4th Australian Lung Cancer Conference (ALCC), Adelaide, Australia, August 23-25, 2012
2012; Elsevier BV; Volume: 7; Issue: 9 Linguagem: Inglês
10.1097/jto.0b013e318268ff90
ISSN1556-1380
Autores Tópico(s)Lung Cancer Treatments and Mutations
Resumo068-P12 LUNG ADENOCARCINOMA BIOMARKER SCREENING IN AN AUSTRALIAN POPULATION Ainge Allen H1, Stone E1, Plit Ml1, Havryk A1, Goldrick A1, Field A2, Mead S2, Qiu M2, Chou A2, Morey A2, 1Department of Respiratory Medicine, St Vincent's Hospital, Sydney, New South Wales/AUSTRALIA; 2Department of Anatomical Pathology, Sydpath, St Vincent's Hospital, Sydney, New South Wales/AUSTRALIA Aims: The emergence of new targeted therapies and clinical trials in lung adenocarcinoma suggest that routine molecular biomarker testing is warranted to detected subtypes of adenocarcinoma which will benefit from new therapies. Australian data is still emerging. We aim to detect the incidence of treatment specific molecular subtypes of lung adenocarcinoma in the Australian population. Methods: This is a single centre prospective pilot study of patients with a histopathological diagnosis of adenocarcinoma who have been presented at a Lung Cancer multidisciplinary meeting. Formalin fixed paraffin embedded tissue of 22 tumour samples were submitted for targeted PCR-based EGFR and KRAS mutation analysis; and EGFR amplification, MET amplification and EML4-ALK rearrangement testing by in-situ hybridization. One sample had insufficient tissue for analysis. Results: So far 22 patients received a definite tissue diagnosis of lung adenocarcinoma, 8/22 with Stage III and 10/22 with Stage IV disease. 4/22 (19%) are positive for an EGFR mutation, with activating EGFR mutations in 3/22 (14%) and an EGFR mutation of uncertain clinical significance in one patient (5%). EGFR amplification was detected in 2/22 patients (9%), KRAS mutations were detected in 5/22 patients (23%) patients, of which none carried EGFR mutations. EML4-ALK translocation was seen in 2/22 patients (9%) and MET amplification in 1/22 (5%) patients. Conclusions: Preliminary results indicate that treatment specific molecular subtypes of lung adenocarcinoma occur more commonly in the Australia population than other Western populations. Though further investigation is required, routine molecular biomarker testing is warranted. Disclosure: This study was funded by an unrestricted grant from Roche. 094-P12 MACROPHAGE POLARISATION IN PRIMARY LUNG CANCER Al Matroodi SA1,2, Collins A2, Darby IA1, McDonald C2, Pouniotis DS1,2 1School of Medical Sciences, RMIT University, Bundoora West, Victoria/AUSTRALIA; 2Institute for Breathing and Sleep, Austin Health, Bowen Centre, Heidelberg, Victoria/AUSTRALIA Macrophages are part of the tumour microenvironment and have been shown to play a major part in promoting and/or suppressing tumour growth and metastasis. Here, we aim to identify how macrophage phenotypes are affected by the local and systemic microenvironment of patients with primary lung cancer. Alveolar macrophages (AMs) were isolated from patients with primary lung cancer (n=8) and non-cancer control patients (n=9) and analysed for phenotypic differences by flow cytometry. Preliminary results showed that surface expression of M2 markers (CD163, CD36, CD150 CD195) were more highly expressed (p < 0.05) compared to M1 marker (CD253, HLA-DR, IP-10) expression was significantly decreased (p < 0.05) in patients with primary lung cancer compared to non-cancer controls. In addition, surface expression of myeloid markers CD11b and CD71 was shown to be increased in patients with primary lung cancer suggesting that lung tumours have the ability to alter AM functions and may also play a role in changing the polarising conditions of AM phenotypes. Although these results are preliminary findings, this study aims to clarify how macrophages in primary lung cancer are affected by the tumour microenvironment and how the local and systemic microenvironment influence macrophage phenotypes and functions and further investigations will also investigate how blood monocyte phenotypes are affected in patients with primary lung cancer This study will potentially contribute to the identification of new biomarkers for primary lung cancer and help in the development of more effective anti-tumour treatments in the future. 020-O12 CELLS OF ORIGIN OF THE DIFFERENT SUBTYPES OF LUNG CANCER Asselin-Labat ML1, Weeden C1, Viitaniemi K1, McQualter J2, Antippa P3, Irving L3, Bertoncello I2, 1The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria/ AUSTRALIA; 2The University of Melbourne, Victoria/ AUSTRALIA; 3The Royal Melbourne Hospital, Parkville, Victoria/ AUSTRALIA Lung cancers are divided into distinct histopathological subclasses. Squamous cell carcinomas are suspected to originate from the proximal airways, small cell lung cancer are predominantly located in the bronchioles while adenocarcinomas, the most common type of lung cancer, are more frequently detected in the distal part of the lung. It is speculated that these different subclasses arise from distinct cells of origin localised within a defined regional compartment. Prospective isolation of progenitor cells in the lung will enable further evaluation of their roles in tumour initiation. To isolate lung epithelial subpopulations, fresh human lung samples obtained from surgery (Victorian Cancer Biobank) are dissociated into a single cell suspension. Cells are stained and sorted by flow cytometry based on their differential expression of specific cell surface markers including EpCAM (Epithelial Cell Adhesion Molecule) and CD49f (Integrin a6). These markers have previously been used to isolate mouse lung stem/progenitor cells. Characterisation of the sorted subpopulations demonstrated that distinct populations of progenitor cells were isolated from the proximal and distal lung. To address potential cells of origin for the different lung tumour subtypes, gene signatures of the normal epithelial subpopulations will be compared to the gene expression profiles of lung carcinomas. Known lung cancer oncogenes (K-Ras, EML4-Alk, KIF5-Ret…) will be introduced into the different progenitor cells to evaluate their capacity to preferentially transform a specific cell type. Establishing a link between the first cell in which a specific mutation occurs and the molecular subtypes of lung cancer will enable better stratification of patients for improved therapeutic strategies. Funding source: Victoria Cancer Agency 034-O12 THE COMPLEX RELATIONSHIP BETWEEN LUNG TUMOR VOLUME AND SURVIVAL IN PATIENTS WITH NON-SMALL CELL LUNG CANCER TREATED BY DEFINITIVE RADIOTHERAPY: A PROSPECTIVE, OBSERVATIONAL PROGNOSTIC FACTOR STUDY OF THE TRANS-TASMAN RADIATION ONCOLOGY GROUP (TROG 99.05). Ball D1, Fisher R1, Burmeister B2, Poulsen M3, Graham P4, Penniment M5, Vinod S6, Krawitz H7, Joseph D8, Wheeler G1, McClure B1, 1Peter MacCallum Cancer Centre, Melbourne, Victoria/AUSTRALIA; 2Princess Alexandra Hospital, Brisbane, Queensland/AUSTRALIA; 3Radiation Oncology Mater Centre, Brisbane, Queensland/AUSTRALIA; 4St George Hospital, Sydney, New South Wales/AUSTRALIA; 5Royal Adelaide Hospital, Adelaide, South Australia/AUSTRALIA; 6Liverpool Hospital, Sydney, New South Wales/AUSTRALIA; 7Auckland City Hospital, Auckland/NEW ZEALAND; 8Sir Charles Gairdner Hospital, Perth, Western Australia/AUSTRALIA Purpose: To investigate the hypothesis that primary tumour volume is prognostic independent of T and N stages in patients with non-small cell lung cancer (NSCLC) treated by definitive radiotherapy. Methods: Multicenter prospective observational study. Patient eligibility: pathologically proven stage I-III NSCLC planned for definitive radiotherapy (minimum 50 Gy in 20 fractions) using CT-based contouring. Volumes of the primary tumour and enlarged nodes were measured according to a standardized protocol. Survival was adjusted for the effect of T and N stage. Results: There were 509 eligible patients. Five-year survival rates for tumour volume grouped by quartiles were, for increasing tumour volume, 22%, 14%, 15% and 21%. Larger primary tumour volume was associated with shorter survival (HR = 1.060 (per doubling); 95% CI 1.01 to 1.12; P = 0.029). This association, after adjusting for the effects of T and N stage, was not evident (HR = 1.029, 95% CI, 0.96 to 1.10, P = 0.39). There was evidence, however, that larger primary tumour volume was associated with an increased risk of dying, independently of T and N stage, in the first 18 months but not beyond. Conclusions: In patients treated by non-surgical means we were unable to show that lung tumour volume, overall, provides additional prognostic information beyond the T and N stage (TNM, 6th edition). There is evidence, however, that larger primary tumour volume adversely affects outcome only within the first 18 months. Larger tumour size alone should not by itself exclude patients from curative (chemo) radiotherapy. Disclosure: None identified. 112-S12 SURVIVAL ANALYSIS IN THE MODERN ERA Barraclough H, MSc. Group Leader Asia Pacific Statistical Sciences, Eli-Lilly Australia Overall survival (OS) or Progression free survival (PFS) can be used as the primary endpoint in pivotal phase III randomized clinical trials (RCTs) for advanced stage solid cancers, according to the US FDA guidelines. At present there is much debate in the medical community about which is the most appropriate endpoint and whether therapies which only demonstrated a statistically significant improvement in PFS but not in OS ultimately benefit patients. This presentation reviews the pros and cons of OS and PFS in light of these discussions and the challenges researchers face when designing a phase III RCT. 023-P12 AN UNUSUAL CASE OF METASTATIC MALIGNANT MELANOMA PRESENTING AS PSEUDOMESOTHELIOMA Bency R1, Bui C1, Morgan L2, 1Department of Nuclear Medicine & PET, Nepean Hospital, Kingswood, New South Wales/AUSTRALIA; 2Department of Respiratory Medicine, Nepean Hospital, Kingswood, New South Wales/AUSTRALIA A 75 year old man, previously fit and a non-smoker, presented with one month history of rapidly progressive dyspnea on exertion, left pleuritic chest pain, and weight loss. His medical background included previous asbestos exposure and 2mm Clark IV cutaneous malignant melanoma in the right upper back, treated with wide excision (surgical margins clear of tumour and no axillary sentinel lymph node involvement) 15 months prior to the presentation. CTPA demonstrated bilateral pulmonary emboli, massive left pleural effusion with collapse of the left lung, bilateral calcified pleural plaques, left hilar and subcarinal lymphadenopathy, and left adrenal lesion. The bloodstained pleural fluid aspirate showed no lymphocytes, bacteria or malignant cells. The patient was anti coagulated. Further evaluation with FDG PET-CT revealed extensive intense FDG uptake (SUVmax 14.1) throughout the pleura of the left hemi-thorax, bilateral hilar and mediastinal lymph nodes, bilateral adrenals and left gluteal musculature, highly suspicious of metastatic malignancy. Mesothelioma was considered and the patient underwent thoracoscopic pleural biopsy. The biopsy was consistent with metastatic melanoma. The patient was referred for consideration of palliative therapy but died 10 days later. Conclusion: The extensive intensely FDG avid pleural disease, with history of asbestos exposure and bilateral calcified pleural plaques, is highly suggestive of mesothelioma. This case illustrates that other malignancies including metastatic melanoma can have a similar appearance. The literature on metastatic malignant melanoma presenting as pseudomesothelioma will be reviewed. 102-P12 DOCETAXEL VERSUS GEFTINIB IN PATIENTS WITH LOCALLY ADVANCED OR METASTATIC NSCLC PRE-TREATED WITH PLATINUM-BASED CHEMOTHERAPY Bhatnagar AR1, Singh DP1, Sharma R1, Kumbhaj P1, 1Department of Radiotherapy & Oncology, S.M.S. Medical College & Attached Hospitals, Rajasthan/INDIA Objective: To assess the safety and efficacy of Docetaxel versus Geftinib therapy used as a second line treatment in patients who had progressed or had recurrence after previous platinum-based chemotherapy. Materials and Methods: 30 patients with locally advanced or metastatic NSCLC previously treated with Cisplatin-based chemotherapy, who had progressive or recurrent disease and ECOG performance score 0-2, were randomized to receive either Geftinib 250 mg /day or Docetaxel 75 mg/m2 every 3 weeks. Tumor response was assessed with RECIST Criteria and adverse events were noted. Patients were followed for 2 years. Results: Tumor response rates and disease-related symptom improvements were similar for Geftinib and Docetaxel. Significantly more Gefitinib treated patients experienced a clinically relevant improvement in quality of life compared to Docetaxel. Conclusions: The study demonstrated non-inferiority of Gefitinib relative to Docetaxel in terms of tumor response. Also Gefitinib had a more favourable tolerability profile than Docetaxel. Disclosure of interest: None Source of funding: None 029-P12 ABORIGINAL CANCER CARE AT PETER MAC: CONNECTING AND RESPONDING (ACCAP) Bird, L,1, Longo R1, Hocking A1, Watson F1, Joubert L1 1Peter MacCallum Cancer Centre Aim: Peter Mac aims to provide a culturally sensitive and appropriate cancer care pathway within Peter Mac to coordinate and effectively coordinate and integrate effective and community linked cancer services to Aboriginal and Torres Strait Islander patients with cancer in Victoria. We will describe the development of an evidence informed pathway for Aboriginal and Torres Strait Islander lung cancer patients. Methodology: 1.Undertake extensive internal and external stakeholder consultation.2.Analyse a retrospective consecutive sample of Aboriginal patients receiving services at Peter Mac using a clinical data mining methodology (Epstein 2004).3.Design, implement and analyse a staff survey addressing Aboriginal health.4.Develop an evidence informed appropriate and culturally sensitive Aboriginal lung cancer care pathway. Results: Among other outcomes, findings from the three data sources indicated that lung cancer was one of the most prevalent diagnoses with patients most usually receiving treatment via surgery and chemotherapy. In addition, 36.5% of Aboriginal patients were smokers, with 17.1% seen by the Peter Mac Smoking Cessation Nurse. A staff survey of 265 respondents indicated that 84% had a moderate to high interest in learning more about Aboriginal health and providing culturally sensitive care. Conclusion: The results support the importance of a process of stakeholder consultation and staff feedback, analysis of referral patterns, assessment of clinical need as well as exploring the reasons for resisting hospital admission, to inform the process of creating a pathway to better support Aboriginal patients with lung cancer. 075-P12 LUNG CANCER AS AN ALLIED HEALTH SPECIALTY: A CASE STUDY. Blair E1, Muir L1, Hill A1, Palmer J1, 1Peter MacCallum Cancer Centre, East Melbourne, Victoria/AUSTRALIA Aims: Allied health professionals are important members of the multidisciplinary team caring for patients with lung cancer. Lung cancer patients experience a high burden of symptoms which can result in rapid deterioration of health and functional status. The aim of allied health intervention is to provide client-centred, family-focused care across the disease trajectory to address patient and family needs, negotiate changing goals, and address quality of life issues. This case study illustrates how allied health intervention from Social Work, Occupational Therapy, Physiotherapy and Nutrition supported a patient and his family through multiple hospital admissions culminating in enabling the eventual goal of end of life care in his own home. Methods: A retrospective analysis of the care of a 56 year old male with NSCLC was undertaken. Data related to occasions of service and time usage was collected for each discipline. An analysis of allied health input over time was also conducted to determine the type and intensity of interventions provided. Results: A high level of input (Occasions of service: Nutrition= 13, Physiotherapy= 18, Occupational Therapy= 19, Social Work= 37) was required in the care of this patient over five hospital admissions. During this time there were multiple changes to needs and goals. Allied health provided ongoing assessment and flexible care to meet these fluctuating needs and enable end of life care at home. Conclusions: A high level of specialist allied health input is required to meet the rapidly changing functional needs and goals of lung cancer patients and their families. Disclosure: None of the above authors have concerns re: dualities or conflict of interest. 100-P12 RETROSPECTIVE ANALYSIS OF NON-SMALL CELL LUNG CANCER (NSCLC) SURGICAL MANAGEMENT IN A SINGLE INSTITUTION STUDY. Bowers PJB1, Dhital K1, Granger E1, Jansz P1, Spratt P1, Stone E1, 1St Vincent's Public Hospital, Sydney, New South Wales/AUSTRALIA Introduction: The surgical management of NSCLC, while relatively uncontroversial in earlier stage disease, can present management dilemmas in later stage disease. In this study we present the results of a single institution, retrospective analysis of surgically managed NSCLC with a focus on the evolution of stage with progression through staging modalities, surgical procedure and length of stay post-operatively for comparison with similar data from international series. Methods: Data was drawn from the SVH Lung Cancer database, an integrated database capturing information from thoracic surgical cases and cases presented to the campus multidisciplinary lung cancer team. Data analysis was restricted to cases appropriate for curative surgery with pre-operative stage I-IIIA. Measurable outcome endpoints included length of stay post-surgery (LOS). Results: Data was analysed from the time period 2006-2011. The database contained 252 cases of NSCLC. 31% (n=79) underwent surgery with a documented curative aim (pre-operative Stage Ia (n=33), Ib (n=10), IIa (n=15), IIb (n=8), IIIa (n=12) and IIIb (n=1)). 9% (n=7) of all patients who underwent surgery were upstaged to Stage IIIa/b based on post-operative histology. Surgical management of pre-operative Stage IIIa included 10 lobectomies and 2 pneumonectomies with curative intent. The average LOS for Stage III was 13 days regardless of procedure. There were no in hospital mortalities or 30 day mortalities. Discussion: This retrospective, single-institution series, while small, demonstrates that the St Vincent's Hospital lung cancer surgery programme manages cases across the spectrum of early stage disease. In our institution's experience surgical management of stage IIIA disease is consistent with international best practice and that initial outcome measures are favourable. Disclosure: Please note this abstract contains no issues of duality or conflicts of interest. 040-O12 DO PATIENTS DISCUSSED AT MULTIDISCIPLINARY MEETINGS RECEIVE GUIDELINE-RECOMMENDED TREATMENT? Boxer MM1, Duggan KJ2, Vinod SK1,3, 1Collaboration for Cancer Outcome, Research and Evaluation, Liverpool Hospital, Liverpool, New South Wales/AUSTRALIA; 2Sydney & South West Sydney Local Health Districts Clinical Cancer Registry, Liverpool Hospital, Liverpool, New South Wales/AUSTRALIA; 3South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales/AUSTRALIA Aim: Australian practice guidelines recommend that all lung cancer patients should be discussed at a multidisciplinary meeting (MDM) to determine a management plan. Previous studies have shown that lung cancer MDM recommendations are largely concordant with guidelines. This study aimed to determine whether patients discussed at a lung cancer MDM actually received NHMRC guideline recommended treatment (GRT). Method: The Liverpool/Macarthur lung cancer MDM collects data prospectively on new lung cancer patients including patient and tumour characteristics, staging investigations, referrals and treatment recommendations. All new lung cancer patients discussed at the MDM between 1/12/05 – 31/12/2010 were identified. Details of patient demographics, tumour characteristics and treatment were obtained from the MDM database and the Area Clinical Cancer Registry. GRT was assigned to each patient according to pathology, stage and ECOG performance status as per the 2004 NHMRC Lung Cancer Guidelines. This was compared to actual treatment received to determine adherence to GRT. Results: 808 patients were discussed at the MDM. 64% were male and the median age was 68years. 81% of patients had pathologically confirmed NSCLC while 15% had SCLC. Of those with NSCLC, 42% had stage IV disease. Most patients had both stage (99.8%) and ECOG performance status (98.2%) documented. GRT could therefore be assigned in 98% of patients. Overall 51% of patients received GRT, and 47% of patients did not receive GRT. Conclusion: Although previous studies have shown that MDM recommendations are largely concordant with practice guidelines, this study shows that only 51% of patients actually received GRT. Further analysis will be done to determine factors influencing adherence to GRT. Disclosure: There are no conflicts of interest. 033-O12 LUX-LUNG 3: A RANDOMIZED, OPEN-LABEL, PHASE III STUDY OF AFATINIB VERSUS PEMETREXED AND CISPLATIN AS FIRST-LINE TREATMENT FOR PATIENTS WITH ADVANCED ADENOCARCINOMA OF THE LUNG HARBOURING EGFR-ACTIVATING MUTATIONS Boyer M1, Schuler M2, Yamamoto N3, O’Byrne K4, Hirsh V5, Mok T6, Massey D7, Zazulina V7, Shahidi M7, Sequist L8, Yang JC9 1Royal Prince Alfred Hospital, Camperdown New South Wales/AUSTRALIA; 2West German Cancer Center, University Duisburg-Essen, Essen/GERMANY; 3Shizuoka Cancer Center, Shizuoka/JAPAN; 4St. James’ Hospital, Dublin/IRELAND; 5McGill University, Montreal, QC/CANADA; 6Prince of Wales Hospital, Shatin/HONG KONG; 7Boehringer Ingelheim Limited, Bracknell/UNITED KINGDOM; 8Massachusetts General Hospital, Boston, MA/UNITED STATES OF AMERICA; 9National Taiwan University Hospital, Taipei/TAIWAN Aim: To investigate the efficacy/safety of afatinib, a selective, orally bioavailable, irreversible ErbB Family Blocker of EGFR (ErbB1), HER2 (ErbB2) and ErbB4, compared with pemetrexed/cisplatin in patients with EGFR mutation positive advanced lung adenocarcinoma. Methods: 345 EGFR mutation positive patients (Stage IIIB/IV, performance status 0–1, chemo-naive) were randomized 2:1 to daily afatinib 40 mg (n=230) or intravenous pemetrexed/cisplatin (500 mg/m2 + 75 mg/m2 every 21 days up to 6 cycles; n=115). Primary endpoint was progression-free survival (PFS) by central independent review. Results: Baseline characteristics were balanced in both arms. Treatment with afatinib significantly prolonged PFS versus pemetrexed/cisplatin (median 11.1 vs. 6.9 months; HR 0.58 [0.43–0.78]; p=0.0004). In 308 patients with common mutations (Del19/L858R), median PFS was 13.6 versus 6.9 months (HR=0.47 [0.34–0.65]; p<0.0001). Objective response rate was significantly higher with afatinib (56% vs. 23%; p<0.0001). Significant delay in time to deterioration of cancer-related symptoms of cough (HR=0.60, p=0.0072) and dyspnoea (HR=0.68, p=0.0145) was seen with afatinib versus pemetrexed/cisplatin. Common drug-related adverse events (AEs) were diarrhoea (95%), rash (62%) and paronychia (57%) with afatinib, and nausea (66%), decreased appetite (53%) and vomiting (42%) with pemetrexed/cisplatin. Drug-related AEs leading to discontinuation were 8% (afatinib) versus 12% (pemetrexed/cisplatin). Conclusions: LUX-Lung 3 is the largest prospective trial in EGFR mutation positive lung cancer and the first study using pemetrexed/cisplatin as a comparator. Treatment with afatinib significantly prolonged PFS compared with pemetrexed/cisplatin, with significant improvements in secondary endpoints, making afatinib a clinically relevant first-line treatment option. AEs with afatinib were manageable. Research funding source: Boehringer Ingelheim Pharma GmbH & Co. KG, Germany Disclosures: M. Boyer: Advisory role, Boehringer Ingelheim, Pfizer; Honoraria, Boehringer Ingelheim, Eli Lilly, Pfizer; Research funding, Boehringer Ingelheim; Other, Roche M. Schuler: Advisory role, Boehringer Ingelheim; Research funding, Boehringer Ingelheim; Other, Eli Lilly N. Yamamoto: None K. O’Byrne: Advisory role, Boehringer Ingelheim; Honoraria, Boehringer Ingelheim, Eli Lilly; Research funding, Boehringer Ingelheim; Other, Eli Lilly, Boehringer Ingelheim V. Hirsh: Advisory role, Boehringer Ingelheim T. Mok:: Advisory role, Astra Zeneca, Eli Lilly, Merck Serono, Aveo, Boehringer Ingelheim, Pfizer, Eisai, Taiho, Roche, BeiGene; Honoraria, Astra Zeneca, Eli Lilly, Merck Serono, Aveo, Boehringer Ingelheim, Pfizer, Eisai, Taiho, Roche, BeiGene; Research funding, Astra Zeneca; D. Massey: Employment, Boehringer Ingelheim; V. Zazulina: Employment, Boehringer Ingelheim; M. Shahidi: Employment, Boehringer Ingelheim L. Sequist: Advisory role, Boehringer Ingelheim, Daichii Sankyo, Merrrimack, Clovis, Celgene; Research funding, Boehringer Ingelheim J.C.-H. Yang: Advisory role, Boehringer Ingelheim; Honoraria, Boehringer Ingelheim 090-P12 LINC: A PILOT LUNG CANCER INTERDISCIPLINARY CLINIC Broderick C2, Blyth K1, Hunt C1, Jeffery E1, Page A1, Rigg D1, Witko S1 1Sir Charles Gairdner Hospital, Western Australia/AUSTRALIA; 2Western Australia Cancer and Palliative Care Network, Western Australia/AUSTRALIA Background: Cancer patients, and in particular lung cancer patients, have a high level of unmet psychological, physical and daily living needs causing personal distress. This distress would be best addressed by access to a combination of health professionals. It is proposed that an interdisciplinary team located in an outpatient setting can better meet the needs of patients through a collaborative approach to treatment, planning, supportive care and preserving current function. Aim: To establish the level of distress by using Screening tool; increase access to outpatient interdisciplinary services; To develop a referral pathway; To provide psychosocial support, practical assistance and education to lung cancer patients to prevent crisis Design and method: A prospective cross sectional study of lung cancer patients will be undertaken. All new patients that are identified by the Lung CNC via the Lung Multidisciplinary clinic will be invited to attend the Lung Interdisciplinary Clinic (LINC). The clinic is an interdisciplinary team made up of lung cancer nurse, physiotherapists, occupational therapists, social workers and dieticians. Patients will be invited to complete the distress thermometer screening tool. Based on results of the screen referral will be made to the appropriate profession for follow up interventions. The aim will be to complete the intervention during this appointment or within 1 week from the initial referral. A repeat conduction of the distress thermometer screening tool will be completed within 4 weeks from the conclusion of interventions Funding from CaPCREU will enable this study to take place. Planned to commence in September 2012. 113-S12 ROLE FOR PET BEYOND INITIAL STAGINS - FOR Chatterton B, Senior Director Nuclear Medicine and PET, Royal Adelaide Hospital, South Australia/AUSTRALIA The contribution of 18FDG PET (usually now PET CT) in combination with conventional imaging in improving staging is well established. Most commonly the cancer is upstaged, with improvement in prognostication related to stage migration and more targeted therapy, often changing management from potentially curative to palliative. Once the original management is planned, PET may have a further role in. •Detecting recurrence early in patients after potentially curative therapy. •Determining at an early stage response to therapy (chemotherapy, radiotherapy and radiofrequency ablation) allowing modifications. •Differentiating recurrence of tumour from post-surgical or post radiotherapy changes •Molecular characterisation (eg EGF receptor targeting with 11C-erlotinib in planning therapy) •Characterising rare tumours (eg bronchial carcinoids with 68Ga-DOTA) with potential for targeted therapy. The Schedule of Medicare Benefits in Australia (item 61529) allows for “Whole body FDG PET study, performed for the staging of proven non-small cell lung cancer, where curative surgery or radiotherapy is planned (R)”, but no other lung cancer indication hence the above are not currently rebatable. It will be important to generate evidence that outcomes (survival or quality of life) are improved with the above uses before they become widespread. Currently, the evidence is not robust. 058-O12 ZIC1 ACTS AS A TUMOUR SUPPRESSOR GENE AND IS SILENCED IN MALIGNANT PLEURAL MESOTHELIOMA Cheng YY1, Kirschner MB1, Gattani S1, Klebe S2, Edelman JJB3, Vallely MP3, McCaughan BC3, Bowman RV4, Fong KM4, Moro L5, Mutti L6, Jin HC7, van Zandwijk N1, Reid G1 1Asbestos Diseases Research Institute (ADRI), University of Sydney, New South Wales/AUSTRALIA; 2Department of Anatomical Pathology, Flinders Medical Centre, Adelaide, South Australia/AUSTRALIA; 3Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, New South Wales/AUSTRALIA, The Baird Institute and Faculty of Medicine, University of Sydney, QL, New South Wales/AUSTRALIA; 4University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Queensland/AUSTRALIA; 5Department of Chemical, Food, Pharmaceutical and Pharmacological Sciences, Drug and Food Biotechnology Center, University of Piemonte Orientale A. Avogadro, Novara/ITALY; 6Dept General Medicine, Lab of Clinical Oncology, Vercelli National Health Trust, Vercelli/ITALY; 7Biomedical Research Center, Sir Runrun Shaw Hospital, Zhejiang University, Hangzhou/CHINA Epigenetic inactivation of tumour suppressor genes through DNA hypermethylation plays a crucial role in the progression of malignant pleural mesothelioma (MPM). ZIC1, a tumour suppressor gene silenced through promoter hypermethylation in gastric and colorectal cancer, was expressed at high levels in normal mesothelial cells. In contrast, ZIC
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