1306P - Effective knowledge dissemination improves histological classification of non small cell lung cancer: Reducing the rates of NSCLC - not otherwise s...

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Pathology/Molecular Biology
Non-Small Cell Lung Cancer
Basic Scientific Principles
Presenter Cheryl Ho
Citation Annals of Oncology (2014) 25 (suppl_4): iv426-iv470. 10.1093/annonc/mdu349
Authors C. Ho1, K.M. Tong2, K. Ramsden2, D. Ionescu3, J. Laskin4
  • 1Medical Oncologist, BC Cancer Agency Vancouver, V5Z 4E6 - Vancouver/CA
  • 2Medical Oncology, BC Cancer Agency Vancouver, V5Z 4E6 - Vancouver/CA
  • 3Pathology, British Columbia Cancer Agency, vancouver/CA
  • 4Medical Oncology, British Columbia Cancer Agency, vancouver/CA



The importance of NSCLC histological classification in selecting appropriate systemic therapy came to attention in 2007. Dissemination of this data was conducted at an international level through lung cancer related organizations. In British Columbia, information was communicated through our centralized cancer care program to oncology providers and the medical community at large via multi-disciplinary forums. We propose to study the impact of educational programs in the categorization of NSCLC and the resulting changes in systemic treatment practices.


The BC Cancer Agency provides cancer care to a population of 4.5 million. A retrospective review was conducted of all referred Stage IV NSCLC in 2007 and 2011. Histology was classified using the International Classification of Disease for Oncology 3 for the Canadian Cancer Registry. Baseline characteristics, treatment and outcome were collected.


In 2007, 671 patients were referred and 170 received chemotherapy and in 2011, 680 and 197 respectively. Baseline characteristics 2007 vs 2011; female 47%/49%, median age 68/69, smoking status never/former/current 13%/42%/43% vs 12%/41%/44%. Histological classification in 2007 nonsquamous NS/squamous SQ/NOS 41%/13%/46% vs 2011 63%/17%/20%. Of the patients treated with chemotherapy, exposure to pemetrexed (pem) in any line of therapy 2007 NS/SQ/NOS 22%/17%/10% vs 2011 39%/3%/37% and EGFR TKI 2007 36%/22%/33% vs 2011 64%/60%/63%. Median OS 2007 vs 2011 – BSC 3.25 vs 3.57 m and chemotherapy 11.31 and 11.54 m.


The specificity of histological categorization of NSCLC improved from 2007 to 2011 with a 26% reduction in the rate of NOS. The proportion of patients treated with chemotherapy over time remained the same however, the usage of pem and EGFR TKIs increased. This likely reflects the practice changes between 2007 and 2011 that included the introduction of 1st line pem/platinum, 1st line EGFR TKI for mutation positive patients, maintenance pem and erlotinib respectively. The increased accuracy in histological classification resulted in more appropriate molecular screening and systemic drug utilization.


C. Ho: The funding of the software platform for population based analysis (Outcome and Surveillance Integrated System OaSIS) was provided by Roche and Lilly; J. Laskin: The funding of the software platform for population based analysis (Outcome and Surveillance Integrated System OaSIS) was provided by Roche and Lilly. All other authors have declared no conflicts of interest.