2021 wrap up

While a trying year on many accounts, 2021 has seen TOGA move from success to success. The year commenced with the welcome news that TOGA had secured the funding for the remainder of the infrastructure grant provided by Cancer Australia, which was subsequently extended until the end of 2021, with an invitation to apply for further funding for 2022-24. This funding underpins the clinical research development undertaken by TOGA and we are grateful for its continuation. Towards the end of the year, we were also notified of our successful application for the Lung Ambition Alliance ILC2 grants ‘Enabling teletrials to provide access to clinical trials for regional and remote Australians’.

TOGA has continued to establish itself as the leading Australia and New Zealand thoracic cancer clinical trials group, establishing a solid financial base and governance structure, a cutting-edge research program, a diverse but topical educational program and commencing a fundraising and donations strategy as the only dedicated lung cancer charity in Australia. Please see the annual financial report for the financial year ending June 30, 2021 for more details.

Research program highlights

After much anticipation, the 18/001 DREAM3R– DuRvalumab (MEDI4736) with chEmotherapy as first line treAtment in advanced pleural Mesothelioma – A phase 3 Randomised trial opened to recruitment in Australia, New Zealand and the United States. The trial is the result of a productive collaboration between PrECOG, University of Sydney NHMHRC CTC and TOGA, and examines the addition of durvalumab to chemotherapy in first line malignant pleural mesothelioma treatment.

The ASPiRATION observational cohort study, conducted in collaboration with Omico Australia and University of Sydney NHMRC CTC, and designed to assess the clinical impact of comprehensive genomic profiling (CGP) in metastatic NSCLC patients, was also activated at up to 15 sites throughout Australia. Treating clinicians can also refer patients form anywhere in Australia for CGP via the ASPiRATION remote referral pathway. At the conclusion of 2021, the study had almost met 25% of the recruitment target.

ASPiRATION is accompanied by clinical trial substudies that enable access to targeted therapies not yet available on the PBS including options for HER2 gene mutations or amplifications, BRAFV600 gene mutations, ROS1 (FISH-ve) gene rearrangements, ALK (FISH -ve) gene alterations, NTRK fusion gene rearrangements and MetEx14 skipping mutations. In addition, patients whose CGP results have identified NSCLC mutations not encompassed by these substudies, may be able to access targeted therapies through other programs and clinical trials.

Prof Ben Solomon explaining the value of the ASPiRATION study at the TOGA Annual Scientific Meeting, July 2021.

Four Scientific Committee meetings were held during 2021, with a total of 17 clinical research proposals presented for TOGA endorsement. While not all were successful in gaining endorsement, concepts submitted for endorsement still benefit from the suggestions provided during the peer and consumer-review process. The pipeline of clinical trials to be coordinated by TOGA, through their partnership with the University of Sydney NHMRC Clinical Trial Centre, finished strongly, with a funded study in start up, and up to 3 other concepts submitted for consideration by funding bodies.

The organisation of the research concept development pathway was enhanced in 2021, with the approval and release of the TOGA Endorsement Policy, and the establishment of the working groups to enhance the peer-review of developing research ideas and to assist in ensuring that lung cancer clinical research is feasible and high-quality.

Cementing the Thoracic Cancer Education Program

Dr Melissa Moore, Education Chair, TOGA Board of Directors, introducing presenter A/Prof Tim Clay, Medical Oncologist during the TOGA 2020 WCLC microsatellite symposium

The Lung Cancer Preceptorship was again held virtually due to COVID, but this did not dampen the enthusiasm of attendees! Forty-six preceptees and 8 preceptors ensured that 40 papers that have contributed to lung cancer management were critically appraised and presented for eachother’s learning. Following a group of papers on a similar theme, attendees divided into breakout rooms to discuss the impact of these findings on their own lung cancer practice and experience. Preceptees also heard about established consultants’ and trialists’ careers, illustrating the pathways that the preceptees may wish to take to further their career in thoracic cancer care.

Throughout the year we continued to release monthly podcasts presenting an unstructured conversation around a topical area in thoracic cancer. Topics included included lung cancer screening, oncogene-driven lung cancer, mesothelioma, SCLC and survivorship. Rating particularly highly were the podcasts released during November, Lung Cancer Awareness Month, that discussed the effect of stigma on patients well-being and the effective delivery of care. The TOGA podcasts are also available on Apple podcasts and Spotify where you can create an alert for when a new episode is released.

The virtual symposia following international thoracic cancer meetings again proved very popular in 2021, with events held after WCLC20, ASCO and ESMO/WCLC21. A new addition this year was the addition of microsatellite symposia providing more in-depth discussion of particular areas of lung cancer treatment, and we were pleased to welcome Prof Sanjay Popat speaking on ‘ALK+ NSCLC patients and sequencing’ in February, a panel discussing ‘Integrated care in early NSCLC’ in June and Dr Malinda Itchins presenting on ‘Immunotherapy in resectable NSCLC’ in October.

A significant highlight for the year was the TOGA Annual Scientific Meeting, where up to 234 virtual attendees tuned into the program throughout the two days, to hear presentations designed to appeal to a multidisciplinary audience and centred around the theme of ‘Equity and Innovation in Multidisciplinary Lung Cancer Care’. Special thanks to A/Prof Emily Stone, TOGA Deputy Chair, Board of Directors and ASM21 convenor.

A selection of the 2021 TOGA podcasts

In the community......

The team from Slater Gordon completing their virtual City2Surf to raise funds for TOGA’s research into thoracic cancers. Their collective efforts raised almost $4000.

TOGA were out and about in the community as much as 2021 allowed us, with a team of approximately 20 completing the virtual Sun-Herald CityToSurf and raising over $20,000. As part of this event, TOGA established a peer to peer fundraising platform, where anyone can design a campaign and web page to raise funds for TOGA’s lung cancer research. We currently have 3 campaigns open run by people touched by lung cancer- Claire’s Ironman, Jen’s swims and in memory of Sally Ho Oi Chan.

TOGA also maintains an online donation form to raise funds for thoracic cancer research.

TOGA also commenced an education program for various patient support groups during 2021, presenting to the staff of various mesothelioma patient support groups on clinical trials and immunotherapy in mesothelioma, and to a lung cancer patient support group on new lung cancer research.

TOGA also re-established and expanded the numbers on the Consumer Panel, whose role is primarily to provide feedback on research concepts and clinical trial documentation from those with a lived experience of thoracic cancers. Two training sessions were conducted- one on providing feedback on research study design at the concept stage, and one on providing feedback on written clinical trial documentation.

TOGA is also establishing a First Nations Committee to specifically focus on researching lung cancer in indigenous Australians.

TOGA membership and governance

The TOGA membership continued to expand in 2021 finishing the year with 371 members and 2.3x growth from the start of 2021. Representation increased across all Australian states and territories and in New Zealand. New South Wales and Victoria were the two states with the highest number of members.

Almost all disciplines in the membership showed appreciable growth in numbers during 2021, with nurses showing the highest percentage growth in numbers. The largest discipline was medical oncology, followed by patient research advocates or consumer representative members, and then radiation oncology and respiratory medicine. Numbers of surgeons remained small, but it is a small discipline. Promisingly, the number of trainees increased, indicating continued interest in thoracic cancers by newly qualifying doctors.

The TOGA Board of Directors met most months during this establishment phase of the organisation to maintain adequate oversight. Unfortunately we said goodbye to Prof Gerry Hanna, Radiation oncologist and Grants and Communications Chair mid year as he returned to Ireland, but were very pleased to welcome Prof Shalini Vinod, also a radiation oncologist, to the role. The Committee for Audit, Risk and Finance was established early in 2021, and continued to meet frequently to manage the finances and potential risks to the organisation.

We thank all our members, committee members, Board Directors, sponsors, partners and collaborators and staff for a very successful 2021.