Lung cancer screening model favored in Europe detects more cancers than one preferred in the United States

Researchers reported today that a prospective trial comparing two screening methods for at-risk lung cancer patients found that a model used by Canadian, Australian and European public health organizations detected more cancers than the screening model used by the United States Preventive Services Task Force

Of the 5,013 patients screened, 110 were found to have lung cancer. Ninety-nine percent of the cancers were found using PLCOm2012 compared to 77 percent using USPSTF criteria. 24/110 (21.8 percent) cancers were found by PLCOm2012 alone while only 1/110 (0.9 percent) was found by USPSTF criteria alone.

"Our analysis of ILST data indicates that classification accuracy of lung cancer screening outcomes supports the PLCOm2012 criteria over the USPSTF criteria," said lead researcher Stephen Lam, M.D., of the University of British Columbia in Vancouver. 

Scottish Study Demonstrates that Autoantibody Test Followed by CT Imaging May Reduce Lung Cancer Mortality

A combination of the EarlyCDT-Lung Test followed by CT imaging in Scottish patients at risk for lung cancer resulted in a significant decrease in late-stage diagnosis of lung cancer and may decrease lung cancer mortality.

Prof. Frank Sullivan, from the University of St. Andrews, St. Andrews/United Kingdom and his research team discovered that 127 lung cancer patients were diagnosed in the study period (56 in the intervention group and 71 in the control arm) and 9.8 percent of the intervention group had a positive  EarlyCDT-Lung test and 3.4 percent (n=18) of these were diagnosed with lung cancer in the study period.

"Our results show that the combination of the EarlyCDT-Lung followed by CT imaging, in those with a positive blood test, results in a significant decrease in late-stage diagnosis of lung cancer and may decrease all cause and lung cancer specific mortality. We shall continue follow up of all participants' lung cancer and mortality outcomes at five years using Scottish Information Services Division data to study these effects further," said Sullivan.

BioMILD Trial Demonstrates Lung Cancer Screening Using MicroRNA Blood Test Enhances Prevention Effort

Lung cancer screening efforts have accelerated in the last decade, with researchers showing that low-dose CT screening is effective in reducing lung cancer mortality. Now, researchers in Milan report that using a blood test, accompanied by low-dose CT screening, is safe and effective, according to research presented today by Ugo Pastorino, M.D., of the Istituto Nazionale dei Tumori Foundation.

Preliminary analysis showed a significantly higher lung cancer incidence and overall mortality in subjects with positive LDCT and/or miRNA at baseline. No detrimental effects on stage one lung cancer proportion, resection rates, or interval cancer incidence were observed in the group of subjects sent to three-year LDCT repeat. Sensitivity and specificity analyses of LDCT and miRNA at baseline and subsequent screening rounds will be presented.

"BioMILD showed that the combination of microRNA assay and LDCT is a valuable and safe tool to assess individual risk profile and reduce unnecessary LDCT repeats in lung cancer screening," said Dr. Pastorino.

Video Assisted lung surgery reduces complications and hospital stays compared to open surgery

Video-assisted thoracic surgery (VATS) is associated with lower in-hospital complications and shorter length of stay compared with open surgery among British patients who were diagnosed at an early stage of lung cancer, according Eric Lim, M.D. from Royal Brompton Hospital, London/United Kingdom.

Video-assisted thoracoscopic surgery is a minimally invasive surgical technique used to diagnose and treat problems in the chest and lungs using small incisions.

After randomizing 503 patients, Lim and his researchers found that patients who received VATS had a significant reduction of overall in-hospital complications (32.8 percent) compared to patients who received open surgery (44.3 percent). Additionally, patients randomized to VATS stayed in the hospital one day less than patients who were given open surgery.

"The VIOLET Trial is the largest randomized trial conducted to date to compare clinical efficacy, safety and oncologic outcomes of VATS versus open surgery for lung cancer," said Lim. "The study achieved its positive results without any compromise to early oncologic outcomes—pathologic complete resection and upstaging of mediastinal lymph nodes."

Registrational Data from LIBRETTO-001 Trial Demonstrate Compelling and Durable Activity of Selpercatinib (LOXO-292) in RET Fusion-Positive Lung Cancer

Selpercatinib was granted Breakthrough Therapy Designation by the U.S. Food & Drug Administration in 2018 after initial data from the clinical trial LOXO-292 Investigated to Block RET-altered Tumors (LIBRETTO-001) showed the therapy demonstrated robust anti-tumor activity in a group of RET fusion-positive non-small cell lung cancer patients, as well as strong evidence of durability. 

Now, the same researchers, led by Alexander Drilon, M.D., of Memorial Sloan Kettering Cancer Center in New York City, report data on a primary analysis set of 105 NSCLC patients on selpercatinib.

In the safety data set of all 531 patients enrolled to the study, 5 treatment-related AEs occurred in ≥15 percent of patients: dry mouth, diarrhea, hypertension, increased AST and increased ALT. Most AEs were grade 1-2. Only 9 of 531 (1.7 percent) patients discontinued LOXO-292 for treatment-related AEs.

"In this large cohort, selpercatinib's response rate, durability, robust intracranial activity and safety show promise. Furthermore, this continues to confirm that RET fusions are clinically targetable alterations, placing them in the company of activating EGFR/ALK/ROS1 alterations. We are encouraged by this data as there is currently an unmet need to provide genomically tailored therapy to patients with RET fusion-positive non-small cell lung patients." Drilon reported.

National Lung Matrix Trial: First Results from an Umbrella Phase II Trial in Advanced Non-Small Cell Lung Cancer

The largest stratified medicine dataset of non-small cell lung cancer patients indicates further molecular stratifications could benefit from targeted therapies, according to research presented by Dr. Gary Middleton from the University of Birmingham, United Kingdom.

The National Lung Matrix Trial is the largest precision medicine trial in non-small cell lung patients globally, testing a wide range of therapies tailored specifically to target key genetic changes in cancer cells.

Middleton and his colleagues recruited 315 patients from a screened population of more than 4,000 patients. Results were as follows:

Of the six palbociclib cohorts, the Bayesian estimate of the true median progression free survival in KRAS mutation was 5.4 months, KRAS mutation with concomitant STK11 loss 2.71 months, CDKN2A loss squamous 4.46 months and CDKN2A loss non-squamous 3.19 months. Data for crizotinib show greater than 99 percent predicted probability of success in ROS1 gene fusions and MET exon 14 skipping mutation but less than 1 percent for MET amplification with regards to objective response rate.

Middleton reported that responses to selumetinib/docetaxel in NF1 mutation in adenocarcinoma warrant continuation. Recruitment to vistusertib was halted at interim for LKB1 single mutation: the predicted probability of success for DCBR in those with KRAS mutation with concomitant STK11 loss is 32 percent with Bayesian estimate of the true DCBR of 27 percent and with no objective responses. Four cohorts received capivasertib including those with PIK3CA amplifications the Bayesian estimate for the true DCBR is less than 15 percent for all arms. 

These first results from the largest stratified medicine dataset in NSCLC indicate further molecular stratifications could benefit from targeted therapies. Reporting interim outputs for all cohorts will allow reappraisal of the global stratified medicine strategy in cancer.

Durvalumab combined with chemotherapy improves overall survival in patients with extensive lung -stage cancer; First-line treatment reduces mortality risk by 27 percent

Adding immunotherapy in the form of durvalumab to chemotherapy improves overall survival in patients with extensive-stage small cell lung cancer, according to research presented today by Dr. Luis Paz-Ares, from Hospital Universitario 12 de Octubre, H120-CNIO Lung Cancer Unit, Universidad Complutense and Ciberonc, in Madrid, Spain.

Paz-Ares and the multi-center, international research team randomized 537 previously untreated patients with extensive-stage lung cancer to receive either durvalumab plus 4 courses of etoposide-platinum (EP) chemotherapy, durvalumab plus tremelimumab plus EP for 4 cycles or up to 6 cycles of EP alone.

Paz-Ares and his team found that patients in the immunotherapy arm of the trial achieved a median overall survival of 13 months compared to 10.3 months for the etoposide-platinum control group.  And, 33.9 percent of the patients who received durvalumab were alive at 18 months as compared to just 24.7 in the control arm of the trial.

"The addition of durvalumab to EP as first-line treatment for extensive-stage non-small cell lung cancer significantly improved overall survival (27 percent reduction in risk of death) versus a robust control arm that permitted up to 6 cycles of etoposide. Of note, this chemo-immunotherapy regimen offers flexibility in platinum choice (carboplatin or cisplatin), reflecting current clinical practice for this challenging disease," he said.

About the WCLC:

The WCLC is the world's largest meeting dedicated to lung cancer and other thoracic malignancies, attracting more than 7,000 researchers, physicians and specialists from more than 100 countries. The goal is to increase awareness, collaboration and understanding of lung cancer, and to help participants implement the latest developments across the globe. The conference will cover a wide range of disciplines and unveil several research studies and clinical trial results. 

About the IASLC:

The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. Founded in 1974, the association's membership includes more than 7,500 lung cancer specialists across all disciplines in over 100 countries, forming a global network working together to conquer lung and thoracic cancers worldwide. The association also publishes theJournal of Thoracic Oncology, the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis and treatment of all thoracic malignancies.