Event highlights: Thoracic Oncology Group of Australasia Annual Scientific Meeting (ASM)
On Day 1 of the ASM we heard updates from the Taiwan Lung Cancer Screening in Never-Smoker Trial (TALENT) which screened heavy smokers as well as never smokers with a strong family history in a first degree relative. The lung cancer detection rate was 2.6% which was higher than the NLST and NELSON trials, but importantly 96.5% of lung cancers found were still at stage 0-1. This further cements the evidence for screening programs such as the one currently being developed by the Australian Government. This is an exciting step forward as it will no doubt increase early diagnosis and survivorship which will in turn improve lung cancer outcomes and mortality rates.
There was ongoing discussion about neoadjuvant treatment in early stage disease resulting from the LCMC3 trial with two cycles of Atezolizumab alone against the CM816 trial which used three cycles of Nivolumab plus chemotherapy. While those who received combination chemo/IO treatment had longer delays to surgery there was a much higher major pathological response at 46.8% compared to 21% with immunotherapy alone. Also, 30.5% of patients having combination chemo/IO achieved complete response compared to only 7% with immunotherapy alone. While this is promising, it was discussed that we must wait on more of the clinical efficacy endpoints such as disease-free survival and overall survival for this to be practice changing. Though we may have some time before practice changes it was a good opportunity to start considering how this will impact our practice and our institutions as specialist lung cancer nurses. Having this new population of previously unseen lung cancer patients in the oncology setting will undoubtedly put further pressure on both medical oncology clinics and already stretched chair bookings in chemotherapy outpatient departments.
In the treatment setting, we learnt about the innovations of precision/personalised treatments. It is pleasing to see that, for lung adenocarcinoma, the piece of pie labelled the “unknown mutation” is getting smaller as we find and target more mutations, thanks to trials such as TOGA’s ASPiRATION study. Data presented from our radiotherapy colleagues at Peter Mac showed that a well tolerated single # SABR in oligometastatic lung cancer led to a 24% widespread failure free survival at 5 years. Quality of life was also improved with 35% of patients at 5 years not requiring any further systemic treatment. We are now using SABR in oligometastatic lung cancer at diagnosis, for consolidation after successful systemic treatment and for oligoprogression.
Day 2 of the TOGA ASM focused on gaps and inequalities in the care of people living with lung cancer. Notably, researchers discussed that only 31% of ‘real world’ people with advanced stage lung cancer meet trial eligibility criteria; people are often deemed ineligible due to pre-existing conditions, steroid use or mutational status. Inequalities experienced by Aboriginal and Torres Strait Islander people were also discussed, as were inequalities experienced by people in lower socio-economic communities.
On Day 2, we were also excited to hear from our very own ANZ-LCNF Steering Committee member Sara McLaughlin-Barrett, who presented a practical tool to guide organisations through the process for applying for funding for specialist lung cancer nurses. We hope that there were multidisciplinary teams in the audience taking notes on how best to prepare a business case for funding specialist lung cancer nurses.
Mel Laan (ANZ-LCNF South Australia Representative)
Lung Cancer Nurse Consultant
Royal Adelaide Hospital