National Lung Cancer Audit (NLCA) co-clinical lead Neal Navani reflects on the International Association for the Study of Lung Cancer (IASLC) annual conference.
Yokohama in Japan was the stunning setting for the 18th World Conference on Lung Cancer (WCLC). Situated 40 minutes from Tokyo by train, Yokohama hosted approximately 7,000 delegates from over 100 countries to discuss the latest advances in the care of patients with thoracic malignancy.
The official opening ceremony took place on Sunday 15 October. It is traditional for the screening committee to convene a full-day seminar the day before the opening ceremony, to discuss the latest research and opinions on lung cancer screening. This year’s seminar featured talks on screening implementation and research on the comparison of risk prediction tools and screening uptake including a primary care perspective. The official opening ceremony the following day was attended by the crown prince of Japan, which highlights the impact and importance that lung cancer care now has.
I presented work by the NLCA on radical treatment rates in England, showing that approximately one-third of patients with early-stage disease and good performance status did not receive radical treatment.
It is fair to say that we did not have the blockbuster trial data presented at this conference that we have become used to in the past few years. However, important randomised data were presented from the CHISEL trial, which confirmed the benefit of stereotactic ablative radiotherapy (SABR) over standard radical therapy for early-stage disease. The PACIFIC trial recently showed a progression-free survival advantage from the addition of immunotherapy for concurrent chemo-radiotherapy for stage III non-small-cell lung cancer. Data presented in a plenary session at the WCLC showed that quality of life was preserved with immunotherapy and it was good to see that a session on patient-reported quality of life was included in a plenary session.
The UK was extremely well represented at the WCLC, with many colleagues chairing sessions, giving talks and presenting new data. I presented work by the NLCA on radical treatment rates in England, showing that approximately one-third of patients with early-stage disease and good performance status did not receive radical treatment. This is the subject of the NLCA spotlight audit that has been completed in the past few months: the results should be available early next year.
Smoking indoors is not banned in Japan and I was alarmed at how prevalent this was in Tokyo. Also, the emergence of ‘heat not burn’ cigarettes has taken the Japanese tobacco market by storm.
John Edwards, a thoracic surgeon from Sheffield, gave a major presentation in a plenary session on the R descriptors of pathological surgical confirmation, which was very well received. He discussed the important prognostic value of removing at least six lymph nodes and pleural lavage at lung cancer surgery. Although these factors will not be included in TNM 8 (the staging system for lung cancer that will be adopted by the UK from 1 January 2018), within the NLCA we will discuss whether to include them as surgical quality metrics in the future.
Finally, I was surprised by two things. Smoking indoors is not banned in Japan and I was alarmed at how prevalent this was in Tokyo. Also, the emergence of ‘heat not burn’ cigarettes has taken the Japanese tobacco market by storm. These are different to e-cigarettes and are being promoted as an alternative to tobacco cigarettes on the basis of favourable urinary metabolite data. In the UK, we can hopefully start an urgent debate about these new products before they become widely available. I expect we will hear a lot more about ‘heat not burn’ products before the next WCLC in Toronto in 2018.
Neal Navani, NLCA co-clinical lead