By ASTRO Staff
This year’s Multidisciplinary Thoracic Cancers Symposium Plenary studies represented the highest-ranking abstracts of the symposium; three abstracts focused on non-small cell lung cancer (NSCLC) and one discussed lung cancer survival trends. David Carbone, MD, PhD, of The Ohio State University, moderated the session.
Abstract 1, “Stereotactic Radiation for Ultra-Central Non-Small Cell Lung Cancer: A Safety and Efficacy Trial (SUNSET),” was presented by David Palma, MD, PhD, Western University. Stereotactic body radiation has transformed the management of medically inoperable lung cancer and has enabled locally ablative therapy of oligometastatic disease but has been of limited utility for tumors near major airways or vascular structures. This study “addresses the most safe and effective way to use stereotactic radiation for these “ultra-central” tumors.” This prospective study investigated the maximally tolerated dose of SBRT for ultra-central NSCLC. This is a carefully done study that identifies 60 Gy in 8 fractions as a safe and effective approach, planned and delivered with only a moderate hotspot and a favorable adverse event ratio and resulted in “excellent” tumor control. This may expand the number of patients eligible for this important therapy. Jeremy Brownstein, MD, The Ohio State University, served as discussant, further evaluating and comparing results of the SUNSET trial with the newly published extended HILUS study. (Hear more about these two studies on the December Red Journal podcast.)
Vivian Tan, MD, Western University, presented Abstract 2, “A Population-Based Analysis of the Management of Symptoms of Depression among Patients with Stage IV Non-Small Cell Lung Cancer in Ontario, Canada." This study addresses the management of depression in metastatic lung cancer patients, a frequent, but often inadequately managed symptom. Dr. Tan noted that there is a high prevalence of moderate to severe depression in individuals with Stage IV NSCLC, and that the proportion of patients receiving public interventions for depression was low. Individuals who reported moderate to severe depression were more likely to receive psychiatry/psychology/social work referrals and antidepressant prescriptions. Females were more likely to receive referrals than males, and residents of non-urban areas were less likely to receive referrals yet more likely to receive anti-depressant prescriptions. “This study was important since it identified patient subsets who are the least likely to receive appropriate treatment, and this could help identify these patients for targeted intervention in the future,” said session moderator David Carbone, MD. Discussant Alan Valentine, MD, Department of Psychiatry at MD Anderson Cancer Center, provided further remarks. “There are a lot of mood disorders out there, and patients are having a hard time,” said Dr. Valentine. “People who are not psychiatrists and psychologists will need to step in. Depression can mean five or six things [to different people], it requires sitting down with patients and teasing it out. Things are getting better, and hopefully we can have more access to care.”
Abstract 3, “Prognostic Performance of a Genome-Wide Methylome Enrichment Platform in Early-Stage Non-Small Cell Lung Cancer (NSCLC),” was presented by Geoffrey Liu, MD, Princess Margaret Cancer Centre, and explored using a tumor-naïve, genome-wide methylation for its ability to define prognosis in early-stage NSCLC. “There is a significant need to identify patients with poor prognosis early-stage disease in order to target that population for more aggressive neo-adjuvant or perioperative therapy. In this study, blood samples were analyzed and used to define a threshold of methylome-enriched ctDNA quantity that was highly correlated with prognosis, with a hazard ratio of 2.79.” After analyzing samples from 41 patients, the authors concluded that this platform can be used for ctDNA quantification and prognostication. Further prospective testing of this classifier is warranted and will be explored in future studies. Aadel Chaudhuri, MD, PhD, Washington University, St. Louis, served as discussant of Dr. Liu’s abstract, agreeing with the concluding results that ctDNA detection pretreatment can be used for prognostication of early-stage non-small cell lung cancer. “The concept also appears to apply to augment static non-small cell lung cancer; this appears to be a general principle that spans across CT and the analytical modalities including targeted mutation techniques and targeted methylation.”
Abstract 4, the final paper presented at the Plenary session, was presented by Drew Moghanaki, MD, MPH, VA Greater Los Angeles Healthcare System and summarized a study of almost 55,000 veterans with lung cancer over the period of 2010 to 2017. “Lung Cancer Survival Trends in the Veterans Health Administration” investigated whether the national trend of improved lung cancer survival was present within the Veterans Health Administration (VHA). The study concluded that lung cancer survival rates are also improving in the VHA, and that when compared to White veterans, Black veterans had similar or higher survival rates. Biniam Kidane, MD, University of Manitoba, served as discussant. “The main message I took away was one of increasing hope, with some caveats of course,” said Dr. Kidane. “There is an increase in more curable cancers, and among the curable cancers, higher survival rate. In this particular study, there is not a lot of racial disparity. What drives lack of racial disparity in the VA population if it actually exists?” When asked earlier about this study, Dr. Carbone shared, “Understanding the factors associated with good outcomes in the Black veteran population could help improve racial disparities in other health care systems.” Additional research is needed to understand and replicate these trends.
