P-236 ‘One-stop’ rapid access lung cancer clinic: The patients perspective

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Posters/Early detection~Prevention Induction chemoraclotherapy for ¢-N2 non-small cell lung cancer

(NSCLC) H Yokomise T Okamoto, M Gotoh, D Masuya, T Nakashima, S Ishikawa, Y Yamemoto. C Huang 2nd Department or Surgery, Faculty or Mecicine,

Kagawa Umvers~ty,Kagawa, Japan Objectives: The therapeutic results for c~12 non-small-call lung cancer (NSCLC) are extremely poor In 2003 ASCO meet]ng. Intergroup tnal 0139 (RTOG 93-09) concluded that chemorediotherapy (CRT) followed by surgery was feasible and yielded supenor progression free survival than CRT alone. To improve prognosis o f c N 2 NSCLC. we have performed induction CRT followed by surgery. Materials and msthods: Eligibility crltena; 1. pathologically proven stage IliA or IIIB NSCLC. 2. c N2 (short a~s diameter of more than 2crn on cheat CT).3. No prior therapy. 4. Less than 75 years old. 5. PS 0-2. 6. Ccr more than 50ml/h 7 Apprepreate pulmonary and cardiac function for surgery ,50 patients underwent operation following CRT from January 1992 to April 2004 Unt]l 1998. MVP (Mltomycin C. Vindesine. Cisplatin) or EP(Etoposide. Cisplat]n) (n 27. group A) was used After that. Taxan+CBDCA (Carboplatin) (Tx+P) (n 23. group B) was used Two cycles of chemotherapy were performed with concurrent radiat]on (50Gy) Results: Radiologicel response rate was 74% In all 50 cases, complete resection was performed with no operative m ortallty. Histological response (less than one third cancer calls viable or complete cancer cell death) rate was 78% (38 cases of 50 eases). Complete histological response (CHR) was observed in 10 cases (20%). Three year survival of all the patients was 64%. Three year survival of CHR patients in group B (Tx+p) was 80% and three patients survived more than 40 months without recurrence. Conclusions: Surgery after CRT Ibr ~N2 NSCLC could be performed safely with premising results Better outcome is ant]cipated ~r pat]ents who e~hiblt good histological response, especially complete histological response

[ • 3 3chemoradlotherapy • H l s t odrug c uresponse l t u r eessay guided concurrent for non-small cell lung cancer T. Yeshimasu. S. Ours. I. Hirai. Y. Kokawa. K. Hata. M. Kawago. T. Tamaki. F. Ohta. R. Nakamura. Y. Okamura. Department of Thoracic and

Cardtovascu/'ar Surgery, Wakayama Medics/Umvers~ Wakayama, Japan Background: To improve response rate for concurrent chemoradiothorapy (CCRT) for non small call lung cancer (NSCLC). we applied histoculture drug response assay (HDRA) to select chemotherapy agents. Methods: Retresgecttvo analysis was done to evaluate the response rates for HDRA orientated CCRT for NSCLC We tTeated 21 NSCLC patients with CCRT using HDRA senst]vie agents from 1999 to 2004 They were consisted of 18 males and 3 ~males. ranging in age 57 78 (average 66) years old. 9 adenocarcinoma. 8 squamous cell carcinoma. 1 large call carcinoma. 1 large cell neudoenclocdne carcinoma, and 1 unknown histology Currently g agents can be used for HDRA: CDDP. ,5#U. DXR. MMC. VP-16. Dec. PAC. SN38 (CPT-11) and GEM Results: Each tumor was tested with 6 agents in average. Average number of pos~]ve agents for each of the tumors was 3. Chemotherapy protocol including at least one HDRA sensitive agent was selected in all patients. Selected chemotherapy agents were CDDP + D e c in 10. CDDP+VP 16 in 6. CDDP+CPF11 in 2. CDDP+VNR in 1. CDDP+VNR+MMC in 1. and PAC in 1. Objective response was evaluated in 20 pat]ents. They are consisted of one CR case. 18 PR cases, and 1 SD case. The response rate was 95%. Ten cancer deaths were observed during 540±460 (60 1795) days folle~v-up Median survival was 604 days One- and 2-year survival rates were 73 9% and 37 9%. respectively Conclusion: Histoculture drug response assay may improve the response rate of concurrent chemoradiotherapy for non-small cell lung cancer

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MIP-3 alpha gene therapy Intlated by radiotherapy elicits specific anti-tumor Immunity against lung carcinoma

B. Z]'~u. Z. Chen. Y. Duan. L. Zou. Y. Wu. Th/'rd M/Ittary Medtcal University,

Chongqtng, China Background: The aim of this study was to validate that MIP 3alpha gane therapy, which chemoat'mact immature DCs in wvo. in combinat]on with local tumor radiotherapy (RT). could improve ant]gen presentat]on from dying. irradiated tumor cells Methods: In order to get enough efficient DCs chemoattTacted in the tumor. Egr-1 promoter was inserted after delet]ng the primary promoter in the plasmid of pcONA3 1 in the constTuction of pcONA3 1-MIP-3alpha plasmid A Lewis lung carcinoma-bearing C57BL/6 mouse model was established to e0¢emine the in rive efficacy and the animals were randomly asslgeed to three lJ'eatment groups. Treatment I was given intra tumoral vaccmat]on alone. Treatment II was grven X~'adiat]on alone and treatment III was given vacanation along v~th X raciation, respectively. The survival rate of animals, the volume of tumor and the tumoFspeclfK: C]L act]vlty wore measured.

Results: RT combined wlth MIP 3alpha gone therapy reduced pulmonary metastases in a munne model of L ~ s lung carcinoma and significantly improved survival in C57BL/6 mica with established footpad tumors Mica heated with MIP-3alpha gone therapy alone showed delayed tumor growth but eventually succumbed to tumor progression Conclusions: These results support an attractive strategy of sequential RT and immunotherapy with MIP-3alpha gone therapy to enhance tumor ant]gen prasentat]on, which may init]ate ant/tumor immunity, which could kill cissominatod tumor calls and metastasis tumor calls and then improve the efficacy of therapy.

Early detection/Prevention Early detection/Prevention Monday, 4 July 2005

10:00-17:00

[P~S~ Patient's and doctor's detays In the diagnosis of lung cancer T. Adzic. G Radesavljavic-Asic. S Filipovic. A Blanka. S Popevic. J Stojsic

Institute for Lung Diseases and TB, Clinical C_,enterof Serbia, Be/grade, Serbia Background Related on lung cancer is very important question is delay before ciagnosis and treatment have any impact on prognosis and stage of disease Methods: 259 pts were analyzed, out of whom 241 (93%) were with NSCLC. stage I 22 (9 13%). II 13 (5%). Ilia 19 (7%). IIIb 93 (34%). IV 100 (41 49%). while 18. (7%) were with SCLC. 10 (56%) had LD. and 8. (44%) ED Results: The mean age was 56 year. female/male rat]o. 55/206 Bilateral lung cancer was found in 6(2%) pts Three(l%) pts had other ext]'apulmonary primary malignant turner: laryngeal cancer, glioblastoma multiformo and cancer of parotid glands in 1 pt each. 42(17.43%) were operated. The village was the place of residence in 44(17%) subjects, the town in 128(49%). Belgrade in 87(34%) cases. There wore 197(76%) smokers. 46(18%) non smokers, and 16(6%) ox smokers. The overall lest time. from manifestation of the initial symptoms of the disease to dagnos~s of lung cancer, was approximately 14 weeks (2-96). The patient delay was 9 weeks on an average, while doctors delay was 5 weeks Conclusion: doctors delay was sigrtficently shorter (p <0 01) than pat]ents delay Total delay was the same for NSCLC and SCLC [ P ~ 6 ] 'One-stop' rapid access lung cancer clinic: The patients

perspective S Baird L Creech. A Burgoine. R Stead. M E!.aboras Macclesfie/d Distnct

Genera/Hospital, Wamngton, UK Background: Increasing focus is being placed on Lung Cancer investigation and b'eatmont by the British government. N.I.C.E. guidelines are to be released later this year and recent S.I.G.N guidelines state that all patients referred to a chest clinic with suspicion of lung cancer should be seen within two weeks of referral and should have all investigations aimed at diagnosing this within two weeks of frst being soon. With this in mind we set up a 'one stop' Rapid Access Lung Cancer Clinic (RALC) in 2003. The aim has been to assess patients within two weeks from referral and if dinicelly indicated undertake CT scan and bronchoscopy that same day Pat]ents are then revie.ved in clinic one week after their first visit to discuss results and a management plan A recent study conducted of this clinic showed that pat]ents were seen in a median(range) of 7(0 - 32) days. and had CT thorax and bronchoscopy per~rmed in a median(range) of 0(0 - 14) days: 100% of these reduidng CT had this pnor to bronchosoopy Patients were seen and referred to a ter~ary centre in median(range) of 7(2 29) days. this was compared with the previous year when a more traditional lung cancer clinic was in place, the median(range) was 20(4 164) days (p < 0.01). The RALC was indeed allowing faster diagnosis with multiple invoshgat]ons performed on the same day. Was this to the pat]ants sat]sfact]on? Method: 38 cFJost]onnalres were handed out to patients on a random basis between January '64 and October '64. 25 quest]onnaires were returned and the responses were analysed (response rate 66%) Results: 24/25 pat]ants (96%) were happy with the level of informat]on they were given and understood the diagnosis: one patient cid not respond On cirect questiohing no one stated they would have liked more informat]on 25/25 pat]ants (100%) ~lt they had enough t]me to ask the doctor/nurse any questions they wanted to 25/2`5 pat]ants (100%) felt they were aware at each stage in the process what was happening next and for what purpose Again pat]ants stated they would not have liked more inlbrmat]on. 24/'25 pat]ents (96%) saw a Macmillan Lung Cancer Nurse on the clinic day. one pat]ant was seen the Ibllowlng day; 2,5/'25 (100%) found this helpful and felt this was the right t]me to see a Macmillan Nurse. 22J25 pat]onts (88%) felt that nothing could have been improved upon by the doctor or nurse in the clinic; 3 pat]ents did not