HOW DO WE GET THERE?
The Lung Ambition Alliance is redefining the focus of lung cancer treatment and endorsing initiatives that provide timely screening and early diagnosis, deliver innovative medicine, and improve quality care. These initiatives, extending across the care continuum, hold great promise in bringing us closer to our goal.
BENDING THE CURVE
Changing the trajectory of lung cancer requires a new way of thinking: about the stigma the community has battled for decades; about certain misconceptions, such as lung cancer being just a “smoker’s disease,” that have contributed to delays in diagnosis; about the poor research funding compared to other cancers; and about the modest improvements in survival despite a significant number of new clinical advances.1,2
Today, lung cancer is the leading cause of cancer-related death.3 Every 18 seconds, a life is lost to lung cancer.3 In 2018 alone, approximately 1.8 million people died from the disease.3 40% are diagnosed after the disease has spread beyond the lung, worsening prognosis.4 As a result, only one in five lung cancer patients are alive five years after they are diagnosed.5
Some of these facts are beginning to change, thanks to medical innovations and an increased understanding of the biology of lung cancer.6 To push further, the Lung Ambition Alliance advocates for:
INCREASED SCREENING RATES AND DIAGNOSTIC TESTING
We must ensure the implementation of screening programs and strive to increase early diagnosis by raising awareness of the strong evidence for screening and addressing the barriers to early detection.7,8 We support the implementation of low-dose CT screening among those at high risk and the further development of blood biomarkers that aim to increase diagnostic accuracy and streamline diagnosis.
ACCELERATED DELIVERY OF INNOVATIVE MEDICINE
We must enable widespread paradigm shifts to earlier intervention when there is greater potential for a cure, and place greater emphasis on early detection of relapse.9,10 The rapid uptake of precision medicine, which uses the genetics of disease to identify which therapies are more likely to be effective,11 is improving prognosis for some lung cancer patients.6,12 We believe precision medicine may be even more effective if utilized earlier in the course of the disease.13 We’re prioritizing the validation of surrogate endpoints, to assist with accelerating development, and the identification of predictive biomarkers, which may enable better targeting of tumor characteristics, to accelerate the development of new treatments.5
IMPROVED QUALITY CARE
We must urgently close the gap in cancer care between urban academic centers and rural, community-based practices and clinics. We must also focus on country-specific unmet needs, as we work to increase timely diagnosis, expand patients’ access to lifesaving treatments and diagnostics, and deliver local, patient-centric solutions for support leading up to, during, and following treatment. Additionally, as we make progress against our survival goal and lives extend, we must prioritize the development of programs and services to assist the growing population of survivors eager to return to everyday life.
CREATING A COMMUNITY OF CARE
We’re already getting started:
For Screening & Diagnosis
For Innovative Medicine
For Quality Care
The Problem: Despite evidence that lung cancer screening saves lives, many countries have not adopted screening policies and few sites are set up to implement screening effectively.7,8 Challenges in engaging the high-risk population mean that few are offered screening, and there is low uptake.14
Our Solution: Advancing Screening
The Alliance is helping to amass a global registry of CT imaging data to enhance screening in early-stage lung cancer as part of the Early Lung Imaging Confederation (ELIC), an IASLC-owned, secured, cloud-based archive of shared CT lung cancer images, that was founded in 2018.15
ELIC could become an important global resource for lung cancer researchers and care teams. The intention is that the collection of images and data will be used to develop better analysis and detection tools, supported by the development of artificial intelligence (AI), to create better risk models. By collecting these images across institutions and throughout the world, researchers who might only have access to a small number of CT images in their centers can interrogate thousands of images to greatly expand their knowledge base and validate software analysis tools.
The Problem: Barriers to accurate and timely lung cancer staging represent a lost opportunity to guide patients on the appropriate treatment path.
Our Solution: Improving Staging
With the support of the Alliance, the IASLC is working to standardize international lung cancer staging guidelines and deepen insights into disease progression. Insights from this effort will inform the 9th Edition of the Tumor, Node and Metastasis (TNM) Staging System, the most common method for staging lung cancer, and guide physicians in identifying the right treatment for the right patient at the right time.16
The Problem: The emergence of precision medicine is making prolonged clinical response a realistic goal of lung cancer therapy; but to further improve lung cancer survival outcomes, we must explore the potential for precision medicines in earlier stages (Stage I-III) where there is a greater chance of cure.6,12
As part of its Major Pathologic Response Project, the Alliance is working to validate surrogate endpoints to accelerate drug approval in early settings and bring its understanding of the molecular features of cancer to identify patients at high risk of early relapse who might benefit most from therapeutic intervention.17
The Problem: The management of lung cancer – and patient access to important diagnostics, treatments and support programs – varies markedly around the world.
Our Solution: Enabling Support Services at the Local Level
The Lung Ambition Alliance strives to enhance the care experience for lung cancer patients through the launch of the Quality Care Grants Program.
Later this year, patient organizations from around the world will be invited to develop and submit pilot projects that have the potential to transform patient care and improve survival in their respective countries, taking into account country-level dynamics that may currently limit quality care.
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2. National Cancer Institute. Cancer Stat Facts: Common Cancer Sites. Available at: https://seer.cancer.gov/statfacts/html//common.html. Accessed May 2019
3. World Health Organization. International Agency for Research on Cancer. Fact Sheet – Lung Cancer. Available at http://gco.iarc.fr/today/data/factsheets/cancers/15-Lung-fact-sheet.pdf. Accessed May 2019
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8. The National Lung Screening Trial Research Team. Reduced Lung-cancer Mortality with Low-dose Computed Tomographic Screening. N Engl J Med. 2011;365(5):395–409.
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11. National Cancer Institute. NCI and the Precision Medicine Institute. Available at https://www.cancer.gov/research/areas/treatment/pmi-oncology. Accessed June 2019
12. Mascaux C, et al. Personalised medicine for nonsmall cell lung cancer. European Respiratory Review. 2017;26
13. Mathur S, et al. Personalised medicine could transform health care. Biomed Rep. 2017; (1) 3-5
14. Jemal a & Fedewa SA. Lung Cancer Screening With Low-Dose Computed Tomography in the United States—2010 to 2015. JAMA Oncol. 2017;3(9):1278-1281
15. IASLC.org. IASLC Successfully Pilots Early Lung Imaging Confederation Project. Available at https://www.iaslc.org/news/iaslc-successfully-pilots-early-lung-imaging-confederation-project-0. Accessed May 2019
16. Giroux, DJ et al. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. Journal of Thoracic Oncology. 2018;13(6):801-809
17. IASLC.org. IASLC Pathology Committee. Available at https://www.iaslc.org/research-education/iaslc-pathology-committee. Accessed May 2019