aplcc 2016 insight: issue 1 - 13 may 2016

8/17/2019 APLCC 2016 Insight: Issue 1 - 13 May 2016

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ISSUE 1 13TH MAY 2016

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TOBACCO CONTROL MUST BE

A PRIORITY FOR HEALTHPROFESSIONALS

“Historically most patients of lung cancerwere smokers with advanced lung disease,advanced cancer and treatments were notvery successful. So there was high degree of

pessimism about lung cancer and lung cancertherapy. There was no way to diagnose lungcancer early and most patients presented withmetastatic disease which could not be curedthereby further increasing the pessimism

about it” said Dr Paul A Bunn Jr, DistinguishedProfessor, Division of Medical Oncology,University of Colorado and James Dud-ley Chair in Lung Cancer Research, USA.Dr Bunn is also the former President ofIASLC; former CEO of IASLC; and formerPresident of American Society of ClinicalOncology (ASCO) and the 2016 ASCOKarnofsky award recipient.

Early diagnosis of lung cancer is possible

Early diagnosis of lung cancer helps savelives. “For early detection, annual low doseCT scans can reduce lung cancer mortalityand they can lead to detection of more stage-1

patients early on that can be cured. So lungcancer ‘cure’ is not a mere hype rather has

become a reality! Cure rate can be higherfor lung cancer by adoption of low dose CTscans for early diagnosis, though there arechallenges still – such as, high false-positiverate of these scans. Hopefully currentlyongoing research might improve the accuracyof these scans in future” said Dr Bunn.

(Cont. on page 2)

As lung cancer treatment outcomes aredicult and ve-year survival is abysmallylow, preventing lung cancer is a top publichealth priority. Up to 90% of lung cancercases are because of tobacco use. “Thereforeeective implementation of evidence-basedand comprehensive tobacco control policieswill make a huge dierence in slashing newcases of lung cancer as well as preventinga large number of other diseases, disabilitiesand premature deaths attributed to tobaccouse” said Professor (Dr) Prakit Vathesatogkit,Executive Secretary of Action on Smokingand Health Foundation of Thailand.

“More than 100,000 deaths occur each year because of lung cancer in ASEAN. Newcases of lung cancer and deaths too are risingeach year in ASEAN. That is why tobaccocontrol attains a never-before urgency”added Prof Prakit Vathesatogkit.

He added: “Out of the 50,710 tobaccorelated deaths occurring in Thailand everyyear, 11,740 or 23% were because of lung

cancer. In ASEAN region, it is estimatedthat out of the total 467,194 smokingrelated deaths every year, 107,454 were dueto lung cancer. Tobacco-related lung cancerdeaths will keep growing in catastrophic

proportions with ageing 121 million smokersin ASEAN region if we fail to act now. Alsoit is important to underline that tobaccorelated lung cancer rate might shoot up

because of the combined eect of tobaccoindustry’s aggressive marketing, weak

political will on tobacco control and otherkey factors. Therefore while making progressin treatment of lung cancer is very welcome,more contribution from healthcare workersin tobacco control is direly needed.”

Healthcare workers can bolstertobacco control

Health professionals including lung cancerexperts have a prominent role to play in tobaccocontrol. They have the trust of the population,the media and opinion leaders, and theirvoices are heard across a vast range of social,economic and political arenas.

“At the individual level, they can educate the population on the harms of tobacco use andexposure to second-hand smoke. They canalso help tobacco users overcome theiraddiction” said Dr Prakit.

(Cont. on page 2)

Platinum: Gold: Silver:Hosted by Supported by Conference Secretariat

APLCC 2016 | IASLC ASIA PACIFIC LUNG CANCER CONFERENCE

"CURE" FORLUNG CANCER: MOREHYPE OR NEW HOPE?

APLCC 2016INSIGHT

Dr Prakit Vathesatogkit


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directed to proteins called checkpointinhibitors. Checkpoints are proteinsthat cancer cells make to protect themfrom being killed by lymphocyteswhich are part of our immune system.These monoclonal antibodies block

proteins which were protecting cancercells so that our lymphocytes cankill those cancer cells. Monoclonalantibodies are proteins that have to

be given intravenously. The responseof immunotherapy with monoclonalantibodies lasts much longer and hasfar less toxicity” said Dr Bunn.

But immunotherapy does not workon all patients of lung cancer becauseall patients do not have checkpoint

inhibitors. “That is why we are tryingto find biomarkers to define which

patients may respond to immunotherapy.These monoclonal antibodies are veryexpensive which makes it even moreimportant to nd which patients aremore likely to respond. Alsocurrently scientists are evaluatingwhether these monoclonal antibodiesare more likely to cure advanced stageor early stage patients of lung cancer.Currently it is likely that these

monoclonal antibodies may improvecure rate for early stage patients oflung cancer” shared Dr Bunn.

Reverse pessimism and makelung cancer care aordable forall

“Outcome for patients of lung canceris much better in 2016 than what itwas in 2000. So lung cancer ‘cure’ isnot a hype. We need to nd ways to

make these new expensive diagnostictools and therapies appropriatelydelivered in developing countries”said Dr Bunn.

Sharing more about a couple of newforms of treatment, Dr Bunn added:“Molecular therapies are for patientswho have driver genetic mutation –

patients receive a pill every day (aform of chemotherapy) – this hasmuch higher response rate, fewerside eects and much longer dura-tion of response. Molecular therapieshave improved outcomes for patientswith metastatic lung cancer butunfortunately these therapies do not

cure people. Molecular therapieseven if not a cure give lung cancer

patients way more hope as they makethem live longer and better. It iscertainly hoped that the combinationof dierent treatments may improveoutcomes in future.”

Immunotherapy: is it a newrevolution?

Another new form of treatment

that has boosted hope for cure isimmunotherapy. “First form ofimmunotherapy that has been a

pproved for lung cancer involvesmonoclonal antibodies that are

(Cont. from page 1: Tobacco control must

be a priority for health professionals)

“At the community level, health

professionals can be initiators or supporters

of some of the policy measures described

above, by engaging, for example, in eorts

to promote smoke-free workplaces andextending the availability of tobacco

cessation resources. At the society level,

health professionals can add their voice and

their weight to national and global tobacco

control eorts like tax increase campaigns

and become involved at the national level

in promoting the WHO FCTC. In addition,

health professional organizations can

show leadership and become a role model

for other professional organizations and

society by embracing the tenants of the

Health Professional Code of Practice

on Tobacco Control” said Prof PrakitVathesatogkit.

ASEAN and tobacco control

Prof Prakit said: “In 2002, through the

6th Health Ministers Meeting, ASEAN

governments committed to a vision and a

“Regional Action Plan on Healthy ASEAN

Lifestyles”. Identifying tobacco control as

one of the priority policy areas, the Action

Plan calls upon member nations to

implement a Programme of Work on

promoting healthy ASEAN lifestyles. Fortobacco control this includes developing

and implementing a national action plan,

consistent with the WHO-FCTC on issues

such as smuggling, taxation, product

advertising, distribution, sale and agricultural

production.”

Summarises

Prof Prakit Vathesatogkit:

“ At the very least, all healthcare personnel must provide brief

advises for smoking cessation to

every patient who has a smoking

history, in every consultation visit.

Worldwide, doctors are among the

most inuential gures in leading

the tobacco control movement.

I urge all doctors to join and

support tobacco control

movement, not just by a

supportive gesture but by action, inwhatever capacity they feel

comfortable.

”

(Cont. from page 1: “Cure” for lung cancer: More Hype or New Hope?)

Dr Paul Bunn

Better treatment options for lungcancer gives hope

Not just early diagnosis of lungcancer has become a reality now, but

new treatment options have come uptoo in the recent years.

“ There are major improvements in

lung cancer treatment. For early

stage patients we have VATS

(Video Assisted Thoracoscopic

Surgery) which is eective,

cheaper and has better outcomes

in terms of morbidity and

mortality. Another advancement is Stereotactic Body Radiation

Therapy (SBRT) which gives

radiation only to the cancer

tumour site and thus morbidity

and mortality due to radiation has

also declined

” said Dr Paul Bunn.


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IASLC Asia Pacic Lung Cancer Conference

(APLCC 2016) is being organized under

the aegis of International Association for

the Study of Lung Cancer (IASLC), Thai

Society of Clinical Oncology (TSCO),

Chiang Mai Lung Cancer Group, Faculty of

Medicine, Chiang Mai University (CMU)

and local organizing committee of APLCC

2016.

APLCC comes back home to Chiang Mai

APLCC 2016 is the seventh regional biennial

lung cancer conference, and it has returned

back after 12 years to its origin in Chiang

Mai, Thailand where rst APLCC was held.

“APLCC 2016 has come back to the host

city of rst APLCC which was organized

by us in 2004” said Professor (Dr) Sumitra

Thongprasert, Chairperson of APLCC 2016,who was also the chairperson of rst

APLCC. Feeling the urgent need to galvanize

more action on lung cancer in Asia Pacic

region, Prof Sumitra Thongprasert had

played a key role in setting up APLCC

Lung Cancer Group which helped organize

this regional scientic meet biennially.

Presently, Prof Thongprasert is the Emeritus

Professor, Chiang Mai University, Chiang

Mai, Thailand and Senior Director, Oncology

Unit, Bangkok Chiangmai Hospital, Chiang

Mai, Thailand.

The venue of the conference shifted around

the region every two years:

• 2nd APLCC was held in Guangzhou,

China;

• 3rd APLCC in Hyderabad, India;

• 4th APLCC in Seoul, South Korea;

• 5th APLCC in Fukuoka, Japan;

• 6th APLCC in Kuala Lumpur, Malaysia;

and

• 7th APLCC is back to the host city of

1st APLCC: Chiang Mai, Thailand.

APLCC helps lung cancer expertsstay on top of latest scientic updates

The regional lung cancer conference has

provided an important platform for latest

scientic exchanges and academic

networking for a range of experts playing

a crucial role in lung cancer research,

diagnosis, treatment and care. “The main

highlights of APLCC 2016 are the latest

advances in lung cancer especially basic

and clinical research, immunotherapy,

multidisciplinary practices in Asia Pacic,

practical clinical management, and also

expert ideas and knowledge sharing from

outside the region from dierent parts of the

world including the Americas and European

region. We have several invited speakers

in key sessions on issues varying from

pathology, surgery, early lung cancer

detection, and cancer treatment aspects

including radiation, surgery, chemotherapy,

immunotherapy, among others. The delegates

will get an opportunity to learn and

share in several thematic oral and poster presentations daily at APLCC 2016” shared

Prof Thongprasert.

Spotlight on plenary sessions at APLCC 2016

Plenary sessions on second day of APLCC

2016 focusses on how to choose 1st, 2nd and

3rd line therapy in Non Small Cell Lung

Cancer (NSCLC) and immunotherapy

for NSCLC. Luminary speakers include

Dr Tony Mok, past President of IASLC andDr David Carbone, President IASLC.

Last but not the least, concluding day of

APLCC 2016 will feature plenaries on

clinical implications of TNM staging 8th

edition and therapy for driver mutation

positive in Asian NSCLC patients.

Distinguished speakers will be Dr Masahiro

Tsuboi, Chief and Director, Division of

Thoracic Surgery and Oncology, National

Cancer Center Hospital East, Japan and

Dr Tetsuya Mitsudomi, Professor at the

Division of Thoracic Surgery, Department

of Surgery, Kinki University Faculty of

Medicine, Osaka, Japan. Dr Mitsudomi is al

so the Board Member of Japan Clinical

Research Organization (JCRO).

APLCC 2016 venue city gets 720 years old this year!

The old city of Chiang Mai completes its 720

years in 2016. Welcome to this northern Thai

city and apart from dwelling into scientic

deliberations do steal a moment to indulgein traditional richness and warmth of Chiang

Mai.

PREVENTING LUNG CANCER

IS A PUBLIC HEALTH

IMPERATIVE

Dr Sumitra Thongprasert

“ In addition to scientic sessions, there are important sessions on

related and compelling public health aspects such as tobacco

control. Lung cancer is the most preventable form of cancer death in the

world. That is why APLCC 2016 features tobacco control sessions

prominently on the scientic agenda. Preventing lung cancer is a top

public health imperative!

”said Prof Sumitra Thongprasert.


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“I would like to welcome all delegates

who are working on lung cancer –

fellows, residents, students who are

exploring their interest in pursuing

lung cancer management, nurses,

pharmacists, all experts from diverse

specialties including prevention, early

detection, molecular and clinical

research, multidisciplinary treatment,

palliative care, tobacco control, etc to

APLCC 2016.

We are very happy that APLCC has

come back to its host city again, as

1st APLCC was initiated and held in

Chiang Mai, Thailand, in 2004.

The city of Chiang Mai completes its

720 years in 2016. Welcome to this

northern Thai city and apart from

dwelling into scientic deliberations

do steal a moment to indulge in

traditional richness and warmth of

Chiang Mai.”

Dr Sumitra Thongprasert

• Chair of APLCC 2016 and former

member of Board of Directors

IASLC

• Special Content Editor, Journal of

Thoracic Oncology (JTO)

• Emeritus Professor, Chiang Mai

University, Chiang Mai, Thailand

• Senior Director, Oncology Unit,

Bangkok Chiangmai Hospital,

Chiang Mai, Thailand

“As President of IASLC and practicinglung cancer physician and researcher Iwould like to welcome the delegates tothe APLCC 2016. I hope this meeting will bring together researchers from withinthe Asia-Pacic region and around theworld to discuss current ndings in thisregion to improve the quality and quantityof life for lung cancer patients.

These are exciting times where we havenew agents and we are trying to learn onhow to best combine them with targetedtherapy, chemotherapy, radiation, orsurgery and meetings like the APLCC2016 are perfect place to allowinvestigators to gather and share thelatest data available on these therapiesand their combination. This will help

lead delivery of these state-of-the-arttherapies to patients throughout the worldand IASLC is proud to be supportingconferences around the world to assist inthis process.”

Dr David Carbone • President of the International

Association for the Study of LungCancer (IASLC)

• Professor in the Division of MedicalOncology, leads thoracic oncologycenter in Ohio State University, USA

“It is good to have regional conferenceslike APLCC 2016 as they can providegreat support on a global level. We willalso learn from the Asian experience. InAsia we have a lot of patients with EGFRmutations of the disease. So it will beinteresting to know how these patientsare being treated. I do not have muchexperience of this as there are far morefrequent cases of this type in Asia ascompared to Central Europe.

APLCC 2016 is of major importance aslung cancer is a very complex disease.This makes education and scienticexchange very important, more so because of the rapid advances in theeld of diagnosis and treatment of lungcancer. It is not easy to keep oneself

updated, as a lot many new things areongoing. So conferences are a goodtime to learn from others and get up todate knowledge about diagnostic andtherapeutic advances in lung cancer”

Dr Robert Pirker • President of 17th IASLC World

Conference on Lung Cancer (WCLC2016) in Vienna, Austria

• Professor of Medicine and ProgramDirector for Lung Cancer, Departmentof Medicine, Medical University ofVienna, Austria


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SCIENTIFIC PROGRAMME FOR

DAY-1 OF APLCC 2016

PS=Plenary Session IS=Invited Session AS=Abstract Session ISS=Industry Supported Symposium


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LUNG CANCER

SCREENING: THE THAI-LAND PERSPECTIVE

The survival rate for lung cancer is strongly

related to the stage of the disease. The

earlier is its detection, better is the survival

rate. “Currently, low-dose computerized

tomography (LDCT) is the standard

technique for lung cancer screening. The

National Lung Screening Trial (NLST),

launched in 2002, found that screening with

LDCT resulted in a 15% - 20% lower lung

cancer-specic mortality and 6.7% lower

all-cause mortality relative to chest

radiography (X-ray) over a median of

6.5 years of follow-up” said Dr Natthaya

Triphuridet, Pulmonologist and Assistant

Director for Medical Aairs at Chulabhorn

Hospital, Bangkok, Thailand. Dr Natthaya isamong the faculty members for IASLC Asia

Pacic Lung Cancer Conference (APLCC

2016).

Dr Natthaya added: “Since the release of the

NLST data, many guidelines have endorsed

the use of LDCT screening for high-risk

individuals. In 2013, United States

Preventive Services Task Force (USPSTF)

recommended ‘annual screening for lung

cancer with LDCT in adults aged 55-80 years

who have a 30 pack-year tobacco smoking

history and currently smoke or have quit

within the past 15 years. The numbers needed

to screen (NNS) to prevent 1 lung cancer

death was 320 among participants who

completed 1 screening and was 219 to

prevent 1 death overall over 6.5 years.

These benets are comparable to NNS with

mammography of 1339 to prevent 1 breast

cancer death after 11-20 years of follow-up

and NNS with exible sigmoidoscopy of

817 to prevent 1 colon cancer death.”

Major advancements in earlydiagnosis, but challenges remain

Despite the pivotal results of LDCT, there

are many concerns regarding high false

positives (96%), over diagnosis, accumulation

of radiation exposure, high cost of screening

and generalization to practice.

Tuberculosis and lung cancer:

Sinister linkages?

According to Dr Natthaya, generalization

of lung cancer screening with LDCT in

the TB endemic Southeast Asia region that

accounts for 41% of the global TB

burden is very challenging. “TB mimics l

ung cancer. Pulmonary TB may present

as an asymptomatic solitary pulmonary

nodule, imitating early stage lung cancer.

Symptoms of cough, hemoptysis, chest pains,

weakness, weight loss, fever and night

sweats are common in both active

pulmonary TB and symptomatic lungcancer. The radiographic ndings of TB

can mimic lung cancer, such as mass-like

lesion, solitary/multiple pulmonary nodule(s),

mediastinal lymph node enlargement, or

pleural eusion. These ndings are also

important in staging of non-small cell lung

cancer in the TNM system: Size of primary

tumour (T), Mediastinal lymph nodes (N),

and metastasized (M) to other organs of the

body” she said.

“Furthermore, pre-existing TB increases

risk of lung cancer and lung cancer may

promote TB infection or reactivation of

latent TB infection, or cause new exogenous

infections. All this makes it dicult to

manage screening, diagnosis, staging,

treatment, monitoring and surveillance of

lung cancer in TB endemic areas. No clear

evidence of lung cancer screening benethas been established in high-risk populations

in a TB endemic area”.

Thailand’s Lung Cancer Screening

Project

Dr Natthaya Triphuridet who is also the

Principal Investigator of Integrative Lung

Cancer Screening Project in Thailand shared

the ndings of a ve-year “Integrative Lung

Cancer Screening” project using LDCT

that was started at Chulabhorn Hospital in

Thailand in 2012. The objectives of the study

were to:

(i) Determine the role of lung cancer

screening using LDCT in a high-risk

population residing in Thailand—a high

TB-burden country; and to

(ii) Study an alternative screening

modality called chest digital tomosynthesis

(DT) that is reported to be as sensitive as CT

for the detection of actionable lung noduleswith a much lower radiation dose and lower

cost compared with LDCT.

(continued on page 7)

Dr Natthaya Triphuridet


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Former and current heavy smokers (>30 pack-years) aged 50-70 years without a history

of active TB within a recent year were included in the study. Out of the 634 high risk

subjects (mostly males) investigated, 66% had lung nodule(s) in their initial LDCT

screening (58% with multiple nodules). Nine out of these 634 cases (1.4%) were

diagnosed to have lung cancer - 5 of stage I, 1 of stage II/III, and 2 of stage 4 lung

cancer. All 6 cases of stage I and II had multiple lung nodules, while 3 cases of stage III

and IV had single lung nodule.

Dr Natthaya Triphuridet who had received the IASLC Global Mentorship Award 2013

for “Screening of Lung Cancer by Low-Dose CT (LDCT), Digital Tomosynthesis (DT)

and Chest Radiography (CR) in a High Risk Population” in Australia shared that thestudy showed: despite a high burden of TB in Thailand, LDCT screening in heavy

smokers could yield a high rate of primary lung cancer in high risk population.

However, high prevalence of lung nodules is one of the major problems in diagnosis and

staging lung cancer in endemic area of TB.

Integration of smoking cessation in lung cancer screening

“All study participants were also made to realize the harmful eects of tobacco

smoking and smoking cessation clinics were integrated with the lung cancer screening

programme”, shared Dr Natthaya. “As per the WHO Report on the Global Tobacco

Epidemic 2015, at present 19.9% adults in Thailand are tobacco smokers (39% males,and 2.1% females). There is data that shows a strong linkage between smoking

cessation rate and cost-eectiveness of CT screening. For example, at smoking

cessation rate of 3%, the annual screening for smokers aged 50-74 years (with 40 pack

years) costs $110,000-$166,000/QALY (quality-adjusted life-years gained). But if

cessation rate is doubled the cost is reduced to


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“There is one topic in the plenary session

titled — ‘Advanced lung cancer - it is time to

cure’ - this is a very challenging and very boldstatement. Right now we are pretty condent that

we can extend the lives of the patients. But now

we can aim to challenge lung cancer up to the next

level: cure! In certain lung cancer patients may be

we can revert the prognosis from incurable and

extending the life to the level of cure. It will

give us a new direction on how to handle lung

cancer”

Dr Virote Sriuranpong, President of Thai Society of Clinical

Oncology (TSCO) and Medical Oncologist and currently

Associate Professor, Department of Medicine, ChulalongkornUniversity, Bangkok, Thailand

“APLCC 2016 Chair Dr Sumitra Thongprasert

has done a marvelous job in representing

Thailand in IASLC, improving cancer care in

Thailand and organizing the APLCC 2016.

There have been lot many changes in lung

cancer eld in a short period of time making

it hard to keep up with them. Also in Thailand

and many other countries medical oncologistshave to deal with multiple type of cancers. This

highlights the importance of meetings like APLCC for lung cancer

experts so that they are able to keep up with major advances occurring

in lung cancer care. The importance of education cannot be

overemphasized!”

Dr Paul A Bunn Jr, Distinguished Professor, Division of Medical

Oncology, University of Colorado and James Dudley Chair in Lung

Cancer Research. Dr Bunn is also the former President of IASLC;

former CEO of IASLC; Member APLCC 2016 International

Committee (and 1st APLCC in 2004)

“In East Asian nations about 40% of lung cancer

patients had EGFR mutation who will benet

from specic targeted therapy. We have large

randomized controlled studies to show that

patients with EGFR mutation need to start with

one of such treatments. Initially patients had

long duration response to these treatments but

some of them developed resistance. Now we

know that half of them had T790M or additionalmutation in the EGFR. There are new drugs that

have entered clinical trials in recent years to target specic resistance

mutations. There will be data of such new drugs targeting resistance

mutations at APLCC 2016”

Dr James CH Yang, Deputy Director, Department of Medical

Oncology and Director, National Cancer Research Centre,

National Taiwan University Hospital; Member, APLCC 2016

International Committee andAssociate Editor (Asia), Journal of Thoracic

Oncology

“Session on tobacco control is very important,

especially in the context of Asia. Tobacco is the

major cause of lung cancer and is responsible formost of the lung cancer globally. Immunotherapy

session is another very interesting session and

people need to understand this new treatment

technique for lung cancer. All delegates of

APLCC 2016 should take the opportunity of the

conference to network and meet others and to

learn from each other so that we are at the top of

information and remain at the cutting edge of lung cancer treatment”

Dr Michael Boyer, Member APLCC 2016 Committee and Member,

Board of Directors, IASLC; Professor of Medicine at the Sydney

Cancer Centre and Chief Clinical Ocer of Chris O’Brien Lifehouse,Australia

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aplcc 2016 insight: issue 1 - 13 may 2016

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