TOGA Podcast

Welcome to the Thoracic Oncology Group of Australasia Podcast series. Associate Professor Shankar Siva, Radiation Oncologist and current Cancer Council Victoria Colebatch Fellow who leads the SABR program at Peter MacCallum Cancer Centre discusses The Management of Stage III NSCLC in this podcast. Shankar is joined by Associate Professor Rachel Wong, Deputy Director of Oncology - Eastern Health, Adjunct Clinical Assoc Professor - Monash University and Clinical Research Fellow – WEHI and also Professor Drew Moghanaki, Chief of Thoracic Oncology, Department of Radiation Oncology at UCLA, Stanley Lezman and Nancy Stark Endowed Chair in Thoracic Radiation Oncology Research, Co-Director Greater Los Angeles Lung Precision Oncology Program and Co-Director Greater Los Angeles CSP NODES Program also joins us today. Our focus today is on what defines inoperable NSCLC, patient selection and how to manage the toxicities associated with treatment.

Thank you to AstraZeneca for sponsoring this podcast.

Welcome to the Thoracic Oncology Group of Australasia Podcast series. In this Podcast, we discuss early NSCLC management and treatment, particularly in light of how immunotherapy will impact surgical and respiratory medicine as the landscape evolves with new data. Dr Melissa Moore Medical Oncologist from St Vincent’s Melbourne and the TOGA Education Chair, is joined by Dr Katharine See, Director and Head of the Respiratory Medicine at the Northern Hospital, Melbourne and Mr Naveed Alam, Thoracic surgeon from St Vincent’s and Epworth, Melbourne to discuss and review the findings and implications for NSCLC patients.

Thank you to Roche for collaborating on this podcast.

For lung cancer patients, the benefits of treatment and potential for cure must always be balanced with risk. Cardiotoxicity is considered a short and long term risk from treatment for lung cancer, but this varies between patients. New radiotherapy techniques, lower doses of radiotherapy and supporting cardiovascular treatments can minimise the risk of cardiotoxicity. Monitoring for cardiac complications is becoming an important aspect of survivorship care, and may require collaboration between medical oncologists, radiation oncologists, GPs and cardiologists. 

Professor Shalini Vinod, Thoracic Radiation Oncologist from Liverpool Hospital Sydney and Chair of the Liverpool and MacArthur Lung Cancer MDT discusses the challenges with Dr Vicky Chin, Radiation Oncologist from the University of NSW and Dr James Otton, Cardiologist from Liverpool Hospital.

Deme Karikios, Medical Oncologist and Director of Clinical trials at Nepean Cancer Care Centre in Sydney is joined by Wanda Cui, Medical Oncologist from the Peter MacCallum Cancer Centre in Melbourne and Chris Karapetis,  Head of the Department of Medical Oncology and Director of Clinical Research at the Flinders Medical Centre in Adelaide.

The identification of molecular subtypes of non-squamous NSCLC continues to grow, spurring the development of targeted therapies designed to target these mutations and prevent the growth of the cancer. People with advanced NSCLC that possess one of these ‘actionable’ mutations and can access targeted treatments can live for many years with very manageable side effects. However, the technology to identify these actionable mutations in a single test and the targeted treatments are not yet accessible to all people with advanced NSCLC.

In this TOGA podcast, we explore access to molecular diagnostics and treatments across ANZ: the past, present, future. Chaired by Professor Nick Pavlakis: Medical Oncologist, Royal North Shore Hospital, Genesis Care and Chair of Thoracic Oncology Group of Australasia ; joined by Dr Laird Cameron: Medical Oncologist Auckland Hospital and Canopy Cancer Care and TOGA Scientific Committee New Zealand representative and Dr Renuka Chittajallu, Medical Oncologist Riverina Cancer Care Centre, Griffith Base Hospital, Genesis cancer care, Kingswood, Director of Clinical Trials, Riverina Cancer Care Centre.

In Australia, the TOGA ASPiRATION study is evaluating the impact of providing comprehensive genomic profiling and access to targeted therapies, with the hope that this will provide the evidence for widespread reimbursement for testing and treatments for patients where an actionable mutation is identified.

https://thoraciconcology.org.au/aspiration/ 

In this TOGA Podcast, we discuss smoking cessation in the face of smoking-related stigma and nihilism. Dr Henry Marshall, Associate Professor and Clinical Academic Fellow, UQ Thoracic Research Centre and Thoracic Physician, The Prince Charles Hospital Queensland is joined by Professor Christine Paul: Behavioural Scientist at the University of Newcastle and School of Medicine and Public Health Dr. Matt Steliga: Chair of The IASLC Tobacco Control and Smoking Cessation Committee and Surgical Oncologist at Winthrop P. Rockefeller Cancer Institute, Little Rock, Arkansas.

The COSA Smoking Cessation in Cancer Patients position statement recommends that brief advice on smoking cessation is everyone’s role, but surveys suggest that many healthcare professionals feel they are inadequately trained to conduct these conversations, and in lung cancer, perceived sensitivities around smoking-related stigma may further hamper the delivery of appropriate smoking cessation advice. Despite clear benefits of smoking cessation and the recognition by healthcare professionals that smoking cessation is part of an individualised treatment plan, smoking cessation support for cancer patients may still not be successfully integrated into patient treatment plans.

This podcast provides practical advice on how to start the conversations using variations on the “Ask, Advise, Help” model and emphasising brief advice and referral that can be conducted by any healthcare professional.  The podcast also covers why continuing to check in on progress at each visit is important, that stigma-related sensitivities are actually negated by asking about quitting regularly and that tandem pharmacotherapy to combat physical withdrawal and behavioural support (e.g QUITLine counselling) is evidence-based best practice for quitting. Finally, the podcast covers some system-based changes that have had phenomenal results, with over 90% uptake of behavioural support services in both lung cancer and non-cancer cohorts, and a 68% quite rate in a lung cancer cohort, and description of a clinical trial in the Australian healthcare system with a similar intervention.

Resources referred to in this podcast:

13QUIT for telephone advice

QUIT online referral form

Clinical Oncology Society of Australia Smoking Cessation Working Group. Smoking Cessation in Cancer Patients: Embedding Smoking Cessation Care in Australian Oncology Health Services. Clinical Oncology Society of Australia. August 2020.https://www.cosa.org.au/media/332692/cosa-smoking-cessation-in-cancer-patients-140820-final.pdf

Position Statements | COSA

tobacco-cessation-guide.pdf (asco.org)

Quitting Smoking At or Around Diagnosis Improves the Overall Survival of Lung Cancer Patients: A Systematic Review and Meta-Analysis - Journal of Thoracic Oncology (jto.org)

Barriers and facilitators and a unique insight into the patient benefits are discussed between Alexandra, patient advocate, teletrials participant and lung cancer survivor, Sabe Sabesan, medical oncologist from the ICON Cancer Centre in Townsville and co-chair of the Australian Teletrial program and the initial teletrials pilot in 2017-2020, and Craig Underhill, medical oncologist from Border Medical Oncology and Haematology in Albury/Wodonga. Incentive funding and harmonising governance requirements for TeleTrials in Australia will help solve many of these issues and continue to transform the way trials are managed. The benefits for patients and their families are clear and positively impact the future of trials in Australia.

Resources:          https://wiki.cancer.org.au/australia/COSA:Teleoncology

https://www.digitalhealth.gov.au/healthcare-providers/initiatives-and-programs/telehealth

                            https://thoraciconcology.org.au/teletrials/

Supported by Takeda

Disclaimer: The opinions, beliefs and viewpoints expressed by the various authors and participants contained in this message do not necessarily reflect the opinions, beliefs and viewpoints of TOGA or official policies of TOGA. Dosage & administration of any treatments mentioned during TOGA medical education may differ between Regions. Please refer to your local prescribing information for further details.  

Welcome to the Thoracic Oncology Group of Australasia Podcast series. Today Rachel Roberts-Thomson, Medical Oncologist from Queen Elizabeth Hospital in Adelaide, discusses Improving Outcomes in EGFR-Mutated Non-Small-Cell Lung Cancer . Rachel is joined byVenessa Chin from St. Vincent’s Hospital in Sydney & Angeline Low who has her own personal experience with EGFR lung cancer .

EGFR mutations are identified in approximately 15% of NSCLC patients. Efficacious, PBS-reimbursed first line treatments are available, but resistance to treatment and progression remains a concern. In this podcast, options for treatment post-progression are discussed, including accessible treatment and sequencing options and the role of patient preferences and clinical trials.

In collaboration/partnership/supported with/by Roche.

Disclaimer: The opinions, beliefs and viewpoints expressed by the various authors and participants contained in this message do not necessarily reflect the opinions, beliefs and viewpoints of TOGA or official policies of TOGA. Dosage & administration of any treatments mentioned during TOGA medical education may differ between Regions. Please refer to your local prescribing information for further details.  

Note: SRS is Stereotactic radiosurgery