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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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