud-AUNA between 2013-2014. Overall survival was determinate using Kaplan-Meier method and survival curves comparison were performed using logrank test.
Results:
The median age was 70 years (range: 39-91) and 49% of patients were women. In patients with clinical stage IV, the metastatic sites were generally brain (28%), osseous (18%), cervical and supraclavicular (14%). The 66.7% of patients received chemotherapy with/without radiotherapy, 9% radiotherapy only and 24% non-treatment. In patients previously treated with chemotherapy, 52% received targeted therapy. The 77% of patients hab died, the follow-up median of survivors was 23 months (CI95%: 17-29), survival median was 9.6 months (CI95%. 5.6-13.5) and 1 and 2 years survival rate were 38% and 23%, respectively. The survival rate at 1 and 2 years in those receiving targeted therapy ware 65% and 43%, and those who did not receive were 35% and 10%. The overall survival present a difference regarding to ECOG scale (p = 0.015) and CYFRA 21.2 (p = 0.04).
Conclusion:
Overall survival for our patients is similar to other series. Patients under ECOG scale <2 and CYFRA 21.1 < 3.3ng/ml had a relatively better prognostic.
