1. business and industrial
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2014 IASLC Asia Pacific
Lung Cancer Conference (APLCC)
6 - 8 November 2014 • Shangri-La Hotel, Kuala Lumpur, Malaysia
PROGRAMME BOOK
www.aplcc2014.com
Co-Hosted By
ONKOLOGI
Malaysian
Oncological
Society
ONCOLOGICAL
Malaysian
Thoracic
Society
Supported By
IASLC
INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER
Table of
Contents
Conference Sponsors
2014 IASLC Asia Pacific Lung Cancer Conference would like to
thank the following organisation for their generous support.
PLATINUM LEVEL
GOLD LEVEL
SILVER LEVEL
4
Conference Supporters
5
Welcome message by
Organising Chairmen
6
Committees
8
Conference Venue
9
Conference Registration
10
Information for Speakers
& Presenters
11
Onsite Services &
General Information
12
Exhibit Information
13
Exhibition Floor Plan
15
Exhibitor Description
20
Scientific Programme
Day 1: 6 November 2014
21
Scientific Programme
Day 2: 7 November 2014
22
Scientific Programme
Day 3: 8 November 2014
23
Speaker Abstracts
38
Oral Free Paper
Presentation
41
Author Index
45
Notes
SUPPORTING ORGANISATIONS
Conference Secretariat
4
My Conference Services
Tel: 03 6241 3850
www.myconference.com.my
1 0 An
C el e b r at i n g t h e
niv ersary ofAPLCC
2014 IASLC Asia Pacific
Lung Cancer Conference (APLCC)
6 - 8 November 2014 • Shangri-La Hotel, Kuala Lumpur, Malaysia
Message from the IASLC
WELCOME TO APLCC 2014
It is with great pleasure to welcome participants to the Asia Pacific Lung
Cancer Conference (APLCC) 2014 in Kuala Lumpur, Malaysia.
IASLC's mission is to educate the scientific community globally, and it has
been much encouraging to see the Asian Pacific Lung Cancer Conference
growing over the years. I feel confident that also this APLCC will be a
continuous success thanks to the very hard work done by the local
organizers and the IASLC staff.
Much progress has occurred in prevention, screening and therapy of lung
cancer over the last years, and IASLC is proud to present and disseminate
the latest scientific achievements at this APLCC conference.
It is our hope that the participants at this conference will take the newest
scientific advances back to their respective local communities and
implement the most up-to-date cancer care to the lung cancer patients in
their communities.
I am confident this conference will bring new hopes and encouragement to
the many lung cancer patients who desperately are in need for new hopes
and perspectives.
Fred R. Hirsch, MD, PhD
Chief Executive Officer
International Association for the Study of Lung Cancer
Co-Hosted By
ONKOLOGI
Malaysian
Oncological
Society
ONCOLOGICAL
Malaysian
Thoracic
Society
Supported By
IASLC
INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER
1 0 An
C el e b r at i n g t h e
niv ersary ofAPLCC
2014 IASLC Asia Pacific
Lung Cancer Conference (APLCC)
6 - 8 November 2014 • Shangri-La Hotel, Kuala Lumpur, Malaysia
Message from the Organising Chairmen
On behalf of the International Association for the Study of Lung Cancer
(IASLC) and the Local Organising Committee, it is a great pleasure to
welcome you to the 2014 IASLC Asia Pacific Lung Cancer Conference
(APLCC) in Kuala Lumpur, Malaysia.
With the theme 'Personalising Lung Cancer Treatment - A Multidisciplinary
Approach' this conference will feature the latest in the epidemiology,
research findings, practice changing results from clinical trials and
treatment recommendations from world renowned experts in the field of
lung cancer.
We encourage you to participate actively in the discussions and hope the
meeting helps in the exchange of information and development of new
collaborations. Take advantage of the various networking opportunities the
Conference offer. Join us for the Conference Dinner on Friday night to mix
and mingle with friends, colleagues and exhibitors.
You are welcome to attend the various satellite symposia hosted by our
industry sponsors which cover topics that will complement the scientific
sessions of the Conference. We also encourage you to visit our exhibitors
and poster display in the exhibition area. Poster presenters will be available
during the morning and afternoon networking breaks to discuss their
research work with you.
We extend our warmest welcome to all of you. “Selamat Datang”!
Chong-Kin Liam & Mohamed Ibrahim A. Wahid
2014 IASLC Asia Pacific Lung Cancer Conference (APLCC)
Local Organising Chairmen
Co-Hosted By
ONKOLOGI
Malaysian
Oncological
Society
ONCOLOGICAL
Malaysian
Thoracic
Society
Supported By
IASLC
INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER
5
Committees
Local Organising Committee
Scientific Programme Committee
Asia-Pacific Scientific Committee
CHAIRS
CHAIRS
Ahmad Kamal Mohamed
Sime Darby Medical Centre
Singapore
Alex Y. Chang
Chong-Kin Liam
University of Malaya
Mohamed Ibrahim Abdul Wahid
Beacon International
Specialist Centre
Yong-Kek Pang
University of Malaya
MEMBERS
MEMBERS
Ahmad Kamal Mohamed
Sime Darby Medical Centre
Muhammad Azrif Ahmad Annuar
Prince Court Medical Centre
Rachael Kit-Tsan Khong
Prince Court Medical Centre
Roslina Abdul Manap
National University of Malaysia
Yong-Kek Pang
University of Malaya
6
Abdul Razak Muttalif
Institute of Respiratory Medicine
Balaji Badmanaban
Hospital Serdang
Basri Johan Jeet Bin Abdullah
University Malaya Medical Centre
Ednin Hamzah
Hospis Malaysia
Jamalul Azizi Abdul Rahman
Hospital Serdang
Australia
David Ball
Philippines
Dennis Tudtud
South Korea
Keunchil Park
India
Purvish Parikh
Thailand
Sumitra Thongprasert
Hong Kong
Tony SK Mok
Indonesia
Tubagus Djumhana Atmakusuma
China
Yi-Long Wu
Lye-Mun Tho
Beacon International
Specialist Centre
Japan
Yoichi Nakanishi
Pathmanathan Rajadurai
Sime Darby Medical Centre
Taiwan
Yuh-Min Chen
Roslina Abdul Manap
National University of Malaysia
Vietnam
Vu-Van Vu
Venue
Conference Venue
2014 IASLC Asia Pacific Lung Cancer Conference (APLCC) is being held at the Shangri-La Hotel Kuala Lumpur,
Malaysia.
All Session Rooms, the Exhibition Hall as well as Registration Counter are located at the Basement II level and
Lower Lobby level of the Shangri-La Hotel Kuala Lumpur.
BUSINESS
SUITE A
SABAH
ANTE
ROOM
STAGE
SELANGOR
SESSION ROOM
SECRETARIAT
KEDAH
SELANGOR 1
BOARDROOM B
RECEPTION
BOARDROOM A
BUSINESS
CENTRE
LIFT LOBBY
Registration Counter
GRAND BALLROOM
GRAND
BALLROOM
PANTRY
BUSINESS
SUITE C
PERAK
Tour Desk &
Exhibitor
Service Desk
REGISTRATION
SABAH
SESSION
ROOM
SABAH
BUSINESS
SUITE B
BASEMENT II
EXHIBITION HALL &
NETWORKING BREAK
SURAU
RESTROOM
Speakers
PERLIS
Ready Room
SARAWAK
SARAWAK
SESSION ROOM
LOADING BAY
Floor Plan
Basement II Level
RESTROOM
CAR PARK
JOHOR
LIFT
PAHANG
POSTER DISPLAY
LOWER LOBBY FOYER
EXHIBITION HALL &
NETWORKING BREAK
Poster Display
Support Desk
PENANG
NEGERI
SEMBILAN
EN
TR
AN
CE
KELANT
KELAN
TAN
Floor Plan
Lower Lobby Level
8
REGISTRATION & EVENTS
Conference Registration
The Registration Counter is located in the foyer area, Basement II level of
Shangri-La Hotel Kuala Lumpur.
Registration Counter Hours:
Wednesday, 5 November 2014
Thursday, 6 November 2014
Friday, 7 November 2014
Saturday, 8 November 2014
Registration Materials include:
Name Badge
15:00hrs - 18:00hrs
06:30hrs - 18:00hrs
06:30hrs - 18:00hrs
06:30hrs - 12:30hrs
Delegate Bag including:
Abstract Book (in USB drive)
Onsite Programme
IASLC Folder
Addendum to Onsite Programme
Invitation Flyers for Industry Symposia
Name Badges
Attendees are requested to wear their name badges at all times
to attend in the Scientific Sessions and Exhibition.
Certificate of Attendance
Delegates can request and pick up a 'Certificate of Attendance' at the
Registration Counter during regular registration hours.
Networking Events
FACULTY DINNER
Thursday, 6 November 2014
19:00hrs - 22:00hrs
By invitation only
CONFERENCE DINNER
Friday, 7 November 2014
19:30hrs - 22:00hrs
All delegates are welcome to the
dinner
NETWORKING BREAKS
(Tea Breaks)
Thursday, 6 November 2014
10:30hrs - 11:00hrs and
15:30hrs - 16:00hrs
Shangri-la Hotel Kuala Lumpur,
Exhibit Hall, Basement II &
Lower Lobby Foyer
Friday, 7 November 2014
10:30hrs - 11:00hrs and
15:30hrs - 16:00hrs
Shangri-la Hotel Kuala Lumpur,
Exhibit Hall, Basement II &
Lower Lobby Foyer
Saturday, 8 November 2014
Coffee, tea and snacks will be
available from 10:30hrs - 11:00hrs
Shangri-la Hotel Kuala Lumpur,
Exhibit Hall, Basement II &
Lower Lobby Foyer
9
SPEAKERS & PRESENTERS
Information for Speakers and Presenters
Invited Speakers
Oral Presenters
and
All speakers are requested to be in
the session room at least 15
minutes prior to the start of their
session. Please provide your
presentation slides to the
technician in the Speaker Ready
Room located in Perlis Room,
Basement II level. The use of
personal laptops for presentations
is not recommended as it can
cause technical delays and cut into
a presenter's time.
Poster Presenters
All poster display boards are
located in the Lower Lobby level
foyer of the Shangri-la Hotel Kuala
Lumpur. Each poster board is
identified with a poster panel
number that corresponds to the
pre-assigned poster panel number
given to the poster presenters.
Different sets of posters will be
displayed each day. Each poster
shall be on display for the entire
day with author stand-by time
during each day's morning and
afternoon networking break.
Poster presenters are required to
stand by their poster during both
times to answer questions from
delegates.
POSTER SESSION 1
THURSDAY, 6 NOVEMBER 2014
Poster Set Up Time
06:30hrs - 08:00hrs
Poster Take Down Time
18:00hrs - 19:00hrs
Poster Display Time
08:00hrs - 18:00hrs
Author Stand - By Time
10:30hrs - 11:00hrs and
15:30hrs - 16:00hrs
POSTER SESSION 2
FRIDAY, 7 NOVEMBER 2014
Poster Set Up Time
06:30hrs - 08:00hrs
Poster Take Down Time
18:00hrs - 19:00hrs
Poster Display Time
08:00hrs - 18:00hrs
Author Stand By Time
10:30hrs - 11:00hrs and
15:30hrs - 16:00hrs
Adhesive tape to set up your
poster will be provided at the
poster display support desk.
Press and Media
Press and Media Access
Pre-registered Press and Media
representatives are required to
check in at the Registration
Counter. Non-registered Press and
Media representatives should also
proceed to the Registration
Counter and need to provide their
media/press credentials to receive
a Press/ Media badge.
Use of APLCC2014 Scientific
Programme Content
Please be informed that the
information and materials
displayed and/ or presented at all
sessions of this meeting are the
property of the 2014 IASLC Asia
Pacific Lung Cancer Conference
and cannot be photographed,
copied, photocopied, transformed
to electronic format, reproduced or
distributed without the written
permission of the International
Association for the Study of Lung
Cancer. Use of the APLCC/IASLC
name and/or logo in any fashion by
any commercial entity for any
purpose is expressly prohibited
without the written permission of
the International Association for
the Study of Lung Cancer.
10
ONSITE SERVICE / INFO
Onsite Services and
General Information
Abstract Book
All accepted and confirmed abstracts
are available in the USB drive,
included in each delegate's bag.
Certificate of Attendance
Delegates can request and pick up a
'Certificate of Attendance' at the
Registration Counter during regular
registration hours.
CME Accreditation
Malaysian registered delegates will
be eligible for 20 CME points. Please
complete the CME form at the
registration counter.
Networking Breaks
During the Conference days,
refreshments will be available in the
Basement II foyer and Lower Lobby
foyer during the scheduled morning
and afternoon Networking Breaks.
Conference Evaluation
A Conference Evaluation Form is
included in your conference
materials. By completing and
returning the form to the Registration
C o u n t e r b e f o r e S a t u r d a y, 8
November, 12:00hrs, you will provide
us with important feedback and help
us to improve on the organisation of
future conferences. Thank you for
your support!
Lost and Found / Messages
Lost and found items should be
returned/claimed at the Registration
Counter.
Wifi
Wireless internet will be provided in
the meeting area. Please check for
signs with the access information.
11
EXHIBITS
Exhibit Information
The 2014 IASLC Asia Pacific Lung Cancer Conference (APLCC) is held in
Basement II Foyer and Lower Lobby Foyer of the Shangri-la Hotel Kuala
Lumpur.
Exhibition Hours
6 November 2014
7 November 2014
8 November 2014
08:00hrs - 17:30hrs
08:00hrs - 17:30hs
08:00hrs - 12:30hrs
Exhibition Events & Highlights
Networking Breaks
On Thursday, 6 November to Saturday, 8 November, refreshments are
available for registered delegates in the Exhibition Area during the morning
and afternoon Networking Breaks.
Poster Sessions
The Poster Sessions are an important educational part of this meeting. All
poster presentations are located in the Lower Lobby foyer. All poster
presentations have been assigned Poster Board numbers.
12
POSTER SESSION 1
THURSDAY, 6 NOVEMBER 2014
Poster Display Time
08:00 - 18:00
Author Stand By Time
10:30hrs - 11:00hrs &
15:30hrs - 16:00hrs
(Networking Breaks)
POSTER SESSION 2
FRIDAY, 7 NOVEMBER 2014
Poster Display Time
08:00hrs - 18:00hrs
Author Stand By Time
10:30hrs - 11:00hrs &
15:30hrs - 16:00hrs
(Networking Breaks)
FLOORPLAN
Exhibition Floor Plan
SELANGOR
SESSION ROOM
SECRETARIAT
Tour Desk &
Exhibitor Service Desk
NOVARTIS
GRAND BALLROOM
NOVARTIS
ROCHE
IASLC
ELI-LILLY
CONFERENCE
LITERATURE
DISPLAY
BOEHRINGER
INGELHEIM
ROCHE
HOSPIRA
DIAGNOSTIC
SABAH
SESSION ROOM
MERCK
& CO
LIFT
CONFERENCE
LITERATURE
DISPLAY
BOEHRINGER
INGELHEIM
ROCHE
ROCHE
HOSPIRA
DIAGNOSTIC
COFFEE
STATION
Speakers
Ready Room
SARAWAK
SESSION ROOM
IASLC
MERCK
& CO
ABBOTT
PFIZER
LUNG
FOUNDATION
OF MALAYSIA
SURAU
COFFEE
STATION
ELI-LILLY
Speakers
PERLIS
Ready Room
L
ABBOTT
PFIZER
LUNG
FOUNDATION
OF MALAYSIA
Floor Plan
Basement II Level
POSTER DISPLAY
POSTER DISPLAY
KOREA UNITED
PHARM INC
POSTER
DISPLAY DESK
MUNDIPHARMA
PANAGENE
MEDIAN
TECHNOLOGIES
TRANS MEDIC
ABEX
MEDICAL
KOREA UNITED
PHARM INC
POSTER
DISPLAY DESK
MUNDIPHARMA
PANAGENE
MEDIAN
TECHNOLOGIES
TRANSMEDIC
NEGERI
SEMBILAN
ABEX
MEDICAL
OLYMPUS
MALAYSIA
CAREFUSION
CAREFUSION
Floor Plan
Lower Lobby Level
EN
TR
AN
CE
OLYMPUS
OLYMPUS
MALAYSIA
13
EXHIBITORS
Exhibitor Descriptions
(in Alphabetical Order)
Abex Medical
Boehringer Ingelheim
ABEX MEDICAL SYSTEM Sdn. Bhd. was
incorporated in 1981 in Healthcare
Industry for Sales and Service of medical
equipment business. We have developed
core strategic partnership with TOSHIBA
Diagnostic Imaging Equipment, INFINITT
Enterprise Imaging Information Solution
(RIS, PACS and 3D Solutions) and Elekta
Oncology Radiotherapy System and
Neuroscience products (Linear
Accelerator, Brachytherapy and Leksell
Gamma Knife ® ). ABEX MEDICAL
SYSTEM Sdn. Bhd. has proven track
records in providing professional and
excellent services over the years which
has gained our clients' satisfactory and
trust, thus made us a customer preferred
company in the Healthcare Industry.
ABEX MEDICAL SYSTEM Sdn. Bhd. is
committed to continuously applying
engineering and managerial skills to bring
service excellence and professionalism to
the medical industry for the benefits of
Healthcare providers and patients.
The Boehringer Ingelheim group is one of
the world's 20 leading pharmaceutical
companies. Headquartered in Ingelheim,
Germany, it operates globally with 140
affiliates and more than 46,000
employees. The family-owned company
is committed to researching, developing,
manufacturing and marketing novel
medications of high therapeutic value for
human and veterinary medicine. The
oncology pipeline is evolving and
demonstrates the continued commitment
to advance the disease area.In 2012,
Boehringer Ingelheim achieved net sales
of about 14.7 billion euro. R&D
expenditure in the business area
Prescription Medicines corresponds to
22.5% of its net sales.
Abbott
CareFusion
Abbott is a global leader in in vitro
diagnostics and offers a broad range of
innovative instrument systems and tests
for hospitals, reference labs, blood banks,
and clinics. Our products offer customers
automation, convenience and flexibility.
Together Abbott Diagnostics and Abbott
Molecular have helped transform the
practice of medical diagnosis through
science and research as well as our
commitment to helping physicians,
laboratories and hospitals improve patient
care. Abbott offers innovative genomic
tests for chromosome changes
associated with congenital disorders and
cancer, including the Vysis PathVysion®
HER-2 DNA Probe kit to identify women
with metastatic breast cancer who could
benefit from Herceptin® therapy and
Vysis ALK Break Apart FISH Probe Kit to
aid in identifying those patients eligible for
treatment with XALKORI® (Crizotinib).
CareFusion is a global corporation
serving the health care industry with
products and services that help hospitals
measurably improve the safety and
quality of care. Our Interventional
Specialties portfolio offers full range of
clinically relevant solutions. Our
comprehensive drainage products
manage symptoms associated with
recurrent pleural effusions and ascites.
PleurX® catheter system and Denver®
shunts for chronic drainage to improve
patients' lives; Safe-T-Centesis® devices
for thoracentesis and paracentesis. Our
proven brands for bone marrow and soft
tissue biopsy needle, such as Achieve®,
Temno® and Jamshidi® offer complete
selection with advanced features to obtain
top-quality samples quickly and efficiently.
Eli-Lilly
No two cancer patients are alike. That's
why Lilly Oncology is committed to
developing treatment approaches as
individual as the people who need them.
We've made contributions toward
improved patient outcomes and with each
door open, we take another step forward.
Our quest to help you provide tailored
therapy continues.
Hospira
Hospira is the world's leading provider of
injectable drugs and infusion
technologies, and a global leader in
biosimilars. Through its broad, integrated
portfolio, Hospira is uniquely positioned to
Advance Wellness™ by improving patient
and caregiver safety while reducing
healthcare costs. The company is
headquartered in Lake Forest, Illinois,
USA and has approximately 17,000
employees. Worldwide sales in 2013 were
approximately $4.0 billion. Hospira was
named to DiversityBusiness.com's Top 50
Organizations for Multicultural Business
Opportunities list for the second
consecutive year. The Div50 is a listing of
the top 50 corporate and organizational
buyers of diversity products and services
throughout the U.S (January 2013). Learn
more at www.hospira.com
International Association
for the Study of Lung Cancer (IASLC)
IASLC
INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER
The Denver-based International
Association for the Study of Lung Cancer
(IASLC) is the only global organization
dedicated to the study of lung cancer.
Founded in 1974, the association's
membership includes more than 4,000
lung cancer specialists in 80 countries.
IASLC members work to enhance the
understanding of lung cancer among
scientists, members of the medical
community and the public. IASLC
publishes the Journal of Thoracic
Oncology, a valuable resource for medical
specialists and scientists who focus on the
detection, prevention, diagnosis and
treatment of lung cancer.
15
EXHIBITORS
Exhibitor Descriptions
(in Alphabetical Order)
16
Korea United Pharm. Inc.
Median Technologies
Merck & Co (MSD)
KOREA UNITED PHARM. INC. (KUPI)
has grown into a manufacturer and
distributor of health & beauty cares, home
cares, Korean ginseng products as well as
a variety of ethical medicines since 1987.
We have worldwide business operations,
connecting global networks in over 42
countries. Key Development Values of
KUPI are “R&D -Heart of Technology and
Innovation, Quality- Global Standardized
& Worldwide Network with Mfg.
Facilitates”. The manufacturing facilities
are Korea, Vietnam, USA & Egypt. The
Main exports are oncology items &
ethicals.To become a global healthcare
enterprise, KUPI is striving to improve our
research and development capacity from
the synthetic pharmaceutical materials to
the finished items. We hope to serve as
your best healthcare provider and enrich
the lives of the people anywhere in the
world, with the support from our excellent
research and quality control
professionals.
M E D I A N Te c h n o l o g i e s d e v e l o p s
advanced medical imaging software and
services dedicated to cancer screening
programs, oncology clinical trials and
clinical practice. MEDIAN sets up and
monitors CT Lung Cancer Screening
programs regionally or nationally through
the implementation of its advanced
proprietary imaging platform LMS Lesion
Management Solutions combined with
customized imaging services. LMS and
associated imaging services standardize,
automate and drive the interpretation of
medical images to diagnose cancer
patients and assess their response to
therapy. Based in France, the company
has a global reach and actively works with
clinical sites and health institutions
located in Asia, Europe, North and South
America, and Australia.
Today's MSD is a global healthcare leader
working to help the world be well. MSD is
known as Merck in the United States and
Canada. Through our prescription
medicines, vaccines, biologic therapies,
and consumer care and animal health
products, we work with customers and
operate in more than 140 countries to
deliver innovative health solutions. We
also demonstrate our commitment to
increasing access to healthcare through
far-reaching policies, programs and
partnerships. MSD. Be well. For more
information, visit www.msd.com
Lung Foundation of Malaysia
Mundipharma
Novartis
The lung foundation of Malaysia (LFM) is
a non-profit established in November
2005 to gather funds to contribute towards
the improvement of standard of care and
treatment of patients with lung diseases.
In LFM, we offer support for patients
afflicted with lung diseases so that they
can lead a better quality of life with
minimal suffering. We also seek to
achieve paradigm shift by increasing the
awareness and knowledge among the
public on lung diseases and fund scientific
researches related to improvement of
treatment of the diseases.
Mundipharma is dedicated to bringing to
patients with moderate to severe pain and
debilitating diseases the benefit of
innovative treatment options, continually
expanding our fields of expertise across
areas such as severe pain, oncology,
respiratory disease, rheumatoid arthritis
and antisepsis. Mundipharma is today a
strong and reputable player in the Asia
Pacific, Latin America, Middle East and
North Africa regions. Driving our growth is
the untiring commitment to excellence of
our people. Our people embody the
wealth of knowledge, innovation and
passion that define Mundipharma's brand
culture.
Lung cancer is a primary focus of research
at Novartis Oncology. Novartis lung
cancer pipeline encompasses a broad
range of therapeutic strategies that aim to
tackle the many steps involved in
carcinogenesis. The targets selected for
drug development are based on extensive
research on the molecular structure of
drug receptors, the specific biochemical
characteristics of intracellular proteins,
the unique products of aberrant genes,
the cellular process underlying the
etiology of cancer, and tumor vasculature.
EXHIBITORS
Exhibitor Descriptions
(in Alphabetical Order)
Olympus
Olympus supports the work of healthcare
professionals by providing advanced,
minimally invasive therapeutic and
diagnostic technologies to improve the
quality of patient care around the globe.
We are a pioneer in innovative
technologies that enable physicians to
peer inside the human body, fight cancers
with minimally invasive procedures,
diagnose and treat a broad range of
illnesses covering a variety of medical
specialties which include
gastroenterology, general surgery,
pulmonology, bronchoscopy, urology,
gynecology, otolaryngology, bariatrics,
orthopaedics and anesthesiology. While
the providers of healthcare are our
primary customers, we are always
focused on patients whose well-being is at
the core of all we do.
Panagene
As a worldwide PNA(Peptide nucleic acid)
oligomer provider, Panagene has
developed its own PNA-based diagnostic
kits such as PNAClamp™
EGFR/KRAS/BRAF/PIK3CA/IDH1
somatic mutation detection kit (Real-time
PCR based ready-to use kit) as well as
HPV, TB/NTM detection kit with CE IVD
approval.
Pfizer
Pfizer Oncology is committed to the
discovery, investigation and development
of innovative treatment options to improve
the outlook for cancer patients worldwide.
Our strong pipeline of biologics and small
molecules is studied with precise focus on
identifying and translating the best
scientific breakthroughs into clinical
application for patients across a wide
range of cancers. For more information
please visit www.pfizer.com.
Roche
Headquartered in Basel, Switzerland,
Roche is a leader in research-focused
healthcare with combined strengths in
pharmaceuticals and diagnostics. Roche
is the world's largest biotech company,
with truly differentiated medicines in
oncology, immunology, infectious
diseases, ophthalmology and
neuroscience. Roche is also the world
leader in in vitro diagnostics and tissuebased cancer diagnostics, and a
frontrunner in diabetes management.
Roche's personalised healthcare strategy
aims at providing medicines and
diagnostics that enable tangible
improvements in the health, quality of life
and survival of patients. Founded in 1896,
Roche has been making important
contributions to global health for more
than a century. Twenty-four medicines
developed by Roche are included in the
World Health Organisation Model Lists of
Essential Medicines, among them lifesaving antibiotics, antimalarials and
chemotherapy. In 2013 the Roche Group
employed over 85,000 people worldwide,
invested 8.7 billion Swiss francs in R&D
and posted sales of 46.8 billion Swiss
francs. Genentech, in the United States, is
a wholly owned member of the Roche
Group. Roche is the majority shareholder
in Chugai Pharmaceutical, Japan. For
more information, please visit
www.roche.com
Transmedic
Transmedic has close to 30 years of indepth industry experience & knowledge in
the field of advanced medical
technologies and healthcare.Today, we
are a leading medical specialty partner of
world-class healthcare institutions and
professionals in S.E.A. Headquartered in
Singapore, branch offices in Malaysia,
Thailand, Indonesia, Philippines & Hong
Kong and sub-distributors in Cambodia,
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17
Scientific Programme
Programme at a glance
Hrs
08:00
Thursday
6-Nov-14
Friday
7-Nov-14
Saturday
8-Nov-14
Registration
(06:30 - 18:00)
Registration
(06:30 - 18:00)
Registration
(06:30 - 12:30)
Opening Ceremony
(08:00 - 08:15)
08:00
08:15
08:30
08:15
Plenary 1
(08:15 - 09:00)
Plenary 2
(08:15 - 09:00)
Plenary 3
(08:15 - 09:00)
09:00
09:30
10:00
Concurrent Session
1A - 1C
(09:00 - 10:30)
Concurrent Session
5A - 5C
(09:00 - 10:30)
Networking Break & Poster Viewing
(10:30 - 11:00)
Networking Break & Poster Viewing
(10:30 - 11:00)
Concurrent Session
8A - 8C
(09:00 - 10:30)
Concurrent Session
2A - 2C
(11:00 - 12:30)
Oral Free Paper
Presentation A
(11:00 - 12:30)
13:30
14:00
Industry Supported
Symposia
by Eli - Lilly
(12:30 - 14:00)
14:30
15:00
Concurrent Session
3A - 3C
(14:00 - 15:30)
Industry Supported
Symposia
by Merck & Co
(12:30 - 14:00)
Oral Free Paper
Presentation B
(14:00 - 15:30)
15:30
16:00
Networking Break & Poster Viewing
(15:30 - 16:00)
16:30
17:00
Concurrent Session
4A - 4C
(16:00 - 17:30)
Oral Free Paper
Presentation C
(16:00 - 17:30)
Novartis Symposium
(10:30 - 11:30)
Concurrent Session 6A - 6C
(11:00 - 12:30)
Industry Supported
Symposium by
Roche
(12:30 - 14:00)
Concurrent Session
7A - 7C
(14:00 - 15:30)
Medscape
Education
Symposium
(12:30 - 14:00)
11:00
11:30
12:30
13:00
Closing Ceremony
(13:00 - 13:15)
13:30
14:00
Oral Free Paper
Presentation D
(14:00 - 15:30)
14:30
15:00
Oral Free Paper
Presentation E
(14:00 - 15:30)
15:30
Networking Break & Poster Viewing
(15:30 - 16:00)
16:00
16:30
The Great Debate
(16:00 - 17:30)
17:00
17:30
17:30
18:00
18:30
10:00
12:00
Concurrent Session 9A - 9C
(11:30 - 13:00)
12:30
13:00
09:30
10:30
11:30
12:00
08:30
09:00
10:30
11:00
Hrs
18:00
Industry Supported Symposia by Pfizer
(17:30 - 19:00)
Industry Supported Symposia by
AstraZeneca
(17:30 - 19:00)
18:30
19:00
19:00
19:30
19:30
20:00
20:00
20:30
21:00
Faculty Dinner
By Invitation only
(19:00 - 22:00)
20:30
Conference Dinner
(19:30 - 22:00)
21:00
21:30
21:30
22:00
22:00
Poster Display & Exhibition
(08:00 - 17:30)
Poster Display & Exhibition
(08:00 - 17:30)
Exhibition
(08:00 - 12:30)
19
Scientific Programme
Thursday, 6 November 2014
Time (hrs)
Thursday, 6 November 2014
0630 – 1800
Registration
0800 – 0815
Opening Ceremony
0815 – 0900
(P1) Plenary 1:
Outcome of patients with advanced NSCLC in the era of molecular diagnosis and targeted treatment
Speakers: (P1-1) Yoichi Nakanishi (Japan) & (P1-2) Sumitra Thongprasert (Thailand)
Chairpersons: Chong-Kin Liam (Malaysia) & Mohamed Ibrahim Abdul Wahid (Malaysia)
Venue: Sabah Room, Basement II Level
Updates on Lung Cancer Classification/Staging
Speaker: Peter Goldstraw (UK)
(1B-1)
New Classification of Adenocarcinoma and its Clinical Implications
Speaker: Keith Kerr (UK)
(1A-2)
(1B-2)
Imaging in the New Lung Cancer Staging
Speaker: Lynette Teo (Singapore)
(1B-3)
0900 - 0930
(1A-1)
(1A-3)
Recent Advances In Genomics - from the Lab to the Bench
Speaker: David Carbone (USA)
(1C-1)
Next Generation Sequencing for Molecular Sub-typing
Speaker: Sai-Hong Ignatius Ou (USA)
(1C-2)
Novel Targets in NSCLC
Speaker: Keunchil Park (South Korea)
(1C-3)
Concurrent Session 2A:
Optimising Chemotherapy for NSCLC
Chairpersons:
Adel Zaatar (Malaysia) & Chong-Kin Liam (Malaysia)
Venue: Sabah Room, Basement II Level
(2A-2) Concurrent Session 2B:
Clinical Grand Round
Chairpersons:
Francoise Mornex (France) & Sumitra Thongprasert (Thailand)
Venue: Sarawak Room, Basement II Level
Chemotherapy in the Era of Expanded Choices
Speaker: Mark Vincent (Canada)
Case 1
(2A-1)
Challenges in Maintenance Therapy
Speaker: Michael Boyer (Australia)
Case 2
(2A-2)
Adjuvant Chemotherapy
Speaker: CaiCun Zhou (China)
Case 3
1100 - 1230
1100 - 1130
1130 - 1200
1200 - 1230
Industry Sponsored Lunch Symposium by Merck & Co (MSD)
Venue: Sarawak Room, Basement II Level
1400 - 1530
Concurrent Session 3A:
Lung Cancer Staging
Chairpersons:
Jamalul Azizi Abdul Rahman (Malaysia) & Peter Goldstraw (UK)
Venue: Sabah Room, Basement II Level
Concurrent Session 3B:
Practical Problems in Lung Cancer Diagnosis
Chairpersons:
Pathmanathan Rajadurai (Malaysia) & Keith Kerr (UK)
Venue: Sarawak Room, Basement II Level
1430 – 1500
(3A-2)
1500 – 1530
(3A-3)
EBUS and Other Endoscopic Techniques in Staging
Speaker: Jamsak Tscheikuna (Thailand)
Surgical Techniques for Staging
Speaker: Balaji Badmanaban (Malaysia)
(3B-1)
(3B-2)
How to Make the Most from Limited Tissue Sample?
Speaker: Pathmanathan Rajadurai (Malaysia)
Molecular Diagnosis in Cytology Samples
Speaker: Keith Kerr (UK)
Re-biopsy When Disease Progresses - What do We Test?
(3B-3) Speaker: James Chung-Man Ho (Hong Kong)
PET-CT in Staging of Lung Cancer
Speaker: Felix Sundram (Malaysia)
1600 - 1730
Concurrent Session 4A:
Concurrent Session 4B:
Palliative Care
Pathological Slide Preparation & Interpretation
Chairpersons: Ednin Hamzah (Malaysia) & Richard Lim (Malaysia)
Chairpersons:
Angela Maria Takano Pena (Singapore) & Nor Salmah Bakar (M’sia)
Venue: Sabah Room, Basement II Level
Venue: Sarawak Room, Basement II Level
1600 - 1630
Integrating Palliative Care and Oncology Treatment for Lung Cancer
Best Strategy in Deploying Immunohistochemical Tests
(4A-1)
(4B-1) Speaker: Pathmanathan Rajadurai (Malaysia)
Speaker: Ednin Hamzah (Malaysia)
(4A-2)
Management of Dyspnoea in Advanced Malignancy
Speaker: Lalit Krishna (Singapore)
(4A-3)
End-of-Life Care in Advanced Lung Cancer
Speaker: Richard Lim (Malaysia)
1630 - 1700
1900 - 2200
Therapeutic Options in Advanced Squamous Cell Lung Cancer
Speaker: Ross Soo (Singapore)
Fibroblast Growth Factor Receptor 1 as a
Target in Squamous Cell Lung Cancer
Speaker: Byoung Chul Cho (South Korea)
Concurrent Session 3C:
Managing Lung Cancer in the Limited Resource Countries
Chairpersons:
Sumitra Thongprasert (Thailand) & Nurhayati Mohd. Marzuki (M’sia)
Venue: Selangor Room, Basement II Level
Is It Possible to Achieve Adequate Diagnosis/
Staging despite Limited Resources?
Speaker: Tubagus Djumhana Atmakusuma (Indonesia)
Strategies I Employ to Overcome Funding Limitation
(3C-2)
Speaker: Sudsawat Laohavinij (Thailand)
How I Balance Guidelines Recommendation and Reality
(3C-3)
Speaker: Soe Aung (Myanmar)
Incorporating Cost Effectiveness Analysis in Lung Cancer
Management
(3C-4)
Speaker: Unchalee Permsuwan (Thailand)
Panel Discussion
(3C-1)
Networking Break & Poster Viewing
1530 – 1600
20
Tumour Biology and Genetics of Lung Squamous Cell Carcinoma
Speaker: Tetsuya Mitsudomi (Japan)
(2C-3)
Industry Sponsored Lunch Symposium by Eli-Lilly
Venue: Sabah Room, Basement II Level
(3A-1)
Concurrent Session 2C:
Squamous Cell Lung Cancer
Chairpersons:
Ross Soo (Singapore) & Nor Salmah Bakar (Malaysia)
Venue: Selangor Room, Basement II Level
(2C-2)
1230 - 1400
1730 - 1900
Translating Research Findings into Clinical Practice
Speaker: Fred Hirsch (USA)
(2C-1)
(2A-3)
1700 - 1730
How to Increase the Chance of Securing a Research Grant?
Speaker: CaiCun Zhou (China)
Networking Break & Poster Viewing
1030 – 1100
1400 - 1430
How to Get your Manuscript Published
Speaker: Alex Adjei (USA)
Oral Free Paper Presentation A
Venue: Penang Room, Lower Lobby Level
1000 – 1030
Concurrent Session 1C:
Biostatistics & Research
Chairpersons:
Andrea Yu-Lin Ban (Malaysia) & Helmy Haja Mydin (Malaysia)
Venue: Selangor Room, Basement II Level
Oral Free Paper Presentation B
Venue: Penang Room, Lower Lobby Level
0930 – 1000
Concurrent Session 1B:
New Targets in Lung Cancer
Chairpersons:
Yi-Long Wu (China) & Roziana Ariffin (Malaysia)
Venue: Sarawak Room, Basement II Level
Concurrent Session 4C:
Other Thoracic Malignancies
Chairpersons:
Balaji Badmanaban (Malaysia) & Tetsuya Mitsudomi (Japan)
Venue: Selangor Room, Basement II Level
Roles of Chemotherapy and Radiotherapy in Thymic Tumours
(4C-1)
Speaker: Francoise Mornex (France)
Pitfalls in Interpreting Pathological Slides
(4B-2) Speaker: Angela Maria Takano Pena (Singapore)
(4C-2)
Pulmonary Metastasectomy - Indication,
Techniques and Long-term Outcomes
Speaker: Anand Sachithanandan (Malaysia)
Tips and Tricks during Rapid on-site Evaluation (ROSE)
(4B-3) Speaker: Angela Maria Takano Pena (Singapore)
(4C-3)
Stereotactic Ablative Body Radiotherapy (SABR) for
Pulmonary Metastases
Speaker: David Ball (Australia)
Industry Sponsored Evening Symposium by Pfizer Venue: Sabah Room, Basement II Level
Faculty Dinner (By invitation only) Dresscode: Formal (Mandatory) Venue: Malaysian Petroleum Club
Oral Free Paper Presentation C
Venue: Penang Room, Lower Lobby Level
0900 - 1030
Concurrent Session 1A:
Classification / Staging of Lung Cancer
Chairpersons:
Kandiah Ampikaipakan (Malaysia) & Balaji Badmanaban (Malaysia)
Venue: Sabah Room, Basement II Level
Scientific Programme
Friday, 7 November 2014
Time (hrs)
Friday, 7 November 2014
0630 – 1800
Registration
0815 - 0900
(P2) Plenary 2:
Personalised Targeted Therapy for Advanced Lung Cancer
Speaker: Tony Mok (Hong Kong)
Chairperson: Ahmad Kamal (Malaysia)
Venue: Sabah Room, Basement II Level
Concurrent Session 5A:
Challenges of Targeted Therapy
Chairpersons:
Yuh-Min Chen (Taiwan) & Yong-Kek Pang (Malaysia)
Venue: Sabah Room, Basement II Level
0900 - 1030
Concurrent Session 5B:
Early Lung Cancer
Chairpersons:
Lye-Mun Tho (Malaysia) & Soon-Hin How (Malaysia)
Venue: Sarawak Room, Basement II Level
0900 - 0930
(5A-1)
Mechanism of Acquired Resistance
to Targeted Therapy
Speaker: James Yang (Taiwan)
(5B-1)
Solitary Lung Nodule - What is the Best Approach?
Speaker: Pyng Lee (Singapore)
0930 - 1000
(5A-2)
TKI Resistance - How to Overcome?
Speaker: Tony Mok (Hong Kong)
Surgical Treatment in Patients with Limited Lung Function
(5B-2) Speaker: Agasthian Thirugnanam (Singapore)
1000 - 1030
(5A-3)
Resistance to ALK/ROS1 Inhibitors What Options Do We Have?
Speaker: Sai-Hong Ignatius Ou (USA)
(5B-3)
Role of Stereotactic Body Radiotherapy (SBRT)
for Early Lung Cancer
Speaker: Brian Collins (USA)
1030 - 1100
(5C-1)
Prevalence of Smoking in the Asia Pacific Region
Speaker: Tara Singh Bam (Indonesia)
(5C-2)
Smoking and Tumour Induction
Speaker: Carolyn Dresler (USA)
(5C-3)
Nicotine and its Effects on Lung Cancer Treatment
Speaker: Carolyn Dresler (USA)
Networking Break & Poster Viewing
Concurrent Session 6A:
Smoking Cessation
Chairperson:
Carolyn Dresler (USA)
Venue: Sabah Room, Basement II Level
Concurrent Session 6B:
Interventional Pulmonology
Chairpersons:
Jamalul Azizi Abdul Rahman (Malaysia) &
Jamsak Tscheikuna (Thailand)
Venue: Sarawak Room, Basement II Level
1100 - 1130
(6A-1)
Tobacco Control Policies:
Challenges in their Implementation
Speaker: Zarihah Zain (Malaysia)
(6B-1)
1130 - 1200
(6A-2)
What are the Ingredients of Success
for a Smoking Cessation Clinic?
Speaker: Mohd Haniki (Malaysia)
(6B-2)
Diagnostic Pathway for Patients with Suspected
Malignant Effusion
Speaker: Kunji Kannan (Malaysia)
(6B-3)
What Can the Interventional Radiologist offer in Lung
Cancer Management
Speaker: Basri Johan Jeet (Malaysia)
1200 - 1230
Role of Bronchoscopy in Endobronchial Tumour
Speaker: Jamsak Tscheikuna (Thailand)
1230 - 1400
Medscape Education Symposium
Venue: Sabah Room, Basement II Level
Industry Sponsored Lunch Symposia by Roche
Venue: Sarawak Room, Basement II Level
1400 - 1530
Concurrent Session 7A:
Small Cell Lung Cancer
Chairpersons:
Fred Hirsch (USA) &
Mohamed Ibrahim Abdul Wahid (Malaysia)
Venue:
Sabah Room, Basement II Level
Concurrent Session 7B:
Management of Lung Cancer in Unchartered Territories
Chairpersons:
Muhammd Azrif Ahmad Annuar (Malaysia) &
Alex Chang (Singapore)
Venue:
Sarawak Room, Basement II Level
(7A-1)
Recent Insights in the Biology of SCLC
Speaker: David Carbone (USA)
1430 – 1500
(7A-2)
Updates in Systemic Management of SCLC
Speaker: Solange Peters (Switzerland)
1500 – 1530
(7A-3)
Updates in Radiotherapy in SCLC
Speaker: Ahmad Kamal (Malaysia)
Concurrent Session 6C:
Oral Free Paper Presentation
Chairperson: Muhammd Azrif Ahmad Annuar (Malaysia)
Venue: Kedah Room, Basement II Level
Chairperson: Rachael Khong (Malaysia)
Venue: Selangor I Room, Basement II Level
Chairperson: Ahmad Kamal (Malaysia)
Venue: Perak Room, Basement II Level
Is there a Role for Adjuvant TKI in Early Lung Cancer?
(7B-1)
Speaker: Yi-Long Wu (China)
(7B-2)
Targeted Therapies in Combination with Radiation
Speaker: Hak Choy (USA)
Significance and Clinical Value of Circulating Tumour
(7B-3)
Cells Speaker: Yasuhiro Koh (Japan)
Oral Free Paper Presentation
Concurrent Session 7C:
Lung Cancer Research
Chairpersons:
Yong-Kek Pang (Malaysia) &
Gwo-Fuang Ho (Malaysia)
Venue:
Selangor Room, Basement II Level
Organising a Collaborative Clinical Trial - Opportunities and
Challenges
(7C-1)
Speaker: James Yang (Taiwan)
Clinical Trials in the Digital Era: How to Exploit the Web in Research
(7C-2)
Speaker: Tom Ruane (UK)
Establishing a Web Registry for Lung Cancer Research
(7C-3)
Speaker: Tom Ruane (UK)
1530 – 1600
Networking Break & Poster Viewing
1600 - 1730
The Great Debate: Chemo surgery is Better Than Chemo RT in Stage 3A N2 Disease
Proposer: Agasthian Thirugnanam (Singapore)
Opposer: Hak Choy (USA)
Chairpersons: Tony Mok (Hong Kong) & Hisao Asamura (Japan)
Venue: Sabah Room, Basement II Level
1730 - 1900
Industry Sponsored Evening Symposium by AstraZeneca
Venue: Selangor Room, Basement II Level
1930 - 2200
Conference Dinner
Venue: Grand Ballroom, Basement II Level
Oral Free Paper Presentation D & E
Venue: Penang & Kelantan Room, Lower Lobby Level
1100 - 1230
1400 - 1430
Concurrent Session 5C:
Smoking and Cancer
Chairpersons:
Abdul Razak Muttalif (Malaysia) &
Tubagus Djumhana Atmakusuma (Indonesia)
Venue: Selangor Room, Basement II Level
21
Scientific Programme
Saturday, 8 November 2014
Time (hrs)
Saturday, 8 November 2014
0630 – 1800
Registration
0815 - 0900
(P3) Plenary 3:
Early Diagnosis of Lung Cancer - Evidence and Challenges
Speaker: Silvia Novello (Italy)
Chairperson: Roslina Abdul Manap (Malaysia)
Venue: Sabah Room, Basement II Level
0900 - 1030
Concurrent Session 8A:
Lung Cancer Screening
Chairpersons:
Sai-Hong Ignatius Ou (USA) & Natthaya Triphuridet (Thailand)
Venue: Sabah Room, Basement II Level
Concurrent Session 8C:
Radiotherapy Technology
Chairpersons:
Lye-Mun Tho (Malaysia) & David Ball (Australia)
Venue: Selangor Room, Basement II Level
KRAS Mutations - What are their Significance?
Speaker: Tetsuya Mitsudomi (Japan)
From Stereotactic Ablative RT for Small Target to
Intensity Modulated RT for Large Target in Treating Lung Cancer
(8C-1)
Speaker: Yong Chan Ahn (Korea)
0900 - 0930
(8A-1)
Risk Stratification for Lung Cancer Screening
Speaker: Sai-Hong Ignatius Ou (USA)
(8B-1)
0930 - 1000
(8A-2)
Volumetric CT Scan for Nodule Assessment
Speaker: Ho Yun Lee (South Korea)
Neuroendocrine Tumours of the Chest - How to Manage Them?
(8B-2)
Speaker: Qing Zhou (China)
1000 - 1030
(8A-3)
Implementation of LDCT Screening: Cost-Effectiveness and Challenges
Speaker: Natthaya Triphuridet (Thailand)
Concurrent Session 9A:
Immune Therapies and Vaccines
Chairpersons:
Fred Hirsch (USA) & Roslina Abdul Manap (Malaysia)
Venue: Sabah Room, Basement II Level
Concurrent Session 9B:
Radiation Therapy
Chairpersons:
Matin Mellor (Malaysia) & Azura Daniel (Malaysia)
Venue: Sarawak Room, Basement II Level
An Overview of the Human Immune System in Lung Cancer
Speaker: Ross Andrew Soo (Singapore)
Trimodality and Bimodality Therapy for Stage III NonSmall Cell Lung Cancer: Experience at Samsung Medical Center
(9B-1)
Speaker: Yong Chan Ahn (Korea)
An Update on Immune Therapy
Speaker: David Carbone (USA)
Safe Dosimetric Predictors to Minimise RT Induced Pneumonitis,
Is There a Role for Dose Escalation?
(9B-2)
Speaker: Laurie Gaspar (USA)
1130 - 1300
1130 - 1200
(9A-1)
1200 - 1230
(9A-2)
1230 - 1300
(9A-3)
1300 - 1315
Approach to patients with Undifferentiated Histological types
(8B-3)
Speaker: Qing Zhou (China)
(8C-2)
Adaptive and Image-Guided RT for Lung Cancer
Speaker: David Ball (Australia)
Chemoradiotherapy for Stage III Disease:
Optimizing the Dose Fractionation and Chemotherapy Schedules
Speaker: Lye-Mun Tho (Malaysia)
(8C-3)
Novartis Symposium
Achieving Precision with Biomarkers in Clinical Decision-Making: Targeted Molecular Therapy in Advanced NSCLC
Venue: Sabah Room, Basement II Level
1030 - 1130
22
Concurrent Session 8B:
Management of Lung Cancer with Uncertain Significance
Chairpersons:
Chong-Kin Liam (Malaysia) & Caicun Zhou (China)
Venue: Sarawak Room, Basement II Level
Lung Cancer Vaccines - is it a Realistic Option?
Speaker: Solange Peters (Switzerland)
Biologic Strategies to Improve Radiotherapy Outcomes
(9B-3)
Speaker: David Ball (Australia)
Closing Ceremony
Concurrent Session 9C:
Surgical Therapy
Chairpersons:
Balaji Badmanaban (M’sia) & Anand Sachithanandan (M’ysia)
Venue: Selangor Room, Basement II Level
Surgical Challenges Post-Induction Chemotherapy or
Chemoradiation therapy
(9C-1)
Speaker: Hisao Asamura (Japan)
(9C-2)
Personalising Surgery Based on Lung Biomarkers
Speaker: Tetsuya Mitsudomi (Japan)
Chest Wall Resection and Reconstruction in Lung Cancer Surgery
Speaker:
(9C-3)
Aneez D.B Ahmed (Singapore)
SPEAKERS
Content
Speaker
Abstracts
(P1) Plenary 1:
Outcome of patients with advanced NSCLC
in the era of molecular diagnosis and targeted treatment
Speaker: (P1-1) Yoichi Nakanishi (Japan)
Speaker: (P1-2) Sumitra Thongprasert (Thailand)
25
25
25
(1A-1) Updates on Lung Cancer Staging and Classification
Speaker: Peter Goldstraw (UK)
25
25
(1A-3) Imaging in light of the New Lung Cancer Staging
Speaker: Lynette Teo (Singapore)
25
25
(1B-1) Recent Advances In Genomics - from the Lab to the Bench
Speaker: David Carbone (USA)
25
25
(1B-2) Next Generation Sequencing for Molecular Sub-typing
Speaker: Sai-Hong Ignatius Ou (USA)
25
25
(1B-3) Novel Targets in NSCLC
Speaker: Keunchil Park (South Korea)
26
26
(1C-2) How to Increase the Chance of Securing a Research Grant?
Speaker: CaiCun Zhou (China)
26
26
(2A-1) Chemotherapy in the Era of Expanded Choices
Speaker: Mark Vincent (Canada)
26
26
(2A-2) Challenges in Maintenance Therapy?
Speaker: Michael Boyer (Australia)
26
26
(2A-3) Adjuvant Chemotherapy
Speaker: CaiCun Zhou (China)
26
26
(2C-1) Tumour Biology and Genetics of Lung Squamous Cell Carcinoma
Speaker: Tetsuya Mitsudomi (Japan)
26
26
(2C-2) Therapeutic Options in Advanced Squamous Cell Lung Cancer
Speaker: Ross Soo (Singapore)
27
27
(2C-3) Fibroblast Growth Factor Receptor 1 as a Target in Squamous Cell Lung Cancer
Speaker: Byoung Chul Cho (South Korea)
27
27
(3A-2) Surgical Techniques for Staging
Speaker: Balaji Badmanaban (Malaysia)
27
27
(3A-3) PET-CT in Staging of Lung Cancer
Speaker: Felix Sundram (Malaysia)
27
27
(3B-1) How to Make the Most from Limited Tissue Sample?
Speaker: Pathmanathan Rajadurai (Malaysia)
27
27
(3B-3) Re-biopsy When Disease Progresses - What do We Test?
Speaker: James Chung-Man Ho (Hong Kong)
27
27
(3C-2) Strategies I Employ to Overcome Funding Limitation
Speaker: Sudsawat Laohavinij (Thailand)
28
28
(3C-3) How I Balance Guidelines Recommendation and Reality
Speaker: Soe Aung (Myanmar)
28
28
(3C-4) Incorporating Cost Effectiveness Analysis in Lung Cancer Management
Speaker: Unchalee Permsuwan (Thailand)
28
28
(4A-1) Integrating Palliative Care and Oncology Treatment for Lung Cancer
Speaker: Ednin Hamzah (Malaysia)
28
28
(4A-3) End-of-Life Care in Advanced Lung Cancer
Speaker: Richard Lim (Malaysia)
28
28
(4B-1) Best Strategy in Deploying Immunohistochemical Tests
Speaker: Pathmanathan Rajadurai (Malaysia)
28
28
(4B-2) Pitfalls in Interpreting Pathological Slides
Speaker: Angela Maria Takano Pena (Singapore)
29
19
(4B-3) Tips and Tricks during Rapid on-site Evaluation (ROSE)
Speaker: Angela Maria Takano Pena (Singapore)
29
29
(4C-1) Roles of Chemotherapy and Radiotherapy in Thymic Tumours
Speaker: Francoise Mornex (France)
29
29
(4C-2) Pulmonary Metastasectomy - Indication, Techniques and Long-term Outcomes
Speaker: Anand Sachithanandan (Malaysia)
29
29
(4C-3) Stereotactic Ablative Body Radiotherapy (SABR) for Pulmonary Metastases
Speaker: David Ball (Australia)
30
30
(5A-3) Resistance to ALK/ROS1 Inhibitors - What Options Do We Have?
Speaker: Sai-Hong Ignatius Ou (USA)
30
30
(5B-1) Solitary Lung Nodule - What is the Best Approach?
Speaker: Pyng Lee (Singapore)
30
30
(5B-3) Role of Stereotactic Body Radiotherapy (SBRT) for Early Lung Cancer
Speaker: Brian Collins (USA)
30
30
(5C-1) Prevalence of Smoking in the Asia Pacific Region
Speaker: Tara Singh Bam (Indonesia)
30
30
(5C-2) Smoking and Tumour Induction
Speaker: Carolyn Dresler (USA)
30
30
(5C-3) Nicotine and its Effects on Lung Cancer Treatment
Speaker: Carolyn Dresler (USA)
31
31
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SPEAKERS
Content
Speaker
Abstracts
24
(6A-1) Tobacco Control Policies: Challenges in their Implementation
Speaker: Zarihah Zain (Malaysia)
31
31
(6A-2) What are the Ingredients of Success for a Smoking Cessation Clinic?
Speaker: Mohd Haniki (Malaysia)
31
31
(6B-2) Diagnostic Pathway for Patients with Suspected Malignant Effusion
Speaker: Kunji Kannan (Malaysia)
31
31
(7A-1) Recent Insights in the Biology of SCLC
Speaker: David Carbone (USA)
31
31
(7A-2) Updates in Systemic Management of SCLC
Speaker: Solange Peters (Switzerland)
31
31
(7B-1) Is there a Role for Adjuvant TKI in Early Lung Cancer?
Speaker: Yi-Long Wu (China)
31
31
(7B-2) Targeted Therapies in Combination with Radiation
Speaker: Hak Choy (USA)
31
31
(7B-3) Significance and Clinical Value of Circulating Tumour Cells
Speaker: Yasuhiro Koh (Japan)
32
32
(7C-2) Clinical Trials in the Digital Era: How to Exploit the Web in Research
Speaker: Tom Ruane (UK)
31
31
(7C-3) Establishing a Web Registry for Lung Cancer Research
Speaker: Tom Ruane (UK)
32
32
(P3) Plenary 3: Early Diagnosis of Lung Cancer - Evidence and Challenges
Speaker: Silvia Novello (Italy)
32
32
(8A-1) Risk Stratification for Lung Cancer Screening
Speaker: Sai-Hong Ignatius Ou (USA)
32
32
(8A-2) Volumetric CT Scan for Nodule Assessment
Speaker: Ho Yun Lee (South Korea)
33
33
(8A-3) Implementation of LDCT Screening: Cost-Effectiveness and Challenges
Speaker: Natthaya Triphuridet (Thailand)
33
33
(8B-1) KRAS Mutations - What are their Significance?
Speaker: Tetsuya Mitsudomi (Japan)
34
34
(8B-2) Neuroendocrine Tumours of the Chest - How to Manage Them?
Speaker: Qing Zhou (China)
34
34
(8B-3) Approach to patients with Undifferentiated Histological types
Speaker: Qing Zhou (China)
34
34
(8C-1) From Stereotactic Ablative RT for Small Target to
Intensity Modulated RT for Large Target in Treating Lung Cancer
Speaker: Yong Chan Ahn (Korea)
35
35
(8C-2) Adaptive and Image-Guided RT for Lung Cancer
Speaker: David Ball (Australia)
35
35
(8C-3) Chemoradiotherapy for Stage III Disease:
Optimizing the Dose Fractionation and Chemotherapy Schedules
Speaker: Lye-Mun Tho (Malaysia)
35
35
(9A-1) An Overview of the Human Immune System in Lung Cancer
Speaker: Ross Andrew Soo (Singapore)
35
35
(9A-2) An Update on Immune Therapy
Speaker: David Carbone (USA)
36
36
(9A-3) Updates in Systemic Management of SCLC
Speaker: Solange Peters (Switzerland)
36
36
(9B-1) Trimodality and Bimodality Therapy for Stage III
Non-Small Cell Lung Cancer: Experience at Samsung Medical Center
Speaker: Yong Chan Ahn (Korea)
36
36
(9B-2) Safe Dosimetric Predictors to Minimise RT Induced Pneumonitis,
Is There a Role for Dose Escalation?
Speaker: Laurie Gaspar (USA)
36
36
(9B-3) Biologic Strategies to Improve Radiotherapy Outcomes
Speaker: David Ball (Australia)
36
36
(9C-1) Surgical Challenges Post-Induction Chemotherapy or Chemoradiation therapy
Speaker: Hisao Asamura (Japan)
37
37
(9C-2) Personalising Surgery Based on Lung Biomarkers
Speaker: Tetsuya Mitsudomi (Japan)
37
37
(9C-3) Chest Wall Resection and Reconstruction in Lung Cancer Surgery
Speaker: Aneez D.B Ahmed (Singapore)
37
37
SPEAKERS
Speaker Abstracts
consensus report of the International Association for the Study of Lung Cancer and the
International Mesothelioma Interest group. J Thorac Oncol 6, 1304-1312. 2011.
(P1) Plenary 1: Outcome of patients with advanced NSCLC in the era of
molecular diagnosis and targeted treatment
Speaker: (P1-1) Yoichi Nakanishi (Japan)
A consideration to ethnic difference is getting more important for lung cancer
medicine. A nation-wide registry study conducted in Japan has shown that
prognoses of Japanese patients with lung cancer is better than those of Caucasian
patients despite of disease stages; the follow-up data of 14,695 Japanese patients
newly diagnosed as having lung cancer in 2002 indicate that 5-year survival rates
were 66.0% for surgery, 13.3% for radiotherapy and 6.5% for drug therapy. In
addition, in western countries MST obtained by platinum doublet therapy for
metastatic NSCLC is nearly 9 months, while in Japan 13 to 14 months. The better
prognoses would be, at least in part, depend on difference in distribution of gene
mutation status such as epidermal growth factor receptor (EGFR) gene, i.e., 30-40
% in Asian patients with NSCLC vs. 8% in Caucasian patients. Japanese clinical
practice guideline and guidance indicate that some clinical biomarkers such as
EGFR gene mutation, EML4-ALK fusion gene, and uridine diphosphate
glucuronosyltransferase (UGT 1A1) genotype should be tested for appropriate
lung cancer patients. And today in Japan, these biomarker tests are covered by the
national health care program as well as treatment with certain targeted drugs and
cytotoxic agents. Therefore, most patients with lung cancer in Japan receive these
tests as a daily practice, if their performance status and organ function are judged
to be eligible for these drug therapy. Today, MST of longer than 24 months is
obtained by EGFR TKI, if a patient harbors EGFR gene mutation. Here,
characteristics of lung cancer in Japanese patients, general aspects of medical
treatment and care system in Japan, and representative researches on lung
cancer in Japan are reviewed.
(5)
Rusch VW, Giroux DJ, Kennedy C, Ruffini E, Cangir AK, Rice D, et al. Initial Analysis of
the International Association for the Study of Lung Cancer Mesothelioma database. J
Thorac Oncol 7, 1631-1639. 2012.
(6)
Pass HI, Giroux DJ, Kennedy C, Ruffini E, Cangir AK, Rice D, et al. Supplementary
Prognostic Variables for Pleural Mesothelioma: A report from the IASLC Staging
Committee. J Thorac Oncol 9, 856-864. 2014.
(7)
Detterbeck FC, Asamura H, Crowley J, Falkson C, Giaccone G, Giroux G, et al. The
IASLC/ITMIG Thymic Maliganancies Staging Project: Development of a stage
classification for thymic malignancies. J Thorac Oncol 8, 1467-1473. 2013.
(8)
Detterbeck FC, Stratton K, Giroux G, Asamura H, Crowley J, Falkson C, et al. The
IASLC/ITMIG Thymic Epithelial Tumors Satging Project: Proposal for an Evidence
Based Stage Classification System for the Forthcoming (8th) Editon of the TNM
Classification of Malignant Tumors. J Thorac Oncol 9, S65-S72. 2014.
(9)
Nicholson AG, Detterbeck FC, Marino M, Kim J, Stratton K, Giroux G, et al. The
IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposals for the T component
of the forthcoming (8th) Edition of the TNM Classification of Malignant Tumors. J Thorac
Oncol S73[S80]. 2014.
(10)
Kondo K, van Schil P, Detterbeck FC, Okumura M, Stratton K, Giroux G, et al. The
IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposals for the N and M
components of the forthcoming (8th) Edition of the TNM Classification of Malignant
Tumors. J Thorac Oncol 9, S81-S87. 2014.
(11)
Bhora FY, Chen DJ, Detterbeck FC, Asamura H, Falkson C, Filosso PL, et al. The
IASLC/ITMIG Thymic Epithelial Tumors Staging Project:A proposed lymph node map for
thymic epithelial tumors in the forthcoming 8th edition of the TNM classification of
maligant tumors. J Thorac Oncol 9, S88-S96. 2014.
Speaker: (P1-2) Sumitra Thongprasert (Thailand)
(1A-3) Imaging in light of the New Lung Cancer Staging
Substantial progress has been made in the treatment of non-small cell lung cancer
(NSCLC) during the last 10 years. For several decades, the standard first line
treatment of non-small cell lung cancer is doublet chemotherapy. For second line
treatment, docetaxel was the only approved agent, the third and fourth line
chemotherapy seems to be futile.
Speaker: Lynette Teo (Singapore)
At the beginning of the 20th century, the major step occurred when EGFR
(Epidermal Growth Factor Receptor) was recognized as the oncogenic driven
gene and EGFR mutation was the targeted for the treatment. the result of the two
oral Tyrosine Kinase Inhibitor (TKI) which had efficacy as second and third line
treatment lead to the approval of the two drugs (gefitinib and erlotinib) in US,
Europe and Asia. Further research with these two drugs in specific population of
NSCLC (Adenocarcinoma with EGFR mutation) had confirmed the efficacy of TKI
as first line. Worldwide approval of gefitinib and erlotinib as first line treatment in
Adenocarcinoma with EGFR mutation lead to the major improvement in survival of
NSCLC.
In East and South East Asia, the incidence of EGFR mutation in Adenocarcinoma
was higher compare to US or Europe ( around 50% versus 25%). Thus, the
improvement in the outcome of NSCLC was noted, however the improvement was
not equal between the developed country and developing country in the region.
The improvement in survival outcome in developing countries was not as high as
developed country.
One of the most difficult decisions apart from the best selection of the patient to
receive the appropriate therapy is the high cost of that particular treatment.
Specifically, the cost of new generation chemotherapy such as taxanes, anti-HER2 targeted therapies: Trastuzumab, and/or the prophylactic use of filgrastim
markedly increase the cost of adjuvant chemotherapy regimens. There are
significant differences in the cost of various commonly used regimens. The cost of
these drug combinations may vary from country to country. Cost is thus one of
several considerations in the selection of optimal therapy for an individual patient.
(1A-1) Updates on Lung Cancer Staging and Classification
Speaker: Peter Goldstraw (UK)
The audience will be reminded of the process for revision of the TNM Classification
for Lung Cancer as it was from inception until the involvement of the IASLC and its
Staging project(1), the benefits that this initiative brought about for the 7th edition,
published in 2009(2). The revision cycle is now under way and the 8th edition will be
published late in 2016 and enacted in January 2017. The IASLC Staging and
Prognostic Factors Committee now has a much wider remit with Domains in Lung
Cancer(3), Malignant Pleural Mesothelioma(4-6), Thymic Epithelial tumours(7-11),
and Cancer of the Oesophagus and Oesophago-gastric junction. The efforts to
date in each of these primary sites at different levels of completion. Progress will be
described and future plans outlined. The proposals for lung cancer are nearing
completion and the audience will be given an early opportunity to hear the changes
to the TNM classification that are being considered for the 8th edition.
(1)
Goldstraw P, Crowley J, IASLC International Staging Project. The IASLC International
Staging Project on Lung Cancer. Journal of Thoracic Oncology 1, 281-286. 2006.
(2)
Goldstraw P. IASLC Staging Manual in Thoracic Oncology. 1st ed. Florida, USA:
EditorialRx Press; 2009.
(3)
Rami-Porta R, Bolejack V, Giroux DJ, Chansky K, Crowley J, Asamura H, et al. The
IASLC Lung Cancer Staging Project: The new database to inform the eigth edition of the
TNM classification of lung cancer. J Thorac Oncol 2014;9:00.
(4)
Rice D, Rusch V, Pass H, Asamura H, Nakano T, Edwards J, et al. Recommendations for
Uniform Definitions of Surgical Techniques for Malignant Pleural Mesothelioma: A
The 7th lung TNM classification was revised in January 2010 and given its
existence for more than 4 years, it is not exactly new. As this classification is based
on a larger surgical and non-surgical cohort from an international lung cancer
database from more than 19 countries, it is more accurate in terms of outcome
prediction compared to the previous classification.
The changes in T staging include reclassification of the size and location of the
primary tumour and satellite nodules. The new system has 5 size-based categories
divided by 2, 3, 5 and 7 cm. Any tumour larger than 7 cm is now classified as T3
(previously was T2). If satellite nodules are in the same lobe, there is downstaging
from T4 to T3. Satellite nodules outside primary lobe, but in same lung are also
downstaged from M1 to T4, rendering suitability for pneumonectomy. The
malignant pleural effusion has been upstaged from T4 to M1.
Given improved computed tomography (CT) technology and the established role of
positron emission tomography (PET), imaging has an important role in the staging
of lung cancer. This talk attempts to illustrate what has changed between the 6th
and 7th classifications and to highlight the increasing role of PET in staging of lung
cancers. It must be pointed out that the database utilized for the 7th TNM
classification did not include any PET studies. With more data from PET studies, it
is most certain that this would be taken into consideration in the 8th edition due in
2018.
(1B-1) Recent Advances In Genomics - from the Lab to the Bench
Speaker: David Carbone (USA)
Genomic analysis of lung adenocarcinoma has transformed the management of
this disease in the last 10 years, and continues to provide novel targets for therapy
testing. Whereas all NSCLC were treated the same, with first line doublet
chemotherapy for good performance status patients, we are now in an era where
laboratory analysis directly drives clinical decision making and patients should be
tested for driver mutations before starting any therapy, as the quality of life and
probably overall survival is improved with this approach. Besides EGFR and ALK,
the next wave of clinically active driver oncogene targets such as BRAF and HER2
is showing clinical activity. Genetic analysis of squamous and small cell lung
cancer is lagging behind, but also with some promising signals. Inherited
mutations in the EGFR, while rare, are also an important consideration in the care
of lung cancer patients.
(1B-2) Next Generation Sequencing for Molecular Sub-typing
Speaker: Sai-Hong Ignatius Ou (USA)
The use of targeted deep sequencing, whole exome sequencing, RNA sequencing
and whole genome sequencing have led to identification of many kinase fusions in
lung cancer. This presentation will give a quick review of the various kinase fusions
identified in lung cancer to date. The importance of these kinase fusions in other
solid tumors other than lung cancer will also be discussed. Furthermore
rearrangement resulting in non-kinase fusion in lung cancer will also be discussed.
Finally the use of next generation sequencing (NGS) in directing treatment arms in
lung cancer (Lung-MAP) will be discussed. It is likely that the wider use of NGS as
time goes on should result in multiple therapeutic break-through in many subtypes
of lung cancer.
25
SPEAKERS
Speaker Abstracts
(1B-3) Novel Targets in NSCLC
Speaker: Keunchil Park (South Korea)
Traditionally the treatment decision was based upon the histopathologic
classification of the lung cancer. During the past decade we have witnessed a great
progress in the management of advanced non-small cell lung cancer(NSCLC).
Precision cancer medicine with the introduction of molecularly targeted agents for
a subset of patients with the corresponding targets is now commonly taking place in
the daily practice. The discovery of the EGFR gene mutations and ALK-EML4 gene
rearrangements in NSCLC paved the way for precision medicine in lung cancer
and represent two prototypes of targeted therapy for oncogene-addicted cancers.
However these driver genes, like the activating EGFR mutations or ALK fusions do
not occur in every patient. EGFR mutations occur in up to 60-70% in some East
Asian ethnicity but only in 10-20% in the Caucasian ethnicity. ALK gene
rearrangements have been reported in 3-7% of NSCLC patients. With increasing
interest and applicability of comprehensive genomic/molecular profiling of lung
cancer patients, there are emerging new potentially targetable oncogenes.
Today I am going to discuss the newly emerging data on potential targetable nonEGFR, non-ALK oncogenes, e.g., RET, ROS, BRAF, HER2 etc. which are under
clinical development.
(1C-2) How to Increase the Chance of Securing a Research Grant?
Speaker: CaiCun Zhou (China)
The advances in the understanding of biomedical and life science are dependent
on research. Although research grants for basic/translational investigation in
cancer are increasing in recent years, the rapid development of molecular biology
raises a challenge to successful application and use of research grant. Therefore,
how to secure a research grant and successfully achieve research aim is very
important. The topic is focused on how to increase the chance of securing a
research grant. Firstly, the importance of the research grant in our scientific career
will be discussed. In our scientific career, research is just one element. Grant is
another significant part of career development. Not only can it support the
development of your research career, but also it can develop your overall scientific
career. Then, a series of strategies on increasing the possibility of securing a
research grant will be introduced, including reading published literatures carefully,
understanding the requirements of grant application and grant writing. Finally, it is a
challenge to let research grant successful in cancer research, especially in lung
cancer. A meaningful and successful research should address important problems
in clinical practice. For example, resistance to targeted drugs and tumor
heterogeneity are the critical barriers to progress in personalized therapy of lung
cancer. The studies on mechanism of resistance to EGFR or ALK inhibitors and
tumor heterogeneity have been published in New England Journal of Medicine,
and pushed the progress in overcoming resistance to targeted drugs. To secure
research grant more efficiently, we should focus on the hot spots in cancer
research that is closely correlated with clinical practice.
(2A-1) Chemotherapy in the Era of Expanded Choices
Speaker: Mark Vincent (Canada)
Dr. Mark Vincent received his MD from the University of Cape Town in 1976, trained
in Oncology at The Royal Marsden Hospital in London, England and came to
Canada in 1987. Currently he is a Professor at the Schuluch School of Medicine
and Dentistry, Western University, where he helped to motivate, invent, and
develop an algorithm for the systemic therapy of advanced nonsmall lung cancer
which has now has been the subject of a publication (Current Oncology, 2009), and
numerous invited lectures. He also developed a computer-based decision aid for
comparing risk-benefit profiles of different regimes. He had received awards for his
teaching expertise back in 2004 and 2007.
Dr. Vincent is a CEO, Co-Founder and President for Sarissa Inc. and also an
experience consultant for numerous pharma companies. Aside from that, he is an
active member of several scholarly and professional memberships.
Dr. Vincent has lectured widely on lung cancer and colorectal cancer throughout
the world and have over 200 publications, journals, abstracts and poster
presentations.
(2A-2) Challenges in Maintenance Therapy?
Speaker: Michael Boyer (Australia)
In recent years, major advances have been made in the management of non-small
cell lung cancer through the recognition of driver mutations, and the use of
appropriate therapies targeting these mutations. Despite the success of this
approach, it is only applicable to a minority of patients and chemotherapy remains
the mainstay of therapy in the remainder. Therefore improvements in outcomes for
these patients requires the optimisation of chemotherapy.
26
Standard chemotherapy comprises 4 6 cycles of a platinum containing doublet,
with the addition of bevacizumab (in some countries) for appropriate patients. In an
effort to improve survival, switch maintenance (where a new agent is introduced
immediately following first line chemotherapy and continued till progression), and
continuation maintenance (where a component of initial treatment is used in the
same way) approaches have been evaluated. Several randomised trials, along
with a meta-analysis have demonstrated that both of these approaches improve
progression free and overall survival. Pemetrexed has been evaluated for switch
and continuation maintenance, while gemcitabine and erlotinib have been
evaluated for switch maintenance only.
There are some differences in the patient populations who seem to benefit from
maintenance therapy based on the agents used. In the SATURN study, patients
received switch maintenance with erlotinib if they had not progressed after 4 cycles
of platinum based chemotherapy. Although there was an overall survival benefit
(HR 0.81 95 % confidence interval 0.70 0.95), this was restricted to those patients
whose best response to induction chemotherapy was stable disease (HR 0.72;
0.59 0.89). Patients with PR or CR had minimal benefit (HR 0.94; 0.74 1.20). By
contrast, in the PARAMOUNT study, which was restricted to non-squamous
tumours and used continuation maintenance with pemetrexed following 4 cycles of
cisplatin and pemetrexed, overall survival was improved in the entire population,
and this was independent of response to induction therapy (0.78; 0.64 0.96). In
both studies, maintenance therapy was well tolerated, with few patients ceasing
therapy due to toxicity.
Although the use of maintenance treatment improves survival outcomes, some
questions remain. There are no data comparing different maintenance therapies.
In addition, it is unclear whether maintenance therapy truly needs to continue
indefinitely (as was the case in the randomised trials examining it) or whether it can
be ceased or given less frequently after a certain amount or treatment has been
given. Finally, there is little information to help identify the ideal patient who will
derive the greatest benefit. Despite these issues, maintenance therapy is an
important part of the management of advanced, non-mutated, non-small cell lung
cancer.
(2A-3) Adjuvant Chemotherapy
Speaker: CaiCun Zhou (China)
Non-small cell lung cancer (NSCLC) is one of the most common lethal tumors in the
world. To date, surgery remains optional therapy for early-stage NSCLC. But
surgery alone could not cure all of resected patients and relapse rate remains high,
suggesting systemic therapy is needed in some cases.
Several randomized phase III trial investigated role of adjuvant chemotherapy in
NSLCC. We observe significant improvement of disease-free survival and overall
survival with adjuvant chemotherapy. The therapy is well tolerated. Afterwards, two
meta-analyses were published. In LACE, 5 randomized phase III trials were
included. 5.4% absolute benefit at 5 years was found with adjuvant chemotherapy.
The risk of disease relapse was decreased by 16%. Adjuvant chemotherapy
proves effective in those with stage II and IIIA disease and may be detrimental in
those with stage IA disease. The patients with ≧
4cm tumor could benefit from
adjuvant chemotherapy. Elderly patients could tolerate adjuvant chemotherapy
and achieve the same efficacy. Cisplatin/vinorelbine is widely studied in adjuvant
setting. Carboplatin-based chemotherapy is acceptable too and often used in the
elderly.
Some strategies have been investigated to improve the efficacy of adjuvant
therapy. Some markers, such as ERCC1, RRM1, p53, Bax, tubulin etc, are found to
be prognostic and predictive for adjuvant chemotherapy. But recent LACE-bio
failed to find predictive and prognostic effects of the markers. EGFR TKI was found
to improve disease free survival in those with positive EGFR mutation but not
overall survival according to RADIANT trial. So, EGFR TKI should not routinely
used as adjuvant therapy even in those with positive EGFR mutation. Again,
vaccination with adjuvant melanoma associated antigen A3 (MAGE-A3) did not
increase DFS compared to placebo in the overall population or in patients with
positive MAGE-A3 on IHC. Adjuvant radiotherapy is not accepted in early staged
NSCLC. It is detrimental on overall survival in those with stage I and II or N0 or N1
disease.
(2C-1) Tumour Biology and Genetics of Lung Squamous Cell Carcinoma
Speaker: Tetsuya Mitsudomi (Japan)
Despite remarkable advances in chemotherapy as well as targeted therapy for
adenocarcinoma of the lung, there has been few progress in the treatment of
squamous cell carcinoma since the turn of the century, either due to lack of efficacy
(pemetrexed, EGFR-TKI, or ALK-TKI etc) or due to toxicity (bevacizumab).
However, the comprehensive genomic characterization of squamous cell lung
cancers conducted by The Cancer Genome Atlas identified several significantly
altered pathways including NFE2L2 andKEAP1 in34%, squamous differentiation
genes in44%, PI3K pathway genes in 47%, and CDKN2A and RB1 in 72% of
tumors. Several of these are potentially “druggable” mutations that are crucial for
the maintenance of malignant phenotype.
Activation of fibroblast growth factor receptor family gene (FGFR1) amplification is
present in 20-25% of the cases and an FGFR inhibitor suppressed growth and
induced apoptosis in vitro and in vivo. Alterations of other receptor tyrosine kinases
including EGFR amplification (~10%), PDGFRA amplification/mutation (9%),
DDR2 mutation (~4%), ERBB2 amplification (~2%) could be targeted by their
respective inhibitors.
Mutations or copy number alterations of NFE2L2 (Nuclear factor, erythroid 2-like 2)
and KEAP1 (Kelch like-ECH-associated protein) and/or deletion or mutation of
CUL3 are found in ~30% of cases. These genes are involved in the oxidative stress
SPEAKERS
Speaker Abstracts
response and genomic alterations resulting in NFE2L2 activatiion are thought to
make cancer cells resistant to chemotherapy by constitutive induction of
cytoprotective enzymes and drug efflux pumps. It has been shown that the
inhibition of NFE2L2 in these cells could be used to enhance chemotherapeutic
sensitivity.
In addition, other recent advances in molecular biology of squamous cell
carcinoma of the lung and their therapeutic implications will be reviewed in this talk.
(2C-2) Therapeutic Options in Advanced Squamous Cell Lung Cancer
Speaker: Ross Soo (Singapore)
Advances in the understanding of tumor biology have led to improved treatment
outcomes for patients with advanced stage non-small cell lung cancer (NSCLC).
This has occurred through the use of molecular targeted therapy of actionable
oncogenes such as EGFR, EML-ALK, and ROS1 in patients with advanced stage
lung adenocarcinoma. It is also recognized the treatment of NSCLC should be
based on histology with differences in efficacy (for pemetrexed) and toxicity (for
anti-angiogenic agents). Treatment options in the treatment of squamous cell lung
cancer remain limited. This presentation will summarise treatment options in the
1st, 2nd line for patients with advanced stage squamous cell lung cancer including
recent phase III trial data with EGFR inhibitors and early phase immunotherapy
studies. Molecular changes in squamous cell lung cancer have been identified and
clinical studies targeting these genetic alterations are ongoing.
(3A-3) PET-CT in Staging of Lung Cancer
Speaker: Felix Sundram (Malaysia)
LUNG cancer is a common cause of cancer related death in many
countries,especially in the West, with 80 85 % being non small cell lung carcinoma
(NSCLC). CT provides good anatomic resolution ,but has limitations in
discriminating benign from malignant lesions .Positron emission tomography
(PET) yields functional/metabolic information ,using a tracer such as F-18
Fluorodeoxyglucose (FDG).A combination of both modalities produces PET/CT
images in a single study.
Accurate staging of lung cancer is important to decide treatment strategies and
prognosis. The TNM(7) staging is a widely used and generally acceptable staging
system. Integrated PET/CT imaging helps in more accurate staging non invasively.
The major importance of PET/CT is that it has a high negative predictive value, thus
contributing to reduced mediastinoscopies.PET/CT is useful when radical
treatment is considered for NSCLC ,especially in patients with small mediastinal
nodes on CT, and in patients with equivocal organ lesions that might be
metastases.
PET/CT imaging has contributed to stage migration (downstaging and upstaging)
in about 20 % of lung cancer patients.There are false positive and false negative
scans and examples of these , and Staging scans will be shown.Though the use of
PET/CT scans for staging will probably increase, further validation of PET/CT
scanning in Staging of lung cancer is most likely necessary.
(3B-1) How to Make the Most from Limited Tissue Sample?
(2C-3) Fibroblast Growth Factor Receptor 1 as a Target in Squamous Cell
Lung Cancer
Speaker: Byoung Chul Cho (South Korea)
Recent advances in molecular medicine and high-throughput sequencing
technologies have achieved major cancer strategies and therapeutics over the
past decades. For example, identification of oncogenic EGF receptor mutations
that are present in up to 20% of lung adenocarcinoma patients confer exquisite
sensitivity to EGF receptor inhibitors. However, currently known 'druggable' targets
are enriched in the subgroup of adenocarcinomas and individuals who have never
smoked. For patients with lung squamous cell carcinoma, the standard-of-care is
still cytotoxic chemotherapy. Research is ongoing to identify driver mutations as
well as targeted agents. Recently, fibroblast growth factor receptor1 (FGFR1) gene
amplification has been reported to be a novel druggable target in lung squamous
cell carcinoma. FGFR1 amplification is more commonly found in lung squamous
cell carcinoma than lung adenocarcinoma, its incidence ranging from 13 to 22%.
FGFR1 gene amplification is often associated with FGFR overexpression, which
leads to ligand-independent signaling FGFR1 amplification in lung squamous cell
carcinoma is required for the survival of FGFR1-amplified cell lines. Currently,
clinical reagents that target the FGFs and FGFRs are being developed accordingly.
My talk focuses on the emerging role of FGFR1 as a therapeutic target in lung
squamous cell carcinoma.
(3A-2) Surgical Techniques for Staging
Speaker: Balaji Badmanaban (Malaysia)
Surgical staging methods in lung cancer include mediastinoscopy,
mediastinotomy, video-assisted thoracoscopic surgery (VATS), rigid
bronchoscopy and scalene lymph node biopsy. The different surgical staging
options and their indications will be discussed in detail in particular
mediastinoscopy and VATS. With respect to mediastinal lymph node staging,
cervical mediastinoscopy is reported to have a sensitivity between 81 and 89%.
This mainly due to the fact, that some lymph node levels (# 8, 9, 5, 6) are not
accessible by the standard cervical approach. The morbidity and mortality of
cervical mediastinoscopy is in experienced centers only minimal. In series with
more than 1000 patients, the mortality was almost 0% and morbidity varied
between 0.5 and 1%. Cervical mediastinoscopy can be performed also as an
outpatient procedure. In addition to 'simple' lymph node staging, mediastinoscopy
clarifies the local resectability of central tumors (T-factor). Video-mediastinoscopy
allows that the procedure gets even more standardized and the sensitivity might be
improved in comparison to conventional mediastinoscopy. Since VATS is widely
accepted by the community of thoracic surgeons, it has become an important
staging tool in many situations. VATS can be used to rule out or confirm a
suspected contralateral lung metastasis. Furthermore, VATS is extremely useful to
exclude malignant pleural effusions in otherwise operable patients. This
examination can be done in the operating room immediately prior to formal
thoracotomy. Additionally, VATS is effective to explore the local resectability in
patients with suspected mediastinal infiltration or a lymphangiosis carcinomatosa
within the mediastinum. VATS allows an accurate staging of more than 90% of the
patients with suspected stage IIIB NSCLC. With respect to lymph node staging,
VATS is complimentary to cervical mediastinoscopy because it helps to stage the
lymph nodes in the A-P. window (#5, 6), as well as the lymph nodes
paraesophageal (#8) and in the pulmonary ligament (#9). In conclusion, surgical
staging methods provide a 100% specificity in combination with a high sensitivity
and only a minimal morbidity.
Speaker: Pathmanathan Rajadurai (Malaysia)
For optimal pathological diagnosis of lung cancer, it is always preferable for as
much biopsy tissue as possible to be obtained. However, this may not always be
possible. It behooves the pathologist therefore to be judicious in the utilization of
whatever precious resource and confer with the involved stake holders beforehand
to decide on how the tissue should be utilized. A multi-disciplinary team approach is
essential, so that the treating physician/s, the clinician performing the biopsy and
reporting pathologist are aware and sensitive to the requirements of the clinical
situation at hand. Care must be taken to ensure that important preanalytic factors
that may adversely impact testing are being addressed, ensure that all biopsy
fragments are processed, and to not waste tissue through excessively shaving of
the paraffin block in the processing steps. Immunohistochemical stains should be
limited to the absolute minimum, essentially to confirm that the tumour is a primary
pulmonary adenocarcinoma, and the rest of the sample should be preserved for
molecular analysis. To this end, in addition to core biopsies, cytology samples,
brushings, washings and effusions can be used to good measure for molecular
determination of mutational status, for analysis with mutation specific antibodies
and for FISH studies. In select cases, on-site evaluation for specimen adequacy
may guide the interventionist's hand, ensuring that suitable and adequate lesional
material is available for all possible tests in the repertoire. Enrichment of tumour
tissue by macro or microdissection may be necessary to improve the quality and
number of tumour cells subjected for testing. Current technologies to detect EGFR
mutations in lung cancer can achieve a sensitivity of up to 1 % and sensitivities of
0.1 % seem feasible soon. NGS (next generation sequencing) technologies
promise simultaneous determination of multiple genetic aberrations, identifying
ever more targets for personalized therapy. Analysis of circulating tumour cells and
cell free DNA is slowly becoming a reality, conceivably ushering in a time when
invasive sampling procedures may be minimized considerably.
(3B-3) Re-biopsy When Disease Progresses - What do We Test?
Speaker: James Chung-Man Ho (Hong Kong)
Lung cancer remains a global health threat with high mortality. In the past decade,
major advances in lung cancer treatment have emerged notably with the discovery
of driver mutations (e.g. epidermal growth factor receptor (EGFR), anaplastic
lymphoma kinase (ALK)) and their specific targeted therapies (tyrosine kinase
inhibitors, TKIs), predominantly in lung adenocarcinoma (ADC). There has been
ample clinical trial evidence that confirms the survival advantage of specific
targeted therapy among this subgroup of mutated lung ADC. Nonetheless, the
progression-free survival with first-line EGFR TKI or ALK TKI treatment in
advanced or metastatic lung ADC is typically under one year, with emergence of
acquired resistance almost inevitable. In recent years, clinical translational
research involving tumour rebiopsy at the time of progressive disease while on TKI
has been conducted, enabling greater insights into the molecular mechanisms of
acquired TKI resistance. Among various acquired resistance mechanisms to
EGFR TKI, occurrence of exon 20 T790M mutation accounts for 50-60% of cases,
while transformation to small cell carcinoma has been reported in up to 14%. The
rapid development of 3rd generation EGFR TKI, with specific inhibitory activity on
both EGFR activating and T790M mutants, may open up a preferred strategy to
specifically overcome T790M-related resistance in the near future. Similarly,
various acquired resistance mechanisms to ALK TKI have been elucidated through
tumour rebiopsy studies after failure to TKI. Interestingly, the acquired resistance
mechanisms to ALK TKI are more diverse, with both ALK-dependent and ALKindependent mechanisms. Knowledge of the exact mechanisms causing acquired
resistance may eventually allow logical combination treatments and possible
clinical trial options. Lastly, immune check-point blockade has recently emerged as
a promising strategy in treating lung cancer with or without actionable driver
27
SPEAKERS
Speaker Abstracts
mutations. Companion diagnostic biomarker (e.g. immunostaining for PD-L1) in
tumour rebiopsy is currently being evaluated as a predicting marker for
immunotherapy, which may serve as a salvage treatment upon disease
progression. In this era of targeted therapy for lung cancer, tumour rebiopsy
should become a standard-of-care that allows specific strategies to overcome
acquired drug resistance.
(3C-2) Strategies I Employ to Overcome Funding Limitation
(4A-1) Integrating Palliative Care and Oncology Treatment for Lung Cancer
Speaker: Sudsawat Laohavinij (Thailand)
Speaker: Ednin Hamzah (Malaysia)
Many countries in Asia Pacific region are still defined as low to middle income
economics countries which has limited resource for health care and also lung
cancer. Thailand is upper middle income economics country. Health care system
for Thai nationals is “Universal Health Care” which is provided through 3 programs,
civil servant medical benefit scheme (CSMBS), social security scheme (SSS), and
universal coverage scheme (UC) which cover 8%, 14%, and 78% of population
respectively.
Lung cancer is amongst the commonest cancers in the world. In Malaysia, it ranks
3rd and about 75% present in stage 3 and 4, making a palliative approach the most
likely course of action. Patients with lung cancer also have a multitude of symptoms
which causes distress and suffering to both patients and their families.
To maintain a sustainable universal health coverage scheme for equitable and
efficient benefit for lung cancer patients in Thailand we use 4 main strategies. First
strategy is capitation for out-patients payment for SSS and UC which covers major
population. Secondly we use diagnosis related groups (DRG) for in-patients
payment for all 3 health insurance schemes. The third strategy for the essential and
/or high cost or new innovative cancer drugs is cost effectiveness. We create
National list of essential medicine (NLEM) for cancer drugs by using evidence
based, cost effectiveness analysis, equity, availability, affordability, and budget
impact policies. Treatment protocols for common 11 cancers are used for
reimbursement in SSS and UC patients. All lung cancer patients in Thailand can
access to essential chemotherapy by lung cancer treatment protocol. For very high
cost drugs the restricted use with predetermined medical criteria and preauthorization process are used to control for the optimal use of targeted drugs for
lung cancer. However, the accessibility to targeted therapy for lung cancer in
Thailand is still low. The last strategy to reduce the cost of cancer treatment is
using quality controlled generic cancer drugs, price negotiation with pooled
purchase, single source price and reference price.
(3C-3) How I Balance Guidelines Recommendation and Reality
Speaker: Soe Aung (Myanmar)
International guidelines for the management of various cancers are not always
appropriate for the low and middle income countries (LMICs) especially when it
comes to metastatic setting where novel and targeted therapies play more and
more significant role in the management. In Myanmar, Lung cancer is the most
common cancer among male patients and the third commonest cancer among
female patients after breast and uterine cervical cancer. According to the hospitalbased cancer registry of the Yangon General Hospital, majority of these cases
(>50%) present in late stages (III and IV). Many factors come into play in actually
trying to implement the internationally established guidelines such as NCCN,
ASCO and ESMO guidelines in the management of these cases, namely, paucity
of up-to-par pathological facilities, poor imaging facilities, lack of effective health
insurance policies, cultural taboos and social stigma, huge disparity in oncological
health care access between urban and rural (remote) areas, insufficiency of
expertise, unavailability of therapeutic resources and, above all, lack of
multidisciplinary management approach. Apart from Myanmar, many other
regional countries share the same experience and, with ever-increasing incidence
of cancer globally, cancer control has become a tremendous challenge in the
region. To tackle this problem, the Asian Oncology Summit 2009 in Singapore
came up with 6 consensus management guidelines for 6 common cancers in Asia,
namely, advanced stage non-small-cell lung cancer, Her-2 positive breast cancer,
hepatocellular cancer, head and neck cancer, endometrial cancer, and T-cell and
natural-killer-cell neoplasm. In these guidelines the recommendations are
stratified into 4 categories in order to suit the 4-tiered resource levels and economic
capacity (basic, limited, enhanced, and maximum) as described previously by the
Breast Global Health Initiative. Since oncology is a rapidly evolving subject, even
these resource-tailored recommendations need to be modified over time. To
reflect the true situation in Myanmar, the management of all lung cancer patients
who sought treatment at the Yangon General Hospital Oncology Centre over a
period of 4 years (2003-2006) (n=561) was reviewed, analysed and discussed in
the context of above-mentioned international and regional guidelines. Many a
time, pragmatic approach seems to be more reasonable and sensible than
idealistic one in resource-limited setting.
(3C-4) Incorporating Cost Effectiveness Analysis in Lung Cancer
Management
Speaker: Unchalee Permsuwan (Thailand)
28
cost-utility analysis (CUA). CUA and CEA are the well-known methods in lung
cancer. Several aspects are needed to be addressed in economic evaluation such
as comparators, type of economic evaluation, measuring costs and outcomes,
time horizon, and sensitivity analysis. The economic evaluation can be conducted
along with well-design randomized controlled trial, or modeling-based technique.
Examples in both approaches are provided.
New cancer drugs usually have higher cost, but higher effect compared with
previous cancer drugs. Within limited budget, economic evaluation becomes
necessary to provide useful information to decision makers. The number of
economic studies in lung cancer has been tremendously rising since the year 2000.
There are four main full economic evaluations. Those are cost-benefit analysis
(CBA), cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), and
In Malaysia and many low resource countries, the traditional approach to lung
cancer is through the physician-oncology-surgery options and only when 'active'
treatment is no longer considered, a palliative care option is referred.
For many physicians and oncologists, a palliative care approach may simply mean
pain management or psychological intervention. An outcome of patient comfort
would be seen as a reasonable success.
Yet, good palliative care may deliver much more. In the past few years, new data
shows that early intervention of palliative care concurrent with good oncology
treatment not only improves quality of life but also enhances patient survival.
(4A-3) End-of-Life Care in Advanced Lung Cancer
Speaker: Richard Lim (Malaysia)
Despite advances in the detection, pathological diagnosis and therapeutics of lung
cancer, many patients still develop advanced, incurable and progressively fatal
disease. As physicians, the duties to cure sometimes, relieve often and comfort
always should always be a constant reminder to us of the needs that must be met
when caring for a patient with lung cancer. Although the area of palliative medicine
has taken a lead in providing knowledge, skills, services and policies to improve the
care of patients facing the end of life, majority of patients with advanced cancer
ultimately rely on the care of their primary physicians to provide them comfort and
dignity in this difficult time. It is therefore essential that physicians caring for
patients with lung cancer should be familiar with the principles and practices of end
of life care.
The key areas of end of life care in advanced lung cancer begin with first
recognising 'when a patient is approaching the end of life'. There is no clear
definition as to 'when a patient is at the end of his/her life' but more importantly is for
a clinician to be able to recognise when the focus of care needs to shift from an
aggressive life-sustaining approach to an approach that helps prepare and support
a patient and family members through a period of progressive inevitable decline.
This is where appropriate communication is paramount to the managment of a
patient in this phase.
Once the end of life is recognised, clear goals of care may be determined in order to
guide subsequent management which will be first and foremost to provide comfort
and dignity. Symptoms which are common towards the end of life in lung cancer
include pain, fatigue, dyspnoea, anorexia-cachexia syndrome, delirium and
respiratory secretions. Such symptoms need to be anticipated and addressed
promptly with appropriate medications and explanations to the patient and family.
Another important area of end of life care is advance care planning which not only
helps physicians but also family members to understand the choices and
preferences of the patient. This helps to provide care in line with patients' autonomy
and reduces ethical dilemmas of decision making in the terminal phase.
Lastly, in order for physicians to provide quality end of life care, it is necessary to
understand the ethical principles applied to end of life care interventions.
Misconceptions about euthanasia versus witholding or withdrawing life sustaining
treatments may lead to physician distress and inappropriate decision making.
(4B-1) Best Strategy in Deploying Immunohistochemical Tests
Speaker: Pathmanathan Rajadurai (Malaysia)
The pathologic diagnosis of lung cancer historically has relied primarily on
examining morphologic features of tumors in histologic sections. With the
emergence of new targeted therapies, the pathologist is called upon increasingly to
provide not only accurate typing of lung cancers, but also to provide prognostic and
predictive information, based on a growing number of ancillary tests, that are
critical to patient management. Although most primary non-small cell lung cancers
(NSCLC) can be diagnosed with confidence by light microscopy, when confronted
with a poorly differentiated malignancy and in complex clinical situations,
immunohistochemical (IHC) is useful in confirming or eliminating a diagnosis.
Small cell and neuroendocrine carcinomas can usually be diagnosed based on
their characteristic morphology, although a subset may require confirmation with
an antibody panel.
For NSCLC, IHC is useful for separating metastatic neoplasms that share
morphological similarities with lung and pleural neoplasms. A critical consideration
SPEAKERS
Speaker Abstracts
is that, since biopsy tissue is precious and often miniscule, unnecessary IHC tests
should be avoided, and preferably limited to two or three tests (TTF-1 / Napsin-A,
p40), with a view to confirming firstly, if the NSCLC is of a primary pulmonary
nature, and secondly, to determine if it is of adenocarcinoma or squamous
histology. The remaining tissue should be preserved for additional molecular tests,
to see if the patient may benefit from targeted therapy. Aside from core biopsies, it
must be remembered that suitably fixed and processed cytology specimens are
also amenable to immunohistochemical analyses.
Newer markers such as antibodies directed against thymidylate synthase, a
protein targeted by pemetrexed are being investigated for usefulness in predicting
response to therapy. In unique situations, when the accuracy of molecular tests is
comprised due to insufficient tumour cell numbers, mutation specific antibodies
directed against EGFR, ALK or even ROS-1 may play a role in providing the
oncologist with an answer for a therapeutic way forward.
(4B-2) Pitfalls in Interpreting Pathological Slides
Speaker: Angela Maria Takano Pena (Singapore)
There are certain difficulties intrinsic to the histopathologic interpretation small
biopsies of the lung and mediastinum, obtained
transbronchially or
transthoracically.
These difficulties are related to the small size of the sample, artefacts that can
occur during the technical processes and diagnostic difficulties due to poor
differentiation or unusual presentations.
Some common pitfalls include P40 or P63 positive tumours in non-smokers,
especially females in whom a possibility of metastatic cervical cancer needs to be
excluded.
diagnostic smears are seen, the evaluator could suggest one additional sample in
formaldehyde to perform the necessary immunhistochemical studies.
If the lesion is large, and the smears are showing only scanty material, the
evaluator should feel encouraged to ask for more material. Don't be shy, if the
patient is in good condition, there are no additional risks for pneumothorax or other
risks, go ahead, ask for more.
On the other side, if the tumour is small, and the amount of material obtained is little,
then there is an option: obtain a small touch prep to do the evaluation and, and
submit all the contents of the syringe in a liquid fixative. This material will be used
for IHC studies and molecular studies if needed.
One interesting problem that is presenting with more frequency recently, is the
presence of very scanty cellular material in TTNA rebiopsy specimens, even after
ROSE indicated that there were numerous tumour cells present. How does this
happen? We have observed that some tumours appear markedly fibrotic in the
core material and there are virtually no cells present. The explanation is that few
clusters of cells can be easily disloged during touch preparation at ROSE, and even
when they appear abundant on a smear, they are really scanty in the cores.
Material like this, is insufficient for molecular studies. In our case, we could scrape
the cytology slides to run an RT-PCR test (Cobas)Rfor the T790M, if needed.
ROSE of TBNA material in post-treatment cases also poses similar difficulties to
those seen in post-treatment TTNAs. The evaluator has to be aware of the initial
diagnosis and the clinical status.
It is ideal if the pulmonary physician has the aid of a cytotechnologist or
cytopathologist to do the ROSE. In some countries, like Japan, the pulmonary
physicians and thoracic surgeons are quite familiar with the histomorphology. If
someone, as a practicing pulmonologist, does not have the technical support to do
ROSE, it is very important to become familiar with the morphology of the material
on DQ stain to be able to decide whether or not the material is diagnostic and /or
enough for additional IHC and molecular studies, if needed.
Another cause of a P40 positive tumour in a non-smoker is a metastatic
nasopharyngeal carcinoma .
There are even more confusing situations, which are most commonly due to lack of
knowledge of the recent or past clinical history. For example, a metastatic triple
negative breast carcinoma can be misinterpreted as a squamous carcinoma based
on CK5/6 positivity typical of basal type breast carcinomas.
But all the pitfalls are not due to metastases from other sites. Some are due to
unusual clinical situations, for example: a small cell carcinoma in a non-smoker is
quite unusual. In such a situation, always look for alternative primaries with similar
morphology.
A relatively common situation is a tumour with a partial small cell morphology, with
reactivity with at least one neuroendocrine marker, but either totally negative for
TTF-1 (unusual for a typical small cell carcinoma) and /or association with a
definitive large cell component.
The presence of a range of sizes of small and large cell neuroendocrine tumours is
not too much a diagnostic dilemma. Recent discoveries indicate that small and
large cell neuroendocrine tumours have more similarities than differences and
should be treated similarly: cisplatin and etoposide based chemotherapy. There
are other circumstances in which the pitfall may involve a tumour appearing
morphologically like a small cell, but representing a squamous cell carcinoma. In
these cases, these tumours will be strongly and diffusely positive for P40, and this
IHC will solve the dilemma.
A common situation is the occurrence of an adenocarcinoma of the lung negative
for TTF-1 and Napsin-A. Approximately 20% of lung adenocarcinomas are
negative for TTF-1. In most of these cases, the morphology is that of an
adenocarcinoma. It needs to be established that there is no other possible primary
site of origin to consider this a primary tumour.
Poorly differentiated tumours which react only focally and weakly with the usual
IHC markers are better diagnosed as NSCLC-NOS. Even though this
nomenclature is discouraged, one should not try to force the tumour to fit into either
category of adenocarcinoma or squamous cell carcinoma, if the
immunophenotype is not clear.
On the other side, sometimes, a tumour reacts strongly with both markers: markers
of ADCA and markers of squamous cell carcinoma. In those cases, there is a
possibility of adenosquamous differentiation.
And last, but not least, the primary lung adenocarcinoma with enteric phenotype:
CDX2 and variably positive for TTF-1. In these situations, one has to rule out any
possibility of a primary in the GI or pancreatobiliary tract, before naming such a
tumour a primary.
(4C-1) Roles of Chemotherapy and Radiotherapy in Thymic Tumours
Speaker: Francoise Mornex (France)
Thymomas are rare intrathoracic malignant tumors. Commonly used staging
system is the Masaoka classification, based on peroperative and histopathological
findings. Surgery is and remains the cornerstone of the management of thymomas,
initially being useful for precise histopathological diagnosis and staging, and in
most cases ensuring the first step of the therapeutics simultaneously.
After tumor stage, complete resection is the most constant and significant
prognostic factor for progression-free and overall survival.
Radiotherapy is a major therapeutic modality for thymic malignancies. The exact
role of adjuvant radiotherapy after complete resection is still debated for stage II
through III tumors. Histology or size, capsular invasion, and even molecular data
may be included in the decision making. Radiotherapy may be recommended for
stage III thymomas, thymic carcinoma, or after incomplete surgical resection.
Completely resected stage II and III tumors may also benefit from adjuvant
radiotherapy, especially to reduce local recurrence rates. However, no impact on
survival has been reported yet.
Combination with chemotherapy may be useful, and must be further evaluated
using validated end points, including 5- and 10-year time-to-progression and
overall survival. Multimodal strategy nowadays includes neoadjuvant
chemotherapy, followed by an extensive surgery, adjuvant radiotherapy, and in
some cases, adjuvant chemotherapy. The most popular chemotherapy regimens
combine cisplatin, adriamycin, etoposide, cyclophophamide, or ifosfamide.
The management of thymomas is a paradigm of cooperation between clinicians,
surgeons, and pathologists from establishing the diagnosis to organizing the
therapeutic strategy and evaluating the prognosis. As a consequence of their rarity,
no prospective randomized trials are available and collaborative studies are
warranted to evaluate and improve current therapeutic standards, taking into
account recent improvements in techniques, such as robotic surgery, radiotherapy,
and supportive treatments.
(4C-2) Pulmonary Metastasectomy - Indication, Techniques and Long-term
Outcomes
Speaker: Anand Sachithanandan (Malaysia)
(4B-3) Tips and Tricks during Rapid on-site Evaluation (ROSE)
Speaker: Angela Maria Takano Pena (Singapore)
Clinical and radiological information are paramount to the person performing the
ROSE. For example, the smoking status should be known to the cytotechnologist
or cytopathologist. So, the first tip and trick is to know the history and how the lesion
looks like on the CT scan.
If the patient is a smoker, the evaluator will feel comfortable seeing a tumour with a
small cell morphology, and since no more material is needed additional
studies(until now), but the usual immunophenotypic.studies, the evaluator will
know in advance, that there is no need for molecular studies. So, after the
Lung metastases usually represents advanced cancer and is a heterogenous
disease. Whilst the criteria and goals for pulmonary metastasectomy have long
been established, the evidence for metastasectomy remains elusive and
equivocal. Much controversy exists regarding to whom surgery should be offered
to and if a less invasive VATS or open approach is best. This lecture will provide a
comprehensive evidence-based overview of the indications for and outcomes of
pulmonary metastasectomy including a review of contemporary trials and studies.
29
SPEAKERS
Speaker Abstracts
(4C-3) Stereotactic Ablative Body Radiotherapy (SABR) for Pulmonary
Metastases
Speaker: David Ball (Australia)
The ability to ablate primary and secondary cancers in lung parenchyma using
SABR with only one or a small number of treatments has transformed traditional
thinking about the management of pulmonary metastatic disease. Previously the
development of lung metastasis whether one or many has been regarded as a sign
of disease dissemination and therefore best managed by non-curative systemic
chemotherapy. The basis for more aggressive treatment of lung metastases is
based on two observations: that surgical resection of lung metastases and that
stereotactic irradiation of brain metastases can both result in long-term survival.
More recently “oligoprogressive” metastatic disease in patients whose cancer is
otherwise controlled by targeted agents has been identified as potentially
benefitting from SABR as well.(1)
Although there is no randomised evidence to support the use of SABR in
oligometastatic cancer, a systematic review of published reports indicated a local
control rate of around 78% and survival of 50% at two years.(2) Outcomes were
similar whether SABR was given as a single or multiple treatments. A similar
observation was made by ourselves in a non-randomised comparison between two
Australian institutions in which a single dose of 26 Gy appeared to achieve local
control rates similar to 48 Gy in 4 fractions or 50 Gy in 5 fractions. A randomised trial
to compare the single and multi-dose schedules is about to be opened by the Trans
Tasman Radiation Oncology Group in Australia and New Zealand (SAFRON II,
Clinicaltrials.gov NCT01965223).
Other questions include the role of SABR versus surgery, radiotherapy technique,
importance of primary histology, the number and size of metastases, the safety of
treating centrally located tumors and the immune priming effect of ablative therapy.
Some, but not all, of these questions will be answered by ongoing trials, but the first
priority is to establish that the aggressive treatment of oligometastases improves
survival compared with standard of care, which is being addressed by the SABRCOMET randomised phase II trial (Clinicaltrials.gov NCT01446744). The subject is
ripe for research.
References
1.
Weickhardt AJ, Scheier B, Burke JM, Gan G, Lu X, Bunn PA, Jr., et al. Local ablative
therapy of oligoprogressive disease prolongs disease control by tyrosine kinase
inhibitors in oncogene-addicted non-small-cell lung cancer. J Thorac Oncol. 2012
Dec;7(12):1807-14.
2.
Siva S, MacManus M, Ball D. Stereotactic radiotherapy for pulmonary oligometastases: a
systematic review. J Thorac Oncol. 2010 Jul;5(7):1091-9.
(5A-3) Resistance to ALK/ROS1 Inhibitors - What Options Do We Have?
Speaker: Sai-Hong Ignatius Ou (USA)
Crizotinib, a multi-targeted ALK/ROS1/MET tyrosine kinase inhibitor, has been
approved in more than 60 countries for the treatment of ALK-rearranged NSCLC.
The clinical activity of crizotinib in ROS1-rearranged NSCLC patients has recently
been published. However almost all of the ALK- or ROS1-rearranged NSCLC
patients will experience disease progression. The different mode of progression
will be discussed. A detailed list of the current second generation ALK and ROS1
inhibitors in clinical development will be discussed. Strategies to continue TKI after
disease progression will also be discussed.
(5B-1) Solitary Lung Nodule - What is the Best Approach?
Speaker: Pyng Lee (Singapore)
30
Targeting a solitary pulmonary nodule (SPN) detected on CT scan presents a
challenge as sensitivity of bronchoscopy for detecting malignancy in SPN is
dependent on size of the nodule, its proximity to the bronchial tree, presence of CT
bronchus sign as well as prevalence of cancer in the population of interest. For
SPN measuring >2.5 cm, the yield from fluoroscopic guided transbronchial biopsy
is 62%, but when the SPN is <2.5 cm, the yield falls below 40%. A major advance is
the multi-detector helical CT that allows data acquisition of the entire thorax during
a single breath hold, and reformatting of axial images into 3-dimensional virtual
bronchoscopy. This has led to more precise targeting of peripheral pulmonary
lesion for biopsy using either electromagnetic steering probe or ultrathin
bronchoscope. Navigational bronchoscopy (ENB) is not real-time as the uploaded
CT data are acquired during patient's breath-hold, hence if confers a diagnostic
accuracy of 69-74% and pneumothorax rate of 3%. Patient's spontaneous
respiration makes localization of small nodules <2 cm, in the lower lobes and close
to the pleura challenging. EBUS with radial probe is useful for sampling peripheral
lesions. A prospective randomized study demonstrates superiority of EBUS guided
transbronchial biopsy (75%) over fluoroscopic guided transbronchial biopsy (31%)
for pulmonary nodules <3 cm. A technique that incorporates a guide sheath (GS)
through which the miniaturized EBUS radial probe (UM-S20-20R, Olympus) is
inserted, does not seem to be affected by tumor size and gives good yield even for
lesions measuring 10 mm and fluoroscopically invisible SPN. A major challenge is
in targeting small pulmonary lesions that are close to the pleura, which has
prompted the combined application of ENB and EBUS. Diagnostic yield from
combined ENB-EBUS (88%) was significantly higher than ENB (59%) or EBUS
(69%) alone. These techniques will be compared against CT guided transthoracic
needle aspiration.
(5B-3) Role of Stereotactic Body Radiotherapy (SBRT) for Early Lung Cancer
Speaker: Brian Collins (USA)
Surgery is not an option for many patients with peripheral clinical stage I non-smallcell lung carcinoma because of associated co-morbidities or advanced age.
Robotic SBRT with fiducial tracking may be the optimal treatment for these
patients. Forty patients ranging in age from 62-94 years (median age 76 years) with
a median percent predicted FEV1 of 61% (range, 21-107%) were treated over a 6year period extending from August 2005 to August 2011 and followed for a
minimum of 30 months or until death. The median maximum tumor diameter was
2.6 cm (range, 1.4-5.0 cm). A median dose of 50 Gy was delivered over a 3 to 13
day period (median, 7 days). Treatments were delivered utilizing robotic SBRT with
fiducial tracking. Gross tumor volumes (GTVs) were contoured using lung
windows; the margins were expanded by 5 mm to establish the planning treatment
volume (PTV). At a median potential follow-up of 53 months, the 4-year KaplanMeier locoregional and distant control estimates were 95% and 79%. Cancerspecific and overall survival estimates were 79% and 57%. Radiation induced rib
fractures were identified in 9 patients. The estimated cumulative incidence of RIRF
was 26.5% at 3 years. The median time to the onset of rib fracture was 24 months
(range, 7-31 months). Robotic SBRT outcomes for peripheral stage I NSCLC
compare favorably with conventional SBRT outcomes, despite the use of a
relatively narrow circumferential PTV margin. Additional research will be required
to determine the optimal SBRT technique.
(5C-1) Prevalence of Smoking in the Asia Pacific Region
Speaker: Tara Singh Bam (Indonesia)
World Health Organization (WHO) reported more than 20% of global TB incidence
may be attributable to smoking (4). WHO and International Union Against
Tuberculosis and Lung Disease (The Union) Monograph on TB and Tobacco
Control examines the associations between active and passive tobacco use and
various TB outcomes including delay occurrences of the disease, risks of infection,
mortality, treatment outcomes and relapse after treatment. The Union guide
Smoking Cessation and Smokefree Environments for Tuberculosis Patients which
outlined ABC (A=ask, B=brief advice, C=cessation support) approach was piloted
in Bangladesh, China, India and Indonesia. Article 14 of WHO Framework
Convention on Tobacco Control suggests a brief advice during the routine
consultation or interaction.
To share the outcomes and lessons learnt from implementing The Union's Guide
Smoking cessation and smokefree environments for tuberculosis patients
Key approaches are; establish TB services 100% tobacco-free, presents 'ABC for
identifying TB patients who smoke, helping them quit, and promoting smokefree
homes for patients and families. It is delivered systematically within routine
programme and can be done within 5-7 minutes.
The Union ABC approach has demonstrated encouraging smoking quit rates at the
end of 6 month TB treatment. In Bangladesh, of the 615 current smokers, 75.4%
reported they quitted smoking. In India, of the 1333 current tobacco users, 67.3%
remained quitters. In China, of the 233 current smokers, 59.7% quitted smoking. In
Indonesia, of the 582 current smokers, 66.8% quitted smoking successfully.
Exposure to secondhand smoke was reduced significantly to 13.5% at the end of 6
months from 83.5% at zero month.
Brief advice of 5-10 minutes with minimum cessation support at every visit of TB
patients resulted in high quit rates and higher awareness of health impacts of
secondhand smoke exposure, which led patients to make smoke-free homes and
health providers to make tobacco free health-care. Key ingredients which
promoted high quit rates were brief advice by health worker at each visit; engaging
family member to support patient in quitting smoking; providing additional
information on danger of secondhand smoke to their family and friends;
encouraging patients and family member to create smoke-free environments at
home; and monitoring status of the intervention with face to face interaction
between smokers and health workers.
(5C-2) Smoking and Tumour Induction
Speaker: Carolyn Dresler (USA)
Smoking is the leading preventable cause of death in the developed world and
quickly becoming so in the developing economies. Eighty percent of the deaths
from tobacco will be in the developing economies. Currently there are between 5
and 6 million deaths per year in the world, and expected to climb to 10 million by
around 2025. If a smoker does not quit, then they have a 50% chance of dying from
a tobacco related disease. It is predominately due to the duration of smoking,
therefore it is important to not only decrease the initiation of smoking, but critical to
increase cessation as quickly as possible.
Cancers caused by tobacco (Surgeon General Report 2014) are lung, oral cavity,
naso, oro and hypopharynx, nasal cavity and paranasal sinuses, larynx,
esophagus, stomach, pancreas, liver, kidney, ureter, urinary bladder, uterine
cervix, colon and AML (breast cancer rated 'suggestive' not causal). There are
estimated to be at least 70 carcinogens in tobacco smoke, with polycyclic aromatic
hydrocarbons and nitrosamines being considered the most probably causative
agents for lung cancer. These carcinogens can be activated by cytochrome p450s
which then become adducts on the DNA. These mutations can then cause either
transversions or less commonly, transitions of the DNA. These mutations then
leads to loss of normal growth control mechanisms, and then cancer.
SPEAKERS
Speaker Abstracts
(5C-3) Nicotine and its Effects on Lung Cancer Treatment
Speaker: Carolyn Dresler (USA)
Despite the title, it should be “Smoking' and its effect on lung cancer treatment. At
this time, it is unclear what is due to persistent smoking and what is due to nicotine
exposure. Certainly inhaled tobacco smoke contains numerous carcinogens, but
also >7000 other chemicals. Between these chemicals, inclusive of nicotine, there
are numerous cellular pathways that are influenced for a variety of effects.
Inhibition of apoptosis, stimulation of cellular proliferation, increase in VEGF, and
increased metabolism of chemotherapy drugs. Perhaps as a result of these, or
other mechanisms, people who continue to smoke have decreased response to
therapy, decreased cancer free survival, decreased overall survival, decreased
quality of life, and increased rate of second primary cancers.
(6A-1) Tobacco Control Policies: Challenges in their Implementation
Speaker: Zarihah Zain (Malaysia)
Tobacco is the only legal consumer commodity that has an international legal tool
to control its demands, production and impact. This tool, the WHO Framework
Convention on Tobacco Control (WHO FCTC) that came into force in 2004, has 1
Protocol and over 8 Guidelines to assist Parties implement tobacco control
measures in their respective jurisdictions.
Out of the numerous control provisions outlined in the Convention, the World
Health Organization (WHO) through the MPOWER approach has identified five
evidence-based strategies that will effectively decrease tobacco demand and its
consequences. These are:
1)
excellent diagnostic algorithms for the management of malignant pleural effusions
that can be found in various Respiratory society guidelines. My talk will focus on the
diagnostic pathway for patients with suspected malignant effusions with an
emphasis on the role of Interventional Pulmonology in such situations. It will cover
the various modalities available with an extra emphasis on Medical thoracoscopy
(Pleuroscopy) and why it should be done higher up the diagnostic algorithm. I will
also discuss on how Pleuroscopy can be introduced especially in resource
challenged situations.
(7A-1) Recent Insights in the Biology of SCLC
Speaker: David Carbone (USA)
The standard therapy for small cell lung cancer has not changed in over 20 years
and remains platinum etoposide with or without radiation. While responses are
frequent, they are not usually durable, and cures are uncommon. No maintenance
therapy has improved survival, and second line therapies have even less durable
efficacy. Targeted agents have not made the impact in this disease that they have
in non-small cell. Advances in radiation therapy technologies are starting to make
an impact, and advances in genetics have given us some candidate targets in a
small subset of SCLC. There are hints that immune therapies may be active in this
disease. Mouse models that accurately mimic the histology and metastatic
potential of human lung cancer may help in the discovery of new approaches as
well. This progress will be reviewed.
protection from tobacco smoke by extensive smoking restrictions,
(7A-2) Updates in Systemic Management of SCLC
2)
offering smoking cessation therapies,
Speaker: Solange Peters (Switzerland)
3)
warning the public about the dangers of tobacco through,
4)
enforcing bans on tobacco advertising, promotion and sponsorship; and
5)
raising tobacco prices through higher taxes.
Small cell lung cancer (SCLC) currently accounts for 10-15% of all lung cancers.
SCLC is generally a rapidly growing cancer with a tendency for early metastases.
While no study has suggested any beneficial role of screening with low-dose CT
scans for SCLC, there have been limited changes in diagnosis and staging for
SCLC and no substantial changes in treatment of or improvement in survival from
this disease. Median survival for limited- stage (LS) disease is 18 to 24 months with
a 5-year survival of 20% to 25%. For extensive-stage (ES) disease, the median
survival is 9 to 10 months, with 10% of patients alive at 2 years.
Although scientifically proven to be effective, there are challenges in the
implementation of each one of these strategies. Apart from circumstantial
constrains, the one obvious major obstacle is tobacco industry interference at
almost all levels of effective policy making and full implementation.
The most significant scope of increasing threat by tobacco industry is in the area of
trade where in recent times, the industry has been exploiting privileges provided to
them in trade and investment agreements. Some examples are legal actions taken
by the tobacco industry against Australia, Uruguay and Thailand when these
governments are merely exercising the nations' sovereign rights to protect public
health, in line with their obligations as Parties to the WHO FCTC.
(6A-2) What are the Ingredients of Success for a Smoking Cessation Clinic?
Speaker: Mohd Haniki (Malaysia)
The provision of a high-quality smoking cessation service is a high priority for
improving the health of Malaysians. Smoking cessation services are extremely
cost-effective and form a key part of tobacco control and health inequalities policies
at both local and national levels. All health and social care services play a key role in
identifying smokers and referring people to stop smoking services; referral
opportunities need to be maximized. In line with best practice recommendations,
service providers should aim to treat at least 5% of their local smoking population.
Services are most effective when configured according to local need. Groups that
are known to experience a high smoking prevalence or require specific targeting
include manual workers and people with mental health disorders (including alcohol
and substance use). These and other groups such as pregnant smokers may
benefit from interventions that address specific needs. Service design and delivery
should be informed by the latest evidence. Offering all licensed stop smoking
medicines as first-line interventions, including varenicline and combination NRT,
will maximize success. Health and social care professionals who assist smokers to
quit, including all stop smoking practitioners, should achieve certification trough
approved mechanisms. Services can provide increasingly intensive interventions
to smokers who make multiple attempts to quit before achieving long-term
success. To show an impact, services must achieve success rates in excess of
35% and at least 85% of four-week quits should be carbon monoxide (CO) verified.
Services should have quality assurance procedures in place to ensure the quality
of the service being provided; this should include an element of independent
auditing to complement internal checks.
(6B-2) Diagnostic Pathway for Patients with Suspected Malignant Effusion
Basically, the treatment of LS SCLC has not been modified during the last decade,
apart from the adoption by many experienced centers of surgery for very early
disease instead of radiotherapy as part of the multimodal strategy.
In ED specifically, many new drugs have been tested in patients with SCLC,
concomitantly to chemotherapy, or as a maintenance or late line treatment after
classical first line platinum-based chemotherapy, all with mostly negative results.
Some attempts to focus on immunotherapy strategy are also being pursued in LS
and to a major extent in ES. In addition, despite an accurate recent description of
the molecular background of SCLC no molecularly targeted therapy has
demonstrated a benefit in SCLC in numerous clinical trials presented. Of note,
several are still ongoing to date. These approaches will be comprehensively
reviewed.
Finally, prophylactic cranial irradiation (PCI) is a standard treatment in several ED
SCLC treatment guidelines. Recent data as well as limitations of PCI will be
discussed.
(7B-1) Is there a Role for Adjuvant TKI in Early Lung Cancer?
Speaker: Yi-Long Wu (China)
In recent decade there is great advance in treatment of advanced non-small cell
lung cancer. Precise medicine with targeting driver gene such as EGFR and ALK
prolong the survival time of advanced NSCLC from 10 months to 30 months. The
emerging issue is that could the advantage of TKIs in advanced disease translate
to that in early lung cancer?
Micrometastasis of cancer cells often limits the
effectiveness of surgery or chemoradiotherapy in stage I-III NSCLC. Adjuvant or
neo-adjuvant chemotherapy result in a 5% overall survival improvement in stage 23 NSCLC. Concurrent chemotherapy and radiotherapy improves radiotherapy
treatment outcome in locally advanced NSCLC, Some investigators tried to use
EGFR TKIs in adjuvant setting for resected or maintenance setting for locally
advanced NSCLC. However most trials were failure in this setting. BR.19 and
RADIANT--- both trials for adjuvant target treatment with gefitinib or erlotinib in
early stages NSCLC, do not increase DFS and OS in early NSCLC. Data from
adjuvant studies suggest that adjuvant TKI treatment might not increase cure rate,
but simply delay recurrences. Two ongoing prospective adjuvant target therapy
trials from China and Japan, one trial focusing on EGFR or ALK driven NSCLC
subsets (ALCHEMIST) potentially offer the opportunity for a definitive answer in
early disease adjuvant setting.
Speaker: Kunji Kannan (Malaysia)
Pleural effusions that are malignant in nature is now a common clinical scenario in
both the developing as well as the developed countries. Almost 15% of patients
who succumbed to malignancies was noted to have an underlying malignant
pleural effusion. The median survival of patients with such an effusion was also
very poor with 12 months being the upper limit of survival time. Therefore it is
imperative that the diagnosis is obtained as urgently as possible. There are many
(7B-2) Targeted Therapies in Combination with Radiation
Speaker: Hak Choy (USA)
While significant progress has been made in the treatment of lung cancer, the
overall survival rate for patients with lung cancer is 14% at 5 years. Advances in
radiation therapy (RT) techniques, chemotherapeutic regimens, and different
31
SPEAKERS
Speaker Abstracts
combined-modality approaches have yielded only a modest impact on the
prognosis of patients with advanced lung cancer. Thus, there is clearly a need for
additional strategies. Recent discoveries in molecular biology have identified a
number of molecular determinants that may be responsible for resistance of cancer
cells to radiation or other cytotoxic agents, and as such may serve as targets for
augmentation of radio- or chemo-response. Among these determinants are
epidermal growth factor receptor (EGFR), cyclooxygenase-2 (COX-2) enzyme,
mutated ras, angiogenic molecules, and various other molecules that regulate
different steps in their signal transduction pathways.
Numerous molecular targeted agents,that interfere these molecular determinants
have been developed and tested in clinical trial setting in NSCLC for the last
several years. The specificity of these agents, directed against pathways that are
often abnormally activated or overexpressed in the malignant cell and not in the
normal cell, should result in reduced toxicity.
(7C-3) Establishing a Web Registry for Lung Cancer Research
Speaker: Tom Ruane (UK)
By definition, a registry is just a list of patients, but with advancing complexity and
functionality of digital engagement, patient registries can be much more interactive
and engaging.
It used to be said…the best place to hide a “dead body” is on page 2 of a Google
search! With the internet a very competitive arena for a particular patient's attention
how do you ensure that it is your Lung Cancer registry that is the one patients and
families immediately engage with?
This discussion will look at what the various stakeholders need to contribute to a
successful and sustaining Lung Cancer patient registry. What actually is it that all
stakeholders want to attain from a well-executed, on-line patient registry? What is
in it for patients and families and what would keep them engaged in contributing to
the registry?
Incorporating newer biologic agents into chemoradiotherapy is critical to further
improve outcomes in this setting. One strategy should improve therapeutic
outcomes by blocking receptors and pathways that help tumor cells survive
radiation and repair damage without increasing normal tissue toxicity. In this
meeting we will review the current research challenges in incorporating these
agents into radiotherapy and chemoradiotherapy and preliminary data in patients
with locally advanced NSCLC.
Depending on the region, there are also implications of and compliance with the
various interpretations of data privacy laws and guidelines to be considered. For a
web based registry, these are relatively cost effective to set up and maintain, but is
it just enough to build it and they will come?
(7B-3) Significance and Clinical Value of Circulating Tumour Cells
Speaker: Silvia Novello (Italy)
Speaker: Yasuhiro Koh (Japan)
For decades, the early detection of common cancers has been advocated in an
attempt to improve the chance for long-term survival and cure, and this has been
reached for breast, cervix, colon, and prostate cancer. Lung cancer, the leading
cause of cancer death in the United States and worldwide has lagged behind. One
of the reasons is the “stigma”: patients with lung cancer often suffer from the
public's and policy-makers' perception of lung cancer as a “self-inflicted” disease.
Also, the poor long term survivorships of lung cancer patients has compromised
advocacy efforts, but nowadays many Associations (like WALCE-Women Against
Lung Cancer in Europe, GLCC-Global Lung Cancer Coalition, NLCP-National
Lung Cancer Prtnership, BJALCF-Bonnie J. Addario Lung Cancer Foundation and
others) are investing time and resources to bridge the gap. Many of the early
screening trials with chest X-rays, sputum cytology and later CT were not designed
to minimize the now well established biases operating in screening trials that result
in longer survival but no reduction in mortality. There was a need for a welldesigned, adequately powered randomised trial and this was first reached with the
National Lung Cancer Screening Trial (NLST). The entry criteria were established
to collect high-risk people into screening and three rounds of screening at 12
months intervals were performed with LDCT versus CXR. A total of 1060 lung
cancers were diagnosed in the LDCT arm, while 941 were detected in the CXR
group. The study showed a rates of 247 deaths per 100,000 person-years in the CT
group and 309 per 100,000 in the CXR group, with a relative reduction of death
from lung cancer with LDCT of 20%. According to this data the National
Comprehensive Cancer Network (NCCN) and multiple other organizations have
subsequently published lung cancer screening guidelines that recommend LDCT
for a high risk population. However, some questions are still open and some
potential harms must be considered. Despite the improvement in mortality with
LDCT screening, a high proportion of false positives was observed. This raises
questions on how best to implement LDCT screening in clinical practice and
additional trials are aimed at further evaluating the role of LDCT. The European
NELSON trial is evaluationg if a nodule management protocol based on volumetry
and volume doubling time (VDT) could reduce the false-positive rate and also the
number of interval cancers. Furthermore, the management of ground glass
opacities (GGOs) represents a challenge in the management of pulmonary lesions
in screening programs, as they could result in a variety of differential diagnosis.
These lesions in most of cases have a high volume doubling, and most of them did
not grow during long-term follow-up with the suspicion that some of that are the
results of what is called overdiagnosis bias. Also the radiation exposure is an issue
that must be investigated, considering that the radiation dose of LDCT is ten times
more than CXR and in case of positive findings a patient could need further
radiological investigations. Moreover most of the LDCT screening trials were
designed for a period from 3 to 5 years, without any data about the executions of
other LDCTs at the end, and currently there are no data to assess a cumulative
benefit of this much re-screening. The cost-effectiveness of a lung cancer
screening program on an already strained health care system must be considered
and an open question is the possible reimbursement of the exams by the
Healthcare Systems. Pyenson et al. demonstrated that in the US population
offering a lung cancer screening to high risk Medicare beneficiaries could reduce
mortality and could be cost-effective, although institutions are not yet convinced.
Although the NLST trials showed promising results about the role of LDCT for the
screening of lung cancer, many issues are still pending and matter of debate.
Results from the NELSON (and other European trials) will possibly answer many of
these questions.
(P3) Plenary 3: Early Diagnosis of Lung Cancer - Evidence and Challenges
Circulating tumor cells (CTCs) have been of interest to the medical and research
communities for over a century. Recent advances in technology have enabled
reproducible CTC detection and enumeration, and these techniques have been
revealed as minimally invasive, real-time, and blood-based “liquid biopsy.” The
presence and number of CTCs in the blood of patients with certain types of solid
tumors is predictive of their clinical outcomes.
To date, the CellSearch system (Veridex LLC, Raritan, NJ, USA) is the only United
States Food and Drug Administration-approved CTC enumeration system for the
provision of prognostic information regarding survival in metastatic breast, prostate
and colorectal cancers. It has also been reported that CTCs have prognostic
impact in other types of solid tumors such as lung cancer, especially small-cell lung
cancer. Clinical utility of CTCs has been also addressed in clinical trials such as
SWOG S0500 study and METABREAST study in patients with metastatic breast
cancer. Evaluation of the clinical feasibility of phenotypic analysis in captured
CTCs by evaluating target gene expression is still ongoing. The DETECT III trial
assesses the use of anti-HER2 treatments in HER2-negative breast cancer
patients selected on the basis of CTC detection/characterization. However, more
sensitivity in detecting CTCs is critically needed for other types of cancer such as
non-small-cell lung cancer which accounts for most of lung cancer cases.
Because of the recent major advances in the treatment of cancer, the genotypebased stratification is now essential to implement the personalized cancer
medicine including lung cancer. There is also a growing need for real-time
monitoring of the disease at the molecular level during treatment. However, in most
cases, only limited amount of tumor sample at diagnosis is available from patients
with lung cancer. To overcome these limitations, the concept of liquid biopsy
utilizing CTCs and/or circulating free DNA (cfDNA) as an alternative diagnostic
resource is of great interest to clinicians and researchers involved in lung cancer
medicine.
The isolation of the rare CTCs for molecular analysis remains technically
challenging. Most of the currently available capture methods retain a considerable
number of white blood cells (WBCs) and cell loss during sample handling. Various
methods to overcome this issue have been under development and evaluation and
there are ongoing efforts to pursue the diagnostic potential of CTCs and cfDNA in
place of conventional tissue-based approach. In addition, these circulating
materials can be utilized not only for diagnostic purposes but also to elucidate the
biology and molecular genetics of lung cancer. Attempts such as sequencing CTCs
and investigating epithelial-mesenchymal transition in CTCs are expected to
provide a better understanding of cancer and accelerate drug development by
identifying novel therapeutic targets.
State-of-the art technologies in this field will be reviewed in this presentation and
their potential and clinical applications will be discussed.
(7C-2) Clinical Trials in the Digital Era: How to Exploit the Web in Research
Speaker: Tom Ruane (UK)
32
The use of digital tactics in platforms is increasing in the clinical trial arena.
Maintaining perspective and propriety on the use of digital channels for patient
engagement in clinical research is if high importance. The use of digital tactics
(web, social media, smart phone technology, apps etc.) in patient recruitment is
now well established but their acceptance, effect and results are often variable.
Tom will explore the complex dynamics around clinical research patient
engagement, the influencing factors, the influencers, development of appropriate
digital channels and will propose ideas around appropriate best practice and “rules
of engagement”.
(8A-1) Risk Stratification for Lung Cancer Screening
Speaker: Sai-Hong Ignatius Ou (USA)
Low dose CT (LDCT) screening for lung cancer has been recommended by the
United States Preventive Service Task Force (USPSTF) since December 31, 2013.
The recommendation is for persons who are between 55 and 80 years of age, had
at least 30 pack year history of smoking and who are actively smoking or quit within
15 years to undergo annual LDCT screening. This recommendation is based on
SPEAKERS
Speaker Abstracts
the positive result of the National Lung cancer Screening Trial (NLST) performed in
the US, which compared 3 annual (1 baseline and 2 follow-up) LDCT scans versus
chest x-ray. The NLST resulted in a 20% reduction of lung cancer mortality and
6.7% reduction in all cause mortality both reductions are statistically significant.
The details of the NLST trial including the positive and negative predictive values of
LDCT will be reviewed. Strategies for improving the positive predictive values
LDCT such as varying the screening parameters, the size cutoff of the detected
pulmonary nodule as positive screen, or the use of mortality modeling will be
discussed in detail.
(8A-2) Volumetric CT Scan for Nodule Assessment
Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl
J Med 2011; 365: 395409.
2.
Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer:
a systematic review. JAMA 2012; 307: 241829.
3.
Linda H, Mark D, Miranda P, et al. Screening for Lung Cancer With Low-Dose Computed
Tomography: A Systematic Review to Update the U.S. Preventive Services Task Force
Recommendation. Ann Intern Med 2013; 159 411-20
4.
Wood DE, Eapen GA, Ettinger DS, et al. National Comprehensive Cancer Network
clinical practice guidelines in oncology. Lung cancer screening. J Natl Compr Canc Netw
2012; 10: 24065.
5.
American Lung Association. Providing guidance on lung cancer screening to patients
and physicians. 2012.
6.
Jaklitsch MT, Jacobson FL, Austin JH, et al. The American Association for Thoracic
Surgery guidelines for lung cancer screening using low-dose computed tomography
scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg
2012; 144: 3338.
7.
Wender R, Fontham E, Barrera EJ, et al. American Cancer Society lung cancer screening
guidelines. CA Cancer J Clin 2013; 63: 10717.
8.
National Comprehensive Cancer Network clinical practice guidelines in oncology. Lung
cancer screening version 1. 2014. h t t p : / / w w w . n c c n . o r g / p r o f e s s i o n a l s / p h y
sician_gls/f_guidelines.asp
9.
Roberts H, Walker-Dilks C, Sivjee K, et al. Screening high-risk populations for lung
cancer: guideline recommendations. J Thorac Oncol 2013; 8: 123237.
10.
Couraud S, Cortot AB, Greillier L, et al. From randomized trials to the clinic: is it time to
implement individual lung-cancer screening in clinical practice? A multidisciplinary
statement from French experts on behalf of the French intergroup (IFCT) and the groupe
d'Oncologie de langue francaise (GOLF). Ann Oncol 2013; 24: 58697.
11.
Lung cancer guidelines. Available at: http://www.asco.org/quality-guidelines/role-ct
screening-lung-cancer-clinical-practice-evidence-based-practice-guideline. Accessed
May 24, 2012.
12.
Frank C.D, Peter JM , David PN , Peter BB. Screening for Lung Cancer Diagnosis and
Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence
Based Clinical Practice Guidelines. CHEST 2013; 143(5)(Suppl):e78Se92S
13.
Moyer VA; U.S. Preventive Services Task Force . Screening for lung cancer: U.S.
Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160:
33038.
14.
Lung Cancer Alliance. National Framework for Excellence in Lung Cancer Screening and
Continuum of Care: uniting the at-risk public with responsible medical care now.
Available at: http://www.lungcanceralliance.org/get-information/am-i-at-risk/national
framework-for-lung-screening-excellence.html.
15.
American College of Radiology. Guidance for ACR members on lung cancer screening
with CT. Available at: http://www.acr.org/News-Publications/News/News
Articles/2013/Quality-Care/20130624-Guidance-for-ACR-Members-on-Lung-Cancer
Screening-with-CT.
16.
Pyenson BS, Sander MS, Jiang Y et al. An actuarial analysis shows that offering lung
cancer screening as an insurance benefit would save lives at relatively low cost. Health
Aff (Millwood) 2012;31:770 779.
17.
Chirikos TN, Hazelton T, Tockman M et al.Screening for lung cancer with CT: A
preliminary cost-effectiveness analysis. Chest 2002;121:15071514.
18.
Mahadevia PJ, Fleisher LA, Fric KD et al. Lung cancer screening with helical computed
tomography in older adult smokers: A decision and cost-effectiveness analysis. JAMA
2003;289:313322.
19.
Marshall D, Simpson KN, Earle CC et al. Potential cost-effectiveness of one-time
screening for lung cancer (LC) in a high risk cohort. Lung Cancer 2001;32:227236.
20.
Wisnivesky JP, Mushlin AI, Sicherman N et al. The cost-effectiveness of low-dose CT
screening for lung cancer: Preliminary results of baseline screening.Chest
2003;124:614621.
21.
McMahon PM, Kong CY, Bouzan C et al. Cost effectiveness of computed tomography
screening for lung cancer in the United States. J Thorac Oncol 2011;6:18411848.
22.
Villanti AC, Jiang Y, David B. Abrams DB, Bruce S. Pyenson BS. A Cost-Utility Analysis of
Lung Cancer Screening and the
Speaker: Ho Yun Lee (South Korea)
The ability to detect an increase in the size of a pulmonary nodule, whether
indeterminate or of known malignant potential, is of high clinical importance,
particularly in light of the recent announcement by the National Lung Screening
Trial that reported preliminarily a reduction in lung cancerrelated deaths by 20%
with computed tomographic (CT) screening, in comparison with chest radiography.
Semi-automated and fully automated three-dimensional (3D) volume evaluation
has been shown to be both accurate and precise for quantifying the size of small
solid nodules. While absolute accuracy or the ability to measure true volume of a
nodule is of interest, in clinical practice, the precision or reproducibility of a
measurement method is more relevant.
Furthermore, through the volumetric assessment of pulmonary nodules, the
extraction and analysis of large amounts of advanced quantitative imaging
features are available and these Radiomics data are in a mineable form that can be
used to build descriptive and predictive models relating image features to
phenotypes or geneprotein signatures. In other words, tumor characteristics
observable at clinical imaging reflect molecular-, cellular-, and tissue-level
dynamics; thus, they may be useful in understanding the underlying evolving
biology in individual patients.
The precision and accuracy of volume measurements depend on several factors,
including the image-acquisition and reconstruction parameters, the nodule
characteristics, and the performance of algorithms for nodule segmentation and
volume estimation. Recent related data highlight the need to standardize all
variables in CT scanning to obtain a reliable volumetric assessment of the
pulmonary nodule. This standardization is even more important in studies that will
use volumetric CT scanning in the follow-up of these nodules.
(8A-3) Implementation of LDCT Screening:
Challenges
Cost-Effectiveness and
Speaker: Natthaya Triphuridet (Thailand)
In era of LDCT screening for lung cancer, the National Lung Screening Trial (NLST)
was the most informative trial, demonstrating that 3 annual rounds of screening
with LDCT resulted in a 20% lower lung cancer-specific mortality and 6·7% lower
all-cause mortality than chest radiographs over a median of 6.5 years of followup.1-3 Since the release of the NLST data, many guidelines and medical societies
have endorsed the use of LDCT screening for high-risk individuals.4-15 There are
some variations in the recommendations including the target screening groups,
management of lung nodules and duration of screening.
Despite this pivotal result of LDCT, there were many concerns regarding high false
positive rate (96%), overdiagnosis (19% with 7 years of follow-up and 9% with
lifetime follow-up), radiation exposure, costs-effectiveness and generalization to
practice. Several screening guidelines emphasize that screening be undertaken
only by centers with multidisciplinary specialized teams capable of providing high
quality care and follow-up.7,11,12 The cost-effectiveness of screening remains
unknown. The outcome of cost effectiveness analyses have ranged widely.16-22
Offering smoking cessation interventions with the annual screening program
improved the cost-effectiveness of lung cancer screening.21-22 The number
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.1 These benefits compare with NNS with mammography of 1339 to
prevent 1 breast cancer death after 11-20 years of follow-up23-24 and NNS with
flexible sigmoidoscopy of 817 to prevent 1 colon cancer death25. Adding LDCT
screening to the Medicare Program could result in the diagnosis of about 54,900
earlier-stage and more treatable lung cancers over a 5-year period. Postulated that
a total cost of $9.3 billion to Medicare would be spend including LDCT, diagnostic
workups, and cancer care.26, 27
There are challenges on lung cancer CT screening, 1) maximizing the benefit and
minimizing the risks of screening which includes; identification of high risk
individuals; optimization of positive test, lung nodule management protocol and
interventions; and integration of smoking cessation practice into screening
programme. 2) Evaluation benefits of LDCT screening in Asian population and
endemic area of Tuberculosis. 3) Promising alternative screening modalities;
Digital Tomosynthesis (DT) was reported to be as sensitive as CT for the detection
of actionable lung nodules28 and diagnostic accuracy of DT was comparable to
LDCT for the detection of primary lung cancer in a high-risk population29 with a
much lower radiation dose30-32, lower cost33 and reading time than CT.34
References
1.
National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, et al.
Additional Benefits of Incorporating Smoking Cessation Interventions. PLoS One 2013
7;8(8):e71379
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Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of
the evidence for the U.S. Preventive Services Task Force. Ann Intern Med.
2002;137:347-60. [PMID: 12204020]
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Nelson H, Tyne K, Naik A, Bougatsos C, Chan B, Nygren P, et al. Screening for Breast
Cancer: Systematic Evidence Review Update for the U. S. Preventive Services Task
Force. Rockville, MD: Agency for Healthcare Research and Quality; 2009. Report 10
05142-EF-1.
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Schoen RE, Pinsky PF, Weissfeld JL, Yokochi LA, Church T, Laiyemo AO, et al; PLCO
Project Team. Colorectal-cancer incidence and mortality with screening flexible
sigmoidoscopy. N Engl J Med. 2012;366:2345-57. [PMID:22612596]
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CT lung cancer screening would cost Medicare $9 billion. Available at:
http://www.medscape.com/viewarticle/825235#1.Accessed September 3, 2014.
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Roth JA, Sullivan SD, Ravelo A, et al. Low-dose computed tomography lung cancer
screening in the Medicare program: projected clinical, resource, and budget impact
[abstract 6501]. J Clin Oncol. 2014;32(suppl):5s.
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Vikgren J, Zachrisson S, Svalkvist A, et al. Comparison of chest tomosynthesis and chest
radiography for detection of pulmonary nodules: human observer study of clinical cases.
Radiology 2008; 249: 103441.
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Triphuridet N, Singharuksa S, Sangfai O, et al. Screening of Lung Cancer by Low-Dose
CT (LDCT), Digital Tomosynthesis (DT) and Chest Radiography (CR) in a High Risk
Population: A Comparison of Detection Methods. Oral abstract O05.030 at the 2013
World Conference on Lung Cancer.
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Dobbins JT 3rd. Tomosynthesis imaging: at a translational crossroads. Med Phys 2009;
36: 195667.
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Sabol JM. A Monte Carlo estimation of effective dose in chest tomosynthesis. Med Phys
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33
SPEAKERS
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Magnus B, Angelica S, Alexa V, Heidi R, Ke C. Effective dose to patients from chest
examinations with tomosynthesis. Radiat Prot Dosimetry 2010; 139: 15358.
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Vult von Steyern K, Björkman-Burtscher I, Geijer M. Tomosynthesis in pulmonary cystic
fibrosis with comparison to radiography and computed tomography: a pictorial review.
Insights Imaging 2012; 3: 8189.
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Johnsson ÅA. Reading time for chest tomosynthesis. Private communication. 2010.
(8B-1) KRAS Mutations - What are their Significance?
Speaker: Tetsuya Mitsudomi (Japan)
Oncogenic point mutations either at codon 12, 13 or 61 make KRAS impair its
intrinsic GTPase activity and confer resistance to GAPs, thereby causing RAS to
accumulate in its active GTP-bound state. Active RAS interacts with more than 20
effector proteins and stimulates downstream signaling cascades. These effectors
and corresponding functional outcomes include RAF (proliferation), RIN1
(endocytosis), PI3K (survival), PLCe (second messenger signaling), RalGEF
(endocytosis). Rather paradoxically, oncogenic RAS has been shown to cause
senescence in primary cell culture through the activation of the WAFp21-p53 or
p16-Rb pathways. RAS proteins should be bound to inner surface of the plasma
membranes by appropriate post-translational modification. This process includes
farnesyltation, proteolytic cleavage of AAX motif, carboxymethylation of the
terminal Cys and palmitoylation. This process was initially thought to be a target of
therapeutic intervention. However, inhibition of farnesyl transferase results in
alternative geranylgeranylation of RAS which supports membrane binding.
RAS gene activation in lung cancer
In lung cancer, mutation of the KRAS gene usually occurs in adenocarcinoma, and
is more frequent in Caucasian patients (~30%) than East Asians (~10%)4. KRAS
mutation in lung cancer is characterized by the frequent a G to a T transversion in
contrast to the frequent a G to an A transitions found in colorectal cancer. Within
lung cancer, more than half of KRAS mutations in smokers are either G12C (GGTTGT) or G12V (GGT-GTT), while those in never smokers are G12D (GGT-GAT). It
is known that G12V has a weaker GTPase activity than G12D. It is also generally
believed that KRAS codon 13 mutation is weaker oncogene than codon 12
mutation. Prognostic impact of KRAS mutations in lung cancer is variably reported,
but in general it is thought to be a weak negative prognostic factor. WIn terms of
histologic types, KRAS mutations are associated with lung adenocarcinoma with
mucus production / goblet cell morphology.
TNET is half less than gastro-entero-pancreatic (GEP). For controlling endocrine
hypersecretion, e.g. cushing disease and acromegaly, are the same with the
codified standard treatment. Somatostatin analogues (SSA) are the basic
therapies which control the neuroendocrine sysmtoms and those whose octreotide
scans are positive. IFN-2α and 2β could also control the symptom, but with more
delay effect. In advanced typical or atypical carnoids TNETs, cytotoxic drug is
usually used, but the respond rate is modest. Novel target drug also be evaluated in
the treatment of NETs. mTOR inhibitors, including everolimus, temsirolimus and
rapamycin proved to be effetive no matter in single use or combination with other
novel drugs, chemotherapy and SSA for low-intermediate grade NETs. Two studies
(NCT01563354; NCT01524783) focus on or included advanced (unresectable or
metastatic) neuroendocrine carcinoma (typical and atypical) of the lung and
thymus compare everolimus with placebo, or with pasireotide LAR alone or in
combination is ongoing [7,8]. Advanced high grade small cell NETs, share the
similarities with SCLC, which have rapid response to chemotherapy but relapse
easily. The treatment for small cell NETs follows the algorism of SCLC. Treatment
for large cell NETs is still debating. LCNETs are as aggressive as SCLC but
respond like NSCLC. Reports showed SCLC-based regimens had equivalent
efficacy with non-SCLC-based regimens in LCNEC patients [9-10]
1.
Yao JC, Hassan M, Phan A, et al. One hundred years after carcinoid: epidemiology of
and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J
Clin Oncol. 2008 Jun 20;26(18):3063-72.
2.
Tsai HJ, Wu CC, Tsai CR, et al. The epidemiology of neuroendocrine tumors in Taiwan: a
nation-wide cancer registry-based study. PLoS One. 2013 Apr 22;8(4):e62487.
3.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines: Small cell
lung cancer. V.1.2015. Accessed at http://www.nccn.org.
4.
Öberg K, Hellman P, Ferolla P, et al. Neuroendocrine bronchial and thymic tumors:
ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol.
2012 Oct; 23 Suppl 7:vii120-3.
5.
Phan AT, Oberg K, Choi J, et al. NANETS consensus guideline for the diagnosis and
management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of
the thorax (includes lung and thymus). Pancreas. 2010 Aug; 39(6):784-98.
6.
Lausi PO, Refai M, Filosso PL et al. Thymic neuroendocrine tumors. Thorac Surg Clin.
2014 Aug; 24(3):327-32.
7.
Chan J, Kulke M. et al.Targeting the mTOR Signaling Pathway in Neuroendocrine
Tumors.Curr Treat Options Oncol. 2014 Sep; 15(3):365-79.
8.
Ferolla P. Medical treatment of advanced thoracic neuroendocrine tumors.Thorac Surg
Clin. 2014 Aug; 24(3):351-5.
9.
Grand B, Cazes A, Mordant P, et al. High grade neuroendocrine lung tumors: pathological
characteristics, surgical management and prognostic implications. Lung Cancer. 2013
Sep; 81(3):404-9.
10.
Rossi G, Bisagni A, Cavazza A.High-grade neuroendocrine carcinoma. Curr Opin Pulm
Med. 2014 Jul; 20(4):332-9.
How to cope with KRAS mutated lung cancer
Although KRAS mutations occur in mutually exclusionary fashion with activation of
other driver oncogenes, it appears that not all cancers with KRAS mutations are
dependent on mutant KRAS. This makes it difficult to develop treatment strategy
against KRAS mutated tumors. Although MEK-ERK signaling is an essential
downstream of mutant KRAS, single treatment of MEK inhibitor exhibits variable
responses and PI3K pathway activation strongly influences its sensitivity.
Therefore, simultaneous downregulation of MEK-ERK and PI3K-AKT may have
potential therapeutic value.
Recent approach is to identify synthetic lethal interactions in cancer cells harboring
KRAS mutation. In other words, it is to find which genes, when silenced, kill cells
harboring mutant RAS gene but not cells without this mutation. However, the list of
genes with synthetic lethal activity against RAS mutated tumors are expanding and
includes THOC1, eNOS, Myc, Survivin, STK33, PLK1, SYK, RON, integrin b6,
TBK1, NFkB, WT1, PKC delta, CDK4, JNK, ATR, GATA2.
Above-mentioned experimental evidence suggests that RAS collaborate with
many different molecules depending on cellular contexts to have oncogenic
activity. This is why the development of RAS-targeted therapy is difficult.
(8B-2) Neuroendocrine Tumours of the Chest - How to Manage Them?
Speaker: Qing Zhou (China)
34
With increasing incident rate, thoracic neuroendocrine tumors (TNETs), which
orgin from foregut NETs, are account for the highest rate in NETs in U.S. and rank
the second in Asian. Most of TNETs are sporadic, few with with hereditary
syndrome, multiple endocrine neoplasms type 1 (MEN1) [1,2]. Base on the
anatomic location, thoracic NETs are divided into bronchial (or lung) and thymic
NETs. Different stage TNETs have different prognosis, median survival of thymus
NETs for localized, region and distant diseases were 92, 68, 40 months, while
median survival for lung NETs were NR, 151 and 17 months respectively. Thoracic
NET (TNET) is a heterogeneous group of neoplasms, ranging from the high-grade
(SCLC, LCNEC), intermediate-grade (atypical carcinoid), to low-grade (typical
carcinoid). SCLC is the most common TNET, follow by typical and atypical
carcinoids, and LCNETs are rarest [3-5]. The clinical management for TNETs
always requires a multidisciplinary approach. Surgery is the only way to cure NETs.
Stage I-IIIA bronchial NETs always have chances for surgery and have high
survival rate. Radiation or chemotherapy after surgery could be performed in
intermediate grade stage II or III bronchial NETs. For those localize disease who
are not available for surgery, radiation alone or combine chemotherapy may be an
option. Thymus NETs are generally advanced at the diagnosis, limited surgical
resections could be given. For incomplete thymus NETs, radiation alone is
recommended and adjuvant chemotherapy is still controversy [6]. Systematic
managements for advanced typical and atypical thoracic carnoids are included
control carcinoid syndrome and primary tumor. Endocrine hypersecretions in
(8B-3) Approach to patients with Undifferentiated Histological types
Speaker: Qing Zhou (China)
The proportion of carcinoma not otherwise specified (NOS) were increasing before
2010s. With the improvement of pathology the unspecified histological types have
decreased slightly recently, however, approach to NSCLC-NOS is still a challenge
in clinical practices [1,2]. Differentiate histology subtype is essential in clinical
practice. Studies showed adenocarcinoma is response greater to pemetrexed
regimen, while squamous cell carcinomas have greater response in gemcitabine
or docetaxel. Life- threatening hemorrhage would be occurred in squamous cell
carcinomas treated with bevacizumab. Furthermore, different histology types also
have different molecular profiles. EGFR mutation, ALK rearrangements always
occurred in adenocarcinoma, while squamous cell carcinomas have higher
incidence of FGFR1 amplification and DDR2 mutation. Not otherwise specified
NSCLC (NSCLC-NOS) is a subtype of NSCLC. Inadequate sample sizes with
small biopsies and cytology in advanced patients are the main reasons for
diagnosis of NSCLC-NOS. Study had reconfirmed the cytological diagnosis
NSCLC-NOS after the surgery, and found NSCLC-NOS is a heterogeneous
tumors, which including adenosquamous carcinoma, squamous cell carcinoma,
plemorphic cell carcinoma, large cell neuroendocrine cell carcinoma, large cell
carcinoma and adenosquamous carcinoma etc. Since the importance of histology
SPEAKERS
Speaker Abstracts
for treatment decision, it is a must to attempt for classify NOS further. Special stain
(i.e., thyroid transcription factor (TTF-1) or napsin-A) for adenocarcinoma and p40
or p63 for squamous cell carcinoma should be recommended for further diagnosis.
With such special stains, IASLC/ATS/ERS further classified NOS with
adenocarcinoma marker as NSCLC-favor adenocarcinoma, so as NSCLC-favor
squamous cell carcinoma. On the other side, to access further separate
histological subtype, rebiopsy is important under permitted situation. The
development of EBUS and micro-invasive surgery could attain further samples for
diagnosis and bring minimal trauma to patients [3]. Studies showed NOS was
independent prognostic factor for survival. Furthermore, NSCLC-NOS seem to
have different respond to histological specified regimen. In the subgroup analysis
from a phase III trial compare pemetrexed with docetaxel in second-line treatment
for NSCLC, median overall survival (OS) was 9.4 versus 7.8 months(HR=0.57,
95% CI(0.27-1.20), P=0.1417), progress free survival(PFS) was 1.8 versus 1.9
months(HR=0.94, 95% CI(0.49-1.80), P=0.857), and respond rate(RR) was 3.7%
versus 10% for pemetrexed and docetaxel, respectively. Another phase III study,
compare pemetrexed and cisplatin with gemcitabine and cisplatin in first-line
treatment, median OS was 8.6 versus 9.2 months (HR=1.08, 95% CI (0.81-1.45),
P=0.586), PFS was 4.5 versus 5.6 months (HR=1.28, 95% CI (0.99-1.67),
P=0.064), and respond rate (RR) was 28.3% versus 21.2%. The combination
analysis of these two studies showed that no significant different toxicities
observed between pemetrexed and other regimens by histologic type. Another
histological specific drug, bevacizumab, also was evaluated in the subgroup
analysis of NSCLC-NOS in ECOG 4599. Median OS was 10.0 versus 9.5 months
(HR=1.16, 95%CI 1.16(0.86-1.61)), PFS was 4.7 versus 5.7 months (HR=0.78,
95%CI 0.78(0.55-1.09)). NSCLC NOS in bevacizumab regimen experienced a
greater incidence of grade 5 bleeding events in NSCLC-NOS(mainly pulmonary
hemorrhage events) than patients with other histologies [4-6]. EGFR mutation or
ALK rearrangements are more frequently detected in adenocarcinoma. However,
such driven gene could be founded in all histological subtypes, and inhibitors
toward these targets could also have great response. It is reasonable do molecular
testing before treatment. Regimens do not differ from NSCLC-NOS to other
subtypes harbored positive driven gene [7].
1.
Lewis DR, Check DP, Caporaso NE, et al. US Lung Cancer Trends by Histologic Type.
Cancer. 2014 Sep 15; 120(18):2883-92.
2.
Sagerup CM, Småstuen M, Johannesen TB,et al. Increasing age and carcinoma not
otherwise specified: a 20-year population study of 40,118 lung cancer patients. J Thorac
Oncol. 2012 Jan; 7(1):57-63.
3.
Travis WD1, Brambilla E, Riely GJ, et al. New Pathologic Classification of Lung Cancer:
Relevance for Clinical Practice and Clinical Trials. J Clin Oncol. 2013 Mar 10;31(8):992
1001.
4.
Tane S, Nishio W, Ogawa H et al, Clinical significance of the 'not otherwise specified'
subtype in candidates for resectable non-small cell lung cancer. Oncol Lett. 2014 Sep;
8(3):1017-1024.
5.
Sandler A, Yi J, Dahlberg S, et al. Treatment outcomes by tumor histology in Eastern
Cooperative Group Study E4599 of bevacizumab with paclitaxel/carboplatin for
advanced non-small cell lung cancer. J Thorac Oncol. 2010 Sep; 5(9):1416-23.
6.
Scagliotti G, Hanna N, Fossella F, et al. The differential efficacy of pemetrexed according
to NSCLC histology: a review of two Phase III studies. Oncologist. 2009 Mar;14(3):253
63.
7.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines:Non small
cell lung cancer. V.4.2014. Accessed at http://www.nccn.org
and CTV ≥300 cm3 than those receiving 3D-CRT. At the median follow-up of 21.7
months, 45 patients (58.4%) experienced disease progression, most frequently
distant metastasis (39, 50.6%). In-field locoregional control, progression-free
survival (PFS), and overall survival (OS) rates at 2 years were 87.9%, 38.7%, and
75.2%, respectively. Though locoregional control was similar between both RT
techniques, the patients receiving IMRT had worse PFS and OS, as SCN
metastases from lower lobe primary tumor and CTV ≥300 cm3 were associated
with worse OS. The incidence and severity of toxicities, however, were not
significantly different between RT techniques. Based on these data at Samsung
Medical Center, IMRT was able to lead to similar locoregional control and toxicity,
while encompassing much greater disease extent than 3D-CRT. However, as the
cost of IMRT is not reimbursed by Korean Medical Insurance system yet, high cost
is incurable to the patients if IMRT is necessary. Therefore, the decision to apply
IMRT should be carefully made considering the rather poor oncologic outcomes
that are mainly associated with greater disease extent.
(8C-2) Adaptive and Image-Guided RT for Lung Cancer
Speaker: David Ball (Australia)
The treatment of locally advanced non-small cell lung cancer (NSCLC) with intent
to cure usually involves a combination of high dose radiotherapy administered with
concomitant chemotherapy and in some instances is followed by surgical
resection. Treatment is usually given over a period of weeks during which there are
opportunities to observe changes in the tumor and/or normal tissues. Adjusting the
treatment in response to these changes is termed adaptive radiotherapy, and it
opens up possibilities for “personalising” therapy based on observed variations in
tumor-to-tumor treatment sensitivity, changes in the tumour environment, and
normal tissue response. At this time there is little evidence supporting the beneficial
effects of adaptive radiotherapy, which remain largely speculative.
The following are some of the techniques available to assess treatment-induced
anatomical and functional changes during a fractionated course of radiotherapy:
Acute mucosal reactions (the patient as a biological dosimeter); cone beam CT;
functional PET imaging with F18 fluorodeoxyglucose (FDG) for metabolic activity,
F18 fluorothymidine (FLT) PET imaging for tumour proliferation and FAZA for
imaging hypoxia in the tumour microenvironment. It is also possible to image
changes in normal tissue function such as lung perfusion and ventilation using
SPECT and PET. Finally, we have demonstrated that it is possible to detect double
stranded DNA breaks in circulating tumour cells after radiotherapy.
The challenge now is to find ways to use these tools to achieve more cures with less
toxicity.
(8C-3) Chemoradiotherapy for Stage III Disease: Optimizing the Dose
Fractionation and Chemotherapy Schedules
Speaker: Lye-Mun Tho (Malaysia)
(8C-1) From Stereotactic Ablative RT for Small Target to Intensity Modulated
RT for Large Target in Treating Lung Cancer
Speaker: Yong Chan Ahn (Korea)
Stereotactic techniques have become very frequently applied to the modern
radiation therapy (RT) techniques recently. With the high level of accuracy
endorsed by stereotactic devices, very high (ablative) radiation dose within a single
to a few fractions can be delivered for small and localized tumors (stereotactic
ablative radiation therapy; SBRT or SABR). SABR has been employed to the
patients with very early stage lung cancer (cT1/2N0M0) and to the patients with
single or oligo-metastatic lung cancer, and more or less, promising clinical
outcomes were achievable at Samsung Medical Center (reported at J Thoracic
Oncol in 2010 and Acta Oncol in 2012).
The patients with locally advanced lung cancer need definitely high dose radiation
therapy (RT), and 3-dimensional conformal therapy (3D-CRT) technique is most
commonly recommended. On many occasions when the clinical target volumes
(CTV) are very large, however, 3D-CRT cannot guarantee the safety by limiting the
radiation doses to the normal tissues like the lungs, the spinal cord, and the heart,
etc… Intensity-modulated radiation therapy (IMRT) technique is regarded a
reasonable alternative to 3D-CRT in such instances. From May 2010 to November
2012, 77 patients with N3-positive stage IIIB non-small cell lung cancer (NSCLC)
received definitive concurrent chemo-radiotherapy (CCRT) at Samsung Medical
Center (in press at Cancer Res and Treat). The median radiation therapy dose was
66 Gy and weekly docetaxel/paclitaxel plus cisplatin (67, 87.0%) was the most
common chemotherapy regimen during RT. With respect to the RT techniques, 48
patients (62.3%) were given 3D-CRT while 29 (37.7%) were given IMRT,
respectively. The choices of RT techniques were individually made based mainly
on the estimated lung toxicity, which were closely related with the sizes of the
clinical target volume (CTV), and the degree of geometric dispersions of the
primary tumor and the involved lymph node(s). The patients receiving IMRT had
greater disease extent in terms of supraclavicular lymph node (SCN) involvement
Radical chemoradiotherapy remains the definitive treatment for locally advanced
stage III unresectable NSCLC. The role of radiotherapy dose escalation has been
called into question with the recent release of RTOG 0617 trial results. Accelerated
repopulation is a concern in NSCLC and both hyper and hypo fractionated regimes
have been investigated to counteract this problem. Concurrent delivery of
chemotherapy yields superior outcomes but at the expense of toxicity.
Technological advances such as IMRT and IGRT may provide means to achieve
better dose delivery to target whilst sparing organs at risk. Molecularly targeted
agents are also being investigated in combination with radiotherapy but their
benefit remains speculative.
(9A-1) An Overview of the Human Immune System in Lung Cancer
Speaker: Ross Andrew Soo (Singapore)
An improvement in the understanding of the interaction between the immune
system and tumor has led to the development of a new generation of immune
modulators in the treatment of NSCLC. T cell mediated immune response is
modulated by stimulatory and inhibitory signals. Immune checkpoints exist in a
normal physiological state to protect against autoimmunity and inflammation.
Immune co-stimulatory molecules include CD28, CD137, glucocorticoid-induced
tumor necrosis factor (TNF) receptor (GITR), and OX-40 whereas immune
checkpoint molecules such as cytotoxic T-lymphocyte antigen-4 (CTLA-4),
programmed death-1 (PD-1), T-cell immunoglobulin- and mucin domain-3containingmolecule 3 (TIM3), Lymphocyte-activation gene 3 (LAG3) and killer cell
immunoglobulin-like receptor (KIR) prevent overstimulation of the immune
response. The dysregulation of checkpoint molecules can lead to tumor tolerance
and eventually allow for tumor “escape” from the immune system. This
presentation provides an overview of the tumor microenvironment, and the costimulatory and inhibitory molecules that regulate the immune response to NSCLC.
35
SPEAKERS
Speaker Abstracts
(9A-2) An Update on Immune Therapy
Speaker: David Carbone (USA)
It has been recognized for many years that the immune system can recognize and
eliminate cells expressing “non-self” features, but it has also been clear that
clinically evident tumors have effectively avoided or circumvented that immune
response. Therapeutic efforts with vaccines directed at inducing specific immune
responses against the tumor or specific tumor antigens have been clinically
minimally effective or completely ineffective to date, even though measurable
specific immune responses can often be seen in the laboratory. It is now
abundantly clear that the main obstacle to effectively harnessing the immune
system is not the availability of unique tumor antigens as typical lung cancers have
hundreds or thousands of expressed peptide sequences that are not present in
normal tissues. Rather, it is clear that tumors have evolved mechanisms either to
prevent the induction of these responses or render an induced response
ineffective. In the last few years, the development of therapies directed at blocking
PD-1/PDL-1 signaling have shown remarkable signals of durable clinical efficacy in
a subset of patients, and multiple antibodies targeting this axis are moving toward
regulatory approval. Remarkably, these agents are associated with a low
frequency of serious adverse events, and single agent first-line trials are ongoing,
testing these agents directly with state-of-the-art chemotherapy. Multiple
combinations with other chemo-, targeted, and radio-therapies are being tested,
including in early stage resectable disease. These studies open the possibility that
chemotherapy will be not the first choice in advanced non-small cell, but only used
in patients without targetable driver mutations or immune responsiveness. Major
questions still need to be answered with these agents, including definition of the
optimal biomarkers for patient selection, optimal combination and sequencing with
other therapies, optimal management of side-effects, and duration of therapy, but it
is clear that immunotherapy will be a cornerstone of lung cancer therapy in the near
future.
% (179 patients) and 13.2 % (47 patients); the median durations of progressionfree survival (PFS) and overall survival (OS) were 16.3 months and 45.5 months;
and the 3-/5-year PFS and OS rates were 32.0%/26.9 %, and 56.7%/43.3 %,
respectively. Age >60 years (p=0.032), pneumonectomy (p<0.001), and ypN+
(p<0.001) were found to be the significant prognosticators for worse PFS than age
≤60 years, lobectomy, and ypN0, respectively. Age >60 years (p=0.013),
pneumonectomy (p<0.001), and ypN+ (p<0.001) were related to worse OS than
age ≤60 years, lobectomy, and ypN0, respectively. Clinical N2 status did not
influence either OS or PFS: the number of involved stations (single station vs.
multi-station; p=0.187 for PFS; p=0.492 for OS), and bulk (clinically evident vs.
microscopic; p=0.902 for PFS; p=0.915 for OS).
From 1997 till 2012, 61 among 633 N2-IIIA NSCLC patients were treated with
definitive CCRT without surgical resection (bimodality therapy), because of the
patients' refusal of surgical resection in 21 patients and the difficulty in surgical
resection in 44 (in press at Cancer Res and Treat). The clinical outcomes following
bimodality therapy were, more or less, inferior to those following trimodality
therapy: the median durations of PFS and OS were 18.8 months and 28.6 months;
and the 2-year PFS and OS rates were 45.9% and 50.1%, respectively. Trimodality
therapy has proved its efficacy in N2-IIIA NSCLC regardless of initial bulk or extent
of cN2 disease, and bimodality therapy seems a reasonable alternative to
trimodality therapy if surgical resection is not feasible.
Based on the clinical outcomes at Samsung Medical Center, the issues on how to
select the patients who would benefit by trimodality therapy that includes surgical
resection remain to be further defined.
(9B-2) Safe Dosimetric Predictors to Minimise RT Induced Pneumonitis, Is
There a Role for Dose Escalation?
Speaker: Laurie Gaspar (USA)
(9A-3) Updates in Systemic Management of SCLC
Speaker: Solange Peters (Switzerland)
Despite advances in the treatment of NSCLC over the past several decades, only
small incremental overall survival benefits have been demonstrated and
treatments beyond first-line remain limited.
Although historically not considered immunogenic, lung cancer has emerged as an
exciting new target for immunotherapy.
Several randomized phase 3 vaccinations trials have been conducted. Promising
phase 2 data have opened the way to an enormous effort for the most successful
clinical trial recruitment ever achieved in phase III trials. Mage A3 vaccination trial in
the adjuvant setting after radical surgery and standard of care adjuvant
chemotherapy in early disease, restricted to tumours expressing MAGE A3
antigen, was presented at ESMO 2014 showing the strict absence of any clinical
benefit.
Anti-MUC1 (tecemotide) vaccination in locally advanced stage III after definitive
radiocheomotherapy was not able to show any improvement in OS, the primary
endpoint of the trial.
Finally, a vaccine composed of allogeneic NSCLC cell lines modified to block TGFβ, Belagenpumatucel-L, was tested in advanced disease, as a maintenance after
classical first line platinum based chemotherapy and again failed to show that
vaccination per se could improve NSCLC patients outcome.
Through all these clinical trials, and the ongoing ones, no reliable biomarker could
be characterized for the identification of a subgroup of patients with a potential
distinct outcome and favorable correlation with vaccination activity.
As more is learnt about the biology of lung cancer, the importance of T cells is
becoming increasingly clear. The role of T cells is important as part of the adaptive
immune response as they specifically target tumour antigens and induce
immunological memory.
These responses by T cells are regulated through a complex balance of inhibitory
'checkpoints' and activating signals. Deregulation of this process is one way that
cancers evade the immune system. A number of ongoing trials with immune
checkpoint inhibitors, including anti-PD-1, anti-PD-L1 and anti-CTLA-4 agents
have shown encouraging activity with the potential for long-term survival and a
manageable safety profile.
Cancer vaccination biological limitations as well as details of the clinical trials
available to date will be discussed.
(9B-1) Trimodality and Bimodality Therapy for Stage III Non-Small Cell Lung
Cancer: Experience at Samsung Medical Center
Cooperative group studies of concurrent chemoradiation therapy in Stage III
NSCLC have demonstrated Grade 3 or higher treatment-related pneumonitis
(TRP) rates in the range of 8-15%. Large institutional experience in stage III
patients treated with concurrent chemoradiation with 3D planning technique,
where the incidence of pneumonitis was calculated on an actuarial basis, the risk of
symptomatic pneumonitis was more than 30%.(1)
The two most frequently utilized dosimetric variables that have been utilized to
quantitate TRP are V20 (the percent of normal lung receiving 20 Gy or more) and
the mean lung dose (MLD). Marks et al (2) reviewed over 70 articles that correlated
dose/volume parameters with subsequent TRP following conventionally
fractionated radiation therapy of NSCLC. This review, frequently referred to as
QUANTEC, cautioned that there was no lung dose following which there was no
risk of TRP.
In addition to the radiation dosimetric factors, there is a definite impact of clinical
factors in predicting the risk of RP. Factors found to significantly increase the risk of
TRP were pre-existing pulmonary co-morbidity, mid or inferior tumor location,
current smoking, age older than 63 years, and sequential (as opposed to
concurrent) chemotherapy. (3) Palma et al (4) performed a meta-analysis of both
dosimetric and nondosimetric factors affecting the risk of TRP following concurrent
chemoradiation. Factors predicting TRP were type of chemotherapy
(carboplatin/paclitaxel vs cisplatin/etoposide or other chemotherapy), age, V20
and MLD.
Intensity modulated radiation therapy (IMRT) is a technique to modestly reduce the
V20 and MLD. Preliminary results of RTOG 0617 indicate that although IMRT was
not associated with decreased TRP, quality of life was superior as compared to
patients treated with 3D therapy. (Movsas 2013).
Other methods to possibly reduce TRP are neoadjuvant chemotherapy to reduce
target volume, adaptive radiation therapy, and pharmacologic manipulations such
as steroids, amifostine, ACE-inhibitors and pentoxifylline,
1.
Wang S, Liao ZX, Wei X, et al. Analysis of clinical and dosimetric factors associated with
treatment related pneumonitis (TRP) in patients with non-small-cell lung cancer
(NSCLC) treated with concurrent chemotherapy (CCT) and three-dimensional conformal
radiotherapy (3D-CRT). Int J Radiat Oncol Biol Phys. 2006;66:13991407
2.
Marks LB, Bentzen SM, Deasy JO, et al. Radiation dose-volume effects in the lung. Int J
Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S70-6.
3.
Appelt AL, Vogelius IR, Farr KP, et al Towards individualized dose constraints: Adjusting
the QUANTEC radiation pneumonitis model for clinical risk factors. Acta Oncol.
2013;53(5):605-6012
4.
Palma DA, Senan S, Tsujino K, et al. Predicting radiation pneumonitis after
chemoradiation therapy for lung cancer: an international individual patient data meta
analysis. Int J Radiat Oncol Biol Phys. 2013;85(2):444-50
5.
Movsas B, Hu C, Sloan J, et al. Quality of Life (QOL) Analysis of the Randomized
Radiation (RT) Dose-Escalation NSCLC Trial (RTOG 0617): The Rest of the Story. Int J
Rad Oncol Biol Phys. Vol 87, No 25, Proc 55th Annual ASTRO Meeting 2013; pS1.
Abstract #2
Speaker: Yong Chan Ahn (Korea)
36
The optimal treatment option for the patients with N2-positive stage IIIA (N2-IIIA)
non-small cell lung cancer (NSCLC) has long been a controversial issue.
Trimodality therapy, consisting of neoadjuvant concurrent chemo-radiotherapy
(CCRT) and surgical resection, has been the primary policy at Samsung Medical
Center since 1997. The clinical outcomes following trimodality therapy on 355
patients, who were treated until 2011, have been reported (published at Ann of
Surg Oncol, 2014): overall down-staging and complete response rates were 50.4
(9B-3) Biologic Strategies to Improve Radiotherapy Outcomes
Speaker: David Ball (Australia)
Since the RTOG dose escalation study 0617failed to demonstrate a survival
benefit of 74 over 60 Gy in stage III non-small cell lung cancer (NSCLC), attention
has turned to biologic strategies to improve radiotherapy outcomes.
SPEAKERS
Speaker Abstracts
It is well established that local control (and survival) is improved by the addition of
concomitant platinum based chemotherapy to external beam radiotherapy. What is
not established however is the optimum chemotherapy drugs and schedule, and
whether two drugs are better than one. The predominant effect of the platinum
agent is thought to be inhibition of repair of radiation induced DNA damage. DNA
repair is also targeted by PARP inhibitors which are currently under investigation in
the clinic. Thus far they do not appear to enhance normal tissue toxicity in
unselected patients.
High levels of NSCLC EGFR expression are thought to be an adverse prognostic
factor. There is some indirect evidence in head and neck cancer that EGFR
expression may be associated with accelerated repopulation which could be
counteracted by shortening overall treatment time. An alternative approach might
be to inhibit EGFR expression with a drug such as cetuximab. Although this drug
did not improve survival in RTOG 0617, subset analysis of patients with higher
levels of EGFR expression may have had longer survival, indicating the
importance of ensuring the presence of the target when using targeted therapy.
and will be applied to those with activation of ROS1, RET, BRAF, and others.
Median survival time of patients with metastatic lung cancer that was about one
year around the turn of this century is now approaching 3 years for these patients
with EGFR mutations.
Yet, lung cancer is still the leading cause of cancer death in many countries and
now claims 1.38 million lives worldwide annually, because these therapies in
general never produce cure of the patients due to emergence of acquired
resistance. The small percentage of patients who are cured are generally from
among the patients who present with localized disease which is totally resected by
surgery. In the past 10-15 years, surgery has become safer and less invasive.
However this does not mean we can now cure the patients who could not be cured
in the past. In the era of personalized medicine, thoracic surgeons have to think
about their evolving roles.
In this talk, I would like to discuss four topics relevant to this issue. Firstly, the value
of surgical specimens as opposed to biopsy specimens for further understanding
tumour biology. Recent advent of next generation sequencing has revealed that
genetic alterations in a single patient is considerably heterogeneous than
previously thought. Understanding the tumor heterogeneity requires a tumor as a
whole which can be obtained only by surgical resection.
Tumor hypoxia is a well established cause of radioresistance, and can be
demonstrated in lung cancer patients using hypoxic imaging agents such as FAZA.
Although numerous strategies for counteracting hypoxia are available, it is
surprising that only fractionation is in routine clinical use. Hypoxic radiosensitisers
such as nimorazole which has proven effective in head and neck cancer, and
agents which normalise the tumor microvasculature to improve tumor blood flow
require further investigation.
Secondly, extended indication of surgery in the era of targeted therapy is
considered. In Role of surgery for the patients with oligo-metastatic or oligorecurrent diseases has been evaluated especially when patients with acquired
resistance to tyrosine kinase inhibitors to EGFR or ALK.
(9C-1) Surgical Challenges Post-Induction Chemotherapy or
Chemoradiation therapy
Thirdly, possibility of patient selection by appropriate biomarkers for peri-operative
therapy is discussed. So far we have not established reliable biomarker in this
regard. Recently we have identified UMP synthase expression as a potential
predictor for adjuvant S-1 treatment.
Speaker: Hisao Asamura (Japan)
The optimal management of the patients with clinical stage IIIA disease (especially
IIIA-N2 disease) has not been clearly defined yet. Although it has been widely
accepted that the upfront surgery for patients with a proven N2 disease cannot
improve their survival and the concurrent chemo-radiotherapy is respected as the
standard management for these patients, the significance of the surgical
intervention in the context of this scenario has not been well established. Should
we operate on the patients after induction chemo-/chemoradiotherapy? If so, what
type of surgery could be accepted, and what type of surgery could not be
accepted? We should realize that the patients undergoing surgery after induction
treatment are more likely to have advanced disease which necessitates bigger
resection such as pneumonectomy or combined resection. Moreover, the induction
treatment may jeopardize the physical condition of the patients and increase the
surgical risk. These are really the technical challenges of the surgeons.
In our previous retrospective study on the incidence, risk factors, and management
of the bronchopleural fistula (BPF), the history of the radiation treatment was one of
the significant risk factors for BPF together with pneumonectomy, R1 operation,
and diabetes.1 Therefore, the addition of radiation to the systemic chemotherapy in
the induction treatment is reasonably expected to increase the risk after
operations. Cerfolio retrospectively studied the mortality rate in 104 patients who
had the pulmonary resection following low-dose and high-dose radiation.2 They
were 2% and 3.7%, respectively. However, looking at 12 patients undergoing
pneumonectomy, it was as high as 16.7%. Similarly, Daly reported the mortality
rate at 13.3% after pneumonectomy following high-dose radiation therapy.3
Recently, the Memorial Sloan-Kettering group launched a report stating that the
mortality rate after pneumonectomy with/without preoperative radiation therapy
was only 4.3%, and radiation or induction treatment did not jeopardize the
outcome.4 However, there should be a cautious comment on this. Although this is a
very important benchmark data in the thoracic oncological community, we should
realize that these outcomes came from the most experienced center in the world,
and that as the authors stated they also experienced a learning curve to reduce the
operative mortality rate after pneumonectomy following induction therapy from at
11.3% to 4.3%. Inexperienced surgeons or institute should consider that this high
risk surgery could not be performed at designated mortality rate in the article.
Integration of the written and unwritten skills, know-hows, knowledge must be
indispensable. Rather we should still respect the surgical intervention following
induction therapy as the challenging, high-risk procedures.
Finally, the possibilities to personalize the surgical procedure or extent of lung
resection according to lung cancer subtypes are reviewed. If we could accurately
predict the patients who will not have lymph-node metastases before surgery, we
should be able to spare more lung parenchyma, which would help preserve the
quality of life of these patients. Prospective trials of wide wedge resection for noninvasive lung caner defined by imaging studies and the randomized trial comparing
lobectomies with segmentectomies for the patients with small invasive cancer is
conducted by the Japan Clinical Oncology Group. I would like to share our recent
evaluation of genetic features of pulmonary adenocarcinoma presenting with
ground-glass opacities between those with growth potential and those without it.
(9C-3) Chest Wall Resection and Reconstruction in Lung Cancer Surgery
Speaker: Aneez D.B Ahmed (Singapore)
Chest wall reconstruction is a challenge that confronts surgeons and causes much
apprehension before embarking on it. Improvements in anesthetic [pain]
management, the refinement of resection and reconstruction techniques, use of
different prosthetic materials, multi-speciality involvement and postoperative care
have allowed chest wall resections and reconstructions to be performed with
acceptable morbidity and mortality .
Defects of the chest wall almost always occur as a result of neoplasm (primary or
recurrent), radiation injury, infection, or trauma. Chest wall defects produced by
excision of most neoplasms whether primary or secondary usually results in the
loss of skeleton and frequently the overlying soft tissues as well. Radiation injury,
infection, and trauma may produce partial or full-thickness defects, depending on
their severity. Not uncommonly, various combinations of these afflictions occur in
the same patient, and management of these problems often becomes problematic.
The surgical practice usually is to obtain wide margins and rid the patient of all
possible malignant, contaminated, or irradiated tissue while leaving a defect that
can be closed to maintain life itself. A thorough knowledge of reconstructive
techniques with a clear operative plan that includes a secondary or repeat
procedure, if possible is required. We believe that this dilemma is best managed by
the combined efforts of both a thoracic and plastic surgeon.
We believe in the five principles which we feel are important in chest wall resection
and reconstruction surgery.
REFERENCES
1.
Asamura H, et al. Bronchopleural fistulas associated with lung cancer surgery. Univariate and
multivariate analysis of risk factors, management, and outcome. J Thorac Cardiovasc Surg
1992; 104:1456-64.
Adequate amount of tissue resection with clear margins providing adequate
cancer cure and removal of devitalized tissue
2.
The replacement of chest wall defect with either synthetic, bio-prosthetic or
new age materials should be rigid, maintain chest rigidity but pliable to
maintain respiratory physiology.
3.
Healthy soft tissue coverage is essential to cover the visceral organs and
also the newly constructed chest wall which we think plays the most crucial”
role in the outcomes.
4.
The procedures should be performed by a well coordinateam which includes
a thoracic surgeon,plastic surgeon and other specialty surgeons as needed
with good anesthetic back up.
5.
The post operative care should be backed up by a good pain control protocol
with good physiotherapy care.
1.
Cerfolio RJ, et al. Pulmonary resection after high-dose and low-dose chest irradiation.
Ann Thorac Surg, 2005;80:1224-30
2.
Daly BDT, et al. Pneumonectomy after high-dose radiation and concurrent
chemotherapy for nonsmall cell lung cancer. Ann Thorac Surg 2006;82:227-31
3.
Barnett SA, et al. Contemporary results of surgical resection of non-small cell lung cancer
(NSCLC) following induction therapy: A review of 549 consecutive cases. J Thorac Oncol
2011;6:1530-6.
(9C-2) Personalising Surgery Based on Lung Biomarkers
Speaker: Tetsuya Mitsudomi (Japan)
The discovery of activating mutations of the EGFR gene and its close association
with sensitivity to the EGFR-tyrosine kinase inhibitors (TKI) brought the paradigm
shift in lung cancer management. This personalization of drug therapy according to
oncogenic drivers in their tumors are now extended to lung cancers with ALK fusion
In conclusion with advanced medical care and increasing evidence for radical
resections associated with improved survival, quality of life care issues play a
major part. Chest wall reconstruction will play a major part in the oncoming years
and these procedures can be done with an acceptable mortality and morbidity
outcomes.
37
ORAL FREE PAPER PRESENTATION
Oral Free Paper Presentation
Oral Free Paper Presentation A
- Thursday, 6 November 2014
Venue: Penang Room, Lower Lobby Level
1100 - 1110
1110 - 1120
A-0126 Clinical characteristics and prognosis of multiple
primary malignancies involving lung cancer
Feng Li, China
1120 - 1130
A-0128 Prognostic Factors in Non-small Cell Lung
Carcinoma Patients with Brain Metastases: A Malaysian
single-institution perspective
Weng Heng Tang, Malaysia
1130 - 1140
A-0131 Baseline FDG-PET/CT parameters were not
independent prognostic factors but might assist in
predicting overall survival in TKI-treated stage IV lung
adenocarcinoma
Elaine Lee, Hong Kong
1140 - 1150
A-0133 Survival analysis of I-IIIA non-Small Cell Lung
Cancer patients with Adjuvant Chemotherapy
Jian Ni, China
1150 - 1200
A-0135 D i a g n o s t i c r o l e o f e n d o b r o n c h i a l
ultrasonography in recurrences of operated lung cancer
Sevda Sener Comert, Turkey
A-0165 The volume of pulmonary lesion as imaging
biomarker: Validity of theoretical thresholds for the
monitoring of response to treatment
Hubert Beaumont, France
1450 - 1500
A-0168 EGFR exon 19 mutation subtypes affect survival
outcomes in advanced non-small cell lung cancer
Balram Chowbay, Singapore
1500 - 1510
A-0173 Metabolic coupling in lung cancer cell lines by
13C NMR isotopomer analy
Ludgero Canari Tavares, Portugal
1510 - 1520
A-0177 Quercetin pentaacetate, 7,8-diacetoxy-4-methyl
coumarin and valproic acid induce p21 expression and
apoptosis in lung cancer
Anju Sharma, India
1520 - 1530
A-0192 Contemporary salvage chemotherapy in patients
with relapsed small cell lung cancer: the role and use of
topotecan
Hitomi Sumiyoshi Okuma, Japan
Oral Free Paper Presentation C
- Thursday, 6 November 2014
Venue: Penang Room, Lower Lobby Level
1600 - 1610
A-0193 Cavitating Bronchogenic Carcinoma of Right
Lung
Abdul Rahman Ismail, Malaysia
1610 - 1620
A-0195 Polymorphisms of rs9387478 correlate with the
overall survival of female non-smoking patients with lung
cancer
Jiefei Han, China
1620 - 1630
A-0197 ABCB1 mediated cross-chemoresistance in lung
cancer cells with acquired resistance to erlotinib
Hiroshi Mizuuchi, Japan
1630 - 1640
Oral Free Paper Presentation B
- Thursday, 6 November 2014
Venue: Penang Room, Lower Lobby Level
A-0198 New York-Esopahageal-1 (NY-ESO-1) promoter
methylation is repressible using 5-Azacitdine and
influences chemosensitivity in NSCLC
Sem Liew, Australia
1640 - 1650
A-0199 Safety and efficacy of crizotinib in patients with de
novo c-MET overexpressed NSCLC
Anna Li, China
1400 - 1410
1200 - 1210
1210 - 1220
1410 - 1420
38
A-0123 Preoperative exercise testing is more predictive
for postoperative cardiopulmonary complications than
pulmonary function test for lung cancer
Yasuo Sekine, Japan
1440 - 1450
A-0139 Limitation of tyrosine kinase inhibitors (TKIs) as
second-line treatment in epidermal growth factor receptor
(EGFR) activating mutation advanced non-small cell lung
cancer (NSCLC) : A retrospective cohort study
Dai Wee Lee, Malaysia
A-0257 Age Affects Risk of Postoperative Atrial
Fibrillation after Robotic-Assisted Video-Thoracoscopic
Pulmonary Lobectomy
Eric Miguel Toloza, United States
A-0258 Body Mass Index Affects Risk of Postoperative
Atrial Fibrillation Differently In Men versus Women after
Robotic-Assisted Video-Thoracoscopic Pulmonary
Lobectomy
Eric Miguel Toloza, United States
1650 - 1700
A-0201 Performance of Lung Cancer Care services in a
middle income developing country Malaysia
Teck-Onn Lim, Malaysia
1700 - 1710
A-0153 Surgical treatment combined with first-line
irinotecan plus platinum chemotherapy for small cell lung
cancer
Jiro Kitamura, Japan
A-0204 Evaluation for quantitative change of EGFR
T790M mutation in EGFR-TKIs treatment by nanofluidic
digital PCR
Eiji Iwama, Japan
1710 - 1720
A-0206 Updated long-term survival results from a phase
II study of gefitinib and inserted cisplatin plus docetaxel
as a first-line treatment for advanced non-small-cell lung
cancer harboring an epidermal growth factor receptor
activating mutation
KazushiYoshida, Japan
1720 - 1730
A-0217 C-MET overexpression coexists with driver
genes and response to TKIs in non-small-cell lung cancer
Na Na Lou, China
1420 - 1430
A-0154 Platinum re-challenge for relapsed non-small
cell lung cancer following postoperative adjuvant
platinum-based chemotherapy
Jiro Kitamura, Japan
1430 - 1440
A-0158 Effects of pemetrexed and AZD6244 in KRAS
mutant non-small cell lung cancer
Lulu Yang, China
ORAL FREE PAPER PRESENTATION
Oral Free Paper Presentation
1130 - 1140
A-0075 Pemetrexed and Carboplatin concomitant with
Thoracic Radiotherapy in Treatment of Elderly Patients
with Non- squamous Non Small Cell Lung Cancer
(NSCLC): Institutional Experience
Sherif Abdelwahab Mohamed, Egypt
Concurrent Session 6C
- Friday, 7 November 2014
Venue: Kedah Room, Lower Lobby Level
1100 - 1110
1110 - 1120
1120 - 1130
1140 - 1150
A-0057 Updated results of BEYOND, a randomised,
multicentre phase III study of first-line
carboplatin/paclitaxel with or without bevacizumab in
Chinese patients with advanced non-squamous non
small-cell lung cancer (NSCLC)
Caicun Zhou, China
A-0076 Efficacy of bevacizumab combined with
paclitaxel and carboplatin: A second line treatment of
elderly patients with advanced non-small cell carcinoma
(NSCLC)
Sherif Abdelwahab Mohamed, Egypt
1150 - 1200
A-0020 Tr o u b l e s h o o t i n g f o r b l e e d i n g d u r i n g
thoracoscopic anatomic pulmonary resection
Hitoshi Igai, Japan
A-0083 First Video-Assisted Thoracic Surgery (VATS)
Lobectomy in Hospital Sultanah Aminah
Abdul Rahman Ismail, Malaysia
1200 - 1210
A-0084 Excision of large mediastinal tumour using
Cardiopulmonary bypass in Hospital Sultanah Aminah
Abdul Rahman Ismail, Malaysia
1210 - 1220
A-0087 Targeting c-Met overexpression for acquired
resistance to EGFR TKIs in NSCLC
Lanying Gou, China
1220 - 1230
A-0089 Analysis of MET expression in primary tumours
and corresponding metastases in Non Small Cell Lung
Cancer (NSCLC)
Babak Tamjid, Australia
A-0022 P A P S S 1 ( 3 ' - P h o s p h o a d e n o s i n e 5 '
-Phosphosulfate Synthase 1) as a novel therapeutic
target for combination treatments in non-small cell lung
cancer
Ada Leung, Canada
1130 - 1140
A-0037 Analysis of recurrence risk factors after complete
resection of stage ⅢA-N2 non-small cell lung cancer
Guangliang Qiang, China
1140 - 1150
A-0042 Chemotherapy treatment of elderly patients ( 70
years or older ) with non-small cell lung cancer. A five-year
material in clinical practice from Karolinska University
Hospital Sweden
Hirsh Koyi, Sweden
Venue: Perak Room, Lower Lobby Level
1100 - 1110
A-0093 Bronchoscopic diagnosis of solitary pulmonary
nodules with the use of NIR and Raman spectroscopy
Tomas Bruha, Czech Republic
1150 - 1200
A-0050 Gefitinib in front line treatment of caucasian
patients with NSCLC in the Czech Republic: analysis of
154 patients
Jana Skrickova, Czech Republic
1110 - 1120
A-0098 Level of awareness of lung cancer among
teachers in India: Do awareness programmes have
impact on prevention and early detection?
Abhishek Shankar, India
1200 - 1210
A-0051 Reciprocal relationship between EGFR T790M
mutation and small cell lung cancer transformation as
acquired resistance molecular mechanisms to EGFR
kinase inhibitor
Kenichi Suda, Japan
1120 - 1130
A-0099 The impact of clinicopathological characteristics
on maximum standardized uptake values of 18F-FDG in
non-small cell lung cancer
Guangliang Qiang, China
1210 - 1220
A-0010 Virtual segmentectomy: preoperative simulation
of segmentectomy using 3 dimensional computed
tomography lung modelin
Hisashi Saji, Japan
1130 - 1140
A-0100 Squamous cell carcinoma of the lung in smokers
and never smokers
Jiunn Liang Tan, Malaysia
1140 - 1150
A-0101 Epidermal growth factor receptor mutations in
squamous cell carcinoma of the lung
Jiunn Liang Tan, Malaysia
1150 - 1200
A-0102 Pharmacokinetic Parameters of Gefitinib
Predicts its Progression Free Survival and Adverse
Events
Shinnosuke Takemoto, Japan
1200 - 1210
A-0107 Impact of EGFR mutation status on survival after
recurrence in patients with completely resected lung
adenocarcinoma
Yujin Kudo, Japan
1210 - 1220
A-0109 Hand assisted thoracoscopic surgery (HATS) for
metastatic lung tumors
Shozo Fujino, Japan
1220 - 1230
A-0112 A Phase II study of Amrubicin and Carboplatin for
Previously Untreated Patients with Extensive-Disease
Small Cell Lung Cancer
HIroaki Senju, Japan
1220 - 1230
A-0061 A Randomized, Double-Blind, Phase 2 Trial of
Veliparib (ABT-888) with Carboplatin and Paclitaxel in
Previously Untreated Metastatic or Advanced Non-Small
Cell Lung Cancer
Jacqueline Nielsen, United States
Venue: Selangor I Room, Lower Lobby Level
1100 - 1110
A-0063 Pleuroscopic Analysis In Diagnosing Lung
Malignancy: A Malaysian Cohort
Nurul Yaqeen Mohd Esa, Malaysia
1110 - 1120
A-0065 Software evaluation for volume quantification as
an imaging biomarker for pulmonary lesions on computed
tomography
Hubert Beaumont, France
1120 - 1130
A-0066 3D-volumetric analysis of preserved lung after
segmentectomy: comparison of the methods of dividing
inter-segmental plane
Hiroyuki Tao, Japan
39
ORAL FREE PAPER PRESENTATION
Oral Free Paper Presentation
Oral Free Paper Presentation D
- Friday, 7 November 2014
Venue: Penang Room, Lower Lobby Level
Oral Free Paper Presentation E
- Friday, 7 November 2014
Venue: Kelantan Room, Lower Lobby Level
1400 - 1410
1400 - 1410
A-0252 Prognostic value of pre-radiotherapy 18F-FDG
PET/CT for Small Cell Lung Carcinoma
Mehmet Koc, Turkey
1410 - 1420
A-0254 The difference between nodal upstaging group
and the others in pathologic stage II, III patients of non
-small cell lung cancer
Youngkyu Moon, South Korea
1420 - 1430
A-0228 Randomized phase III trial of stereotactic
radiosurgery (SRS) versus observation for patients with
asymptomatic cerebral oligo-metastases in non-small
cell lung cancer
Sung Hee Lim, South Korea
A-0255 Comparison of Peri-Operative Outcomes after
Robotic-Assisted Lobectomy versus Robotic-Assisted
Segmentectomy
Eric Miguel Toloza, United States
1430 - 1440
A-0256 Comparison of Predicted Post-Operative
Pulmonary Function after Robotic-Assisted Video
-Thoracoscopic Lobectomies versus Segmentectomies
Eric Miguel Toloza, United States
A-0229 Management of Respiratory Malignancies in
Gold Coast
Myitzu Khaing, Australia
1440 - 1450
A-0142 Overall survival (OS) in Asian patients with
advanced non-small cell lung cancer (NSCLC) harboring
common (Del19/L858R) Epidermal Growth Factor
Receptor (EGFR) mutations: combined analysis of two
large open-label phase III studies (LUX-Lung 3 [LL3] and
LUX-Lung 6 [LL6]) comparing afatinib with chemotherapy
Yi-Long Wu, China
1450 - 1500
A-0144 A 4DCT-Based Workflow for SBRT Image
Guidance
Prema Rassiah-Szegedi, United States
1410 - 1420
1420 - 1430
1430 - 1440
A-0227 Spatiotemporal T790M heterogeneity in
individual patients with non-small cell lung cancer
(NSCLC) after acquired resistance to EGFR-tyrosine
kinase inhibitor (TKI)
Akito Hata, Japan
1440 - 1450
A-0233 VATS lobectomy for elderly non-small cell lung
cancer: a propensity score-matched study
Xi Zhao Sui, China
1450 - 1500
A-0235 KEYNOTE-042: Open-Label, Phase 3 Study of
Pembrolizumab (MK-3475) versus Platinum Doublet
Chemotherapy as First-Line Therapy for PD-L1-Positive
Non-Small Cell Lung Cancer
Tony Mok, Hong Kong
1500 - 1510
1510 - 1520
1520 - 1530
40
A-0221 Molecular Epidemiology and Correlation among
c-MET amplification and phospho-c-MET or HGF
expression in c-MET overexpressed non-small cell lung
cancer patients
Yuanyuan Lei, China
1500 - 1510
A-0238 Cryosurgery and Weekly Chemotherapy as a
Combine Treatment for Advance Stages of Non-Small
Cell Lung Cancer in Geriatric Patients
Darmawan Ismail Bin Guntur, Indonesia
A-0259 NextGeneration Sequencing In Lung Cancer
Diagnosis: Malaysian View Point
Roziana Ariffin, Malaysia
1510 - 1520
A-0240 Is brain metastasis is a poor prognostic factor in
EGFR positive NSCLC.
Kumar Prabhash, India
A-0260 EGFR and K-RAS mutation analysis in lung
adenocarcinoma - preliminary results
Nor Rizan Kamaluddin, Malaysia
1520 - 1530
A-0138 Association of graded folic acid supplementation
and total plasma homocysteine levels with hematological
toxicity during first-line treatment of non-squamous
NSCLC patients with pemetrexed based chemotherapy
Navneet Singh, India
A-0251 Comprehensive analysis of MET alterations in
Non-small cell lung cancer
Ka Fai To, Hong Kong
AUTHOR INDEX
Author Index
Abdelhafiez Z ...............................................................................A-0075 MO
Abdelwahab Sherif..........................................................A-0075, A-0076 MO
Abdul Rahman Ismail.......................................................A-0083, A-0084 SU
Abdul Razak Bin Abdul Muttalif .....................................................A-0259 PA
AbdulRahman Ismail.....................................................................A-0193 SU
Abhishek Shankar....................................................................A-0098 RASC
Ada Leung ....................................................................................A-0022 CM
Ahmad Izuanuddin Ismail..............................................................A-0063 PU
Ahmed M Malki.............................................................................A-0079 MO
Ahn Jin Seok ................................................................................A-0090 CM
Ahn Myung-Ju ..............................................................................A-0090 CM
Ahn Yong Chan ............................................................................A-0090 CM
AI Ismail ........................................................................................A-0232 PU
Akihiro Bessho .............................................................................A-0092 MO
Akihiro Nishiyama.........................................................................A-0227 MO
Akihiro Ono ..................................................................................A-0219 MO
Akihiro Yoshii................................................................................A-0046 MO
Akiko Fujii.....................................................................................A-0121 MO
Akira Mogi.....................................................................................A-0111 MO
Akira Ono .....................................................................................A-0045 MO
Akira Sato .....................................................................................A-0073 PU
Akito Hata .......................................................................A-0150, A-0227 MO
Akitoshi Kinoshita .........................................................................A-0112 MO
Alberto Caprioli .............................................................................A-0189 NU
Aleksandra Szczesna...................................................................A-0094 MO
Alessandro Del Conte...................................................................A-0189 NU
Ali Fidan.....................................................................................A-0135 IMST
Alip Adlinda ..................................................................................A-0128 RA
Alla Synytsya.................................................................................A-0093 PU
Álvaro Undurraga..................................................................P A-0040 RASC
AM Ismail.......................................................................................A-0018 EP
AM Mohamed Sakr........................................................................A-0018 EP
Ambarish Dutta..............................................................................A-0151 EP
Amit Janu .....................................................................................A-0240 MO
Amit Joshi.....................................................................................A-0240 MO
Amith Ahluwalia ............................................................................A-0022 CM
Anamarija Kruljac-Letunic ............................................................A-0094 MO
Andrzej Kazarnowicz....................................................................A-0094 MO
Anju Sharma...................................................................................A-0177 BI
Anna Ceribelli................................................................................A-0189 NU
Anna Li.......................................................................A-0199 MO A-0221 EP
Anna M. Cheng......................................A-0255, A-0256,A-0257, A-0258 SU
Annamaria Miccianza....................................................................A-0189 NU
Anny-Yue Yin................................................................................A-0057 MO
Antoine Iannessi...........................................................A-0065, A-0165 IMST
Antonio Piottante B ..................................................................A-0040 RASC
Antonio Rossi................................................................................A-0189 NU
Antonio Santo ...............................................................................A-0189 NU
Anuradha Chougule .....................................................................A-0240 MO
AR Muttalif.....................................................................................A-0201 EP
Arzu Erturk ...................................................................................A-0163 MO
Ashish Jakhetiya..............................................................A-0160, A-0246 SU
Ashutosh N. Aggarwal..................................................................A-0138 MO
Asma Tulbah..................................................................................A-0007 PA
Atsushi Hata..................................................................................A-0123 SU
Atsushi Osoegawa ........................................................................A-0226 SU
Atsushi Takise .................................................................A-0111, A-0219 MO
Ayperi Ozturk................................................................................A-0163 MO
Azmy A .........................................................................................A-0076 MO
B Salter..........................................................................................A-0113 RA
B Wang..........................................................................................A-0113 RA
Babak Tamjid................................................................................A-0089 MO
Balram Chowbay..........................................................................A-0168 MO
Banu Salepci .............................................................................A-0135 IMST
Baohui Han ..................................................................................A-0057 MO
Beatrix Bálint ................................................................................A-0094 MO
Benan Caglayan........................................................................A-0135 IMST
Ben-Yuan Jiang ..........................A-0087, A-0199 MO A-0225 EP A-0217 PU
Berrin B. Yavuz .............................................................................A-0252 RA
Bill J. Salter ...................................................................................A-0144 RA
Bin Shi......................................................................................A-0099 RASC
Bin-Chao Wang.............................................A 0087, A-0199 MO A-0217 PU
Bing Shi.........................................................................................A-0037 SU
Bing-Ching Ho..............................................................................A-0250 MO
Bong-Seog Kim ............................................................................A-0220 MO
Boo Yang Liang.............................................................................A-0009 PU
Boram Lee....................................................................................A-0062 MO
Brendan Pang ..............................................................................A-0207 MO
Brian Kwok ...................................................................................A-0022 CM
Brian Wang ...................................................................................A-0144 RA
Bulent Karagoz .............................................................................A-0186 PU
Busyamas Chewaskulyong ..........................................................A-0230 MO
Byoung Chul Cho............................................................A-0068, A-0220 MO
Byungsup Kim...............................................................................A-0228 RA
C Michael Jones...........................................................................A-0061 MO
Caicun Zhou ......................................................A-0057, A-0104, A-0142 MO
Carla C. Moodie....................................A-0255, A-0256, A-0257, A-0258 SU
Carmel Murone.............................................................................A-0089 MO
Caroline Nickner...........................................................................A-0061 MO
Cebon J........................................................................................A-0198 MO
Chan AW .......................................................................................A-0251 PA
Chandran H...................................................................................A-0128 RA
Chang Dong Yeo ..........................................................................A-0024 MO
Chang Youl Lee.............................................................................A-0023 PU
Chao-Hua Chiu .............................................................................A-0141 PU
Chaoyang Liang.....................................................A-0037 SU A-0099 RASC
Charu Singh ..................................................................................A-0106 RA
Chee-Keong Toh ...........................................................................A-0035 EP
Chee-Kuan Wong..........................................................................A-0101 PU
Chen Bin ......................................................................................A-0132 MO
Chen DF .......................................................................................A-0088 CM
Chen Ming ....................................................................................A-0090 CM
Cheng Nang Leong.......................................................................A-0208 RA
Cheng-Ping Hu.............................................................................A-0142 MO
Chieh-Hung Wu............................................................................A-0187 MO
Chih-Chieh Chang.........................................................................A-0194 RA
Chih-Wei Wu ................................................................................A-0187 MO
Chi-Lu Chiang ...............................................................................A-0141 PU
Chin Pek Woon .............................................................................A-0009 PU
Ching-Chih Lee .............................................................................A-0114 PU
Chiyuki Okuda..............................................................................A-0150 MO
Cho Eun Kyung ............................................................................A-0090 CM
Choi Jin-Hyuck .............................................................................A-0090 CM
Chong-Kin Liam.............................................A-0100, A-0101 PU A-0201 EP
Chong-Rui Xu...............................................A-0087, A-0199 MO A-0217 PU
Claudio Pardo B.......................................................................A-0040 RASC
Dai Ishii .........................................................................................A-0086 SU
Daiki Ogawara.................................................................A-0102, A-0112 MO
Daisuke Kasai ..............................................................................A-0150 MO
Daisuke Morichika........................................................................A-0092 MO
Dai-Wee Lee ................................................................................A-0139 MO
Dai-Wei Liu .................................................................A-0114 PU A-0129 RA
Dan Massey .................................................................................A-0142 MO
Daniel Ricaurte.............................................................................A-0022 CM
Daniel Shao-Weng Tan .................................................................A-0035 EP
Daniel Tan ....................................................................................A-0168 MO
Daren Choon-Yu Teoh..................................................................A-0139 MO
Darmawan I...................................................................................A-0238 SU
Darren Wan-Teck Lim...................................................................A-0168 MO
David Ladrón de Guevara H.......................................A-0040, A-0041 RASC
David Lazo P............................................................................A-0040 RASC
David Spigel .................................................................................A-0064 MO
Deo SVS..........................................................................A-0160, A-0246 SU
Deruo Liu ...............................................................A-0037 SU A-0099 RASC
Di Zheng.......................................................................................A-0133 MO
Diego Cortinovis............................................................................A-0189 NU
Digambar Behera .........................................................................A-0138 MO
Dilaver Tas ....................................................................................A-0186 PU
Domenico Galetta .........................................................................A-0189 NU
Don X. Zhang ...............................................................................A-0166 MO
Dongryul Oh..................................................................................A-0244 RA
Dong-Wan Kim .............................................................................A-0080 MO
Durgatosh Pandey...........................................................A-0160, A-0246 SU
Dwi Wahyunianto Hadisantoso ....................................................A-0125 MO
Ebenezer Kio................................................................................A-0061 MO
Edris Sadeghi...............................................................................A-0175 MO
Eiichi Maruyama .............................................................................A-0176 BI
Eiji Iwama.......................................................A-0204, A-0236 BI A-0121 MO
Eiko Inamasu ................................................................................A-0108 SU
Eisuke Matsuda.............................................................................A-0066 SU
Eitetsu Koh....................................................................................A-0123 SU
Elaine Lee ................................................................................A-0131 RASC
Emily Ng................................................A-0255, A-0256, A-0257, A-0258 SU
En Yun Loy.................................................................A-0207 MO A-0208 RA
Eng-Huat Tan .............................................................A-0035 EP A-0168 MO
Enrica Capelletto...........................................................................A-0189 NU
Eric M. Toloza .......................................A-0255, A-0256, A-0257, A-0258 SU
Ersin Demirer ................................................................................A-0186 PU
Erzsebet Juhasz...........................................................................A-0061 MO
Eskandarain Shafuddin.................................................................A-0054 PU
Esra Ozayd?n ..............................................................................A-0163 MO
Estanislao Oubel .......................................................................A-0065 IMST
Eun Kyung Cho...............................................................A-0068, A-0080 MO
Eunjue Yi.......................................................................................A-0122 SU
Eun-Taik Jung ..............................................................................A-0224 MO
F. Hirai ..........................................................................................A-0171 MO
Fabrice Barlesi .............................................................................A-0061 MO
Fang Ying .....................................................................................A-0196 MO
Fei Xiao.........................................................................................A-0037 SU
Fei-Yu Niu.....................................................................................A-0126 MO
Feng Li .........................................................................................A-0126 MO
Feng-Chun Hsu...........................................................A-0114 PU A-0129 RA
Ferhan Karatas..........................................................................A-0135 IMST
Fouad Al Dayel ..............................................................................A-0007 PA
Fouad I .........................................................................................A-0075 MO
Francesco Rosetti.........................................................................A-0189 NU
Francisca Furnaro L.................................................................A-0040 RASC
Frank O. Velez-Cubian..........................A-0255, A-0256, A-0257, A-0258 SU
Frantisek Salajka..........................................................................A-0050 MO
Fred Hirsch...................................................................................A-0094 MO
Fujino S.........................................................................................A-0109 SU
Fumi Yokote ..................................................................................A-0200 SU
Fumihiko Hirai ...............................................................................A-0108 SU
Fumio Imamura ............................................................................A-0150 MO
Gaku Yamaguchi ...........................................................................A-0119 SU
Gang Cheng.................................................................................A-0057 MO
Gee-Chen Chang .........................................................................A-0250 MO
Geum-Suk Jeong .........................................................................A-0082 MO
Ghana Kumar................................................................................A-0100 PU
Gianfranco Ferrero........................................................................A-0189 NU
Gilberto de Lima Lopes ................................................................A-0235 MO
Giulia Meoni..................................................................................A-0189 NU
Giuseppe Valmadre ......................................................................A-0189 NU
Gong Zhang...................................................................................A-0117 EP
Gongyan Chen .............................................................................A-0057 MO
Gouji Toyokawa.............................................................................A-0108 SU
Grace Kim..................................................................................A-0165 IMST
Guangliang Qiang..................................................A-0037 SU A-0099 RASC
Gul Kanyilmaz...............................................................................A-0252 RA
Gunnar Hillerdal ...........................................................................A-0042 MO
Guohao Xia ...................................................................................A-0213 PU
Guoliang Jiang .............................................................................A-0057 MO
Gwo Fuang Ho ..............................................................................A-0201 EP
György Losonczy..........................................................................A-0094 MO
Gyu Young Hur.............................................................................A-0245 MO
H Zhao...........................................................................................A-0113 RA
H. Kaneda ....................................................................................A-0171 MO
H. Kawakami ................................................................................A-0171 MO
Hae Su Kim...................................................................................A-0228 RA
Hai-Yan Tu....................................................A-0087, A-0199 MO A-0217 PU
Hak-Ryul Kim ...............................................................................A-0224 MO
Hamad Al Husaini ..........................................................................A-0007 PA
Hao Xiong ....................................................................................A-0061 MO
Hao Zhang ...................................................................................A-0057 MO
Haruhiko Nakamura ......................................................................A-0010 SU
Haruhiko Nakayama..................................................................A-0149 IMST
Haruyasu Murakami .....................................................................A-0045 MO
Haylee Boyens..............................................................................A-0054 PU
Heae Surng Park..............................................................A-0067, A-0249 PA
Helen Ross...................................................................................A-0064 MO
Henrik Depenbrock.......................................................................A-0094 MO
Heo Dae Seog..............................................................................A-0090 CM
Heyan Li ......................................................................A-0121 MO A-0236 BI
Hidayah .........................................................................................A-0259 PA
Hidehito Horinouchi.........................................................A-0206, A-0218 MO
Hideo Kunitoh...............................................................................A-0206 MO
Hideyuki Harada...........................................................................A-0045 MO
Hiroaki Akamatsu .........................................................................A-0045 MO
Hiroaki Kataba...............................................................................A-0119 SU
Hiroaki Senju ................................................................................A-0112 MO
Hirofumi Nakano...........................................................................A-0112 MO
Hirokazu Taniguch ........................................................................A-0112 MO
Hiroko Gotoda ..............................................................................A-0092 MO
Hiromasa Arai ............................................................A-0096 MO A-0120 SU
Hiroshi Kumakiri ...........................................................................A-0096 MO
Hiroshi Mizuuchi..............................................A-0051, A-0197 BI A-0019 SU
Hiroshi Nokihara .............................................................A-0206, A-0218 MO
Hiroshige Yoshioka.......................................................................A-0227 MO
Hirotsugu Kenmotsu.....................................................................A-0045 MO
Hirotsugu Yamazaki ......................................................................A-0086 SU
Hiroyasu Nakashima.....................................................................A-0086 SU
Hiroyuki Adachi.............................................................................A-0096 MO
Hiroyuki Ito.................................................................................A-0149 IMST
Hiroyuki Tao ..................................................................................A-0066 SU
Hiroyuki Yamaguchi ........................................................A-0102, A-0112 MO
Hirsh Koyi.....................................................................................A-0042 MO
Hisao Asanuma ............................................................................A-0218 MO
Hisao Imai .............................................A-0045, A-0046, A-0111,A-0219 MO
Hisashi Saji ...................................................................................A-0010 SU
Hitoshi Igai ....................................................................................A-0020 SU
Ho Sung Lee ................................................................................A-0223 CM
Ho Yun Lee ................................................................................A-0115 IMST
41
AUTHOR INDEX
Author Index
42
Hojoong Kim............................................................A-0115 IMST A-0228 RA
Hongfei Gao ..................................................................................A-0225 EP
Hong-hong Yan ...............................................................A-0126, A-0195 MO
Hongming Pan..............................................................................A-0057 MO
HongryullPyo.................................................................................A-0244 RA
Hon-Yi Lin ......................................................A-0129, A-0194 RA A-0114 PU
Hsiu-Ying Hung .............................................................................A-0070 PU
Hsu-Ching Huang..........................................................................A-0141 PU
Hua-Jun Chen ............................A-0087, A-0199 MO A-0217 PU A-0225 EP
Huan Lin ........................................................................................A-0117 EP
Hubert Beaumont.........................................................A-0065, A-0165 IMST
Hui Zhao .......................................................................................A-0144 RA
Huili Zheng ...................................................................................A-0207 MO
Hung-Chih Lai .............................................................A-0114 PU A-0129 RA
Hyo-Jun Jang................................................................................A-0122 SU
Hyun Ae Jung...............................................................................A-0140 MO
Hyun Woo Lee..............................................................................A-0082 MO
Hyung Joo Park.............................................................................A-0254 SU
Ichidai Tanaka.................................................................................A-0176 BI
Ikuo Sekine ..................................................................................A-0206 MO
In-Bum Suh ...................................................................................A-0023 PU
In-Gu Do.......................................................................................A-0140 MO
Isamu Okamoto .............................................A-0204, A-0236 BI A-0121 MO
Isao Murakami ................................................................................A-0051 BI
Ismail AI.........................................................................................A-0243 EP
Ivan Tham Weng Keong ...............................................................A-0208 RA
Izumi Takeyoshi.............................................................................A-0172 SU
J Chan...........................................................................................A-0018 EP
J Huang .........................................................................................A-0113 RA
J Uchang .......................................................................................A-0018 EP
J. Thaddeus Beck.........................................................................A-0064 MO
J. Tsurutani...................................................................................A-0171 MO
Jacqueline Whang-Peng............................................A-0070 PU A-0187 MO
Jacques-Pierre Fontaine.......................A-0255, A-0256, A-0257, A-0258 SU
Jae Jeong Shim ...........................................................................A-0245 MO
Jae Kil Park...................................................................................A-0254 SU
Jae Kyeom Shim ..........................................................................A-0245 MO
Jae Myoung Noh...........................................................................A-0244 RA
Jae Sung Choi..............................................................................A-0223 CM
Jae-Uk Song ..............................................................................A-0115 IMST
James Chih-Hsin Yang ......................................A-0104, A-0142, A-0169 MO
Jana Skrickova.............................................................................A-0050 MO
Janice Wong .................................................................................A-0054 PU
Jaromir Roubec............................................................................A-0050 MO
Jayalakshmi Pailoor.........................................................A-0100, A-0101 PU
Jayashree Bhattacharjee................................................................A-0177 BI
Jayoung Lee .................................................................................A-0122 SU
Jeeyun Lee ...................................................................................A-0228 RA
Jessica Y. Huang...........................................................................A-0144 RA
Jhingook Kim ..........................................................A-0062 MO A-0115 IMST
Ji Won YU.....................................................................................A-0223 CM
Ji Yu Sun .......................................................................................A-0228 RA
Ji Yun Lee ..................................................................A-0137 MO A-0228 RA
Jia-Ming Chang...............................................................................A-0222 BI
Jian Ni ..........................................................................................A-0133 MO
Jian Su.............A-0087, A-0195, A-0199 MO A-0085, A-0221 EP A-0217 PU
Jiang guanchao.............................................................................A-0233 SU
Jiang Qian ....................................................................................A-0061 MO
Jianxing He ..................................................................................A-0057 MO
Jie Liu.......................................................................................A-0099 RASC
Jie Wang .........................................................................A-0057, A-0104 MO
Jie-Fei Han...................................................................................A-0195 MO
Jifeng Feng...................................................A-0057, A-0142 MO A-0213 PU
Jilin Guan ......................................................................................A-0225 EP
Jin Ho Baek..................................................................................A-0068 MO
Jin Hyoung Kang ...............................................A-0080, A-0169, A-0220 MO
Jin Seok Ahn.................................................A-0137, A-0140 MO A-0228 RA
Jin Zhang .....................................................................................A-0235 MO
Jingyi Liu ......................................................................................A-0064 MO
Jin-haeng Chung...........................................................................A-0122 SU
Jinho Park..................................................................................A-0038 IMST
Jin-Hyuk Choi...............................................................................A-0082 MO
Jin-Ji Yang..................A-0087, A-0126, A-0195, A-0199 MO A-0221, A-0225
.................................................................................................EP A-0217 PU
Jinxi Di......................................................................................A-0099 RASC
Jiping Da ..................................................................................A-0099 RASC
Jiri Votruba ....................................................................................A-0093 PU
Jiro Kitamura...................................................................A-0153, A-0154 CM
Jirong Peng ..................................................................................A-0166 MO
Jiunn-Liang Tan ...............................................................A-0100, A-0101 PU
Ji-Young Song ..............................................................................A-0062 MO
JL Wong ........................................................................................A-0018 EP
John T ..........................................................................................A-0198 MO
Jong Seok Kim................................................................A-0080, A-0169 MO
Jong-Mu Sun...................................A-0068, A-0137, A-0140 MO A-0228 RA
Joo-Hang Kim .................................................................A-0068, A-0080 MO
Joon Young Choi........................................................................A-0115 IMST
José Miguel Clavero R.............................................................A-0040 RASC
Joseph R. Garrett..................................A-0255, A-0256, A-0257, A-0258 SU
Joungho Han ..........................................................A-0062 MO A-0115 IMST
Ju Ock Na.....................................................................................A-0223 CM
Jue Yan ....................................................................................A-0099 RASC
Juliann Dziubinski.........................................................................A-0061 MO
Julien Mazieres ............................................................................A-0061 MO
Jun Matsubayashi ...................................................A-0038 IMST A-0107 SU
Jung Yong Hong .............................................................A-0137, A-0140 MO
Jung-Il Lee ....................................................................................A-0228 RA
Junichi Maeda...............................................................................A-0107 SU
Junichi Shimizu..........................................................A-0216 MO A-0237 PU
Junichiro Osawa............................................................................A-0107 SU
Junwhi Song ..............................................................................A-0115 IMST
Jyotdeep Kaur ..............................................................................A-0138 MO
Jyoti Patel.....................................................................................A-0064 MO
K Kokeny .......................................................................................A-0113 RA
K Ratnavelu...................................................................................A-0201 EP
K. Nakagawa................................................................................A-0171 MO
K. Noguchi....................................................................................A-0171 MO
Kai Obayashi.................................................................................A-0172 SU
Kamalru .........................................................................................A-0259 PA
Kaname Nozaki.............................................................................A-0108 SU
Kang Jin-Hyoung..........................................................................A-0090 CM
Kang-chung Yang.........................................................................A-0250 MO
Kaori Seki .....................................................................................A-0111 MO
Kaoru Kubota ...............................................................................A-0206 MO
Karel Hejduk.................................................................................A-0050 MO
Karl-Gustav Kölbeck.....................................................................A-0042 MO
Katsuaki Sato..................................................A-0051, A-0197 BI A-0019 SU
Katsuhiro Masago ........................................................................A-0227 MO
Katsumi Nakatomi ...........................................................A-0102, A-0112 MO
Katsuya Watanabe .......................................................................A-0096 MO
Kayo Ijichi.....................................................................................A-0121 MO
Kazu Shiomi..................................................................................A-0086 SU
Kazuhiro Tsukamoto .....................................................................A-0112 MO
Kazuki Yamanaka.........................................................................A-0096 MO
Kazuko Sakai..................................................................................A-0051 BI
Kazumi Nishino ............................................................................A-0150 MO
Kazumi Sano................................................................................A-0102 MO
Kazunori Okabe ............................................................................A-0066 SU
Kazushi Yoshida...........................................................................A-0206 MO
Kazuto Furuyama.........................................................................A-0121 MO
Kazuto Nishio .................................................................................A-0051 BI
Kazuya Nishii................................................................................A-0092 MO
Kean Fatt Ho .................................................................................A-0201 EP
Kee San Goh ................................................................................A-0231 PU
Keiichi Ota....................................................................................A-0121 MO
Keisuke Tomii ...............................................................................A-0227 MO
Keita Fujii .....................................................................................A-0096 MO
Keita Mori .....................................................................................A-0045 MO
Keitaro Matsumoto........................................................................A-0069 SU
Kenichi Suda...................................................A-0051, A-0197 BI A-0019 SU
Kenji Inafuku ................................................................................A-0096 MO
Kenji Sugio....................................................................................A-0226 SU
Kenji Tomizawa ............................................................A-0019 SU A-0051 BI
Kenneth O’Byrne..........................................................................A-0142 MO
Kensaku Dote ...............................................................................A-0019 SU
Ken-Siong Kow .............................................................................A-0101 PU
Kenta Hasumi................................................................................A-0073 PU
Kentaro Imai ..............................................................................A-0149 IMST
Ker-chau Li .................................................................A-0250 MO A-0253 PA
Keshav Barnwal .......................................................................A-0098 RASC
Keunchil Park .......A-0068, A-0080, A-0094, A-0137, A-0140 MO A-0228 RA
Khashayar Asadi ..........................................................................A-0089 MO
Khatijah..........................................................................................A-0259 PA
Khawla Al Kuray ............................................................................A-0007 PA
Ki Hyun Seo..................................................................................A-0223 CM
Ki-Eun Hwang ..............................................................................A-0224 MO
Kim Hoon-Kyo ..............................................................................A-0090 CM
Kim Sang-We ...............................................................................A-0090 CM
Kim Sung Rok...............................................................................A-0090 CM
Kim, Joo-Hang..............................................................................A-0090 CM
Kimihiro Shimizu ...........................................A-0020, A-0172 SU A-0111 MO
Kimitoshi Nawa..............................................................................A-0110 SU
Kogane T.......................................................................................A-0109 SU
Kohei Ando...................................................................................A-0096 MO
Kohei Motoshima ............................................................A-0102, A-0112 MO
Kohyama T....................................................................................A-0109 SU
Koichi Minato .....................................................A-0111, A-0136, A-0219 MO
Koichi Takayama ............................................A-0204, A-0236 BI A-0121 MO
Koichi Tokuuye .........................................................................A-0038 IMST
Koichi Yoshida ...............................................................................A-0110 SU
Koji Okudela..................................................................................A-0120 SU
Koji Tsuta......................................................................................A-0218 MO
Kong Leong Yu..............................................................................A-0018 EP
Kosuke Mizoguchi ........................................................................A-0102 MO
Kosuke Tanaka ..........................................................A-0216 MO A-0237 PU
Kouichi Tanabe.............................................................................A-0124 MO
Kouichi Yoshiyama........................................................................A-0066 SU
Kousuke Takei ..............................................................................A-0046 MO
Koyama H .....................................................................................A-0109 SU
Kumar Prabhash ..........................................................................A-0240 MO
Kumiko Yoshida ............................................................................A-0066 SU
Kuniko Sunami .............................................................................A-0218 MO
Kwhanmien Kim ............................................................................A-0122 SU
Kye Young Lee ..............................................................................A-0242 PA
Kyoichi Kaira.........................................A-0045, A-0046, A-0111, A-0219 MO
Kyueng-Whan Min .........................................................................A-0242 PA
Kyung Ho Kang ............................................................................A-0245 MO
Kyung Hoon Min...........................................................................A-0245 MO
Kyung Soo Kim .............................................................................A-0254 SU
Kyungsoo Jung ............................................................................A-0062 MO
L.C. Tavares ......................................................................A-0173, A-0174 BI
Lan-Ying Gou .............................................................A-0087 MO A-0221 EP
Lary A. Robinson...................................A-0255, A-0256, A-0257, A-0258 SU
Laszlo Urban ................................................................................A-0061 MO
Lecia V Sequist ............................................................................A-0142 MO
Lee Chang Geol ...........................................................................A-0090 CM
Lee Kyu Chan...............................................................................A-0090 CM
Lee Kyung Hee.............................................................................A-0090 CM
Leona Koubkova ..........................................................................A-0050 MO
Li jianfeng......................................................................................A-0233 SU
Li Khen Lem..................................................................................A-0231 PU
Li Wang .........................................................................................A-0213 PU
Li Yun ............................................................................................A-0233 SU
Li Zhang .....................................................................A-0161 MO A-0162 PA
Liang J..........................................................................................A-0088 CM
Libor Havel ...................................................................................A-0050 MO
Liew MS........................................................................................A-0198 MO
Lijie Yin.....................................................................................A-0099 RASC
Lim Suat Yee.................................................................................A-0009 PU
Lin ...............................................................................A-0114 PU A-0129 RA
Liu LP ...........................................................................................A-0088 CM
Luis Paz-Ares...............................................................................A-0094 MO
Lulu Yang......................................................................................A-0158 CM
M Szegedi .....................................................................................A-0113 RA
MA M.Zim......................................................................................A-0232 PU
Mahmoud A ..................................................................................A-0075 MO
Mai Tomizawa...............................................................................A-0046 MO
Makoto Sakugawa........................................................................A-0092 MO
Man Pyo Chung .........................................................................A-0115 IMST
Manu Sharma...............................................................................A-0130 MO
Manuel Álvarez ........................................................................A-0041 RASC
Marcel B. Bally..............................................................................A-0022 CM
Marcela Tomiskova.......................................................................A-0050 MO
Marcello Tiseo...............................................................................A-0189 NU
Marco Matos.................................................................................A-0229 MO
Margerges M
........................................................................A-0076 MO
Maria Echavarria...................................A-0255, A-0256, A-0257, A-0258 SU
Maria Vittoria Pacchiana...............................................................A-0189 NU
Maria Wong..............................................................................A-0131 RASC
Mariadason J................................................................................A-0198 MO
Marie Juston..............................................................................A-0065 IMST
Mark A. Socinski...........................................................................A-0094 MO
Mark Boye ....................................................................................A-0169 MO
Mark McKee .................................................................................A-0061 MO
Mark Socinski...............................................................................A-0064 MO
Martin Dunbar...............................................................................A-0061 MO
Martin Reck.....................................................................A-0061, A-0094 MO
Martin Schuler ..............................................................................A-0142 MO
Martin Szegedi ..............................................................................A-0144 RA
Masafumi Yamaguchi....................................................................A-0108 SU
Masahide Mori..............................................................................A-0150 MO
Masahiro Endo .............................................................................A-0045 MO
Masahiro Morise .............................................................................A-0176 BI
Masahiro Sakaguchi.....................................................A-0019 SU A-0051 BI
Masahiro Tsuboi ...........................................................................A-0096 MO
Masahito Naito ..............................................................................A-0086 SU
Masaki Shimoji..............................................................A-0019 SU A 0051 BI
Masako Shotsu ............................................................................A-0096 MO
Masanobu Yamada .................A-0045, A-0046, A-0111, A-0136, A-0219 MO
Masaru Hagiwara .............................................................A-0110, A-0119 SU
Masashi Kondo...............................................................................A-0176 BI
Masashi Mikubo ............................................................................A-0086 SU
AUTHOR INDEX
Author Index
Masatoshi Kakihana ...........................................A-0107, A-0110, A-0119 SU
Masoud Sadeghi ..........................................................................A-0175 MO
Mau-Ern Poh.................................................................................A-0101 PU
Mauro Orlando...................................................A-0080, A-0104, A-0169 MO
Mehmet Koc..................................................................................A-0252 RA
Mehrdad Payendeh......................................................................A-0175 MO
Meiqi Shi .......................................................................................A-0213 PU
Mei-Yin Su ......................................................................................A-0222 BI
Meryem Aktan ...............................................................................A-0252 RA
Mi Sun Ahn...................................................................................A-0082 MO
Michael A. Green..........................................................................A-0166 MO
Michael Costanzo.........................................................................A-0166 MO
Michael W.Y. Chan ........................................................................A-0114 PU
Micharl Greco...............................................................................A-0166 MO
Michihiko Tajiri............................................................A-0096 MO A-0120 SU
Michiyo Miyawaki ..........................................................................A-0226 SU
Midori Shimada.............................................................................A-0112 MO
Mi-Hyun Kim ...................................................................................A-0209 BI
Milos Pesek..................................................................................A-0050 MO
Min Ki Lee.......................................................................................A-0209 BI
Min Young Joo..............................................................................A-0090 CM
Mineui Hong .................................................................................A-0062 MO
Minjung Sung ...............................................................................A-0062 MO
Minoru Fukuda ................................................................A-0102, A-0112 MO
Min-Young Lee ..............................................................................A-0228 RA
Mio Fukuda ..................................................................................A-0096 MO
Mircea Dediu ................................................................................A-0094 MO
Mitchell P......................................................................................A-0198 MO
Mitsuhiro Kamiyoshihara...............................................................A-0020 SU
Mitsuhiro Takenoyama ..................................................................A-0108 SU
Mitsuo Sato.....................................................................................A-0176 BI
Mitsuyoshi Utsugi..........................................................................A-0111 MO
Miyuki Abe.....................................................................................A-0226 SU
Moeko Ito...................................................................................A-0038 IMST
Mohammed A Osman...................................................................A-0053 MO
Mohammed A. Qadir.....................................................................A-0022 CM
Mohd Arif Mohd Zim......................................................................A-0063 PU
Moon Ki Choi ..................................................................A-0137, A-0140 MO
Moonjin Kim ....................................................................A-0137, A-0140 MO
Moon-Sing Lee ..............................................A-0129, A-0194 RA A-0114 PU
Motoko Tachihara .........................................................................A-0150 MO
Mototsugu Ono .............................................................................A-0086 SU
Mulawarman Jayusman ...............................................................A-0125 MO
Munetaka Masuda .....................................................A-0096 MO A-0120 SU
Musa AN........................................................................................A-0243 EP
Mustafa Adli ..................................................................................A-0252 RA
Myitzu Khaing...............................................................................A-0229 MO
Myung-Goo Lee ............................................................................A-0023 PU
Myung-Ju Ahn....................A-0068, A-0080, A-0137, A-0140 MO A-0228 RA
N Momin........................................................................................A-0018 EP
Nai-Chuan Chien...........................................................................A-0114 PU
Nakanishi Yoichi ...........................................................................A-0121 MO
Nana Lou ....................................................................A-0217 PU A-0221 EP
Nanae Tomonaga .........................................................................A-0102 MO
Naohiro Kajiwara ..........................A-0107, A-0110, A-0119 SU A-0038 IMST
Naoya Yamasaki ...........................................................................A-0069 SU
Naoyuki Yogo..................................................................................A-0176 BI
Narayan Rajan .............................................................................A-0169 MO
Natalia Sutiman............................................................................A-0168 MO
Natasha Mohd Arifin......................................................................A-0063 PU
Nathaniel Rothman.......................................................................A-0195 MO
Natsuko Kawatani .........................................................................A-0020 SU
Navneet Singh..............................................................................A-0138 MO
Nermin Capan ..............................................................................A-0163 MO
Nesaretnam B.Kumarakulasinghe .............................A-0207 MO A-0208 RA
Nesrin Kiral................................................................................A-0135 IMST
Nevin Taci Hoca ...........................................................................A-0163 MO
Ni Jian ..........................................................................................A-0132 MO
Nick Thatcher ...............................................................................A-0094 MO
Nilendu Purandare .......................................................................A-0240 MO
Nirmala Jambekar ........................................................................A-0240 MO
NK Shukla .....................................................................................A-0160 SU
NM Marzuki ...................................................................................A-0201 EP
Noboru Yamamoto ..........................................................A-0206, A-0218 MO
Nobuaki Fukamatsu .....................................................................A-0092 MO
Nobuyuki Katakami.........................................................A-0150, A-0227 MO
Nobuyuki Yamamoto ....................................................................A-0142 MO
Noor Aliza bt. Md Tarekh ...............................................................A-0009 PU
Noor Laili MM ................................................................................A-0260 EP
Noorwati Sutandyo.......................................................................A-0125 MO
Nor Rizan K...................................................................................A-0260 EP
Nor Yatizah MY .............................................................................A-0260 EP
Noriaki Sunaga .....................................A-0046, A-0111, A-0136, A-0219 MO
Norihiko Ikeda ....A-0010, A-0107, A-0110, A-0119 SU A-0038, A-0149 IMST
Noriko Fujimoto ............................................................................A-0121 MO
Normand Blais..............................................................................A-0061 MO
NS Awang Basry ...........................................................................A-0018 EP
Nurnadiah bt Nordin......................................................................A-0063 PU
Nurul Yaqeen Mohd Esa ...............................................................A-0063 PU
NY Esa..........................................................................................A-0232 PU
O Jung Kwon .......................................................... A-0115 IMST A-0228 RA
Okumura T ................................................................................... A-0109 SU
OL Wong ...................................................................................... A-0018 EP
Olga Martelli................................................................................. A-0189 NU
Olov Andersson ........................................................................... A-0042 MO
Omer Ayten .................................................................................. A-0186 PU
Ong Choo Khoon ......................................................................... A-0231 PU
Onkar Singh ................................................................................ A-0168 MO
Osamu Kawamata .......................................................... A-0039, A-0091 SU
P Rassiah-Szegedi ....................................................................... A-0113 RA
P. J. Oliveira...................................................................... A-0173, A-0174 BI
Pablo Matamala ...................................................................... A-0041 RASC
Palaniappan R ................................................................ A-0160, A-0246 SU
Pan-Chyr Yang ............................................................................ A-0250 MO
Park Keunchil............................................................................... A-0090 CM
Pasi A. Jänne............................................................................... A-0158 CM
Pathmanathan Rajadurai.............................................................. A-0101 PU
Patricia A. Watson ....................................................................... A-0235 MO
Paul Mitchell ................................................................................ A-0089 MO
Pek-Lan Khong........................................................................ A-0131 RASC
Per Liv, Eva Branden................................................................... A-0042 MO
Philip Bonomi .............................................................................. A-0064 MO
Phua VCE .................................................................................... A-0128 RA
Pierluigi Bullian............................................................................. A-0189 NU
Ping-hai Zhang ............................................................................ A-0104 MO
PJ Voon ........................................................................................ A-0018 EP
Prabhat Malik ............................................................................... A-0160 SU
Pranamita Ray.............................................................................. A-0151 EP
Prema Rassiah-Szegedi............................................................... A-0144 RA
Qiang Nie ..................................................................................... A-0103 SU
Qiduo Yu....................................................................................... A-0037 SU
Qin Qin ........................................................................................ A-0061 MO
Qing Lan...................................................................................... A-0195 MO
Qing Zhou.................................................... A-0087, A-0199 MO A-0217 PU
R. A. Carvalho .................................................................. A-0173, A-0174 BI
Raffaella Morena.......................................................................... A-0189 NU
Rajeev Kaushal ........................................................................... A-0240 MO
Ralph Zinner............................................................................... A-0064 MO
Ramaswamy Govindan ............................................................... A-0064 MO
RasAzira R ................................................................................... A-0260 EP
Raúl Pefaur D.......................................................................... A-0040 RASC
Raymond Varughese.................................................................... A-0101 PU
Reika Iwakawa-Kawabata ........................................................... A-0218 MO
Reiko Yoshino ................................................... A-0046, A-0111, A-0219 MO
Reshma Rangwala ...................................................................... A-0235 MO
Reury-Perng Perng ................................................... A-0070 PU A-0187 MO
Reza Khodarahmi........................................................................ A-0175 MO
Rinat K. Galiulin........................................................................... A-0094 MO
Rini Joshi ....................................................................................... A-0177 BI
Ri-Qiang Liao ............................................................................... A-0103 SU
Rodrigo Quera......................................................................... A-0041 RASC
Rodryg Ramlau............................................................................ A-0094 MO
Ross A. Soo .............................................................. A-0207 MO A-0208 RA
Roziana Ariffin............................................................................... A-0259 PA
Rui Xu...................................................................................... A-0099 RASC
Ruidong Zhang............................................................................. A-0012 SU
Ryuhei Masuno......................................................................... A-0038 IMST
Ryusei Saito ...................................................... A-0046, A-0111, A-0219 MO
S.H Jung ...................................................................................... A-0228 RA
Saad M......................................................................................... A-0128 RA
Sachio Maehara ........................................................................... A-0107 SU
Sakae Fujimoto ........................................................................... A-0136 MO
Salim D........................................................................... A-0075, A-0076 MO
Sang Won Shin............................................................................ A-0080 MO
Sanghoon Jheon .......................................................................... A-0122 SU
Sang-Won Um ........................................................ A-0115 IMST A-0228 RA
Sara Pilotto .................................................................................. A-0189 NU
Sarayut L Geater ......................................................................... A-0142 MO
Satoru Watanabe......................................................................... A-0046 MO
Satoshi Morita ............................................................................. A-0150 MO
Satoshi Nagasaka ........................................................................ A-0200 SU
Satsuki Kina ................................................................................. A-0200 SU
Sebastián Yévenes A .............................................................. A-0040 RASC
Seher Satar ................................................................................. A-0163 MO
Seiji Nagashima ............................................................. A-0102, A-0112 MO
Sema Canbakan.......................................................................... A-0163 MO
Seok Yun Kang............................................................................ A-0082 MO
Sergey Orlov ............................................................................... A-0061 MO
Seung Eun Lee............................................................................ A-0062 MO
Seung-Hyun Nam........................................................................ A-0220 MO
Sevda Sener Comert ................................................................ A-0135 IMST
Shalabi H ....................................................................... A-0075, A-0076 MO
Shamayel Mohammed.................................................................. A-0007 PA
Shaodong Hong......................................................... A-0161 MO A-0162 PA
Shaorong Yu................................................................................. A-0213 PU
She-Juan An................................................................................ A-0195 MO
Shi Li ........................................................................................... A-0064 MO
Shi Mei-qi .................................................................................... A-0196 MO
Shiang-Jiun Tsai......................................................... A-0114 PU A-0129 RA
Shigeki Shimizu ............................................................................. A-0051 BI
Shigeru Kohno................................................................ A-0102, A-0112 MO
Shih-Kai Hung.............................................. A-0129, A-0194 RA A-0114 PU
Shi-liang Chen........................................................... A-0085 EP A-0195 MO
Shine Young Kim ........................................................................... A-0209 BI
Shinichi Ishihara ............................................................. A-0111, A-0219 MO
Shinnosuke Takemoto .................................................... A-0102, A-0112 MO
Shinobu Hosokawa...................................................................... A-0092 MO
Shinsaku Matsumoto................................................................... A-0092 MO
Shinsheng Yuan ........................................................ A-0250 MO A-0253 PA
Shinsuke Kitahara ....................................................................... A-0218 MO
Shinsuke Nagasawa.................................................................... A-0096 MO
Shintaro Kanda .............................................................. A-0206, A-0218 MO
Shinya Kajiura ............................................................................. A-0124 MO
Shiro Fujita .................................................................................. A-0227 MO
Shivani Gupta............................................................................... A-0106 RA
Shivani Nanda ............................................................................. A-0094 MO
Shi-Xu Jiang................................................................................. A-0086 SU
Shiyang Kang ............................................................ A-0161 MO A-0162 PA
Sho Horiuchi................................................................................. A-0073 PU
Shoko Hayashi ............................................................................. A-0086 SU
Shubham Roy.......................................................................... A-0098 RASC
Shuji Suehiro................................................................................ A-0226 SU
Shukla NK .................................................................................... A-0246 SU
Shum Weng Yoon ...................................................... A-0114 PU A-0129 RA
Shun Lu ............................................................A-0057, A-0104, A-0142 MO
Shunichi Matsumoto.................................................................... A-0045 MO
Shunichi Negoro.......................................................................... A-0150 MO
Shun-ichi Watanabe .................................................................... A-0218 MO
Shuo Wang .................................................................................... A-0236 BI
Shuta Tomida.................................................................... A-0051, A-0197 BI
Shweta Paul................................................................................... A-0177 BI
Silvia Novello................................................................................ A-0189 NU
Silvia Park ................................................................................... A-0137 MO
Simon Knight ............................................................................... A-0089 MO
Simon Souchet ......................................................................... A-0165 IMST
Siti Kamariah Othman .................................................................. A-0063 PU
Sivasangaran G .............................................................. A-0156, A-0157 SU
SK Othman................................................................................... A-0232 PU
Sneha Upadhyaya................................................................... A-0098 RASC
Soebandrijo .................................................................................. A-0238 SU
Soichi Akata.............................................................................. A-0038 IMST
Song Dong ................................................................................... A-0103 SU
Song Hong Suk ........................................................................... A-0090 CM
Sook Whan Sung ......................................................................... A-0254 SU
Sotaro Enatsu.............................................................................. A-0064 MO
Souhil Zaim ................................................................. A-0065, A-0165 IMST
ST Tie ........................................................................................... A-0018 EP
Stefania Vallone ........................................................................... A-0189 NU
Stephen C. Bergmeir................................................................... A-0079 MO
Su Chun-xia................................................................................. A-0132 MO
Su Jin Lee ................................................................................... A-0137 MO
Sui Xizhao .................................................................................... A-0233 SU
Sukki Cho..................................................................................... A-0122 SU
Sun Jong-Mu ............................................................................... A-0090 CM
Sung Hee Lim ........................................................... A-0137 MO A-0228 RA
Sung Yong Lee ............................................................................ A-0245 MO
Sung-Liang Yu ............................................................................. A-0250 MO
Sungmin Kim.................................................................. A-0137, A-0140 MO
Sunil Kumar .................................................................... A-0160, A-0246 SU
Sunil Kumar Sharma...................................................................... A-0177 BI
Suranjan Mukherjee ..................................................................... A-0151 EP
Suresh Ramalingam.................................................................... A-0061 MO
Suriani S....................................................................................... A-0260 EP
Susan Guba ................................................................................ A-0064 MO
SY Soon ....................................................................................... A-0018 EP
Szu-Chi Li................................................................... A-0114 PU A-0129 RA
T Ismail......................................................................................... A-0232 PU
T. Iwasa ....................................................................................... A-0171 MO
T. Seto ......................................................................................... A-0171 MO
T. Shimamoto .............................................................................. A-0171 MO
T. Shimizu.................................................................................... A-0171 MO
T. Takenaka ................................................................................. A-0171 MO
43
AUTHOR INDEX
Author Index
44
Tadashi Ishida ............................................................................. A-0227 MO
Taekyu Lim .................................................................................. A-0220 MO
Taichiro Ishizumi........................................................................... A-0073 PU
Taishi Harada ................................................ A-0204, A-0236 BI A-0121 MO
Takafumi Hahimoto....................................................................... A-0226 SU
Takahumi Yamada .................................................................... A-0038 IMST
Takamitsu Maehara ..................................................................... A-0096 MO
Takao Ishizuka ............................................................................. A-0111 MO
Takao Sato ................................................................................... A-0019 SU
Takashi Ibe ................................................................................... A-0020 SU
Takashi Kohno............................................................................. A-0218 MO
Takashi Nakajima ........................................................................ A-0045 MO
Takashi Nishimura ....................................................................... A-0150 MO
Takashi Seto................................................................................. A-0108 SU
Takashi Yamamichi....................................................................... A-0200 SU
Takaya Ikeda .................................................................. A-0102, A-0112 MO
Takayuki Ibi ..................................................................................A-0073 PU
Takeshi Hisada ..................................................A-0046, A-0111, A-0219 MO
Takeshi Kitazaki ...........................................................................A-0112 MO
Takeshi Nagayasu ........................................................................A-0069 SU
Taketsugu Yamamoto ..................................................................A-0096 MO
Takuro Miyazaki ...........................................................................A-0069 SU
Takuya Iwasaki ............................................................ A-0019 SU A-0051 BI
Takuya Nagashima ......................................................................A-0096 MO
Tan YH.......................................................................................... A-0128 RA
Tan YY ..........................................................................................A-0128 RA
Tang Liang ...................................................................................A-0132 MO
Tang WH ......................................................................................A-0128 RA
Tarun Puri ....................................................................................A-0169 MO
Tateaki Naito ...............................................................................A-0045 MO
Tatsuhiko Kashii ..........................................................................A-0124 MO
Tatsuo Ohira ................................A-0107, A-0110, A-0119 SU A-0038 IMST
Tatsuro Okamoto .........................................................................A-0121 MO
Tatsurou Hayashi .........................................................................A-0066 SU
Tatsuya Inoue ...............................................................................A-0073 PU
Tatsuya Yoshida ........................................................A-0216 MO A-0237 PU
Tayfun Caliskan ............................................................................A-0186 PU
Tekkan Woo .................................................................................A-0096 MO
Temiko Shimada ..........................................................................A-0150 MO
Teodor Balaz ................................................................................A-0093 PU
Teppei Nishii ..........................................................A-0096 MO A-0149 IMST
Tetsuhiko Asao ............................................................................A-0218 MO
Tetsuhiko Taira ............................................................................A-0045 MO
Tetsunari Hase ...............................................................................A-0176 BI
Tetsuya Mitsudomi .......................................................A-0019 SU A-0051 BI
Tho LM .........................................................................................A-0128 RA
Thomas John ..............................................................................A-0089 MO
TO KF ...........................................................................................A-0251 PA
TO Lim ..........................................................................................A-0201 EP
Tolga Tuncel .................................................................................A-0186 PU
Tomas Bruha ................................................................................A-0093 PU
Tomohide Sanada .....................................................................A-0038 IMST
Tomohide Tamura ........................................................................A-0206 MO
Tomohiko Kakumu .........................................................................A-0176 BI
Tomohito Kuwako ...........................................................A-0111, A-0219 MO
Tomomi Masuda .............................................................A-0111, A-0219 MO
Tomoshi Tsuchiya .........................................................................A-0069 SU
Tomoyo Oguri ............................................................A-0216 MO A-0237 PU
Tomoyoshi Takenaka ....................................................................A-0108 SU
Tong JH ........................................................................................A-0251 PA
Tony Mok .......................................................................A-0142, A-0235 MO
Toru Kumagai ..............................................................................A-0150 MO
Toshiaki Takahashi ......................................................................A-0045 MO
Toshihiko Kaneda ........................................................................A-0150 MO
Toshiki Takemoto .........................................................A-0019 SU A-0051 BI
Toshiki Tanaka ..............................................................................A-0066 SU
Toshio Kato ....................................................................................A-0176 BI
Toshiro Miwa ...............................................................................A-0124 MO
Toshiteru Nagashima ...................................................................A-0172 SU
Toyoaki Hida .............................................................A-0216 MO A-0237 PU
Tsukihisa Yoshida .........................................................................A-0108 SU
Tsutomu Yoneda ..........................................................................A-0150 MO
Tudor E. Ciuleanu .......................................................................A-0094 MO
Tuyoshi Uchida ............................................................................A-0200 SU
Ujainah Zaini Nasir ......................................................................A-0125 MO
Ulrich Keilholz ..............................................................................A-0061 MO
Usuda Jitsuo ................................................................................A-0073 PU
V Sarkar .......................................................................................A-0113 RA
Vanita Noronha ............................................................................A-0240 MO
Vera Gorbunova ..........................................................................A-0061 MO
Vera Hirsh ....................................................................................A-0142 MO
Vichien Srimuninnimit ..................................................................A-0169 MO
Victor Lee ................................................................................A-0131 RASC
Victoria L. Wilde ..........................................................................A-0166 MO
Vieri Scotti ....................................................................................A-0189 NU
Vikren Sarkar ...............................................................................A-0144 RA
Vincent Giranda ...........................................................................A-0061 MO
Vishwajeet Rohil ............................................................................A-0177 BI
Vitezslav Kolek ............................................................................A-0050 MO
Vivek Srivastava ......................................................................A-0098 RASC
Vladimir Setnicka .........................................................................A-0093 PU
Wahid MI ......................................................................................A-0128 RA
Waldo Ortuzar .............................................................................A-0064 MO
Walkiewicz M ...............................................................................A-0198 MO
Wan Seop Kim ..............................................................................A-0242 PA
Wang Jun .....................................................................................A-0233 SU
Wang LH ......................................................................................A-0088 CM
Wang Li .......................................................................................A-0196 MO
Wang Yun .....................................................................................A-0233 SU
Wan-Teck Lim ...............................................................................A-0035 EP
Watanabe M .................................................................................A-0109 SU
Wee Yao Koh ...............................................................................A-0208 RA
Wei Li ...........................................................................................A-0103 SU
Wei-Bang Guo .............................................................................A-0195 MO
Wenfeng Fang ...........................................................A-0161 MO A-0162 PA
Wenhua Liang ...........................................................A-0161 MO A-0162 PA
Wenjuan Zheng ...........................................................................A-0057 MO
Wen-Lin Hsu ..............................................................A-0114 PU A-0129 RA
Wen-mei Su ..............................................................A-0085 EP A-0195 MO
Wen-Shuo Wu .............................................................................A-0187 MO
Wen-Yen Chiou ............................................A-0129, A-0194 RA A-0114 PU
Wen-zhao Zhong .....A-0126, A-0199 MO A-0103 SU A-0117 EP A-0217 PU
Winnie Ling ..................................................................................A-0018 EP
Wojciech Szafranski ....................................................................A-0094 MO
Won Jin Chang ............................................................................A-0137 MO
Wonil Choi ...................................................................................A-0105 MO
Wonjin Chang ..............................................................................A-0140 MO
Wonkyung Cho .............................................................................A-0244 RA
Wu Yi Long ..................................................................................A-0090 CM
Xia Guo-hao ................................................................................A-0196 MO
Xiangqun Song ............................................................................A-0057 MO
Xiaoqing Liu ................................................................................A-0057 MO
Xiao-qing Zhang ..........................................................................A-0104 MO
Xiao-Yan Bai ................................................A-0087, A-0199 MO A-0217 PU
Xin Wang ..........................................................A-0080, A-0104, A-0169 MO
Xu Jian-fang ...................................................................A-0132, A-0133 MO
Xu Ying ..........................................................................A-0132, A-0133 MO
Xu-chao Zhang ...........................................A-0085, A-0117, A-0221, A-0225
..............................................EP A-0087, A-0199 MO A-0217 PU A-0103 SU
Xue-Ning Yang ............................................................................. A-0103 SU
Y Hitchcock................................................................................... A-0113 RA
Y Yusuf ......................................................................................... A-0018 EP
Yan................................................................................................ A-0117 EP
Yanchu Tian ................................................................................. A-0037 SU
Yang Fan ...................................................................................... A-0233 SU
Yang Shi ...................................................................................... A-0142 MO
Yasufumi Kato.............................. A-0107, A-0110, A-0119 SU A-0149 IMST
Yasuhiko Koga............................................................................. A-0219 MO
Yasuhiro Funada .........................................................................A-0150 MO
Yasuo Sekine ...............................................................................A-0123 SU
Yasushi Rino ................................................................................A-0120 SU
Yasushi Yatabe ........................................A-0051 BI A-0216 MO A-0237 PU
Yasuto Kondo ...............................................................................A-0086 SU
Yaxiong Zhang ..........................................................A-0161 MO A-0162 PA
Yen-Chiang Tseng ........................................................................A-0070 PU
Yen-Han Tseng .............................................................................A-0070 PU
Yeuh-Ru Lin ................................................................................A-0194 RA
Yeung SF ......................................................................................A-0251 PA
Yi Han ..........................................................................................A-0012 SU
Yi-An ..........................................................................A-0114 PU A-0129 RA
Yi-Chen Sung ...............................................................................A-0070 PU
Yi-Chun Chen ...............................................................................A-0114 PU
Yilmaz Tezcan ..............................................................................A-0252 RA
Yi-long Wu ....................................A-0057, A-0087, A-0104, A-0126, A-0142,
..............................A-0195, A-0199 MO A-0085, A-0117, A-0221, A-0225 EP
.................................................................A-0103 SU A-0158 CM A-0217 PU
Ying Cheng ..................................................................................A-0104 MO
Ying Huang ..................................................................................A-0195 MO
Yi-Sheng Huang ..........................................A-0087, A-0199 MO A-0217 PU
Yi-Wei Chen .................................................................................A-0141 PU
Yohei Kawaguchi ..........................................................................A-0119 SU
Yohei Takumi ................................................................................A-0226 SU
Yoichi Nakamura ............................................................A-0102, A-0112 MO
Yoichi Nakanishi ............................................................................A-0236 BI
Yoichi Ohtaki ................................................................................A-0172 SU
Yoji Ikegami .................................................................................A-0102 MO
Yong Chan Ahn ............................................................................A-0244 RA
Yong Hoon Kim ............................................................................A-0223 CM
Yonging Guo ...........................................................................A-0099 RASC
Yong-Kek Pang ...............................................................A-0100, A-0101 PU
Yongqing Guo ..............................................................................A-0037 SU
Yoon-la Choi ..................................................................A-0062, A-0140 MO
Yoshida Koichi ..............................................................................A-0107 SU
Yoshihiro Hattori ..........................................................................A-0150 MO
Yoshihiro Ishikawa .......................................................................A-0096 MO
Yoshihisa Kobayashi ...................................................A-0019 SU A-0051 BI
Yoshihisa Shimada ............................................A-0107, A-0110, A-0119 SU
Yoshiko Ogata .............................................................................A-0092 MO
Yoshiko Urata ..............................................................................A-0150 MO
Yoshinori Hasegawa ......................................................................A-0176 BI
Yoshio Matsui ...............................................................................A-0086 SU
Yoshio Tomizawa ..............................................A-0046, A-0111, A-0219 MO
Yoshitsugu Horio .......................................................A-0216 MO A-0237 PU
Yosuke Kamide ...........................................................................A-0219 MO
Yosuke Miura ....................................................A-0111, A-0136, A-0219 MO
You Lu .........................................................................................A-0057 MO
Young il Kim .................................................................................A-0223 CM
Young Joo Min .............................................................................A-0068 MO
Youngkyu Moon ...........................................................................A-0254 SU
Young-Woo Sohn ........................................................................A-0062 MO
YS Jong ........................................................................................A-0018 EP
Yu Yang Soon ...........................................................A-0207 MO A-0208 RA
YuanYuan Lei ............................................................A-0199 MO A-0221 EP
Yu-cheng Li ...............................................................A-0250 MO A-0253 PA
Yu-Chieh Su ...............................................................A-0114 PU A-0129 RA
Yu-Chin Lee ..............................................................A-0070 PU A-0187 MO
Yue Yan .....................................................................A-0161 MO A-0162 PA
Yuh-Min Chen ...........................................................A-0070 PU A-0187 MO
Yuichi Miyashima .........................................................................A-0091 SU
Yuichi Sesumi ...............................................................................A-0019 SU
Yuichiro Ohe ..................................................................A-0206, A-0218 MO
Yujin Kudo .......................................................................A-0107, A-0119 SU
Yukihiro Imai ................................................................................A-0227 MO
Yukinori Sakao .............................................................................A-0237 PU
Yukito Ichinose .............................................................................A-0108 SU
Yukitoshi Satoh ............................................................................A-0086 SU
Yuko Kawano ..............................................................................A-0121 MO
Yuko Oya ..................................................................A-0216 MO A-0237 PU
Yunchao Huang ...........................................................................A-0142 MO
Yung-Hsiang Lin ..........................................................................A-0194 RA
Yung-Hung Luo ...........................................................................A-0187 MO
Yunsong Li ...................................................................................A-0012 SU
Yunzhong Zhu .............................................................................A-0057 MO
Yutaka Fujiwara .............................................................A-0206, A-0218 MO
Yutong Xu ..................................................................A-0161 MO A-0162 PA
Zainal Abidin MZ ...........................................................................A-0243 EP
Zbynnek Bortlicek ........................................................................A-0050 MO
Zeng Wanling ...............................................................................A-0035 EP
Zhao ayin-min ..............................................................................A-0132 MO
Zhao Hui ......................................................................................A-0233 SU
Zhen Wang ..................................................A-0087, A-0199 MO A-0217 PU
Zhi Xie ............A-0085, A-0221, A-0225 EP A-0087, A-0199 MO A-0217 PU
Zhidong Liu ..................................................................................A-0012 SU
Zhi-hong Chen ..........................................................A-0085 EP A-0195 MO
Zhi-Xie .........................................................................................A-0195 MO
Zhiyi Song ....................................................................................A-0037 SU
Zhi-Yong Chen ..........................................................A-0199 MO A-0217 PU
Zhong Chen .................................................................................A-0012 SU
Zhu, Guangying ...........................................................................A-0090 CM
Zubaidah Z ...................................................................................A-0260 EP
2014 IASLC Asia Pacific
Lung Cancer Conference (APLCC)
NOTES
45
NOTES
46
2014 IASLC Asia Pacific
Lung Cancer Conference (APLCC)