Abstract 4292
Background
Concurrent Chemo-Radiotherapy (cCRT) is standard treatment in “fit patients” (pts) affected with locally advanced (LA) NSCLC, with surgery limited to few selected cases. Despite some improvements, outcomes are still unsatisfactory, with only 15-25% of pts alive at 5 years. Recently, encouraging results were obtained with the addition of immunotherapy (IT) to cCRT. Survey was conducted to evaluate the pattern of care of LA-NSCLC treatment among Italian Thoracic Oncologists (TO) involving pneumologists, thoracic surgeons, radiation and medical oncologists.
Methods
In February 2018, all Italian TO were invited to participate to a “web-based” survey consisting in 15 multiple-choice questions about staging procedures and most appropriate multimodal approach to manage LA-NSCLC. Questions were also focused on diagnostic imaging and histopathological modalities.
Results
421 responses were analyzed;69% of responders had more than 5 years experience in thoracic oncology. In 72% of Centers, TO regularly attend a weekly multidisciplinary Team (MDT) meeting, while in 28% MDT is not regularly planned. About pathology, cytological/histological morphologic diagnosis of malignancy were considered enough to define a therapeutic approach in 63% of responders. In N2, Stage IIIA, "minimal" pts upfront surgery was considered the preferred option from 43% of responders, while in N2, multi-nodal and/or bulky pts cCRT was recommended. For this latter group (“unresectable”) only 54% considered cCRT the most appropriate choice, while 46% preferred a sequential chemo-RT, even in fit pts due to better pts compliance and lower toxicity profiles.
Conclusions
Our analysis showed an inhomogeneous scenario between different specialists regarding the appropriate therapeutic choices for LA-NSCLC treatment. Additionally, some discrepancies were found about a correct selection of pts fit for cCRT. Many efforts have to be put towards the increase of a true multidisciplinarity, since in many Institutions lack of MDT was described. Future investigations and trials are necessary to optimize treatment approaches in LA-NSCLC, in particular considering recent clinical results on combination of cCRT and IT.
Clinical trial identification
Legal entity responsible for the study
Alessio Bruni.
Funding
AstraZeneca.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
5964 - Longitudinal Assessment of Multiplex Patient-Specific ctDNA Biomarkers in Bladder Cancer for Diagnosis, Surveillance, and Recurrence
Presenter: Karin Birkenkamp-Demtröder
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract
2197 - Distinct functional consequences of HER2 gene amplification in colorectal and lung adenocarcinomas
Presenter: Evgeny Imyanitov
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract
2422 - Role of AR-V7 and AR-FL in resistance to hormonal therapy in mCRPC: independent actors or reciprocal drivers? A translational study by Meet-Uro group
Presenter: Marzia Del Re
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract
2750 - Validation of a 90-gene assay for tissue origin diagnosis of brain metastases
Presenter: Yulong Zheng
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract
2960 - Development of a Pan-Cancer Biomarker Panel for Improved Detection of MSI Across all Cancer Types
Presenter: Jeff Bacher
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract
3791 - bMSI better predicts the responses to immune checkpoint inhibitors (ICI) than MMR/MSI from historical tissue specimens in metastatic gastrointestinal cancer patients
Presenter: Zhenghang Wang
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract
5189 - Vall d’Hebron Institute of Oncology (VHIO) Immuno-Oncology prognostic index (VIO): a new tool for improved patient (pt) selection in Phase 1 (Ph1) trials with Immune Checkpoint Inhibitors (ICI).
Presenter: Cinta Hierro
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract
5372 - Augmenting TNM Staging with Machine Learning-based Immune Profiling for Improved Prognosis Prediction in Muscle-Invasive Bladder Cancer Patients
Presenter: Nicolas Brieu
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract
2249 - HPV circulating tumor DNA as predictive biomarker of sustained response to chemotherapy in advanced anal carcinoma
Presenter: Alice Bernard-Tessier
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract
2287 - Predicting toxicity and response to pembrolizumab (P) through germline genomic HLA class I analysis
Presenter: Marco Iafolla
Session: Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research
Resources:
Abstract