4th Australian Lung Cancer Conference (ALCC), Adelaide, Australia, August 23-25, 2012
Journal of Thoracic Oncology
Aims: The emergence of new targeted therapies and clinical trials in lung adenocarcinoma suggest that routine molecular biomarker testing is warranted to detected subtypes of adenocarcinoma which will benefit from new therapies. Australian data is still emerging. We aim to detect the incidence of treatment specific molecular subtypes of lung adenocarcinoma in the Australian population. Methods: This is a single centre prospective pilot study of patients with a histopathological diagnosis of
... ocarcinoma who have been presented at a Lung Cancer multidisciplinary meeting. Formalin fixed paraffin embedded tissue of 22 tumour samples were submitted for targeted PCR-based EGFR and KRAS mutation analysis; and EGFR amplification, MET amplification and EML4-ALK rearrangement testing by in-situ hybridization. one sample had insufficient tissue for analysis. Results: So far 22 patients received a definite tissue diagnosis of lung adenocarcinoma, 8/22 with Stage III and 10/22 with Stage IV disease. 4/22 (19%) are positive for an EGFR mutation, with activating EGFR mutations in 3/22 (14%) and an EGFR mutation of uncertain clinical significance in one patient (5%). EGFR amplification was detected in 2/22 patients (9%), KRAS mutations were detected in 5/22 patients (23%) patients, of which none carried EGFR mutations. EML4-ALK translocation was seen in 2/22 patients (9%) and MET amplification in 1/22 (5%) patients. Conclusions: Preliminary results indicate that treatment specific molecular subtypes of lung adenocarcinoma occur more commonly in the Australia population than other Western populations. Though further investigation is required, routine molecular biomarker testing is warranted. Purpose: To investigate the hypothesis that primary tumour volume is prognostic independent of T and N stages in patients with non-small cell lung cancer (NSCLC) treated by definitive radiotherapy. Methods: Multicenter prospective observational study. Patient eligibility: pathologically proven stage I-III NSCLC planned for definitive radiotherapy (minimum 50 Gy in 20 fractions) using CT-based contouring. Volumes of the primary tumour and enlarged nodes were measured according to a standardized protocol. Survival was adjusted for the effect of T and N stage. Results: There were 509 eligible patients. Five-year survival rates for tumour volume grouped by quartiles were, for increasing tumour volume, 22%, 14%, 15% and 21%. Larger primary tumour volume was associated with shorter survival (HR = 1.060 (per doubling); 95% CI 1.01 to 1.12; P = 0.029). This association, after adjusting for the effects of T and N stage, was not evident (HR = 1.029, 95% CI, 0.96 to 1.10, P = 0.39). There was evidence, however, that larger primary tumour volume was associated with an increased risk of dying, independently of T and N stage, in the first 18 months but not beyond. Conclusions: In patients treated by non-surgical means we were unable to show that lung tumour volume, overall, provides additional prognostic information beyond the T and N stage (TNM , 6 th edition). There is evidence, however, that larger primary tumour volume adversely affects outcome only within the first 18 months. Larger tumour size alone should not by itself exclude patients from curative (chemo) radiotherapy. Disclosure: None identified. Objective: To assess the safety and efficacy of Docetaxel versus Geftinib therapy used as a second line treatment in patients who had progressed or had recurrence after previous platinum-based chemotherapy. Materials and Methods: 30 patients with locally advanced or metastatic NSCLC previously treated with Cisplatin-based chemotherapy, who had progressive or recurrent disease and ECoG performance score 0-2, were randomized to receive either Geftinib 250 mg /day or Docetaxel 75 mg/m2 every 3 weeks. Tumor response was assessed with RECIST Criteria and adverse events were noted. Patients were followed for 2 years. Results: Tumor response rates and disease-related symptom improvements were similar for Geftinib and Docetaxel . Significantly more Gefitinib treated patients experienced a clinically relevant improvement in quality of life compared to Docetaxel. Conclusions: The study demonstrated non-inferiority of Gefitinib relative to Docetaxel in terms of tumor response. Also Gefitinib had a more favourable tolerability profile than Docetaxel. Aim: Peter Mac aims to provide a culturally sensitive and appropriate cancer care pathway within Peter Mac to coordinate and effectively coordinate and integrate effective and community linked cancer services to Aboriginal and Torres Strait Islander patients with cancer in Victoria. We will describe the development of an evidence informed pathway for Aboriginal and Torres Strait Islander lung cancer patients.