NEWS WCLC. Genetics Offer a Promise of Cure for NSCLC Despite advances in genetic research,

International Association for the Study of Lung Cancer NEWS WCLC 2013 wclc.iaslc.org 15th World Conference on Lung Cancer Tuesday October 29, 2013 Sydney, Australia Today s Schedule Monday s Highlights of the Day: Radiotherapy, Radiology and Surgery Bayside Auditorium A, Level 1 07:00 08:00 Monday s Highlights of the Day: Medical Oncology, Biology and Pathology Bayside Auditorium B, Level 1 07:00 08:00 Presidential Symposium: Top 4 Rated Abstracts Plenary Hall, Ground Level 08:15 09:45 Networking Break and Poster Presenters Poster Session 2 in Attendance 09:45 10:30 Best of Posters 09:55-10:25 Exhibit Showcase Theater, 09:55 10:25 Symposium supported by Boehringer Ingelheim: Questions in the Treatment of NSCLC: Focus on EGFR Mutation-Positive NSCLC Bayside Auditorium B, Level 1 12:15 13:45 Networking Break and Poster Presenters Poster Session 2 in Attendance 15:30 16:15 IASLC Happy Hour 15:30-16:25 Symposium supported by Roche: New Horizons in First-Line NSCLC Therapy Parkside Auditorium, Level 1 18:00 19:30 Gala Dinner Reception and Gala Dinner (Ticketed Event) Plenary Hall, Ground Level 19:15 23:00 Genetics Offer a Promise of Cure for NSCLC Despite advances in genetic research, many challenges remain to improve the treatment options for nonsmall cell lung cancer (NSCLC). A Monday plenary session offered three in-depth looks at scientific advances in learning more about genetic abnormalities, and a final presentation discussed curing NSCLC. Will Personalized Therapies Ever Cure Metastatic NSCLC addressed identifying druggable targets that could translate into identifying predictive biomarkers, genomic and epigenomic testing, tumor heterogeneity and strategies that could lead to a cure for NSCLC. Matthew Meyerson, MD, PhD, discussed next generation sequencing for genetic abnormalities in Identifying Druggable Targets Through Whole Genome Sequencing: TCGA (The Cancer Genome Atlas). Dr. Meyerson is director of the Center for Cancer Genome Discovery at Dana-Farber Cancer Institute and a professor of pathology at Harvard University, Boston, USA. Normal human genomes are all mostly alike, but every cancer genome is abnormal in its own way, Dr. Meyerson said. Each cancer genome has a unique set of genome alterations from its normal host. These alterations, however, are not random but act in common pathways and mechanisms. Most cancer-causing mutations are somatic, but somatic alterations may provide Associates Honor Dr. Bunn for Service to IASLC The IASLC owes a debt of gratitude to Paul A. Bunn Jr., MD, who has served as the executive director/ceo since 2003. Dr. Bunn steps down from this position, leaving the IASLC as a strong association because of his vision, his leadership and his strong ties to the lung cancer community. It is impossible to overstate the contribution that Paul Bunn has made to the IASLC over the 10 years that he has been our executive director/ceo. As one of the most active researchers in the field of lung cancer he was well placed to lead our scientific and educational activities over the past decade, INSIDE Paul A. Bunn Jr., MD said Peter Goldstraw, MB, ChB, FRCS, Royal Brompton Hospital and Imperial College, London and 2011-2013 IASLC president. Paul has seen to it that our budget has remained healthy during recent turbulent years, creating additional revenue streams with webinars and online learning materials, and judiciously pruning costs wherever possible, added Dr. Goldstraw. IASLC resources include 20 webinars on the IASLC website (www.iaslc.org), staging and pathology manuals and handbooks and new meetings, including the Best of WCLC series. These diversified sources of revenue helped 02 Business Meeting 05 IASLC Committee IASLC President Tony Mok, MD: Cure is a survival rate. It is a probability of cure. Cure is actually an estimate. a therapeutic window, he said. Genometargeted treatments can be selective for the genomically altered cancer cell and spare the rest of the body, which is genomically normal. A key to this approach is genome sequencing, which is becoming less expensive. There are four technical approaches to cancer sequencing: whole genome, transcriptome, whole exome and targeted exome sequencing, Dr. Meyerson said. These approaches may help find recurrent mutations in human lung cancer, but there are challenges in going from the DNA sequence to significant mutations, he said. Statistical recurrence could help find the true genome alterations, but the right statistical model for this has not been developed. Also, statistical methods fail to detect many functionally important genes. Dr. Meyer concluded by listing successes see Plenary, page 8 boost IASLC s net assets to more than $8.6 million in 2012, up from nearly $3.6 million in 2003. Before becoming the executive director of the IASLC, Dr. Bunn served as its president (2002-2003). He also served as president of other organizations, including the American Association of Cancer Institutes and the American Society of Clinical Oncology. These positions, said Dr. Goldstraw, were invaluable to Dr. Bunn s leadership in developing and implementing the reforms of a strategic review of the IASLC in 2011. These [reforms] have provided the Association with an effective head office, staffed by enthusiastic and energetic staff that prosee Bunn, page 8 08 improved screening Learner Content Professional Requirements Delivery

2 15th World Conference on Lung Cancer #wclc2013 wclc.iaslc.org Press Conference Media from around the world packed Bayside 101 to attend the WCLC 2013 Press Conference Monday. Experts including Robert Rintoul, MD, discussed the latest in screening, prevention and treatment in lung cancer and other thoracic malignancies. Members of the IASLC leadership explained the importance of the WCLCs, where researchers from all disciplines around the world can come together and share what they ve learned. Multidisciplinary Smoking-Cessation Program Successful in Australia A small study of a tailored smokingcessation program for patients with a cancer diagnosis showed that counseling and access to smokingcessation agents were successful for the majority of enrolled patients. However, the study also demonstrated obvious areas for improvement, said Marliese Alexander, of the Department of Cancer Medicine at the Peter MacCallum Cancer Centre, East Melbourne, Australia. Ms. Alexander presented the findings of the study in Monday s Oral Abstract Session: Cancer Control and Epidemiology 1. The study included a retrospective review of datasets for patients registered at the cancer centre to evaluate their smoking behaviors and the success of a multidisciplinary smoking-cessation program between 2009 and 2011. Among 20,728 new patient registrations with recorded data on smoking, 2,448 (12 percent) were identified as current smokers. Of these smokers, 178 enrolled in the program, which consisted of counseling, behavior techniques and pharmacologic therapy (nicotine-replacement therapy or varenicline). An additional 134 patients who did not disclose smoking status at registration also enrolled in the program. Most referrals were made by nurses (53 percent), compared with physicians (24 percent) and pharmacists (7 percent). All patients had at least one counseling session or behavioral intervention, but 46 percent had only one. The majority (78 percent) used pharmacotherapy, with most using nicotine-replacement therapy. A subset of 30 patients was used to evaluate the success of the smokingcessation program. Twenty of the patients (66 percent) reported that the program was successful, which was defined as a decreased daily cigarette consumption or smoking cessation for six months or longer. Among the patients in the subset, 96 percent recognized the benefits of quitting, 48 percent believed their illness was caused by smoking and 45 percent recognized the negative effects of smoking on anticancer treatments. Ms. Alexander discussed the three areas in need of improvement and ongoing objectives to address them. First, she said, 43 percent of the patients enrolled in the smoking-cessation program did not disclose their smoking status at the time of hospital registration. She said that staff would be trained on how to ask about smoking behaviors in a way that makes patients feel comfortable. To address the problem of the unexpectedly low recruitment rate of 7 percent, Ms. Alexander said she and her colleagues are looking at ways to use existing health care systems to prompt and guide treatment. She added that clinical pharmacists may be used to facilitate the delivery of interventions. Lastly, the low retention rate needs to be further explored, as it was not fully elucidated in the current study, said Ms. Alexander. We need to understand why patients are not returning for counseling, to identify and, as much as possible, eliminate barriers to ongoing participation. Dr. Mok Becomes IASLC President at Business Meeting The IASLC moved to a new era during its Business Meeting Monday when Tony Mok, MD, became the 2013-2015 president, succeeding Peter Goldstraw, MB, ChB, FRCS. Peter will be a tough act to follow, Dr. Mok said after the ceremonial passing of the presidential gavel from Dr. Goldstraw. Peter, as a seasoned surgeon, has been a tremendous leader in our society. Under his leadership in the past two years, he has managed to improve the numbers of the membership, shrink the structure of the organization, increase the education activity and steer us through a difficult financial time. Dr. Mok also honored Paul A. Bunn Jr., MD, who has served as the executive director/ceo since 2003 and is retiring. Dr. Mok said he is looking forward to working with Dr. Bunn s successor, Fred R. Hirsch, MD, PhD. I am your servant, Dr. Mok told members at the meeting. If there is anything you need, send me an email. I want to keep the dialog moving. In his last act as president, Dr. Goldstraw walked members through the changes in the organization, which has witnessed great growth, to a total of 3,622 members. There has been dramatic growth in membership, he said. It has accelerated through the efforts of the head office and the regents. The greatest numbers of IASLC members are from medical oncology, with 1,309 members, followed by thoracic surgery, 807; pulmonary medicine, 555; radiation oncology, 287; basic sciences/cancer research, 174; pathology, 156; and nurses/ allied health/advocates, 80. By region, Asia has the most IASLC members, with 1,190, followed by Europe, 1,090; North America, 1,065; rest of the world, 445. Membership has doubled in Asia because of increasing interest and awareness in China and the Japan Lung Cancer Society, Dr. Goldstraw said. I am pleased that membership in the rest of the world is increasing, particularly in South America. Dr. Goldstraw also discussed changes in WCLC, which will be an annual event starting in 2015. Next year will be the last year without a world conference, he said. It will be an annual conference and rotate among the three regions (Asia, Europe and North America). With the move to an annual meeting, the process for selecting meeting sites also will change. Convention centers in the cities of IASLC 2013-2013 President Tony Mok, MD, (left) accepts the presidential gavel from 2011-2013 President Peter Goldstraw, MB, ChB, FRCS. an appropriate region can express interest or be polled by the ICS approximately seven years ahead of a meeting. The facilities in those cities will be screened and a short list of finalists will be selected. From that list a final site will be chosen by the head office, International Conference Services and the presidents from the last three conferences. Also, the conferences will be run by a Regional Organizing Committee, with 15-20 members from around the region, not just the host city, Dr. Goldstraw said. Other items addressed at the meeting: The Journal of Thoracic Oncology (JTO) had a slight decrease in impact factor, which is still greater than 4. It is ranked 54 th out of 194 oncology journals indexed by the National Library of Medicine. Its website had 180,768 visitors in 2012, with 1,139,038 page views and 294,697 fullarticle views. Dr. Goldstraw noted a difference between income and expenditures in 2012. In 2012, IASLC had actual income of $4,240,832 and expenses of $4,777,089, for a loss of $536,257. The forecast for 2013 is to have a loss of $250,000. This has been typical over the history of the organization because the IASLC makes the majority of income at the world conferences. The assets of the Association have fluctuated because of biennial meetings, and this is part of the rationale to move to an annual conference, he said. New IASLC initiatives include the IASLC Staging Classification, IASLC Pathology Classification, Genetic Testing Guideline with CAP and AMP, Best of WCLC 2013, Publications such as the ALK Atlas, the IASLC Text Book and the 40th Monograph, and webinars. Award winners also were recognized.

wclc.iaslc.org #wclc2013 Tuesday, October 29, 2013 Sydney, Australia 3 More Emphasis on Cancer Prevention Needed Among Underserved Stronger efforts to educate the underserved population about cancer prevention are needed to reduce inequities in lung cancer control because the population has risky behaviors in terms of smoking, according to a study presented Monday. The take-home message is that the underserved are overconfident in the efficiency of lung cancer screening; paradoxically their behavior put them at higher risk due to their smoking habits, said Jean-Francois Morere, MD, Jean-Francois Morere, MD head of the Oncology Department at Paul Brousse Hospital, Paris, France Dr. Morere presented the abstract Lung Cancer Risks, Beliefs and Health Care Access Among the Underprivileged during the Oral Abstract Session: Prevention/ Epidemiology. The abstract examined the results of the EDIFICE 3 study, which interviewed 1,603 subjects ages 40-75 about lung cancer risk factors, beliefs and health care access in France. The French National Cancer Plan seeks to reduce health inequities in cancer control, so EDIFICE 3 was used to poll the population. Underserved subjects represented 33 percent of those polled and they subjectively perceived a higher risk of cancer compared to subjects in the served population (21 percent versus 14 percent), according to the abstract authors. The underserved group also had more cancer risk factors, including a body mass index (BMI) of 26.0 versus 24.8 for the served population; a higher consumption of cigarettes, 16 a day versus 10.1 a day for the served population; and smoked for a longer period, 29.4 years versus 26.3 for the served population. The underserved population versus the served population also had more: comorbidities, 2.2 versus 1.8; respiratory disease, 13 percent versus 7 percent; and cardiovascular disease, 13 percent versus 9 percent. Also of interest, 85 percent of the underserved population said lung cancer could be efficiently screened, versus 78 percent of the served population. To reduce inequities in lung cancer control, the effort of upstream interventions should be focused on prevention, as health care access does not discriminate, the study authors concluded. Underserved subjects have a high level of trust in lung cancer screening but a riskier behavior in terms of smoking. This constitutes new targets for specific communication campaigns and health authorities interventions. Differences in Stage Distribution and Size of Screen-Diagnosed Lung Cancers A comparison of data from two large databases of screen-diagnosed lung cancers demonstrated significant differences in the size and stage distribution of the lung cancers. Claudia Henschke, MD, PhD, professor of radiology, Icahn School of Medicine at Mount Sinai, New York, USA, reported the findings of the study at the Oral Abstract Session: Screening and Epidemiology on Monday. Dr. Henschke pointed out that the two databases were chosen because one the International Early Lung Cancer Action Program (I-ELCAP) had a prescribed regimen for the diagnostic workup and timing and the other the National Lung Screening Trial (NLST) mandated no specified diagnostic evaluation process. Dr. Henschke noted that the evaluation was based on 788 screen-diagnosed lung cancers in I-ELCAP and 649 screendiagnosed lung cancers in NLST. Compared with the lung cancers detected in NLST, the average size of nodules detected in I-ELCAP were significantly smaller (15 mm versus 21 mm, p<0.0001). In addition, significantly more nodules were classified as clinical stage I (82 percent versus 52 percent, p<0.0001) and mixed stage I nodules were more common (73 percent versus 63 percent, p<0.0001) in I-ELCAP. Surgical resection was performed more frequently in I-ELCAP (86 percent versus 77 percent, p<0.0001). The five-year survival was also higher in I-ELCAP compared with NLST (83 percent versus 63 percent). In reviewing possible explanations for the differences, Dr. Henschke noted that the differences could be attributed to the acquisition and reading of CT scans, but good scanners and experienced radiologists were used in both studies. She also said that NLST is an older cohort, but added that the differences persisted when patients of the same age and with similar smoking history within I-ELCAP were considered. The regimen of screening is critical, said Dr. Henschke. The acquisition of images, the diagnostic workup and timing, and the therapy and timing are all important aspects, she added, and all need to be regularly updated to reflect advances in knowledge and technology. Dr. Henschke said that what has been learned about mammographic screening for breast cancer should be translated to lung cancer screening. For example, readers of images should be credentialed, the entire process of screening should be evaluated annually and key quality assurance measures should be assessed each year. Ultimately, the benefit of screening is provided by the initial test together with the entire process of diagnosis and therapy, said Dr. Henschke. VISIT US AT BOOTH #1417 FOR COMPLIMENTARY COPIES AND MORE INFORMATION

4 15th World Conference on Lung Cancer #wclc2013 wclc.iaslc.org Question of the Day Could You Comment on Your Country s Smoking Cessation Efforts? I wish we had some politicians who could do the same as here in Australia. We have not done much, but we have done some things with the package, putting a warning on it about the dangers. I see nonsmoking areas everywhere in Sydney, and I wish we had that in Denmark. Malene Missel, MS Cophagen, Denmark Quite a lot has happened in the last years. Less than 20 percent of people in Norway are current smokers. There are many reasons for this success. It is expensive because the taxes are very high. They cannot make commercials for tobacco and they have to hide it in the stores so you cannot see it. Sverre Fluge, MD Haugesund, Norway Most people don t even know that smoking can cause lung cancer, especially among the rural population. More young people are beginning to smoke, so it is as if we are 30-40 years behind the Western world, where they have good control of smoking. Pritesh Lohar, MD Pune, India We have seen significant reductions in the portion of patients who smoke in the UK, and the reduction in the young women starting to smoke, which was on the rise. This is the result of a number of things, such as education and the social rejection of smoking. Rohit Lal, MD London, UK Work of Committee Members Is Valuable The IASLC Board of Directors and staff thank all IASLC members who have served on an IASLC committee. IASLC Committees contribute significantly to the effective operation and development of IASLC programs, and the Association s achievements could not be accomplished without the efforts of these valuable volunteers. The Association continues to seek a highly competent and active pool of members to serve on its organizational committees. Typically committee membership represents a broad geographic spectrum and a multidisciplinary perspective. Committee members are recommended by the president with approval of the Board of Directors. Committee members are in place to serve until 2015, but you can review the list of committees here to see how you might serve in the future. Award Committee Committee members determine the recipients of the IASLC Distinguished Awards that are presented at each WCLC. Bylaws Committee The committee receives and develops proposed IASLC bylaws changes. Proposed changes are circulated to IASLC members two months before the biennial meeting. Career Development Committee The committee works on initiatives to help members progress through their professional career. Committee members seek involvement from mentors, who play an active role in mentoring professionals early in their careers. Communications Committee The committee develops outreach programs to increase IASLC s name recognition and credibility. Its initiatives enhance the prestige of IASLC products and services, while educating the public about complex cancer issues. Committee members also manage the WCLC media programs and serve as spokespeople for the Association. Education Committee The committee plans, develops and initiates IASLC education programs, with special emphasis on the WCLC. Ethics Committee The Ethics Committee guides the development of the IASLC member code and Board of Directors code of ethical conduct and renders opinions to the Association concerning ethical issues that may arise during IASLC-sponsored activities, including but not limited to meetings, workshops and publications. The committee also provides guidelines for IASLC sponsorship proposals (including initiatives and products) and for the monitoring of IASLC-sponsored meetings. The committee will review IASLC activities, including sponsorship, when deemed necessary, including when requested by the Board of Directors, and provide a report and recommendations to the Board of Directors. Fellowship Committee The committee reviews the IASLC Lung Cancer Fellowship Award/Young Investigators Award applications and selects recipients. The committee also formulates policy related to the selection criteria, candidate application, funding and administration of the fellowship awards program. Membership Committee The committee reviews and recommends requirements for Regular Members, Senior Members, Fellows and Allied Professional membership status in accordance with the bylaws, changes in membership criteria, joint promotions with other societies and member benefits. The committee also discusses strategies to increase membership and retain members, considers any disputes, monitors the general status of membership and makes recommendations to the IASLC Board. Nominating Committee In accordance with the bylaws, the committee develops a slate of candidates for elected positions, including president-elect, treasurer, board of directors and nominating committee members. Nurses and Allied Health Professionals Committee The committee works to ensure that IASLC addresses the needs of nurses and allied health professionals involved in thoracic oncology. Members of the committee comprehensively address the educational and related needs of allied health professionals as members of the thoracic oncology team and as IASLC members. Pathology Committee The committee provides an integrated approach to review various types of lung and thoracic cancers to help define categories that have distinct clinical, radiographic, molecular and pathologic characteristics. The committee leads the development of new and revised classifications and contributes to educational products and services of the IASLC. Patient Advocates Committee The committee strives to ensure that IASLC addresses the informational needs of the public and public advocates regarding issues of importance in thoracic oncology. This committee comprehensively addresses the educational and related needs of the public as an important constituency in the work of the Association. Prevention, Screening and Early Detection Committee The committee provides leadership and oversight of IASLC s cancer prevention activities. It works with appropriate committees and groups within the Association to enhance the quality and quantity of cancer prevention in relevant programs and provides leadership in joint efforts with other societies in the area of cancer prevention. Publications Committee The committee oversees operations for IASLC publications, including the Journal of Thoracic Oncology (JTO), educational books, program/proceedings and others. The committee explores and evaluates print and multimedia opportunities to ensure IASLC s commitment to education and advancement of research through the production of highquality materials. Staging Committee The committee participates in the study and improvement of cancer staging systems relevant to thoracic cancers. The committee directs collection and analysis of patient information and periodically updates staging systems and contributes to IASLC educational products and services. Tobacco Control and Smoking Cessation Committee This committee, established in 2012, is designed to provide more comprehensive consideration of activities and initiatives in which the Association should engage to reduce the use of tobacco worldwide. The committee works to ensure that IASLC addresses the needs of practitioners seeking to help their patients stop tobacco use and recommends actions to contribute to international and local/national efforts in tobacco control initiatives and interventions.

Tuesday, October 29, 2013 Sydney, Australia 5 Update on IASLC Education Committee Primo N. Lara, Jr, chair The Education Committee assesses the education programs of the IASLC and makes recommendations to advance the Association s mission. Its responsibilities include the evaluation of proposed and ongoing educational activities, and the integration of the full range of the Association s educational programs within the comprehensive oversight that comprises the Committee s activities. The committee is engaged in the review of ongoing educational needs assessments, determination of learning objectives, design of educational programs, and the evaluation of effectiveness of these programs. To this end, the committee has evolved rapidly in the past three years from simply reviewing educational event proposals to its direct and active involvement in content development, delivery and outcomes evaluation. Multidisciplinary membership within the committee provides the necessary breadth and depth to create and review educational materials and to identify knowledge gaps. Demographics Motivations Optimal learning methods Learner Professional Requirements Maintenance of certification Licensure CME credits, etc. Content Delivery The establishment of a Continuing Medical Education Subcommittee in 2012 as a component of the parent Education Committee and the accreditation of the IASLC as a continuing medical education (CME) provider by the ACCME has allowed for a more organized approach to the process of content delivery as well as outcomes evaluation. New efforts in promoting content generation have led to the creation of committee-led webinars (such as the Grand Rounds Webinar Series) and the development of the Advanced Radiation Technology Subcommittee. The current vision of the Education Committee is to transform IASLC-coordinated educational initiatives, including CME, from compliance to best-in-class. The major components of this vision include learner, content, delivery and professional requirements (see figure). Currently, the committee is deeply involved in the development of a Global Curricular Framework for thoracic cancer. This curriculum is anticipated to serve as a foundation for lifelong learning culture in the IASLC. Ultimately, it is envisioned that every IASLC-sponsored educational event would be aligned with the overarching curriculum. This proposed curriculum will be used to plan and develop materials for workshops, webinars and IASLC-sponsored live educational events. Also in development is a consolidated online education portal. This proposed Thoracic Oncology Learning Center will draw from the Global Curricular Framework to populate its content and provide Curricular framework in Thoracic Cancer Live Meetings Distance Learning Others centralized access to listings of live and distance-learning activities, including performance improvement CME modules. In the future, online access to an individual s collective CME credits and certificates earned through IASLC-sponsored learning activities will be available from this portal. Other benefits of this effort include the expansion of offerings to include topics that are not commonly incorporated in typical live or webinar programs, such as quality of care and survivorship. The Education Committee is clearly on a determined path to not only educate the global thoracic oncology community but to have a meaningful impact on clinical care and to enhance patient outcomes. Join us at Booth 1210 to learn more about Immuno-Oncology research in multiple tumor types. Current approaches to lung cancer treatment include radiation, surgery and chemotherapy/targeted therapy, all of which are intended to target the tumor. Through our ongoing clinical program, Bristol-Myers Squibb is investigating an entirely new way to treat lung cancer by targeting the immune system. Our research is focused on transforming the way tumor cells and the immune system communicate, including checkpoint pathways; we hope to find new ways to stop lung cancer from evading the immune system, thereby restoring the body s natural ability to fight it. Visit us at www.immunooncology.com. Bristol-Myers Squibb Australia Pty Ltd. Po Box 1080, Mount Waverley, Victoria, 3149, Australia. Phone (03)8523 4200. Date of preparation: September 2013. ONC/0014/09-13. Leading the way

6 15th World Conference on Lung Cancer #wclc2013 wclc.iaslc.org Future WCLCs The World Conference on Lung Cancer was initially an event hosted by the IASLC every three years. It then changed to being hosted every other year. Starting in 2015, the WCLC will now be hosted annually. Here is a list of the upcoming World Conferences: 16 th World Conference on Lung Cancer Sept. 6-10, 2015, Denver, Colorado Conference President: Fred R. Hirsch 17 th World Conference on Lung Cancer December 4 7, 2016, Vienna, Austria Conference President: Robert Pirker 18 th World Conference on Lung Cancer October/November 2017, Yokohama, Japan Conference President: Hisao Asamura 19 th World Conference on Lung Cancer November 2018, Toronto, Canada Preview of the Presidential Symposium Michael Boyer and Kwun Fong WCLC 2013 Conference Presidents We are very excited to invite you to the Presidential Symposium with the top-ranked abstracts, assessed by members of the International Scientific Review committee anonymously, using predefined criteria. The resulting short list of abstracts is further evaluated at the Abstract Review meeting to ensure that the final selection of abstracts represent the multidisciplinary nature of the IASLC and delegates to the WCLCs. The Presidential Symposium will be from 08:15 to 09:45 today in the Plenary Hall, Ground Level. This year s symposium promises to be as important as those at previous WCLCs, with the presentation of major new findings in several important areas. Management of Screen- Detected Pulmonary Nodules Low-dose computed tomography (LDCT) has now been proven to save lives, and the IASLC is supporting a working group to help address issues in translation and applicability of the pivotal results from the National Lung Screening Trial. One of the challenges facing population-level implementation of LDCT is the downstream management of nodules detected on screening. Inefficiencies at this stage will incur costs, may prevent successful implementation if the workforce is insufficient and, most importantly, may delay treatment or subject people with benign nodules to unnecessary interventions. The PL03.1 study highlights one way to optimize the management of CT-detected lung nodules. Surgical Approach for Malignant Mesothelioma Surgery for malignant mesothelioma has long been controversial, and the study presented as abstract PL03.03 compares the outcomes of video-assisted thoracic surgery (VATS) pleurectomy with VATS pleurodesis, which is often a standard of care in many jurisdictions. If this procedure is effective, this study may alter what type of routine surgery is performed for mesothelioma and identify the benefits, morbidity, and mortality potentially associated with this approach. Chemoradiation Therapy for Stage III Non-small Cell Lung Cancer Stage III non-small cell lung cancer is not only common but difficult to treat, with guarded outcomes. Many investigators have been working on improving dose response by using higher doses of chemotherapy agents or radiation, as well as by integrating the new generation of targeted therapies. The authors of PL03.05 will report the outcomes of the RTOG0617 intergroup randomized controlled trial of 60 Gy compared with 74 Gy chemoradiation therapy with or without cetuximab. Oncogenic Drivers and Response to Targeted Therapy The fourth presentation (PL03.07) will give us a taste of the future. The Lung Cancer Mutation Consortium tested tumors for 10 gene mutations with the rationale that actionable mutations predict response to targeted therapies, thereby providing a more suitable alternative than conventional chemotherapy. Studies such as this, as well as future studies that evaluate even more genes, are very likely to drive changes in practice. As effective therapies based on these tumor vulnerabilities are increasingly developed, precision medicine will become a reality. We look forward to seeing you at the Presidential Symposium to share what we learn from these pivotal research studies that will influence how we treat lung cancer in the future. Presidential Symposium 08:15 09:45 Today Plenary Hall, Ground Level New Guideline Designed to Enhance Outcomes after Lung Resection The United Kingdom National Lung Cancer Forum for Nurses (NLCFN) Thoracic Surgical Group has produced a guideline to give health care professionals direction in better preparing patients for lung surgery. The resource, Guideline to Prepare and Support Patients Undergoing a Lung Resection, provides examples of current best practice and describes interventions to help patients better understand several key concepts that will improve their recovery after surgery. The guideline has the aim to promote patient self-management, said Vanessa Beattie, a lung cancer clinical nurse specialist at Aintree Hospital, Liverpool, UK, and a member of the NLCFN Thoracic Surgical Group. Ms. Beattie presented information about the guideline at the Oral Abstract Session: Supportive and Surgical Care on Monday. Ms. Beattie noted that lung cancer is diagnosed in approximately 40,000 people in the UK each year, and about 5,000 (12 percent) will have major lung resection for primary lung cancer. Postoperative complications occur in about 15 percent of these patients, she said, and these complications have been associated with longer lengths of stay and higher mortality rates. The development of the guideline was driven by the idea that a formal educational program delivered preoperatively to patients may help them engage more successfully in postoperative activities. This enhanced patient engagement could help reduce the rate of postoperative complications and thus enhance outcomes. The guideline was developed through a literature review and discussion among the Thoracic Surgical Group. The key topic areas identified to incorporate into the guideline were patient understanding of the condition, nutritional assessment, smoking cessation, exercise and breathing, pain management, inpatient pathway and discharge advice. Ms. Beattie explained that the guideline supplements an earlier NLCFN Thoracic Surgical Group document, Surgical Follow Up Guideline. The current guideline includes a series of broad statements, and she noted that these statements should be adapted locally to complement guidelines already in use within each clinical area. The guideline has been sent to all unit leads in thoracic surgery in the UK and all NLCF Thoracic Surgical Group members. The guideline could be adapted for use in other countries, but further work is needed to determine if widespread adoption of such guidance results in approved clinical outcomes, said Ms. Beattie. The full guideline is available at www. nlcfn.org.uk.

wclc.iaslc.org #wclc2013 Tuesday, October 29, 2013 Sydney, Australia 7 Interview with Key Leaders Research Advances and Patient Education IASLC members and others in the lung cancer community have engaged in research that has led to advances in diagnostic tools and treatments. As physicians strive to keep up-to-date with the latest advances, they must also learn new ways to communicate the increasing complexity of lung cancer to the public and their patients. Perhaps the most important advance in lung cancer is the greater understanding Heather Wakelee, MD of the biology of lung cancer. We recognize that non-small cell lung cancer is not one disease but a series of diseases that differ in how they develop and present and respond. The research in this area has changed the whole way we think about lung cancer, said Heather Wakelee, MD, associate professor of medicine at Stanford University, Palo Alto, USA. The greatest gains in knowledge have been made in the molecular basis of lung cancer. For about a decade, we ve known about EGFR mutations and then we learned about ALK rearrangements and now there are at least 10 actionable mutations in lung cancer that allow for targeted therapy. Every year we learn more about the mutations that drive the development of lung cancer, said Dr. Wakelee. This enhanced molecular understanding of lung cancer has led the way for personalized treatment of lung cancer. Dr. Wakelee noted, Even five years ago, EGFR testing was recommended, but it wasn t at the forefront as it is today. Now, if a patient has adenocarcinoma, we try not to Silvia Novello, MD even start treatment until we can tell that patient the results of mutation testing. As chair of the IASLC Communications Committee, Dr. Wakelee oversees IASLC s efforts to educate the public about lung cancer, primarily through regular press releases based on research published in the Journal of Thoracic Oncology. It is critical that the breakthroughs in the understanding and treatment of lung cancer are shared with everyone, not just among the researchers and medical professionals, she said. Educating patients specifically has become a new focus for IASLC with the creation of the Patient Education Task Force, which is chaired by Silvia Novello, MD, PhD, assistant professor, Oncology Department, University of Turin, and Thoracic Oncology Unit, San Luigi Gonzaga Hospital, Orbassano, Italy. Good patient-physician communication is crucial for treatment success and has an impact on quality of life, said Dr. Novello. Procedures must be described in full detail and in language patients can understand. For example, she said, It is mandatory to explain clearly to patients that a tumor being positive or negative for a marker does not mean the person is lucky or unlucky but is rather a way to better decide on the most precise treatment. Dr. Novello noted that the first step for the Task Force is to identify the needs in patient education, and it has already conducted two surveys, one of physicians and one of more than 500 patients and advocates in the United States, Asia and Europe. The next step is to address identified needs with appropriate tools and resources. Many educational materials are already available online, and research has shown that most people use the Internet to search for health information. However, as Dr. Novello commented, Information on the Web is not always scientifically correct, updated or readable by a non-health care professional. Good patient-physician communication is crucial for treatment success and has an impact on quality of life Silvia Novello, MD A member of the IASLC Board of Directors, Dr. Novello also serves as president of the Board of Directors for Women Against Lung Cancer in Europe (www.womenagainstlungcancer.eu), a nonprofit organization whose mission includes educating patients about lung cancer. Dr. Novello said that some of the scientific documents that IASLC has produced can be starting points for creating patient materials. Until then, the Task Force is gathering existing resources appropriate for patients and has posted them to a new area of the IASLC website dedicated to patients. WWW.IASLC.ORG FOR MORE INFORMATION VISIT US AT BOOTH #1417 Special Offer for NEW Regular Members at WCLC IASLC Regular annual dues 2014 US $250.00 IASLC Allied Professional annual dues 2014 US $50.00 IASLC Developing Countries annual dues 2014 US $50.00 Multi-year discounts available! Save $150 on 3-year membership IASLC Fellowship 2014 Complimentary

8 15th World Conference on Lung Cancer #wclc2013 wclc.iaslc.org Computer-Aided Diagnosis Tool Improves CT Screening for Lung Cancer A computer-aided diagnosis (CAD) tool that gathers texture information about cancerous nodules and their surrounding parenchyma shows the potential to improve the use of computed tomography (CT) screening to detect lung cancer in at-risk populations. This advance was reported by Jessica Sieren, PhD, assistant professor in physiologic imaging at the University of Iowa, USA, during Monday s Oral Abstract Session: Prevention and Epidemiology. Dr. Sieren presented the abstract Local, Surrounding and Global Features for Improved Computer-Aided Diagnosis of Lung Cancer. We believe our CAD tool is uniquely suitable for application to very small, early detected lesions from lung cancer screening programs incorporating CT imaging, she said. We foresee this tool becoming highly valuable in addressing the high number of false-positive findings incurred through CT screening and allowing for more effective and cost-effective management of the screened patient population. The National Lung Screening Trial reported a 20 percent reduction in lung cancer mortality by using low-dose CT screening of the at-risk population when compared to screening with chest X rays. A challenge in the use of CT screening for lung cancer is that a great number of very small nodules 4-10 mm detected require further follow up, and about 97 percent of these lesions are benign. In our study, we capture texture information from both the nodule and the surrounding parenchyma, making the approach suitable for application to small nodules, and hence more effective in distinguishing malignant from benign cases, Dr. Sieren said. In the study, the CAD tool was applied to 27 lung nodule cases 10 malignant and 17 benign. Through statistical testing, 36 features were found to be significant predictors of malignancy (p < 0.05), including many textural and parenchymal features, according to Dr. Sieren and her co-author, Samantha Dilger, MS, also of the University of Iowa Department of Radiology. We believe all of these features to be of potential use in classification, Dr. Sieren said. However, we only have a limited dataset size in this study, which restricts how many features we can use in classification to prevent over-fitting of the data. With an increased number of cases in the future, we will incorporate more of these significant features. The study plans to incorporate CT data and corresponding diagnostic information Jessica Sieren, PhD: We foresee this tool becoming highly valuable in addressing the high number of false-positive findings incurred through CT screening. from the Lung Image Database Consortium to collect more information, she said. In addition, more data are expected to be collected from an ancillary study for a large multicenter trail in the USA, a COPD gene study. Preliminary findings indicate features from both the nodule and the surrounding parenchyma have value in distinguishing benign and malignant lesions, concluded the authors. By incorporating local, surrounding and global features, more information is included, and augmented CAD performance may be achieved. Finally, many significant features were identified despite diversity in the CT data acquisition parameters, which indicate the suitability of the approach to broad clinical application. Dr. Sieren added that, We anticipate publishing results with a larger cohort within the next 3-6 months. Plenary Continued from page 1 in genome analysis, including significant increases in the number of druggable genes in both adenocarcinoma and squamous cell carcinoma of the lung, and a comprehensive characterization of mutated, amplified and translocated genes that helps to identify most of the common genes. Challenges are that more statistical power is needed to find rare mutations, some lesions are now undetectable and there are no drugs yet for most genome alterations, he said. Charles Rudin, MD, PhD, took a different approach in his presentation, Dark Matter: Defining Drivers in the Epigenome, which he said he took as an invitation to speculate. Dr. Rudin is the chief of the Thoracic Oncology Service at Memorial Sloan-Kettering Cancer Center, New York, USA. Something the field has been good at is subsegmenting lung cancer into mutationally defined subsets and then targeting those subsets with inhibitors that really benefit almost everybody within that class, Dr. Rudin said. But the limitation in those targeted therapies is that none of those patients treated with EGFR inhibitors are cured of their disease, and unfortunately do suffer recurrence. He discussed a hypothesis that targeting stem/progenitor pathways activated by epigenetic therapy could prime tumors for immunotherapy response, but concluded by asking if immunotherapy could really cure metastatic solid tumors. Could successful targeted epigenetic therapy contribute to durable responses in advanced lung cancer? Dr. Rudin asked, and then he answered his own question with Maybe. Charles Swanton, MB, FRCP, PhD, of the London Research Institute, followed by presenting Tumor Heterogeneity: An Obstacle to Cure. He started by reviewing the principles of intratumor heterogeneity learned in the analysis of renal cancer and discussed efforts to apply the same methods to study cancer evolution in NSCLC. There is order in chaos, Dr. Swanton said, and he added that genetic heterogeneity may affect the same protein complex in different branches leading from a trunk, or clonally dominant drivers. So, one approach may be to target tumor phylogenetic trunks and their branches or subclonal drivers. That approach to lung cancer research is being applied through two projects. One is TRACERx, which aims to perform multiregional sequencing with repeat biopsies at diagnosis and recurrence to define drivers of diversity and genome instability. A second is the DARWIN clinical program, which will target clonally dominant events and monitor branched evolution dynamics. The final speaker was Tony Mok, MD, professor in the Department of Clinical Oncology at the Chinese University of Hong Kong, who presented What Is Cure and How We May Achieve That With Molecular Targeted Therapy? There are several definitions of cure, but Dr. Mok said, Cure is a survival rate. It is a probability of cure. Cure is actually an estimate. He then defined cure as improving the rate of long-term survival in the absence of detectable disease. To achieve this, he suggested a war on lung cancer, and quoted The Art of War, which says that, Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat. Dr. Mok concluded by suggesting that too much time and money is spent on clinical trials that do not benefit patients. bunn Continued from page 1 vides support for senior staff, the Board, and the volunteer members on whom we rely, said Dr. Goldstraw. When Dr. Bunn became executive director/ceo, the organization had one employee. The staff has grown to five full-time employees, including a Chief Operating and Finance Officer, Director of Education, Director of Membership and Director of Communications. Dr. Bunn was steadfast in pursuing accreditation for IASLC as a continuing medical education provider, and he achieved that goal in 2011. Accreditation reflects the highest standard of professional education and allows IASLC to be an independent source of accredited educational activities. Dr. Bunn also expanded IASLC s membership through outreach to various areas around the world. I first met Paul when he visited Hong Kong in his capacity as ASCO President. He stood out to be a charismatic natural leader and a visionary who saw the importance of collaboration with Asia. From that day onward, I have become one of his faithful followers. And I shall continue to follow his vision, said Tony Mok, MD, of Chinese University of Hong Kong in Prince of Wales Hospital, and the 2013-2015 IASLC president. During Dr. Bunn s tenure as executive director, the number of members from Asia almost quadrupled from about 300 to nearly 1,200. Asia is now the region with the greatest proportion of IASLC members. Dr. Bunn s active participation in other cancer-related organizations and initiatives provided him the opportunity to form partnerships that enhanced IASLC s leadership role in the lung cancer community. For example, IASLC and the American Association for Cancer Research jointly sponsored the first Molecular Origins of Lung Cancer in 2010. He has made the IASLC a more professional organization, extended its global reach and ensured that we are involved in new areas of advocacy, tobacco policy and specialist cancer nursing, said Dr. Goldstraw. It is impossible to overstate the contribution that Paul Bunn has made to the IASLC Peter Goldstraw, MB, ChB, FRCS David Gandara, MD, of the University of California, Davis, School of Medicine and the UC Davis Comprehensive Cancer Center, and a past president of IASLC, agrees. Transformative is a good word to describe Dr. Bunn s role in IASLC and his tenure as CEO. He personally elevated IASLC to new heights. This marks the second retirement for Dr. Bunn. He founded the University of Colorado Cancer Center, one of the foremost cancer centers in the country, and served as director of the center for 20 years. He retired from that position in 2008, dedicating his time and energy to IASLC. I hope that his interest and involvement in the IASLC will continue beyond his retirement, said Dr. Goldstraw. He has even groomed his own successor to ensure the future of our organization.