Immunotherapy has become standard of care for all stages of NSCLC. However, there is a gap in knowledge on how to select patients for neoadjuvant immunotherapy followed by surgical resection. In addition, neoadjuvant immunotherapy may pose new challenges in technique aspect of surgical resection. For patients who received adjuvant immunotherapy following concurrent chemoradiation therapy, or stage IV patients who received first line chemoimmunotherapy, many patients develop required resistance to therapy. This section intends to discuss these challenges in practice and future direction.
It is imperative that the clinicians treating lung cancer patients understand the new trend and challenges in immunotherapy and direction of future in this area. This educational session will provide attendees the opportunity to gain exposure to the latest information in combination of immunotherapy in NSCLC and challenges in clinical practice.
Attendees need to determine when and how the latest science will affect their day-to-day practice, and thus be able to narrow competency gaps across the various stages of NSCLC most commonly treated with immunotherapy.
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Upon completion of this live activity, attendees should be able to do the following:
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There have been many advances in the systemic therapy for lung cancer. Novel agents carry with them unique toxicities and considerations for multidisciplinary cancer care. The understanding of unique toxicities with combination therapy (IO and RT) and novel agents (targeted therapies, ADCs, bispecific antibodites) is essential for optimal patient care.
It is essential for multidisciplinary lung cancer providers to have an understanding of combination therapy studies with IO and RT. It is also important to recognize the unique spectrum of activity and toxicity for newly approved agents and drugs in development, notably pneumonitis and dermtologic toxicities.
The session on the emerging benefits of targeted therapy and immunotherapy is intended to bridge the disciplines by providing data and research landscape updates on the combinations of immunotherapy and SBRT for early-stage lung cancer. Futhermore, the non-classical targeted therapies and their unique spectrum of efficacy and toxicity will be reviewed. These therapies have toxicities and considerations of importance for the multidisciplinary team. This overview will familiarize members of the multidisciplinary team on these recent therapy updates.
Potential Challenges/Barriers to Change: Not notably relevant to this education session.
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Upon completion of this live activity, attendees should be able to do the following:
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With the increasing use of cancer immunotherapies for a variety of cancers, including lung cancer, there has been a parallel increase in the toxicity profile across organ systems. The lungs are not the most frequent organ system adversely impacted by cancer immunotherapy, but toxicity to this organ system may be severe and potentially life-threatening. Practitioners must have a working knowledge that permits early identification of patients at risk for lung injury associated with cancer immunotherapies. Furthermore, knowledge of best practices regarding management and drug rechallenge in this group of patients is critical to successful patient outcomes.
Cancer immunotherapy has quickly become the cornerstone of treatment for many cancers, including lung cancers. Severe and potential life-threatening toxicities have emerged with wider use of these agents given as monotherapy or as a component of multi-drug and multi-modality treatment schemes. Early recognition and treatment are key factors to successful outcomes.
It is imperative that the all practitioners remain current in the recognition and management of patients with immunotherapy-related lung injury. This session provides state of the art data regarding the diagnosis and management of cancer treatment-related lung toxicity, particularly as it relates to immunotherapies and other systemic therapies for lung cancer.
Medical and surgical oncologists whose day-to-day practice involves direct care of patients with cancer as well as clinical practitioners who are not involved in direct cancer care are increasingly faced with patients undergoing cancer immunotherapy. Thus, all practitioners should be adept in the nuanced challenges associated with this relatively new class of drugs. This session is aimed at narrowing the knowledge gaps by providing the latest consensus guidelines and, where available, evidence-based reports regarding the management of these patients.
The reported incidence of immune checkpoint inhibitor-related lung toxicity ranges from 3% to 19% in recent literature. Most lung toxicities are mild, however severe disease may occur, resulting in treatment discontinuation or failure and even death. Early identification of at-risk patients for severe disease poses a considerable challenge in daily clinical care but remains a key factor in successful outcomes. Practitioners should have a working knowledge of early recognition, risk stratification, and active surveillance of patients receiving this class of agents.
Comprehensive understanding of the risk factors and clinical and radiologic presentation of immune checkpoint inhibitor-related adverse lung events represents a basis for clinical decision making to tailor the best immunotherapy strategy for each patient with lung cancer.
Practitioners need to be skilled in the use of primary and secondary lines of treatment in the management of patients with immune-checkpoint inhibitor-related lung injury and should be familiar with the safety of drug rechallenge once the lung injury has resolved. Successful treatment strategies may involve multidisciplinary teams of experts that work collaboratively in the management of these patients.
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Upon completion of this live activity, attendees should be able to do the following:
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Use of tobacco products, marijuana, opioids, herbal supplements and illicit substances is quite common and can have significant impact on safety and efficacy of cancer treatments and pain tolerance. Better understanding of these interactions and how we can help patients navigate their use or cessation will lead to better outcomes with lung cancer treatment.
Providers need to know about the scope of the issues of illicit substance use, or recreational drug use, and to understand how these substances can impact cancer treatments. Understanding is needed for prescribing tobacco cessation medications, and how to use cannabinoids effectively.
We will have two speakers. The first speaker will talk about various tobacco use patterns – cigarette smoking, vaping; what is the latest for prescribing and or assisting with smoking cessation. The second speaker will discuss “Non prescribed drugs: the good, the bad, and the ugly – impact on cancer treatments.” This talk will review the influence of marijuana, opioids and other substances (such as psilocybans).
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Upon completion of this live activity, attendees should be able to do the following:
The development of LDCT screening for lung cancer was a significant advance; there are patient populations that were not included in the original studies. The current criteria for LDCT is based on age and history of tobacco use, and more accurate risk models have been developed, and recent studies have investigated patient populations defined by factors other than age and history of tobacco use. Blood based tests may compliment LDCT, and a number of different tests are being evaluated in clinical trials.
The current risk models have been published but not adopted, and recent studies have revealed increased risk in patient populations outside the standard criteria.
Attendees need to determine when and how the latest science will affect their day-to-day practice, and thus be able to narrow competency gaps across the various stages of NSCLC most commonly treated with immunotherapy. Awareness of recent findings will improve understanding of the risk/benefit ratio of LDCT. Participation in LDCT is low among eligible patients (<10%), and additional information may improve participation in LDCT and clinicians will be better able to discuss the risks and benefits of LDCT with patients.
Early detection for lung cancer involves multiple specialties including primary care, pulmonary medicine, radiologists and thoracic surgeons. Consequently, many centers have developed multidisciplinary LDCT screening programs. Despite the established mortality benefit of LDCT screening patient participation remains low. Some patient populations are disproportionately excluded from the current eligibility criteria. Blood based testing has the potential to improve the performance of LDCT and/or identify patient populations in need of screening or at higher risk of developing lung cancer. This session will review risk models, ongoing studies in patient populations outside the standard criteria, and emerging role of blood based tests in lung cancer screening.
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Upon completion of this live activity, attendees should be able to do the following:
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The session entitled “The Changing Landscape of Lung Cancer Biomarkers” will provide updated information about former and novel regulatory approvals requiring the use of biomarkers for patient selection to optimal anti-cancer treatments. The focus will be on how to navigate and prioritize biomarkers, optimal use of specimens, scientific rationale and future directions in the field.
It is imperative that therapeutic radiologists, medical oncologists, pathologists and other health professionals have a comprehensive understanding of how to optimally select patients for specific treatment modalities; and how to execute state-of the art biomarker testing using both tumor and non-tumor specimens. This also includes assessment of biomarkers for early diagnosis/screening and treating patients with resectable disease using neoadjuvant treatments.
The session will discuss the current landscape and future directions of the use of biomarkers to select lung cancer patients for optimal treatments. The topics will include detailed discussion about current molecular biomarkers for standard treatments (e.g., chemotherapy, radiation, targeted therapies, immunotherapy and antibody-drug conjugates) as well as future directions in this field. The topics will also discuss biomarkers for early cancer detection, early stage disease and the role of advanced computational methods such as machine learning and artificial intelligence.
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Surgical outcomes are less than ideal and recent data will be reviewed on optimal combination of immunotherapy with surgery to improve those outcomes.
It is imperative for physicians managing patients with early stage lung cancer to be aware of the data supporting the very new standard of care using pre-, post-, and perioperative immunotherapy to support their practice decisions. Attendees need to determine when and how the latest science will affect their day-to-day practice, and thus be able to narrow competency gaps in the management of early stage lung cancer. Attendees should use the information provided in this session to work with their medical and surgical oncology colleagues to optimally manage surgically resectable lung cancer. The role of radiation in this setting needs further study to optimally integrate into this paradigm.
Completely surgically resected non-small cell lung cancer, even with adjuvant chemotherapy, resulted in approximately 50% five-year survival, with many patients relapsing and dying in spite of complete resections. In this session, we will review the current data for the use of immunotherapy before and after surgery, learn how to best apply these data to attendee clinical practice and review the questions being addressed in current clinical trials.
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Advances in medical oncology, radiation oncology and thoracic surgery have made advanced treatments available to older and more frail patients. A better understanding the interaction of patient frailty and comorbidities to evolving interventions and outcomes is needed.
This session will involve three lectures given by a thoracic surgeon, medical oncologist and radiation oncologist to explore individual patient variables that may influence complications related to treatment. Some of these variables may be well understood (such as poor lung function, renal failure) and some may be less well defined and less well understood, such as patient frailty, exercise capacity or body muscle mass.
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There are phase II randomized trials that show a benefit to local consolidative SBRT in oligometastatic non-small cell lung cancer. There are pending phase III trials that have not yet read out. This leaves questions to practioners as to how to best treat oligometastatic non-small cell lung cancer in the real world setting.
There are emerging strategies examining biomarkers that may be able to identify oligometastatic patients who will benefit from local consolidative therapy.
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Upon completion of this live activity, attendees should be able to do the following:
There are many ongoing advances in patient safety in the context of radiation therapy delivery, clinical research on treatment options, and advanced techniques in radiotherapy delivery. Failure to stay informed leads to lower quality of care by practicing clinicians.
It is imperative that pulmonologists, surgeons and radiation oncologists remain current in technological advances in localization of small early stage lung cancers.
This session will delve into the current and shifting standard of care in the curative surgical treatment for small early stage lung cancers. It will also delve into techniques and advances in being able to localize, biopsy and potentially treat small early stage lung cancers. Discussions about selection of optimal methods will follow.
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Thymic malignancies and mesothelioma are rare cancers that require complex multidisciplinary management. There have been recent advances in the management of these cancers including the integration of PD-L1 immunotherapy, major surgical trials and consensus statements that have aimed to improve standard of care. It is important to disseminate these advances in care to improve patient outcomes for these rare tumors.
This will be a multidisciplinary session focusing on the management of mesothelioma and thymic carcinoma. Surgical discussion will include technical considerations for the multidisciplinary team and recently presented trials such as MARS-2. There will be discussion on the indications for radiation in management as well as technological improvements like particle therapy that might offer opportunities to improve the therapeutic ratio. In terms of systemic therapy, the historic cytotoxic backbones will be presented as well as advances based upon an understanding of disease biology such as PD-L1 directed immune therapy.
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The role of multidisciplinary care for small cell lung cancer has never been more important. Novel insights into subclassification of small cell lung cancer may unlock novel therapies that may be effective for each subtype. Emerging use of stereotactic radiosurgery for brain metastases in small cell lung cancer may reduce toxicities while maintaining efficacy. Finally, novel combinations of radiation therapy with immunotherapy and other novel systemic agents in limited stage small cell lung cancer may improve outcomes for these patients.
There are many ongoing advances in the treatment of limited stage and extensive stage small cell lung cancer. Failure to stay informed leads to potentially delivering suboptimal quality of care by practicing physicians.
It is imperative that practicing clinician stay current in the developing subclassification for small cell lung cancer, novel systemic treatment options in second and third line therapies, novel radiation delivery approaches and combinations with systemic agents, as well as current approaches to address brain metastases in small cell lung cancer.
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The management of stage III NSCLC is controversial and rapidly evolving, to the point that practitioners have difficulty processing and understanding the fast moving changes in the standard of care and communications among multidisciplinary teams is challenging given the uneven knowledge levels.
It is imperative that lung cancer health care professionals remain current in the state-of-the-art management and techniques. Attendees need to determine when and how the latest clinical trial findings will affect their day-to-day practice, and thus be able to narrow competency gaps in management of this large proportion of NSCLC patients.
This will be a series of lectures by experts on complex areas in the current management of stage III NSCLC. Panelists will provide foundational information and then will dialogue as a group under the direction of the moderator to clarify areas of uncertainty and controversy. Panelists will also answer questions from the participants in the audience to further explain difficult clinical challenges in stage III NSCLC.
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Upon completion of this live activity, attendees should be able to do the following:
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Advancements in the diagnosis and treatment of thoracic cancers have improved survival rates, making survivorship issues such as fertility and sexual wellness a priority. A lack of knowledge on how to manage these concerns leads to a missed opportunity to help survivors thrive after a cancer diagnosis.
The goal of this presentation is to emphasize how important it is to recognize and address fertility and sexual health concerns of patients who have been diagnosed with cancer. It will also provide baseline knowledge on how to approach these discussions with patients as well as strategies on how to partner with and refer to specialists who can provide appropriate care.
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Prognosis, therapeutic choices, end of life care are three key themes for patients with lung cancer. Understanding how to design and discuss phase I clinical trials, communication tools, integration of palliative care, and financial toxicity are key themes that need to be addressed among patients and caregivers with advanced NSCLC. Initial research has demonstrated the need for all of these areas, but the medical community still has a long way to go in terms of breaking down barriers to care, improving eligibility criteria for clinical trials and communication, and the dissemination of early palliative care not only in the U.S. but globally.
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