22/005 Mesothelioma patterns of care

The use of circulating tumour DNA as liquid biopsies in cancer care is rapidly expanding.  ctDNA has many potential advantages as it is non-invasive and potentially more efficient and less-costly compared to tissue genotyping.  Accurate genotyping of lung cancer is of particular interest in the Australia/NZ due to high rates of targetable mutations in cancers, especially in the Māori and Pacific population^{1, 2}.  Furthermore, this technology can improve diagnostic and cancer monitoring in rural communities, where access to hospital-based services can be limited.  Data on the current usage and barriers to implementation is needed to support its use in clinical practice. This study aims to survey assess the current usage of ctDNA in clinical practice and identify barriers to implementation in the Australia/NZ.

Lung cancer patients expect to feel breathless, and little is done to implement therapies to address this symptom. Without management breathlessness negatively impacts physical function, social and psychological wellbeing. Despite there being evidence-based interventions to support people there remains a gap in implementation. This project will investigate existing datasets and co-design a study to determine current practice and potentially lead to implementation research or clinical trials to improve the translation of research evidence to manage breathlessness in lung cancer patients.

The Victorian Lung Cancer Registry is a Clinical Quality Registry established in 2011 and housed in the Clinical Registry Unit, Monash University. With governance oversight and nationally-based opt out ethical consent, the VLCR has recruited 44 hospitals from 19 health services representing over 85% of Victorian lung cancer diagnoses and registered 11,000 lung cancer patients providing both a Quality Indicator Report and an Annual Report to stakeholders with the objective of driving Quality Improvement through gap analysis and local on-site innovation.

LUCAP is a patient-focused research group who are developing a national clinical quality data platform for lung cancer that collects, analyses and reports on information such as how quickly people get lung cancer tests, what sort of tests are done and how quickly people get treatments. When large datasets are analysed, this real world data can provide an indication of quality of advances in lung cancer care. Reports from this platform for individual lung cancer service providers can be compared against a set of national standards to inform of unwanted variation in care, and provide compelling evidence for this to be addressed. The platform can further extend to support innovative research in lung cancer care and treatments.

This project will conduct early stage, small scale research, to assess the potential and feasibility of developing the first Australian Tissue Repository of Airway Cancers for Knowledge Expansion of Resistance (TRACKER) to address issues in translational lung cancer research. Since 2015, immunotherapy has emerged as a promising treatment, however 95% of patients will develop resistance. Conventional tissue sampling and analysis often means the opportunity to study mechanisms of immunotherapy resistance in tissue samples is not maximised. This study aims to establish a clinically annotated biobank of tissue samples from patients with metastatic lung cancer that can be harnessed to advance knowledge in immunotherapy resistance. This will provide a platform for mechanism-driven therapeutic pre-clinical and clinical studies, to enhance personalised medicine approaches.

Previous work has demonstrated that patients with metastatic disease, including mNSCLC, who experience long periods of disease stability have unique survivorship challenges. It is unclear whether such survivorship needs are addressed by community clinicians. The aim of this study is to facilitate and enhance communication between hospital-based cancer care teams, primary care clinicians and patients via the implementation of a multi-disciplinary team (MDT) consultation including both the patient’s GP and the patient to identify the survivorship concerns of individual long-term responder patients with mNSCLC and formulate a tailored survivorship care plan.

Cancer-related cognitive impairment is a well-recognised problem in cancer patients. However, there is little data that has assessed cognitive function in patients with metastatic disease, warranting further attention as a growing number of people are living with metastatic NSCLC. To understand whether cognitive function is a problem for people who have received, chemotherapy, immunotherapy or targeted therapies, COGNITION aims to investigate self-reported cognitive symptoms in patients living beyond the first 3 months of diagnosis with stage IV NSLC.

This research program will test ways of inviting and educating high-risk people about lung cancer screening. Lung cancer is the number one cause of cancer death worldwide. A screening test using low dose CT could save thousands of lives. The study will invite people, aged between 50 and 80 years and who smoke cigarettes daily or quit less than 15 years ago, via their family doctor.

Approximately one third of lung adenocarcinomas are driven by mutations in the oncogene Kirsten Rat Sarcoma Virus (KRAS). Immunotherapy has improved survival outcomes compared with standard chemotherapy both as a monotherapy, and in combination with chemotherapy. Approximately 20% of KRAS mutant lung cancers do not respond to immunotherapy due to co-occurring mutations in other genes. To enhance response to immunotherapy, combination treatments tailored for these tumours are needed. This research project aims to test whether using drugs specifically tailored to inhibit KRAS, in combination with immunotherapy in a laboratory setting, will provide evidence to suggest this approach is further assessed through clinical trials. This study also aims to identify novel drug targets to increase treatment options, and has the potential to identify new treatment regimens for improved survival in high-risk lung cancer patients.