ISSUE 1

13TH MAY 2016

APLCC 2016
INSIGHT
APLCC 2016 | IASLC ASIA PACIFIC LUNG CANCER CONFERENCE

TOBACCO CONTROL MUST BE
A PRIORITY FOR HEALTH
PROFESSIONALS

“More than 100,000 deaths occur each year
because of lung cancer in ASEAN. New
cases of lung cancer and deaths too are rising
each year in ASEAN. That is why tobacco
control attains a never-before urgency”
added Prof Prakit Vathesatogkit.

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LUNG CANCER: MORE
HYPE OR NEW HOPE?

“Historically most patients of lung cancer
were smokers with advanced lung disease,
advanced cancer and treatments were not
very successful. So there was high degree of
pessimism about lung cancer and lung cancer
therapy. There was no way to diagnose lung
cancer early and most patients presented with
metastatic disease which could not be cured
thereby further increasing the pessimism
about it” said Dr Paul A Bunn Jr, Distinguished
Professor, Division of Medical Oncology,
University of Colorado and James Dudley Chair in Lung Cancer Research, USA.
Dr Bunn is also the former President of
IASLC; former CEO of IASLC; and former
President of American Society of Clinical
Oncology (ASCO) and the 2016 ASCO
Karnofsky award recipient.

As lung cancer treatment outcomes are
difficult and five-year survival is abysmally
low, preventing lung cancer is a top public
health priority. Up to 90% of lung cancer
cases are because of tobacco use. “Therefore
effective implementation of evidence-based
and comprehensive tobacco control policies
will make a huge difference in slashing new
cases of lung cancer as well as preventing
a large number of other diseases, disabilities
and premature deaths attributed to tobacco
use” said Professor (Dr) Prakit Vathesatogkit,
Executive Secretary of Action on Smoking
and Health Foundation of Thailand.

He added: “Out of the 50,710 tobacco
related deaths occurring in Thailand every
year, 11,740 or 23% were because of lung
cancer. In ASEAN region, it is estimated
that out of the total 467,194 smoking
related deaths every year, 107,454 were due
to lung cancer. Tobacco-related lung cancer
deaths will keep growing in catastrophic
proportions with ageing 121 million smokers
in ASEAN region if we fail to act now. Also
it is important to underline that tobacco
related lung cancer rate might shoot up
because of the combined effect of tobacco
industry’s aggressive marketing, weak
political will on tobacco control and other
key factors. Therefore while making progress
in treatment of lung cancer is very welcome,
more contribution from healthcare workers
in tobacco control is direly needed.”

"CURE" FOR

Dr Prakit Vathesatogkit
Healthcare workers can bolster
tobacco control
Health professionals including lung cancer
experts have a prominent role to play in tobacco
control. They have the trust of the population,
the media and opinion leaders, and their
voices are heard across a vast range of social,
economic and political arenas.
“At the individual level, they can educate the
population on the harms of tobacco use and
exposure to second-hand smoke. They can
also help tobacco users overcome their
addiction” said Dr Prakit.
(Cont. on page 2)
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Early diagnosis of lung cancer is
possible
Early diagnosis of lung cancer helps save
lives. “For early detection, annual low dose
CT scans can reduce lung cancer mortality
and they can lead to detection of more stage-1
patients early on that can be cured. So lung
cancer ‘cure’ is not a mere hype rather has
become a reality! Cure rate can be higher
for lung cancer by adoption of low dose CT
scans for early diagnosis, though there are
challenges still – such as, high false-positive
rate of these scans. Hopefully currently
ongoing research might improve the accuracy
of these scans in future” said Dr Bunn.
(Cont. on page 2)

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ISSUE 1

13TH MAY 2016

(Cont. from page 1: Tobacco control must
be a priority for health professionals)
“At the community level, health
professionals can be initiators or supporters
of some of the policy measures described
above, by engaging, for example, in efforts
to promote smoke-free workplaces and
extending the availability of tobacco
cessation resources. At the society level,
health professionals can add their voice and
their weight to national and global tobacco
control efforts like tax increase campaigns
and become involved at the national level
in promoting the WHO FCTC. In addition,
health professional organizations can
show leadership and become a role model
for other professional organizations and
society by embracing the tenants of the
Health Professional Code of Practice
on Tobacco Control” said Prof Prakit
Vathesatogkit.

ASEAN and tobacco control
Prof Prakit said: “In 2002, through the
6th Health Ministers Meeting, ASEAN
governments committed to a vision and a
“Regional Action Plan on Healthy ASEAN
Lifestyles”. Identifying tobacco control as
one of the priority policy areas, the Action
Plan calls upon member nations to
implement a Programme of Work on
promoting healthy ASEAN lifestyles. For
tobacco control this includes developing
and implementing a national action plan,
consistent with the WHO-FCTC on issues
such as smuggling, taxation, product
advertising, distribution, sale and agricultural
production.”

Summarises
Prof Prakit Vathesatogkit:

At the very least, all healthcare
personnel must provide brief
advises for smoking cessation to
every patient who has a smoking
history, in every consultation visit.
Worldwide, doctors are among the
most influential figures in leading
the tobacco control movement.
I urge all doctors to join and
support tobacco control
movement, not just by a
supportive gesture but by action, in
whatever capacity they feel
comfortable.

(Cont. from page 1: “Cure” for lung cancer: More Hype or New Hope?)

Better treatment options for lung
cancer gives hope
Not just early diagnosis of lung
cancer has become a reality now, but
new treatment options have come up
too in the recent years.

There are major improvements in
lung cancer treatment. For early
stage patients we have VATS
(Video Assisted Thoracoscopic
Surgery) which is effective,
cheaper and has better outcomes
in terms of morbidity and
mortality. Another advancement is
Stereotactic Body Radiation
Therapy (SBRT) which gives
radiation only to the cancer
tumour site and thus morbidity
and mortality due to radiation has
also declined

said Dr Paul Bunn.
Sharing more about a couple of new
forms of treatment, Dr Bunn added:
“Molecular therapies are for patients
who have driver genetic mutation –
patients receive a pill every day (a
form of chemotherapy) – this has
much higher response rate, fewer
side effects and much longer duration of response. Molecular therapies
have improved outcomes for patients
with metastatic lung cancer but
unfortunately these therapies do not
cure people. Molecular therapies
even if not a cure give lung cancer
patients way more hope as they make
them live longer and better. It is
certainly hoped that the combination
of different treatments may improve
outcomes in future.”

Immunotherapy: is it a new
revolution?
Another new form of treatment
that has boosted hope for cure is
immunotherapy. “First form of
immunotherapy that has been a
pproved for lung cancer involves
monoclonal antibodies that are
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Dr Paul Bunn
directed to proteins called checkpoint
inhibitors. Checkpoints are proteins
that cancer cells make to protect them
from being killed by lymphocytes
which are part of our immune system.
These monoclonal antibodies block
proteins which were protecting cancer
cells so that our lymphocytes can
kill those cancer cells. Monoclonal
antibodies are proteins that have to
be given intravenously. The response
of immunotherapy with monoclonal
antibodies lasts much longer and has
far less toxicity” said Dr Bunn.
But immunotherapy does not work
on all patients of lung cancer because
all patients do not have checkpoint
inhibitors. “That is why we are trying
to find biomarkers to define which
patients may respond to immunotherapy.
These monoclonal antibodies are very
expensive which makes it even more
important to find which patients are
more likely to respond. Also
currently scientists are evaluating
whether these monoclonal antibodies
are more likely to cure advanced stage
or early stage patients of lung cancer.
Currently it is likely that these
monoclonal antibodies may improve
cure rate for early stage patients of
lung cancer” shared Dr Bunn.

Reverse pessimism and make
lung cancer care affordable for
all
“Outcome for patients of lung cancer
is much better in 2016 than what it
was in 2000. So lung cancer ‘cure’ is
not a hype. We need to find ways to
make these new expensive diagnostic
tools and therapies appropriately
delivered in developing countries”
said Dr Bunn.

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13TH MAY 2016

PREVENTING LUNG CANCER
IS A PUBLIC HEALTH
IMPERATIVE
IASLC Asia Pacific Lung Cancer Conference
(APLCC 2016) is being organized under
the aegis of International Association for
the Study of Lung Cancer (IASLC), Thai
Society of Clinical Oncology (TSCO),
Chiang Mai Lung Cancer Group, Faculty of
Medicine, Chiang Mai University (CMU)
and local organizing committee of APLCC
2016.

APLCC comes back home to Chiang Mai
APLCC 2016 is the seventh regional biennial
lung cancer conference, and it has returned
back after 12 years to its origin in Chiang
Mai, Thailand where first APLCC was held.
“APLCC 2016 has come back to the host
city of first APLCC which was organized
by us in 2004” said Professor (Dr) Sumitra
Thongprasert, Chairperson of APLCC 2016,
who was also the chairperson of first
APLCC. Feeling the urgent need to galvanize
more action on lung cancer in Asia Pacific
region, Prof Sumitra Thongprasert had
played a key role in setting up APLCC
Lung Cancer Group which helped organize
this regional scientific meet biennially.
Presently, Prof Thongprasert is the Emeritus
Professor, Chiang Mai University, Chiang
Mai, Thailand and Senior Director, Oncology
Unit, Bangkok Chiangmai Hospital, Chiang
Mai, Thailand.
The venue of the conference shifted around
the region every two years:
• 2nd APLCC was held in Guangzhou,
China;
• 3rd APLCC in Hyderabad, India;
• 4th APLCC in Seoul, South Korea;
• 5th APLCC in Fukuoka, Japan;
• 6th APLCC in Kuala Lumpur, Malaysia;
and
• 7th APLCC is back to the host city of
1st APLCC: Chiang Mai, Thailand.

APLCC helps lung cancer experts
stay on top of latest scientific updates
The regional lung cancer conference has
provided an important platform for latest

scientific
exchanges
and
academic
networking for a range of experts playing
a crucial role in lung cancer research,
diagnosis, treatment and care. “The main
highlights of APLCC 2016 are the latest
advances in lung cancer especially basic
and clinical research, immunotherapy,
multidisciplinary practices in Asia Pacific,
practical clinical management, and also
expert ideas and knowledge sharing from
outside the region from different parts of the
world including the Americas and European
region. We have several invited speakers
in key sessions on issues varying from
pathology, surgery, early lung cancer
detection, and cancer treatment aspects
including radiation, surgery, chemotherapy,
immunotherapy, among others. The delegates
will get an opportunity to learn and
share in several thematic oral and poster
presentations daily at APLCC 2016” shared
Prof Thongprasert.

edition and therapy for driver mutation
positive in Asian NSCLC patients.
Distinguished speakers will be Dr Masahiro
Tsuboi, Chief and Director, Division of
Thoracic Surgery and Oncology, National
Cancer Center Hospital East, Japan and
Dr Tetsuya Mitsudomi, Professor at the
Division of Thoracic Surgery, Department
of Surgery, Kinki University Faculty of
Medicine, Osaka, Japan. Dr Mitsudomi is al
so the Board Member of Japan Clinical
Research Organization (JCRO).

APLCC 2016 venue city gets 720
years old this year!
The old city of Chiang Mai completes its 720
years in 2016. Welcome to this northern Thai
city and apart from dwelling into scientific
deliberations do steal a moment to indulge
in traditional richness and warmth of Chiang
Mai.

In addition to scientific sessions, there are important sessions on
related and compelling public health aspects such as tobacco
control. Lung cancer is the most preventable form of cancer death in the
world. That is why APLCC 2016 features tobacco control sessions
prominently on the scientific agenda. Preventing lung cancer is a top
public health imperative!

said Prof Sumitra Thongprasert.
Spotlight on plenary sessions at
APLCC 2016
Plenary sessions on second day of APLCC
2016 focusses on how to choose 1st, 2nd and
3rd line therapy in Non Small Cell Lung
Cancer (NSCLC) and immunotherapy
for NSCLC. Luminary speakers include
Dr Tony Mok, past President of IASLC and
Dr David Carbone, President IASLC.
Last but not the least, concluding day of
APLCC 2016 will feature plenaries on
clinical implications of TNM staging 8th
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Dr Sumitra Thongprasert

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13TH MAY 2016

“It is good to have regional conferences
like APLCC 2016 as they can provide
great support on a global level. We will
also learn from the Asian experience. In
Asia we have a lot of patients with EGFR
mutations of the disease. So it will be
interesting to know how these patients
are being treated. I do not have much
experience of this as there are far more
frequent cases of this type in Asia as
compared to Central Europe.
APLCC 2016 is of major importance as
lung cancer is a very complex disease.
This makes education and scientific
exchange very important, more so
because of the rapid advances in the
field of diagnosis and treatment of lung
cancer. It is not easy to keep oneself
updated, as a lot many new things are
ongoing. So conferences are a good
time to learn from others and get up to
date knowledge about diagnostic and
therapeutic advances in lung cancer”
Dr Robert Pirker

President of 17th IASLC World
Conference on Lung Cancer (WCLC
2016) in Vienna, Austria
• Professor of Medicine and Program
Director for Lung Cancer, Department
of Medicine, Medical University of
Vienna, Austria

“As President of IASLC and practicing
lung cancer physician and researcher I
would like to welcome the delegates to
the APLCC 2016. I hope this meeting will
bring together researchers from within
the Asia-Pacific region and around the
world to discuss current findings in this
region to improve the quality and quantity
of life for lung cancer patients.
These are exciting times where we have
new agents and we are trying to learn on
how to best combine them with targeted
therapy, chemotherapy, radiation, or
surgery and meetings like the APLCC
2016 are perfect place to allow
investigators to gather and share the
latest data available on these therapies
and their combination. This will help
lead delivery of these state-of-the-art
therapies to patients throughout the world
and IASLC is proud to be supporting
conferences around the world to assist in
this process.”
Dr David Carbone


President of the International
Association for the Study of Lung
Cancer (IASLC)
• Professor in the Division of Medical
Oncology, leads thoracic oncology
center in Ohio State University, USA

“I would like to welcome all delegates
who are working on lung cancer –
fellows, residents, students who are
exploring their interest in pursuing
lung cancer management, nurses,
pharmacists, all experts from diverse
specialties including prevention, early
detection, molecular and clinical
research, multidisciplinary treatment,
palliative care, tobacco control, etc to
APLCC 2016.
We are very happy that APLCC has
come back to its host city again, as
1st APLCC was initiated and held in
Chiang Mai, Thailand, in 2004.
The city of Chiang Mai completes its
720 years in 2016. Welcome to this
northern Thai city and apart from
dwelling into scientific deliberations
do steal a moment to indulge in
traditional richness and warmth of
Chiang Mai.”
Dr Sumitra Thongprasert
• Chair of APLCC 2016 and former
member of Board of Directors
IASLC
• Special Content Editor, Journal of
Thoracic Oncology (JTO)

Emeritus Professor, Chiang Mai
University, Chiang Mai, Thailand

Senior Director, Oncology Unit,
Bangkok Chiangmai Hospital,
Chiang Mai, Thailand

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13TH MAY 2016

SCIENTIFIC PROGRAMME FOR
DAY-1 OF APLCC 2016

PS=Plenary Session

IS=Invited Session

AS=Abstract Session

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ISS=Industry Supported Symposium

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13TH MAY 2016

LUNG CANCER
SCREENING: THE THAILAND PERSPECTIVE
The survival rate for lung cancer is strongly
related to the stage of the disease. The
earlier is its detection, better is the survival
rate. “Currently, low-dose computerized
tomography (LDCT) is the standard
technique for lung cancer screening. The
National Lung Screening Trial (NLST),
launched in 2002, found that screening with
LDCT resulted in a 15% - 20% lower lung
cancer-specific mortality and 6.7% lower
all-cause mortality relative to chest
radiography (X-ray) over a median of
6.5 years of follow-up” said Dr Natthaya
Triphuridet, Pulmonologist and Assistant
Director for Medical Affairs at Chulabhorn
Hospital, Bangkok, Thailand. Dr Natthaya is
among the faculty members for IASLC Asia
Pacific Lung Cancer Conference (APLCC
2016).
Dr Natthaya added: “Since the release of the
NLST data, many guidelines have endorsed
the use of LDCT screening for high-risk
individuals. In 2013, United States
Preventive Services Task Force (USPSTF)

Dr Natthaya Triphuridet

recommended ‘annual screening for lung
cancer with LDCT in adults aged 55-80 years
who have a 30 pack-year tobacco smoking
history and currently smoke or have quit
within the past 15 years. The numbers needed
to screen (NNS) to prevent 1 lung cancer
death was 320 among participants who
completed 1 screening and was 219 to
prevent 1 death overall over 6.5 years.
These benefits are comparable to NNS with
mammography of 1339 to prevent 1 breast
cancer death after 11-20 years of follow-up
and NNS with flexible sigmoidoscopy of
817 to prevent 1 colon cancer death.”

Major advancements in early
diagnosis, but challenges remain
Despite the pivotal results of LDCT, there
are many concerns regarding high false
positives (96%), over diagnosis, accumulation
of radiation exposure, high cost of screening
and generalization to practice.

Tuberculosis and lung cancer:
Sinister linkages?
According to Dr Natthaya, generalization
of lung cancer screening with LDCT in
the TB endemic Southeast Asia region that
accounts for 41% of the global TB
burden is very challenging. “TB mimics l
ung cancer. Pulmonary TB may present
as an asymptomatic solitary pulmonary
nodule, imitating early stage lung cancer.
Symptoms of cough, hemoptysis, chest pains,
weakness, weight loss, fever and night
sweats are common in both active
pulmonary TB and symptomatic lung
cancer. The radiographic findings of TB
can mimic lung cancer, such as mass-like
lesion, solitary/multiple pulmonary nodule(s),
mediastinal lymph node enlargement, or
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pleural effusion. These findings are also
important in staging of non-small cell lung
cancer in the TNM system: Size of primary
tumour (T), Mediastinal lymph nodes (N),
and metastasized (M) to other organs of the
body” she said.
“Furthermore, pre-existing TB increases
risk of lung cancer and lung cancer may
promote TB infection or reactivation of
latent TB infection, or cause new exogenous
infections. All this makes it difficult to
manage screening, diagnosis, staging,
treatment, monitoring and surveillance of
lung cancer in TB endemic areas. No clear
evidence of lung cancer screening benefit
has been established in high-risk populations
in a TB endemic area”.

Thailand’s Lung Cancer Screening
Project
Dr Natthaya Triphuridet who is also the
Principal Investigator of Integrative Lung
Cancer Screening Project in Thailand shared
the findings of a five-year “Integrative Lung
Cancer Screening” project using LDCT
that was started at Chulabhorn Hospital in
Thailand in 2012. The objectives of the study
were to:
(i) Determine the role of lung cancer
screening using LDCT in a high-risk
population residing in Thailand—a high
TB-burden country; and to

(ii)
Study an alternative screening
modality called chest digital tomosynthesis
(DT) that is reported to be as sensitive as CT
for the detection of actionable lung nodules
with a much lower radiation dose and lower
cost compared with LDCT.
(continued on page 7)

ISSUE 1

Former and current heavy smokers (>30 pack-years) aged 50-70 years without a history
of active TB within a recent year were included in the study. Out of the 634 high risk
subjects (mostly males) investigated, 66% had lung nodule(s) in their initial LDCT
screening (58% with multiple nodules). Nine out of these 634 cases (1.4%) were
diagnosed to have lung cancer - 5 of stage I, 1 of stage II/III, and 2 of stage 4 lung
cancer. All 6 cases of stage I and II had multiple lung nodules, while 3 cases of stage III
and IV had single lung nodule.
Dr Natthaya Triphuridet who had received the IASLC Global Mentorship Award 2013
for “Screening of Lung Cancer by Low-Dose CT (LDCT), Digital Tomosynthesis (DT)
and Chest Radiography (CR) in a High Risk Population” in Australia shared that the
study showed: despite a high burden of TB in Thailand, LDCT screening in heavy
smokers could yield a high rate of primary lung cancer in high risk population.
However, high prevalence of lung nodules is one of the major problems in diagnosis and
staging lung cancer in endemic area of TB.

Integration of smoking cessation in lung cancer screening
“All study participants were also made to realize the harmful effects of tobacco
smoking and smoking cessation clinics were integrated with the lung cancer screening
programme”, shared Dr Natthaya. “As per the WHO Report on the Global Tobacco
Epidemic 2015, at present 19.9% adults in Thailand are tobacco smokers (39% males,
and 2.1% females). There is data that shows a strong linkage between smoking
cessation rate and cost-effectiveness of CT screening. For example, at smoking
cessation rate of 3%, the annual screening for smokers aged 50-74 years (with 40 pack
years) costs $110,000-$166,000/QALY (quality-adjusted life-years gained). But if
cessation rate is doubled the cost is reduced to <$75,000/QALY. If quit rates are halved,
benefits from screening are almost wiped out”, said Dr Natthaya. Thus integration of
smoking cessation practice into lung cancer screening programme is an important part
to improve the cost-effectiveness of screening.

Challenges in implementing LDCT in Thailand
Currently only a few hospitals, including Chulabhorn Hospital, offer lung cancer
screening to heavy smokers. While admitting that there are many challenges in
implementation of LDCT screening in Thailand, Dr Natthaya advocates that,
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13TH MAY 2016

For maximizing the
benefits and minimizing
the risks of screening and
promoting efficient
utilization of healthcare
resources, screening
referral centre model may
be useful for initial
implementation of lung
cancer screening with
LDCT. The screening
referral centre comprises a
multidisciplinary
specialized team of
radiologists,
pulmonologists, thoracic
surgeons, and medical/
radiation oncologists who
are capable of
developing standardized
practices (including lung
nodule management
protocol and
interventions, diagnosis,
staging, and treatment)
and integrating smoking
cessation practice into
screening programmes to
improve the
cost-effectiveness of lung
cancer screening and
studying the remaining
areas of uncertainty
regarding lung cancer
screening.

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13TH MAY 2016

QUOTES FROM KEY APLCC LEADERS
“There is one topic in the plenary session
titled — ‘Advanced lung cancer - it is time to
cure’ - this is a very challenging and very bold
statement. Right now we are pretty confident that
we can extend the lives of the patients. But now
we can aim to challenge lung cancer up to the next
level: cure! In certain lung cancer patients may be
we can revert the prognosis from incurable and
extending the life to the level of cure. It will
give us a new direction on how to handle lung
cancer”

“Session on tobacco control is very important,
especially in the context of Asia. Tobacco is the
major cause of lung cancer and is responsible for
most of the lung cancer globally. Immunotherapy
session is another very interesting session and
people need to understand this new treatment
technique for lung cancer. All delegates of
APLCC 2016 should take the opportunity of the
conference to network and meet others and to
learn from each other so that we are at the top of
information and remain at the cutting edge of lung cancer treatment”

Dr Virote Sriuranpong, President of Thai Society of Clinical
Oncology (TSCO) and Medical Oncologist and currently
Associate Professor, Department of Medicine, Chulalongkorn
University, Bangkok, Thailand

Dr Michael Boyer, Member APLCC 2016 Committee and Member,
Board of Directors, IASLC; Professor of Medicine at the Sydney
Cancer Centre and Chief Clinical Officer of Chris O’Brien Lifehouse,
Australia

“APLCC 2016 Chair Dr Sumitra Thongprasert
has done a marvelous job in representing
Thailand in IASLC, improving cancer care in
Thailand and organizing the APLCC 2016.

“In East Asian nations about 40% of lung cancer
patients had EGFR mutation who will benefit
from specific targeted therapy. We have large
randomized controlled studies to show that
patients with EGFR mutation need to start with
one of such treatments. Initially patients had
long duration response to these treatments but
some of them developed resistance. Now we
know that half of them had T790M or additional
mutation in the EGFR. There are new drugs that
have entered clinical trials in recent years to target specific resistance
mutations. There will be data of such new drugs targeting resistance
mutations at APLCC 2016”

There have been lot many changes in lung
cancer field in a short period of time making
it hard to keep up with them. Also in Thailand
and many other countries medical oncologists
have to deal with multiple type of cancers. This
highlights the importance of meetings like APLCC for lung cancer
experts so that they are able to keep up with major advances occurring
in lung cancer care. The importance of education cannot be
overemphasized!”
Dr Paul A Bunn Jr, Distinguished Professor, Division of Medical
Oncology, University of Colorado and James Dudley Chair in Lung
Cancer Research. Dr Bunn is also the former President of IASLC;
former CEO of IASLC; Member APLCC 2016 International
Committee (and 1st APLCC in 2004)

Dr James CH Yang, Deputy Director, Department of Medical
Oncology and Director, National Cancer Research Centre,
National Taiwan University Hospital; Member, APLCC 2016
International Committee andAssociate Editor (Asia), Journal ofThoracic
Oncology

FOLLOW APLCC 2016 ON

• Twitter: @APLCC2016
• Twitter conference hashtag: #APLCC2016
• Facebook.com/APLCC2016
Check www.aplcc2016.com for conference updates!
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APLCC 2016 Editor: Dr Suebpong Tanasanvimon
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