Recently, lung cancer professionals from across the globe gathered to connect and discuss developments impacting the lung cancer community at the International Association for the Study of Lung Cancer (IASLC)’s World Conference for Lung Cancer (WCLC) in San Diego, CA. This year, IASLC celebrated its 50th anniversary at WCLC. At the conference, GO2 for Lung Cancer (GO2) team members shared a record number of posters and presentations.

Reflecting upon this year’s meeting, members of the GO2 research team shared their thoughts about some of the major takeaways from the conference.

Heather Law, MA, Associate Director, Lung Cancer Registry

Several presentations focused on developing research showing the correlations between air pollution, climate change, and lung cancer risk. Researchers from Oncology Advocates United for Climate and Health (OUCH) presented data stating that 14% of all lung cancer deaths worldwide in 2017 were due to air pollution. This can be primarily attributed to the following factors:

Reliance on Fossil Fuels
Fossil fuels are a shared cause of air pollution, climate change, and the rise in our exposure to carcinogens. Air pollution from burning fossil fuels drives the release of greenhouse gases that increase lung cancer risk. Tiny particles, called particulate matter 2.5 (PM2.5), released when burning fossil fuels, are known to be associated with EGFR-driven lung cancer.

Wildfires
With our reliance on fossil fuels leading to climate change, extreme weather events like wildfires have become more common. PM2.5 released from wildfires is far more dangerous than PM2.5 released by burning fossil fuels. Additionally, pollution caused by wildfires has reversed clean energy efforts in some areas, and wildfires impact air pollution levels far beyond where the fires are burning. One example of this was the case in 2023 when smoke from wildfires in Canada reached the east coast of the United States.

Air Pollution and Lung Cancer Risk
Hope is on the horizon. Canadian researchers are developing a tool to assess an individual’s lung cancer risk based on a specific street address’s the annual air pollution levels. The tool will be available for healthcare providers and researchers to help better understand the connections between air pollution, climate change, and lung cancer risk.

Shanada Monestime, PharmD, BCOP, Director, Community Engaged Research

From a health disparities perspective, 2 presentations are worth highlighting. These sessions offered valuable insights into the challenges and innovative strategies to increase lung cancer screening uptake and reduce disparities within screening programs.

Promoting Lung Cancer Screening Using a Centralized Approach in the Veterans Administration Health System – Nichole Tanner, Medical University of South Carolina, SC 

The numbers are alarming: Between 1.5 to 2.5 million Veterans are potentially eligible for lung cancer screening annually, but only 8,000 are diagnosed with lung cancer each year. Unfortunately, Veterans face a higher risk of lung cancer compared to civilians, primarily due to smoking and other toxic exposures. Therefore, the U.S. Department of Veteran’s Affairs (VA) has implemented a comprehensive centralized screening program called the Lung Precision Oncology Program (LPOP), which provides lung cancer screening, smoking cessation, genomic testing, and improved treatment. This program operates through 21 centers of expertise, ensuring that even rural Veterans can access high-quality screening services.

Remarkable results demonstrate the program’s effectiveness:

  • 79% of VA Medical Centers have implemented clinical screening programs.
  • Half of the eligible 2+ million Veterans completed tobacco assessments.
  • 300,000 Veterans were found to be eligible, with 200,000 offered screening.
  • 85% agreed to complete screening.
  • 49% had a low-dose computed tomography (LDCT) scan within one year.

The program’s follow-up rates are exceptional, with a 74% return rate within 15 months. The presenter also noted that around 20% of African Americans have been screened, and disparities often diminish within the system due to improved access.

As the VA continues to grow the program, future directions include launching a mobile LDCT unit, integrating risk prediction models, and incorporating biomarkers for eligibility assessment. The speaker emphasized that while centralized screening requires significant resources and infrastructure, it is essential for ensuring high-quality lung cancer screening.

Overcoming Geographic, Socioeconomic, and Racial Disparities in Lung Cancer Screening in the United States – Raymond Osarogiagbon, Baptist Cancer Center, TN 

Geographic disparities in lung cancer incidence and mortality rates exist across the United States, particularly with high mortality rates in regions like the Southeast and the Mississippi Delta. These disparities are not merely the result of individual circumstances; they are deeply rooted in systemic factors. One study shared by Dr. Osarogiagbon highlighted that out of 3,074 patients diagnosed with lung cancer, 52% were ineligible for screening based on current guidelines, leaving nearly half of all cases undetected until diagnosis. A disproportionately high number of Black individuals were part of the ineligible group. The reasons for ineligibility varied:

  • 7% were younger than the age required for screening eligibility.
  • 21% were older than the age required for screening eligibility.
  • 20% had never smoked, excluding them from consideration.
  • 31% had quit smoking more than 15 years ago, which falls outside the recommended screening window.
  • 14% had a smoking history of fewer than 20 pack-years, while current guidelines recommend screening for those with more than 20 pack-years.

To address this, Dr. Osarogiagbon implemented a nodule program to provide comprehensive care to patients when a lung nodule is found incidentally, creating a vital pathway for those who may not qualify for traditional screening. This enables providers to support patients who might otherwise be overlooked. Notably, a significant number of patients identified were diagnosed with stage 1 (I) and 2 (II) lung cancer and demonstrated improved survival rates compared to those who remained undetected. The success of this program highlights the need for expanding access and updating guidelines to go beyond smoking history and age.

Andrew Ciupek, PhD, Associate Director, Clinical Research

This year’s conference showcased several studies that could have a significant impact on the lung cancer community. Several trends that stood out:

  • Researchers continued to focus on improving targeted therapy options for lung cancer with driver mutations – including studies with the EGFR targeted therapy combination of Rybrevant (amivantamab) and Lazcluze (lazertinib) and several new HER2-targeted therapies, including zongertinib and BAY 2927008.
  • Researchers also explored ways to bring therapies that benefit metastatic stage 4 (IV) lung cancer to early-stage individuals. For example, several studies focused on the best way to use immunotherapies, such as Imfinzi (durvalumab) and Opdivo (nivolumab), along with surgery, including perioperative (given both before and after surgery) and neoadjuvant (given before surgery) treatment to reduce the chance of the cancer coming back after it is removed.
  • We saw several presentations on new therapeutic options for small cell lung cancer (SCLC), including several new drugs called antibody drug conjugates (ADCs) and a new type of drug called bi-specific T-cell engagers (BITEs) that help activate the immune system to find and attack SCLC. These are particularly exciting since SCLC is an aggressive form of lung cancer that has had few treatment advances until recently.
  • There was a significant focus on understanding non-smoking risk factors for lung cancer –including presentations on household exposures like cooking and heating fuels or radon, environmental exposures such as air pollution, and military-related exposures such as burn pits, fires, and debris from bombings.

These are only some snapshots from the wide variety of lung cancer research presented. Overall, there was a great sense of hope that the pace of research will continue to lead to new advances, improving the prevention and treatment of lung cancer.