Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Data from at least 15 of the highest populated LATAM countries regarding
their lung cancer test menu, the technical platforms used, and efforts for
investigation of the assay performance characteristics have been surveyed
and results will be discussed.
Keywords: Precision Medicine Latin America
MTE28: IMPLEMENTATION OF PRECISION MEDICINE IN ROUTINE PRACTICE: THE LATIN
AMERICAN EXPERIENCE (TICKETED SESSION)
WEDNESDAY, DECEMBER 7, 2016 - 07:30-08:30
Nevertheless, the continuous update with the evolving field required from the
pathologists, the scarceness of trained bioinformaticians for data sequencing
analysis, and the vigorous integration of the entire professional team are still
challenging personnel issues to be addressed. Data from at least 15 of the
highest populated LATAM countries regarding their efforts in initiating and
expanding molecular testing for lung cancer and the strengths and challenges
faced have been surveyed and results will be discussed.
Keywords: Pathology, Latin-America, molecular testing
MTE28.02 IMPLEMENTATION OF PRECISION MEDICINE IN
ROUTINE PRACTICE: THE LATIN AMERICAN EXPERIENCE
Marileila Varella-Garcia
Medicine/ Medical Oncology, University of Colorado School of Medicine, Aurora/
United States of America
The increasing application of the concept of precision medicine (PM) in the
last decade has revolutionized health care. Under this concept, the approach
to disease treatment and prevention takes into account individual variability
in genes, environment, and lifestyle to more accurately predict treatment
and prevention strategies for a particular disease in specific patient subsets.
PM has been progressing faster among infectious diseases and neoplasia,
with emphasis in non-small cell lung cancer (NSCLC) among the solid tumors.
However, we are still far away from a stable scenario to which we should
adjust. The field is in continuous evolution with constant new discoveries
and proposals. The implementation of PM for lung cancer has dramatically
impacted several medical areas mainly in two basic aspects: the molecular
diagnosis and the therapy regimen. The first involves questions such as
how to collect and process specimen for testing, which tests to apply and
in which level, how to define scoring criteria and cut-offs for variables with
continuous distribution in the population, how to interpret and validate
clinical assays, and how to properly communicate with the multidisciplinary
team. The second involves questions pertinent to understanding the
molecular diagnostic, access to and cost of new and old drugs, evaluation
of side effects, selection of combination or sequential regimens, definition
of clinical progression and resistance, and proper communication with the
multidisciplinary team. Our discussion will primarily address molecular
testing in lung cancer in Latin America countries (LATAM). One of the medical
areas most largely affected by the changes accompanying PM is Pathology.
The new specialty of Molecular Pathology has emerged to focus on the
sub-microscopic aspects of disease by examination of molecules within
tissues and bodily fluids. Molecular Pathology encompasses aspects of
anatomic and clinical pathology as well as molecular biology, biochemistry,
genetics, and bioinformatics. Molecular lung cancer testing in LATAM is
centralized in the main cities of several countries and usually performed
in laboratories of few large, private or public hospitals, mostly belonging
to academic institutions. Examples of those laboratories are located in
the Hospital Italiano and Hospital Roffo in Buenos Aires, Argentina; in the
Instituto Nacional do Cancer in Rio de Janeiro and Instituto AC Camargo
in Sao Paulo, Brazil; in the Universidad Catolica de Chile; in the Fundacion
Santa Fe de Bogota and Fundacion Valle de Lili in Colombia, and in the
Instituto Nacional de Cancerologia in Mexico City. There are also few
commercial laboratories that offer standard tests under good laboratory
practices. Examples are the laboratories Hermes Pardini and Consultoria
em Patologia in Brazil, Argenomics and Biomarkers in Argentina, and ROE in
Peru. The implementation of molecular testing poses important challenges
to pathology practices in commercial and academic institutions, and efforts
to overcome them have been extensively discussed. It is well recognized that
changes in two organizational levels are required, one related to personnel
and another related to equipment and technology. In terms of personnel,
there is a need to increase multi-disciplinary communication affecting all
areas including oncologists or surgeons requesting the tests, professionals
(surgeons, pulmonologists, interventionists) collecting the specimens,
technologists processing and handling the specimens, pathologists
performing histology diagnosis and molecular testing interpretation, lab
scientists (biologists, biotechnologists, biochemists) executing assays and
interpreting the results, and bioinformaticians handling computer-generated
data. The interdisciplinary work in the anatomic and clinical pathology
laboratory must be intensified and personnel with distinct expertise and no
clinical experience must be added and integrated to the team. The role of the
pathologist in the communication and integration among team members
(clinical/medical and laboratory group) is crucial. Interestingly, the work
environment in a complex molecular testing laboratory has changed to
demand personnel not only with excellent hard technical skills but also with
soft skills such as active listening, coordination, adaptability, punctuality,
problem solving, and friendly personality. The lab success relies in that each
team member clearly understands his/her role and the value of efficient
communication among team members, which is mainly modulated by the
pathologists. Most of the LATAM laboratories already performing molecular
testing have increased and strengthened this interdisciplinary work
using biologists and biotechnologists originally trained in research fields.
SESSION MTE29: ADVANCES IN MALIGNANT PLEURAL ME-
SOTHELIOMA (TICKETED SESSION)
WEDNESDAY, DECEMBER 7, 2016 - 07:30-08:30
MTE29.01 ADVANCES IN MALIGNANT PLEURAL MESOTHELIOMA
Paolo Boffetta 1 , Matteo Malvezzi 2 , Enrico Pira 3 , Carlo La Vecchia 2
1 Tisch Cancer Institute, ICAHN School of Medicine at Mount Sinai, New York Ny/
NY/United States of America, 2 Dept. of Clinical Sciences and Community Health,
University of Milan, Milan/Italy, 3 University of Turin, Turin/Italy
Background More than 30 years have passed since industrialized countries
started to strictly regulate the use of asbestos, including, in several of them,
introducing a total ban on import of raw material and of asbestos-containing
products. The use of the International Classification of Diseases (ICD) to
classify deaths from mesothelioma has been a source of concern in the past
because, before the 10 th version of ICD (ICD-10), no specific code existed
for this type of neoplasm, and analyses based on entities such as ‘pleural
cancer’ were subject to misclassification. Since the late 1990s ICD-10 has
been used for death certification in many developed countries. Methods We
analyzed age-specific mesothelioma mortality rates (all sites), calculated
on the basis of the data of the WHO Mortality Database, among men from
Canada (2000-2011), USA (1999-2013), Japan (1995-2008), France (2000-2011),
Germany (1998-2013), Italy (2003-2012), the Netherlands (1996-2013), Poland
(1999-2013), United Kingdom (2001-2013) and Australia (1998-2011), based
on ICD-10, to identify temporal patterns following reduction of asbestos
exposure. Results Mortality in the age groups 35-54 and 55-64 decreased
throughout the study period in all countries (median decrease, 7.9% per year
and 4.1% per year, respectively) except in Poland and (up to 2007) in Japan, two
countries which started from lower rates. In the age group 65-74, mortality
decreased in the USA and, since 2009, in the Netherlands, was stable in
Australia, and increased in other countries (median increase, 3.0% per year).
In the age group above age 74, a decrease was apparent only in the USA after
2003 (median increase in the other countries, 3.5% per year). Conclusions
Our analysis, based on consistent mortality data for mesothelioma, provide
strong evidence for a decrease in mortality in the young age groups in most
high-income countries: these birth cohorts experienced reduced opportunity
for exposure to asbestos during their occupational life. In the case of older age
groups, whose members had greater opportunity of exposure, in particular
to amphiboles, the evidence of a decrease in mortality is present only in a few
countries. Overall, these results stress the importance of early-life exposure
circumstances to determine mesothelioma risk throughout life.
Keywords: Mesothelioma, epidemiology
MTE29: ADVANCES IN MALIGNANT PLEURAL MESOTHELIOMA (TICKETED SESSION)
WEDNESDAY, DECEMBER 7, 2016 - 07:30-08:30
MTE29.02 ADVANCES IN MALIGNANT PLEURAL MESOTHELIOMA
Nico Van Zandwijk, Matthew Soeberg, Glen Reid
University of Sydney, Asbestos Diseases Research Institute, Concord/NSW/
Australia
Epidemiology: MPM, representing around 90% of all mesothelioma cases
diagnosed, is an aggressive tumour with a poor prognosis, and relatively few
treatment options. The association of mesothelioma with asbestos exposure
is well established. The latency period, the interval between first asbestos
exposure to the diagnosis is long (around 40 years), and explains why in many
instances the effect of banning asbestos from the workplace has yet to be
seen. At the same time there is evidence accumulating that non-occupational
asbestos exposure may significantly contribute to mesothelioma incidence [1]
and it is most worrying that unrestricted use of this carcinogen is allowed in
Russia and most Asian, African and South American countries. Unfortunately
the multilateral treaty to promote shared responsibilities in relation
hazardous chemicals (Rotterdam convention) has become paralyzed by the
veto of asbestos producers and considering the rapid surge of asbestos
consumption in developing countries the end of the mesothelioma epidemic is
not in sight [2]. Molecular biology: Major efforts have been undertaken to
Copyright © 2016 by the International Association for the Study of Lung Cancer
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