TOGA Podcast

The first TOGA Podcast for 2022 is about the need for a national clinical quality registry in lung cancer. A/Professor Emily Stone, the Deputy Chair of TOGA, is a Respiratory Physician, Senior Staff Specialist and Head of Thoracic Medicine within the Department of Thoracic Medicine and Lung Transplantation at St Vincent’s Hospital Sydney. She is a conjoint Senior Lecturer at the University of New South Wales and the Chair of the St Vincent’s Hospital Lung Cancer Multidisciplinary Team. Emily is joined by Professor Rob Stirling, Respiratory Physician from the Alfred and Monash University who is the lead for the Victorian Lung Cancer Registry (VLCR) and also Professor Fraser Brims, Respiratory Physician from Sir Charles Gairdner Hospital and Curtin University Medical School and Institute of Medical Health.

The high burden of disease and poor outcomes in lung cancer necessitate provision of optimal and timely care to ensure the best possible outcomes for people with lung cancer. A national clinical quality registry will reduce unwarranted variation in care by benchmarking performance and evaluate strategies designed to improve care, such as the expected lung cancer screening program. Registries are not just about collecting data.  Examples of varied care in lung cancer and a vision of what a clinical quality process should look like for lung cancer is explored in this podcast, together with an urgent call to action to demand funding for a national Clinical Quality Registry for lung cancer.

Welcome to the Thoracic Oncology Group of Australasia Podcast series. Today Mal Itchins, Medical Oncologist from Royal North Shore Hospital discusses ALK therapy choices & considerations when treating ALK NSCLC. Mal is joined by Steven Kao, Medical Oncologist from the Chris O’Brien Lifehouse and Lisa Briggs who has her own personal experience with ALK lung cancer having been diagnosed in 2014, when only limited treatment options were available

We have seen rapid transformation in treating ALK lung cancer with emerging therapies and new indications over the last decade. We discuss how to choose one treatment over another, optimizing sequencing as well as addressing potential side effects associated with each of the options. Patient preferences, needs and wants are also considered.

Two of the associated TOGA trials, ASPiRATION and ALKternate are exploring how molecular testing can monitor emerging mutations and influence treatment decisions, as well as exploring liquid biopsy to search for emerging mechanisms of resistance.

https://thoraciconcology.org.au/clinical-trials/

Thank you to Pfizer for sponsoring this Podcast.

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.

In this Podcast, Briony Scott discusses the stigma often associated with a diagnosis of lung cancer with Danielle and Terri – both diagnosed with lung cancer and managing the impact on their lives. They also explore self-stigma, family implications, cultural and social behaviours and systemic beliefs.

Drugs that target cancer gene mutations or rearrangements have improved outcomes for patients with many different cancers, including lung cancer, melanoma, and others . The challenge is being able to identify these genomic changes in a timely and efficient manner. Next-generation sequencing (NGS) based tumour comprehensive genomic profiling (CGP) that detects a wide range of genomic aberrations is one method being utilized to match patients to relevant targeted therapies against several oncogenic drivers, particularly for lung cancer. Several in-house as well as commercial testing panels are now available that help Medical Oncologists understand the cancer genomic profile of their patients. This information helps inform whether there these patients are likely to respond to a targeted agent, either as standard of care or as part of a clinical trial.

In this Podcast, we will discuss some of the challenges that exist in being able to identify these molecular changes. The value of comprehensive genomic profiling for lung cancer patients in Australia will be discussed including the TOGA ASPiRATION study, an observational cohort study to assess the clinical impact of CGP in metastatic lung cancer patients. Professor Nick Pavlakis, TOGA Chair and Senior Staff Specialist in the Department of Medical Oncology at Royal North Shore Hospital and conjoint Professor in the Faculty of Medicine University of Sydney, is joined by Professor Stephen Fox, Head of the Molecular Pathology Laboratory, also currently Director of Pathology at Peter MacCallum Cancer Institute and Professorial Fellow in the Department of Pathology, The University of Melbourne.

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

Thank you to Roche for sponsoring this Podcast.

Inflammation plays an important role in pathogenesis, development and progression of lung cancer. Widespread literature exists on the prognostic impact of tumor-related factors, whereas host-related factors have not been deeply evaluated to date. Inflammatory indicators could play a vital role in assisting Medical Oncologists to identify which patients are considered at a higher probability of unfavourable prognosis and probably worse toxicity, justifying an appropriate management plan in advance.

In this podcast Stephen Clarke, Professor of Medicine from the University of Sydney joins Associate Professor Kellie Charles, Head of Pharmacology at the University of Sydney Australia, who were part of the team that discovered that cancer-related inflammation altered chemotherapy pharmacokinetics, toxicity and survival, to discuss the issue.

Thank you to Novartis for sponsoring this Podcast.

Delays in diagnosis are one of the main factors associated with reduced survival rates for lung cancer patients. Clinical guidelines have been implemented in some countries to standardize the diagnosis process, better define the time from diagnosis to the beginning of treatment, and to improve clinical results in lung cancer. In Australia, periods of 14 days from the initial referral of the GP to the first specialty consultation, and also from diagnosis to the first treatment are recommended. However, previous reviews showed an average time of 27 days for lung cancer diagnosis, with time distributions below those recommended by international guidelines (ranging from 6 to 45 days). Across all three modalities, a treatment delay of four weeks is associated with an increase in the risk of death.

In this TOGA Podcast, we will discuss some of the challenges associated with treatment delay and how we can improve these for lung cancer patients in Australia. Dr Mal Itchins, is a thoracic medical oncologist at Royal North Shore Hospital, GenesisCare, and North Shore Private; Professor Wendy Cooper,  Staff Specialist in Tissue Pathology and Diagnostic Oncology at Royal Prince Alfred Hospital and Mr Phillip Antippa a specialist Cardiothoracic surgeon and the Head of Thoracic Surgical Services at The Royal Melbourne Hospital and the Peter MacCallum Cancer Centre, join us in the conversation.

Thank you to Novartis for sponsoring this TOGA Podcast.

Reference:

ASPiRATION is an observational cohort study to assess the clinical impact of comprehensive genomic profiling in metastatic lung cancer patients. Find more information here: https://thoraciconcology.org.au/aspiration/

Welcome to the Thoracic Oncology Group of Australasia Podcast series. 

This TOGA Podcast focuses on thriving with lung cancer and overcoming the challenges associated with long term survivorship and lung cancer. The past decade has seen significant advances in the management of metastatic NSCLC with the advent of multiple targeted therapies, immunotherapy approaches and combination approaches and associated improvements in survival outcomes for patients. There is an emerging cohort of patients with advanced NSCLC who experience long periods of disease control whilst on these treatments. 

Traditionally survivorship has referred to the care of or issues for patients following curative treatment of early-stage disease. However, due to the recent advances described here, there is a compelling need to begin addressing the issues faced by long term metastatic disease ’survivors’. 

In this Podcast, we welcome Lillian Leigh, a long-term survivor of lung cancer, Dr Sarah Heynemann, Oncology Fellow from the Chris O’Brien Lifehouse and Mary Duffy, Lung Cancer Clinical Nurse Consultant (CNC) in the Lung MDT at Peter MacCallum Cancer Institute about the issue’s patients face and how to support long term survivors of lung cancer.

Cigarette smoking is by far the greatest cause for lung cancer. But the proportion of lung cancer in patients who have never smoked before is on the rise. 

In this podcast, Melissa Moore and Lucy Morgan discuss the increase in lung cancer diagnoses for young women who have never smoked before. 

Welcome to the Thoracic Oncology Group of Australasia Podcast series. This TOGA Podcast focuses on Small Cell Lung cancer (SCLC) – a type of lung cancer with the poorest prognosis of any lung cancer. SCLC patients make up about 13% of new lung cancer diagnoses that are characterized by early & rapid spread with only modest progress in its treatment over the last decades. Immunotherapy continues to radically change the way we treat many types of lung cancer and today we explore what these treatments mean for the SCLC patient and the practical implications of using immunotherapies in the clinic. We also discuss future combinations and novel agents in clinical trial development.

Our guests today include Dr Steven Kao, Medical Oncologist from the Chris O’Brien Lifehouse in Sydney Australia, Associate Professor Stephen Liu, Director of Thoracic Oncology & Director of Developmental Therapeutics at the Lombardi Comprehensive Cancer Centre of Georgetown University and also Dr Rebecca Tay, a Medical Oncologist from the Royal Hobart Hospital in Tasmania, having recently completed a Clinical Research Fellowship at the Christie NHS Foundation Trust in Manchester.

Thank you for joining us and also thank you to Roche for sponsoring this Podcast.

Useful link: https://www.frontiersin.org/articles/10.3389/fonc.2020.01074/full

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.

Lung cancer screening works. Earlier detection of lung cancer presents a vastly different prognosis. Stage I disease has a median 5 year survival of greater than 65%, whereas metastatic disease has a 5 year median survival rate of 15-20%. It is time to shift the perception of a lung cancer diagnosis to that of a treatable cancer with a potential cure, through a combination of early-stage detection, and effective communication that newer treatments offer better survival and QoL. The recently released Cancer Australia Report on lung cancer screening has been presented to the Health Minister and is awaiting actions. 

Dr Emily Stone, Respiratory Physician from St Vincent’s Hospital in Sydney, interviews Professor Kwun Fong, Thoracic and Sleep Physician at The Prince Charles Hospital, Brisbane. Both are long time advocates and researchers in early screening for lung cancer and they discuss the challenges of implementing a lung cancer screening program.

Australia has one of the highest incidence rates of mesothelioma in the world.

Mesothelioma is a form of cancer that most often affects the thin linings of the organs in the chest (pleura) and abdomen (peritoneum). Mesothelioma is closely linked with asbestos exposure either at work or among family members of workers and people living in neighbourhoods near asbestos factories and mines. The risk is lifelong.

TOGA, the Thoracic Oncology Group of Australasia, is working to positively change the outcome for patients with mesothelioma through an innovative clinical trials program and by providing medical education & awareness.

In this Podcast, we talk with Professor Anna Nowak, Pro Vice Chancellor at UWA, Medical Oncologist and Director of the National Centre for Asbestos Related Diseases and Medical Oncologist Dr Steven Kao from the Chris O’Brien Lifehouse with a special interest in predictive and prognostic factors in mesothelioma, about emerging treatments for mesothelioma patients and the DREAM3R trial.

In a successful partnership spanning US, Australia and New Zealand, TOGA investigators are collaborating with PrECOG and NHMRC CTC and have opened a Phase III trial called DREAM3R investigating the addition of immunotherapy to chemotherapy in patients with newly diagnosed malignant pleural mesothelioma. Australia has one of the highest incidence rates of mesothelioma in the world, and new promising therapies are desperately needed. The DREAM3R trial follows on from the exciting Phase II clinical trial results in PrECOG’s PrE0505 trial https://rb.gy/q44it3 and the Australian DREAM trial https://rb.gy/lrkhvo that both showed early promising results with the chemotherapy and durvalumab combination. More information on the DREAM3R trial can be found here: https://rb.gy/2h9f5v and https://rb.gy/rkznyt’

Further trial information available here:

https://rb.gy/2h9f5v and https://rb.gy/rkznyt

The first virtual TOGA Preceptorship enabled 38 Preceptees involving Fellows, Advanced Trainees, Nurses and Patients to come together and discuss the landmark papers in lung cancer and the latest in treatment.

A multidisciplinary group including Medical Oncology, Radiation Oncology, Respiratory, Nursing, Palliative Care and Surgery were involved and available to share expertise.

Hear from two of the Preceptors - Prunella Blinman and Shankar Siva, and three Preceptees – Anna Lawless, Abhijit Pal and Melanie Rabbets, about their experiences, their learnings, what they are looking forward to in future research and how the Preceptorship has impacted their career choices.

Dorothy Keefe, CEO of Cancer Australia and Mark Scott discuss the COVID impact on diagnosing and treating lung cancer patients – a 4 week delay in diagnosis makes a difference. The red flag symptoms of lung cancer need increased education, especially for the younger, non-smoking women, who are not always aware that a lung cancer diagnosis is possible. GP awareness and early screening is also important here. We are very good at treating breast cancer, colorectal cancer and prostate cancer – we need more focus to reach this point with lung cancer. Developing a specific thoracic oncology research group will enable such a focus, especially a multidisciplinary, patient centric group such as TOGA.

Cancer Australia: Investigating Symptoms of Lung Cancer

Remarkable advances in screening, diagnosing and treating lung cancer are discussed in this Podcast. Associate Professor Nick Pavlakis, Medical Oncologists from Royal North Shore Hospital Sydney and Dr Emily Stone, Respiratory Physician from St Vincent’s Hospital Sydney join TOGA for a conversation about public health measures to ensure the survival increase we are seeing for patients with lung cancer continues to accelerate into this decade.

Sponsored with a Takeda Educational Grant.

Lung cancer is the leading cause of cancer related deaths in Australia, and lung cancer in never smokers is still the seventh leading cause of death. Lung cancer kills more women every year than breast, ovarian and uterine cancers combined even though many seem to think that the only cancer women ever get is breast cancer! More young women are being diagnosed every year who have never smoked – around 1/3 of new diagnoses fit this category for women.

Thankfully this statistic is declining.

Higher awareness, earlier screening and targeted treatments have played a role in better outcomes for lung cancer patients, as has the identification of driver mutations that can cause some lung cancers.

Alexandra’s story is inspiring. Diagnosed with lung cancer 8 years ago, her treatments have varied due to the discovery of a rare mutation called ALK and she is now involved in an innovative clinical trial using a targeted agent for patients with the ALK gene rearrangements. 

In this Podcast, Mark Scott talks with Alexandra about her challenges in diagnosis, searching for the best treatments available, living in a regional area and what it’s like to be involved in lung cancer clinical trials. 

Alexandra is redefining survival rates for those with lung cancer and bringing new hope for patients all around the world.

Join us for a conversation with internationally recognized Medical Oncologists and researchers, Professor Ben Solomon & Associate Professor Tom John as they discuss the increased survival benefits for patients with oncogene driven lung cancer and how novel treatments are contributing.

Oncogenes discussed include EGFR & osimertinib; ALK & brigatinib, alectinib, lorlatinib; ROS1 & crizotinib, entrectinib; KRAS & sotorasib; G12C; Exon20 insertions & poziotinib, amivantamab, RET & selpercatinib, pralcetinib. Also discussed – the importance of the move beyond single gene testing to panels and NGS is important to maximise turn-around times and the efficient utilization of clinical samples.