Report from 10th World Conference on Lung Cancer Vancouver August 2003 by ov70Wv87

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									  Report from 10th World
Conference on Lung Cancer
 Vancouver August 2003



              Joe Maguire
               November 2003
format

   1040 presentations (316 oral)
   parallel sessions, 4 days
   3000 delegates
   whole spectrum:
    aetiology ◄---------------► supportive care
   scientific and clinical
          Where’s the beef?

   Results to change practice and
    improve care

   Relevance to UK population

   Context – NHS, Cancer Networks
overview
• Early diagnosis/screening
• PET – staging and diagnosis

• Adjuvant chemotherapy
• Treatment of >70s

• Concurrent chemo-radiotherapy
      Tockman et al -1150 high risk
             participants

   Initial screen + 4 annual re-examinations
   Sputum induction and low dose helical CT
   Nodules - PET prior to FU or therapy
   35% initial CT abnormal
   28 lung ca diagnosed, 24 NSCLC
   Stage I -14(58%), Stage II – 2(8.3%)
        Mayo clinic (Midthun et al)
        1520 high risk participants

   Spiral CT + 3 annual scans
   Single/multiple nodules in 782/1150
   FU depending on size – bx/excision if 8mm or
    larger
   Malignancy 18.7% nodules 8-20mm,
               50% nodules>20mm

   28 cancers, >98% nodules benign
                     PET

   MSK – pre-op SUV helps to predict survival
    after resection

   Multicentre French study (prospective)
     PET modified management in 19/89
      cases – 21.3%
    Adjuvant Chemotherapy -IALT
   1867 patients
   148 centres, 33 countries
   3 – 4 cycles platinum + vinca alkaloid
                   vs control (no chemo)
   5 year survival:
                      chemo 45%
                      control 40% p<0.003
            IALT - implications

   “it’s the same as CMF for breast cancer”
     ……….but ALPI (1200 patients) negative
   Meta-analysis available next year
   role of RT may be crucial -
     probably detrimental
   worth discussing but not yet routinely
    recommended
          Treatment of >70s

    consensus – if good PS, >70s tolerate
    chemotherapy and derive as much benefit
    as younger patients

   20% patients ECOG 1594 – same results

   Carboplatin dosed as AUC
> 70 PS 0-2 Liverpool Lung Cancer Unit


Treatment Options Limited by Co-morbidity


     age      PS 0-1        PS 2

      70     8.5%          23%

     < 70     8.1%          20.6%
> 70 PS 0-2

   Treatment Related Death
   (within 21 days)


         PS 0-1       2.2%

         PS 2         2.6%
Survival
NSCLC - Patients  70 1996-2002                         PS 0-2
  %
1.0

                           Active          BSC
            n              168             229
 .8
            median         63 weeks        34 weeks
            12 months      59%             28%
 .6         18 months      44%             16%
            24 months      34%              9%

 .4                        p<0.0001

                                                    Radical/Chemo
 .2
                                                    Observe/Pall

0.0
      0    100            200            300               400

                        Weeks         Liverpool Lung Cancer Unit
       Concurrent chemo-radiotherapy
       Intergroup 0139

   429 patients, Stage IIIA (pN2)

    concurrent chemo-RT + surgery
     vs concurrent chemo-RT

   ms both groups 22 months,
       3 yrs 38% vs 33%

   6.9% vs 1.6% trt related deaths: survival
    curves cross at median
conclusions
• CT screening not practicable here
• Thoracic units should have PET
• Adjuvant chemo interesting but not
    proven
•   Age should not be a determining factor
•   Concurrent chemo-RT is leading edge of
    therapy – SOCCAR opens 2004

								
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