Welcome to the ISLC webinar, ISLC 2024 Highlights. I'm Dr. Hidehito Horinouchi from National Cancer Center Hospital Tokyo, Japan. I'm a Swazic medical oncologist. Dr. Calvin Ng and I will be your presentation moderator today. We will start this activity with some brief housekeeping items. After each presentation has concluded, you may ask questions by using the Q&A button feature located on your video screen, the downside, and we will be addressing questions after each presenter's presentation as time permits. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education, ACCME. The International Association for the Study of Lung Cancer, ISLC, is accredited by the ACCME to provide continuing medical education for physicians, and the International Association for the Study of Lung Cancer designates the live format for this education activity for a maximum of 1.0 AMA PRA Category 1 credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. All faculty, planners, and reviewers for the webinar today have disclosed their conflicts of interest. This information is provided on the following slide. So Dr. Tetsuya Misudomi will be our first presenter today. Dr. Misudomi is the professor in the Division of Thoracic Surgery, Department of Surgery at Kindai University, Faculty of Medicine, Osaka, Seiyama. Today, we have the pleasure of hearing his talk on neoadjuvant nivolumab and chemotherapy in resectable NSCLC, four-year update and Asian subpopulation data from Checkmate 816. Dr. Ngu, thank you very much for your kind attention. It is my great pleasure on behalf of my co-investigators and the BMS team to present the data of the neoadjuvant nivolumab and chemotherapy in resectable non-small cell cancer, four-year update and Asian subpopulation data from Checkmate 816. And here are my co-investigators. So as you know, there are many treatment options for resectable lung cancer. So there are some options for the adjuvant immunotherapy, as exemplified by the recent results of the INPAR-010 or KINO-091. And for the Checkmate 816, which I am going to present tonight or today, these are the neoadjuvant chemoimmunotherapy followed by surgery. And then there are many perioperative, so-called perioperative or sandwich approach, which combines the perioperative immunochemotherapy followed by surgery, then followed by immunotherapy. So there are those five studies so far published. And if the patient has an EGL mutation or ALK translocation, the neoadjuvant TKR therapy is shown to be very effective. But tonight, I'm going to talk about the Asian subset of Checkmate 816. And as you may know, the Checkmate 816 is in the randomized global phase 3 studies that compared neoadjuvant EbolaMAP plus chemotherapy with neoadjuvant chemotherapy followed by surgery. And event-free survival and PCR rate is the co-primary endpoints. And earlier this year, the four-year update of the results are presented. And here, I show the global OS results of the global population. Although there appears to be very nice separation of the curve, so far it does not reach the statistical significance. So we have to say there is a very nice trend, but we cannot say significant improvement of the overall survival. On the right, you see the Rankine's survival. And again, there is a very nice separation of the curve. But today, I'm going to present mainly on the Asian subpopulation of the Checkmate 816. And here, the comparison of the baseline backgrounds of the Asian subpopulation in contrast to non-Asian subpopulation. As you see, about half of the patients are from Asia. So altogether, 177 are from Asia and 179 are from non-Asia. And although the stratification factor of this randomization, this trial was a PD-ROM expression at a stage, so the race was not the stratification factor. So you have to be aware of that fact. And yet, the balance between the two arms in the Asian subpopulation is well maintained. However, if you compare the Asian with non-Asian, there is some difference. For example, there are more males. So 86% of the Asian subpopulation male compared to 59% or 55% are male in the non-Asian. And more ECOG0, PS0 patients are present. So there is better patients included in the Asian subpopulations. And when you look at the histology, more skeletal patients are included in the Asian subpopulation. And when you look at the tumor PD-ROM expression, the higher percentage of the PD-ROMs are more frequent in the Asian subpopulation. For example, the PD-ROMs are 50% present in 32% of the nevo-chemo and 26% of the chemo compared to 12 or 21. So there is some difference in the background of the patients between the Asian and non-Asian patients. So we have to be aware of that fact when you interpret the following data. And here's the surgical outcomes in the Asian and non-Asian subpopulations. And this is the rate of the cancellation of the surgery. And I don't know why, but the cancellation and the nevo-chemo is a bit low, 11% compared to 21%. But in the non-Asian subpopulation, this cancellation was similar in the nevo-chemo and the chemo arm. And if you look at the thalacotomy instance, it's lower in the Asian patient, 50 to 59 compared to 69 to 68. And also the R0 resection is very frequent in the Asian subpopulation, 91 or 89 compared to 76 to 65%. And here the event-free survival in the global population and Asian subpopulation. So please note, the global population includes the Asian subpopulations. And if you look at the hazard ratio, the hazard ratio is 0.66 for the global and Asian is 0.53. And the survival curve for the nevo-chemo arm is very similar. So the four-year event-free survival rate is 49 versus 51. But in the chemo arm, that was 38 versus 30. So that's why the hazard ratio is better in the Asian. And there is some data about the non-Asian population. In this case, you might guess that the non-Asian hazard ratio was worse than the numerical was, 0.82. But again, there are some differences in the background of patients. So the interpretation of the data should be very cautious. Here, the comparison of the PCR rate and the NPR. Again, PCR is a bit better in the Asian subpopulation, just numerically. But the difference in the NPR was not so great compared to the PCR difference. And these are the description about the non-Asian PCR rate. That's 20.4 percent, and NPR was 35.5 percent, which is, again, numerically worse in the Asian population. And here's the relationship between the PCR rate and the CT DNA clearance. In this study, the CT DNA was taken before the first course, and then the CT DNA clearance was defined as if the CT DNA was cleared, C3D1, course three, day one. And as you see, if there is no CT DNA clearance, the PCR rate was zero in the nivol chemo arm. And this tendency was very exactly the same in the Asian subpopulations. So you can say that the CT DNA clearance is a necessary condition to achieve the PCR, but it's not a sufficient condition. And these are the subsequent anticancer therapy after the event-free EFS events. And in general, subsequent therapy was more frequent in the Asian subpopulations. So 73 percent of the nivol chemo arm, or 81 percent of the chemo arm, received subsequent, any subsequent therapy, compared to 40 or 60. And these are the breakdown of the subsequent therapy, radiotherapy, surgery system therapy, any of those subsequent therapies more frequent in the Asian subpopulation. And these are the safety summary, Asian versus non-Asian subpopulations. And in general, if you look at any grade separation, most of the patients experienced any grade at AE, but grade three or four, AE was more frequent in the nivol chemo arm, 46 percent, plus 27. And surgery-related AIDS, any grade was more frequent in the nivol chemo arm, 69 percent in the nivol chemo arm, 72 percent in the chemo arm, compared to the 22 percent in the nivol chemo arm and 24 percent in the chemo arm. However, the grade three to four surgical-related AIDS is not so different between the two populations. And it is important to note that there's no treatment-related death in the nivol chemo arm, both in the Asian and non-Asian subpopulations. And here's the breakdown of the surgical-related AIDS. And the anemia, pain, wound complication, procedural pain was the frequent surgical-related AE, but mostly the grade one or two. So, in summary, AS4E update from checkments X16 new adjuvant nivol plus chemotherapy demonstrated durable, long-term EFs benefit. And the clinically important was improvement trend versus chemotherapy, neoadjuvant chemotherapy. And if you look at the Asian subpopulation, neoadjuvant nivol chemo showed a higher PCR rate and long-term EFs benefit versus chemotherapy, and consistent with the finding in the global population. The safety profile of the neoadjuvant nivol plus chemo was consistent with the previous reports. And so, in conclusion, these four-year results from checkments X16 provide the first understanding of the long-term benefits of the neoadjuvant immunotherapy versus chemotherapy and reinforce nivol plus chemo as a standard of care for patients with resectable non-sponsored cancers. So, even in the Asian patients, we can say that checkments X16 would be the one of the standard of care treatment for the patients with resectable stage 2 to 3 non-sponsored cancers. But I'd like to point out that there are many unsolved questions. So, one is a very important question is what is the boundary between the resectable and unresectable disease? So, this definition may vary from the doctors to doctors or from the country or from the modality to modality. So, this is a very difficult question. And the next question will be whether we should give the adjuvant to a newspaper and how we can select the patients. So, but there are several points to be considered. Anti-tumor effects may be a little bit better in the neoadjuvant approach compared to adjuvant. But the cancellation of the surgery in the neoadjuvant over a period of periodical approach may be a concern. And sometimes surgical maneuver may become difficult after the neoadjuvant treatment. And so, it used to be before the immunotherapy, there are many doctors give the neoadjuvant chemotherapy, especially for the N2 disease. But what is the role of the neoadjuvant chemotherapy in this immunotherapy era? And again, there are one neoadjuvant trial, which is CHECKMED S16 and several operative approaches. So, the question is whether the post-adjuvant immunotherapy is necessary or not. How can we select who is suitable for the sandwich approach or not? And then, there are several special populations. How do we treat the patients with either a negative stage 1B or multiple or bulky N2 and so on? And some of the patients may be cured by the surgery alone. Or on the other hand, even with the immunotherapy approach, some patients are not cured at all and may die of lung cancer. So, how can we escalate what is correct and what kind of the biomarker we should use? So, those are the emerging questions. And so, we have to do our best to solve these kinds of questions. And thank you very much. I'll stop here. Thank you very much for your kind attention. Thank you, Professor Mitsudomi. And now, we are open for the question and answer. So, please share your question and answer on the Q&A button in the bottom of the webinar screen. And right now, we don't have any questions from the audience. So, I would like to ask several questions. It's my privilege to ask Professor Mitsudomi. So, my first question is about the very common questions. So, for which patient population we should conduct an argument, ICIs? Because we have pretty good data based on the CheckMate A1-6. So, if we compare the trial to trial, maybe it might be very cautious, but the point estimate of the survival in the EFS and the OS is quite similar even between the perioperative approach and also the neoargument-only approach. So, do you have any thoughts about how to select the right patient for the perioperative, so the neo and post? So, your question is whether we should use the neo-only or peri? Or your question is whether we should use the neo versus argument? Yeah. So, my question is for which patient population we should add the postoperative ICIs? Oh, that's a great question, but no one can answer right now. I mean, so if you compare the neo-argument component and the argument component, I think, I believe that the neo-argument component of the immunotherapy is doing a greater job compared to the argument-postoperative immunotherapy. But we cannot say that the immunotherapy after the surgery are doing nothing. So, maybe in some patients, argument immunotherapy may do something good for the patients. But if the patient has achieved a PCR after the neo-argument treatment, or on the other hand, the tumor shrinkage is not at all, so the residual viable tumor is 100 percent, then a neo-argument treatment doesn't do anything. So, those extreme cases, I think that the neo-argument treatment will not do anything. So, there may be some boundary which may define the importance of the adding the adjuvant therapy. So far, we don't know the very definite data. So, we have to guess something. And in the previous WCLC, there's some subset data of the kinase C71, depending on the residual viable tumor. So, Dr. Cascone showed that if the residual tumor is more than 30 percent, there may be no benefit. So, maybe that could be the one threshold. But sure, that's a subset study, and it's not very definite. So, it's very difficult questions. Thank you. So, yes. So, there is another question from the audience. So, my last question for you is about the ctDNA analysis, because in CheckMate A16, there is additional ctDNA clearance analysis. And my question is about, because when we talk about adjuvant, purely adjuvant treatment, it's quite easy to implement the MRD analysis. But when it comes to the neo-adjuvant setting, so what's the timing is the best one to analyze the MRD to expect some kind of de-escalation or escalation? Yes. So, again, this is a very difficult question. But if you think about the de-escalation or escalation, that should be after the surgery, right? So, if the information of the ctDNA after surgery is available, they may help. But currently available, the ctDNA analysis, for example, the Signatera, which was used for the adjunct study of the importer 010, was the result was the ctDNA or MRD presence was very prognostic. But even for the patient with ctDNA negative, there appears some benefit of adding the atherosma. So, we cannot omit the atherosmal therapy for even the ctDNA negative. So, particularly, if you use the Signatera, so that in the future, if the sensitivity of the CT DNA analysis is improved, we may be able to omit as band therapy for that kind of patients. And also, in the checkmate X16, C3D1 clearance was examined. And as I told you, all the PCR patients are CT DNA negative and the CT DNA is cleared. But some patients, PCR is not achieved, but CT DNA is cleared. And again, the other patients are both positive. So maybe we may be able to stratify, or we may change the intensity of the follow-up, or those kind of things we may be able to do now, even now. And still, a lot of patients remains. So your opinion is maybe we can stratify the patient based on the PCR or not PCR, and also the CT DNA cleared or not cleared? Yeah. Yeah, maybe. But we don't know how to do that kind of patient, right? Yeah. Thank you. Thank you. So thank you very much. So thank you very much answering my many, several questions. And so the time is running out, so I'd like to proceed to the next speaker. Thank you, Professor Mitsudomi. And I'd like to proceed to the next speaker. Next speaker is Professor Fei-Fei Huang from the School of Nursing, Fujian Medical University, Fuzhou, China. It's my great pleasure to have her to present us the feasibility and the cost-effectiveness of the implementing mobile low-dose computed tomography with an artificial intelligence-based diagnostic system in undeserved populations. So please go ahead. Okay, thank you. Thank you for introductions. I'm very happy to share our research topic about the feasibility and the cost-effectiveness of implementing mobile low-dose computed tomographies with artificial intelligence-based diagnostic systems in underserved population. So next slide. Thank you. This is our team members, and Professor Chen is our corresponding authors. So next slide. As we know, the incidence and mortality rates of lung cancer ranks first among all cancers. They were 2,000,000 new cases and 176,000,000 deaths in 2022. So approximately 75% of lung cancer patients are diagnosed at advanced stage, resulting in over five years survival rates and less than 30%. In contrast, patients detected at an earlier stage have a survival rates up to 92%. So we can see the significant differences in survival rates among the different stage of lung cancer emphasize the importance of earlier detectations while lung cancer screening. So next slide. This is our report. The significant difference in the survival rates among the lung cancers emphasize the importance to earlier detectations while lung cancer screening. Next slide. So low-dose computed etymographies, LDCT has been showed to reduce lung cancer-specific mortalities, and it was recommended by its global lung cancer screening guidelines. However, the rates of LDCTs remains low globally. For example, in the United States, it's range from 3.8% to 60.3%. And in China, it is less than 33%. Next. Study have a source that health disparities and health equities impact to the takings of LDCT. Therefore, implementing mobile CT scanners and AI technologies can significantly enhance lung cancer screening assessed for underserved populations. However, the evidence of it in China is limited. And the most importantly, the cost-effectiveness of using AIs in mobile CT screenings in underserved areas remains unclear. Next. So our purpose, our study... Next slide. Yeah, thank you. So our studies aims to conduct an inefficient feasibility and the cost-effectiveness analysis of community-based programs that use a mobile LDCT scans unit and discuss operational and challenges faced during its implementation. Next. Next slide. Yeah, thank you. So from July 2022 to August 2022, it's the government's and the community's health centers were responsibilities for promoting the study to eligible individuals through posters and media announcements. The first step is confirmed screening site. The programs and screening site were located within its rural areas of seven cities in Fujian province, China. And they are sourced in finger one. The second step is participant recruitment. Areas with a high incidence of lung cancer, such as Jurong County, a consensus strategy was important for screening all participants. While in other regions, if participants is interested, they were included. So the individuals age 40 years and above who have not previously undergoes lung cancer screenings and or socioeconomically is marginalized, participants were included. And the individuals who were previously diagnosed with lung cancer or who were unwilling to undergo mobile CT examinations were excluded. So next slide. The third step is participants take a mobile LOD CT screenings under our team's collaborations. For example, patients navigators have to appointment and schedule and data collections. And the nurses provide health counseling and education. And doctors and radiologists work to performing and analyzing screens with the assistance of AI. And the fourth step is new data detections, risk and stratifications, and lens we work on conductors after the LOD CT examination. The process of our whole programs is we can see it in finger two. And we also tied our programs as a happy homestead village is Metro's eight projects. Next slide. Regarding the statistics as measures earlier, because we want to conduct the cost-effectiveness analysis. So earlier detectations cost index, EDCIs was used to reflect the cost-effectiveness analysis is findings of the mobile CT. EDCIs is a simplified index for health economic evaluations. And the EDCIs represent a radius of average cost of detectating earlier cases to its per capita GDP. So the smallest EDPIs means the smallest cost of screenings and the largest, the health benefits and the most cost-effectiveness cancer screening. Next slide. Finally, as 10,159 participants underwent LOD CT, and we found 108 suspected lung cancer cases and 71 participants were confirmed lung cancer cases. And the detectations rates of suspective lung cancer cases and the confirmed cases is 1.06% and 0.7%. Next slide. And the details of the confirmed lung cancer cases is shows as following. Okay, next slide. So the total cost of lung cancer screenings we use is, we use is 1,000, is about 12 millions of 500, 4 Yuan, is in, let me be in China. And the specific spendings, we can see these statistics figures. Okay, next slide. Okay, therefore, the CERs follow the statistics of the suspected lung cancer and represent radius of total cost of lung cancer screenings to the numbers of cases of suspected lung cancer. And similarly, the CERs for the confirmed lung cancers is about 10,000 and 100 is 43 Yuan. Okay, next slide. So according to the Fujian statistics yearbooks 2022, and per capita GDP is 126,829 Yuan. 126,829 Yuan. So the EDCIs of suspected lung cancers and the confirmed lung cancers were 0.09 and the 0.13 respectively. Okay, next slide. Okay, we also met during, when we conducting our these programs, we also met some operational changes, such as changes in security and stable fundings. In these programs, it is funded by our governments. Governments and human resources. And we also think how to conduct to promote the projects as public cities. And also we need to assure the logistics service. And we also have some changes in standardized resident health records. Because when we use the health records of the participant is in the rural hospitals, but they also have some conflicts or have some mistakes in their records. So we need to recheck. And we also need some persons and some more personals to conduct these works. And so we also, so these changes, we think we need to consider and to resolve in future studies. Okay, next slide. So in our programs and in our research, we present our feasibility and a cost effectiveness analysis result of a large populations participants in lung cancer screening mobile city in China. And we address is multi-prize lung cancer screenings behaviors. Encounters in and the service rural areas. So in on the whole effect is this promotes earlier detect detectations of lung cancers and it's host promoses for reducing health disparities in and the service areas. So in conclusion, we think at least LDCTs with artificial intelligence mobiles for lung cancer screening hosts economically pronoun is promotes for reducing health disparities and promotes health equities in and the service areas. And we think it's maybe it's promotes largest populations in similar low incomes country. Okay, let's thank you for listening. Thank you. Thank you for your great presentation. So yeah, now the abstract is open for the question and answer and we are still not having any question and question from the audience. So yeah, can I ask one questions? Because yeah, the mobile LDCT screening and also the AI implementation is very attractive. So based on this achievement, is there any next step such as a governmental supported LDCT screening like this program has been implemented in the public healthcare system or not? So my question is about what's happened after this research in your regions? Hmm, our programs is at least our least programs is funded by our government. Yeah, so because I think this is, we need to a lot of a lot of is fundings to perform the least projects and because we need to need to mobile bus and the need to pay some is an participant. And sound gift. And we also need to paid for work is personals. So of the fund is very important. And we, this projects is mobile to conduct in rural areas. And we found the participant in rural areas may be some, they have a sound and loss and has beliefs and health knowledge is to screening. And they may be have some, maybe have some problems. What is they may be leaves a soul, so very long distance to law hospital. So they have some problems to perform LDCT. So we use our mobiles is mobiles bus and to facilitate they conduct this LDCT. So as they were very happy to, yeah, this project is the participant is very happy to and very welcomes to conduct these projects. Thank you so much. So based on the time limitation, I would like to hand over to the next speaker. Calvin, can you chair the next talk? Thank you. Thank you, Professor Huang. So our next speaker is final speaker is Dr. Matthew Smeltzer. And Professor Smeltzer is Associate Professor of Epidemiology and Biostatistics and University Research Professor at the Memphis University. And he's going to be telling us a bit about the 2024 ISLC global survey on biomarker testing. All yours. Thank you. Thank you for the opportunity to present this information. We conducted this survey in 2024 to try to better understand the landscape around biomarker testing globally. And today I want to share with you some highlights from the global data on the survey, as well as some specific results from the Asia region. We know biomarker status is vital to inform optimal care for individuals with lung cancer, but implementation of testing has been suboptimal. So the ISLC and partners launched the second global survey on biomarker testing in the spring of 2024 as part of a larger initiative to improve biomarker testing globally. Overall, I'm going to show you these results. We found that perceived testing rates did improve since the 2018 survey, but there are still substantial barriers to testing. And some of these barriers are similar regardless of tumor stage, which is one thing we wanted to look at in this new survey. When we conducted the survey, we put together a multidisciplinary committee, including medical oncologists, pathologists, pulmonology, surgery, epidemiology, and advocacy partners to write this survey. And we made it available in six different languages, which you can see there on the screen. We used a mixed methods framework, so we conducted qualitative focus groups to understand the real questions around biomarker testing that we needed to ask and try to establish what do we really need to learn from this survey and what's the most important information to glean from it. We're also using the focus group information to interpret the results of the quantitative survey now that it is completed. In addition, you're going to see results today broken up by high- or upper-middle-income countries, which we've abbreviated HMIC, or low- or low- or middle-income countries, LMIC. And there was some different effect based on median income per World Bank of the country. And so for the Asia results, most of those results I'm going to share today are stratified by this. Our key takeaway from the focus groups – and these focus groups were conducted with thought leaders across the world in the lung cancer space. And the key takeaway – one of the key takeaways from the focus groups was that we've really experienced a paradigm shift in how we should be thinking about biomarker testing for lung cancer. It's no longer something that's nice to have for individuals with lung cancer, but it's really a must-have. And so we need to work in terms of awareness and understanding. We need to work with providers across the world to make sure people understand that this biomarker testing for actionable mutations is really a must-have in order to treat patients appropriately. We also heard from the focus groups that the complex issues often vary by region and care setting, and cost is a universal concern. But it does mean different things in different settings when we talk about cost as a barrier, which we'll expand on the barriers a little bit more in a minute. So we, in total, received 1,677 responses across 90 countries and 14 disciplines. You can see the specialties in the bar chart on the right. And in particular, 533 responses from the Asia region were received. You can see which countries responded in red here. 81% of these responses were from upper-middle-income countries and 19% from LMICs. Some of our key results. 98% of respondents globally believe that testing significantly impacts outcomes, and 91% have a clear understanding of who should receive testing. But when we asked specifically, is it highly important to perform comprehensive biomarker testing for all late-stage patients or all early-stage patients, we responded, yeah, it was highly important in 63% and 29% of individuals. And these numbers were fairly consistent when we looked at this question across region and across specialty type in terms of who was answering the survey. You can see, when I broke it up by Asia HMIC and Asia LMIC, that the results were also largely consistent compared to the world results. We then asked respondents, do you think more than half of individuals in your country receive biomarker testing who have lung cancer? And 39% said yes in 2018. So we wanted to repeat this question to try to gauge whether things had improved. And the global number for this question was 67% in the 2024 survey. So we concluded that at least in perception, more people are being tested. And for Asia HMICs, that number was 75%, but only 30% for Asia LMICs, showing us that we still have a gap. We also ask, do you sometimes or often treat patients prior to receiving biomarker testing? Globally, 43% still report in 2024 that they sometimes or often treat patients without biomarker testing results. That number was 38% in HMIC in Asia and in 78% in LMIC in Asia. So there is still an implementation gap in getting these tests in the hands of the physicians in time to make treatment decisions. So what is keeping us from optimizing biomarker testing around the world? The top five barriers that we heard were cost, sample quality, time, access, and awareness. And 27% ranked cost as the number one barrier globally. When we look at this across the Asian countries, Asia HMICs were pretty consistent with the global results. But we see in LMICs, the lower income countries, 37% say cost was the number one barrier. And the second largest barrier for Asia LMICs was 18% access. And so we do see there are some variation in the strength of these barriers across the income levels of the country. But globally, pretty consistently, we need to work on cost. We need to make sure that we can acquire quality samples, that we can do this in a timely manner, that everyone has access to this technology, which we now know is really necessary for most patients, and that everyone is aware that this is all treating, all individuals treating lung cancer are really aware that we really need this. So we also ask what biomarker testing guidelines does your institution use? And one option was the CAP-ISLC-AMP guidelines. So in the world data, 54% said that is what they use. 21% used another guideline other than that, and 26% were not aware of any guidelines. When we look across the entire Asia region, the numbers match the global numbers pretty consistently. And we see actually in Asia, LMICs, 62% use the CAP-ISLC-AMP guidelines, which was a little higher than the world percentage, while 29% were not aware of any guidelines, and 10% are using other guidelines. So I think there's an opportunity we've identified here to make sure that people have the CAP-ISLC-AMP guidelines and can implement them in practice, and these guidelines are currently being updated. There will be an updated version coming out very soon. So we ask, how do we solve this? We ask respondents, what solutions do you think would be most impactful to improve biomarker testing in your country and globally? And respondents advocated for numerous solutions, including implementing testing protocols at the institution level, government-level interventions to improve access and cost, addressing cost and reimbursement specifically, improving awareness and education of biomarker testing, increasing administrative and organizational support, and working on access and availability more broadly. Overall, we found improvements in the perception of testing rates compared to 2018, but continued and substantial barriers still exist, and these barriers also are similar regardless of tumor stage, largely. We did see a little bit of the feeling that it's really comprehensive testing is mandatory. That feeling is stronger in the later-stage patients, but overall, the early-stage barriers seem to be pretty consistent with the late-stage barriers, which is one thing we wanted to understand from the survey. As we all know, biomarker testing for early-stage lung cancer is an emerging field, and it's established but much newer than late-stage. The key solutions that we need to focus on based on the survey are education, clinical processes, eliminating bureaucracy in government and payer organizations, and increasing funding. The ISLC is launching a series of initiatives trying to use these data to target awareness, access, processes, quality, and policy. You'll be hearing more about some of these initiatives to try to improve biomarker testing globally, and there's a big initiative now to try to do this. The ISLC partners for thoracic cancer care have been funding the survey and are funding some additional work that's going on right now that's taking deep dives in certain regions and hospitals and looking at what we consider to be higher-performing care settings and lower-performing care settings to try to understand in more detail some of the processes around biomarker testing to see what we can learn to optimize and how we can figure out what practices work to get things really done and how we can scale that up across other areas of the globe. I'd like to thank all the survey respondents. A lot of you probably responded to this survey. Again, over 1,600 individuals participated, and the steering committee and co-authors for this work are listed below. And again, the ISLC partners for thoracic cancer care are funding this work and some continued work to better understand the landscape around biomarker testing globally. Thank you for the time today. Thank you very much, Dr. Smeltzer, for the very nice presentation. I just can't see any questions right now, but if I may start the ball rolling. In terms of costs and reimbursement, certainly in Asia, we see that as an explanation by a lot of clinicians to say that biomarkers are expensive, testing and also the subsequent therapies are expensive, and there's no point in some ways, because even if we know about it, we can't implement the trials, the data that is available there. How do you think we can really tackle that cost and reimbursement issue? Does it have to go from the government, you think? Great question. I think probably we're going to need some customized approaches, depending on the care setting and the particular country that we're operating in, because in some cases, it's just a question of reallocating resources and understanding that really the cost is in the system. It's just that we need to spend it wisely and realize that doing the biomarker testing is the best thing to do, because it will allow us to get the proper treatment, which long-term is going to potentially make the system more efficient. But in other regions, as you mentioned, there's really a larger issue around funding healthcare and getting access to targeted therapies that we would need to use based on the test. And so there, I think more government support and more broad approaches to funding are going to be important. And lastly, there are some cases where the governments in some countries, we heard in the focus groups, the government really decides what drugs are approved and what drugs are going to be paid for. And we heard in particular that sometimes there's a lag of up to two years in getting something, once it's been scientifically demonstrated to be effective and we know patients should be receiving it, there can be quite a bit of lag time before it's actually approved to use in the country, even though technically the resources are there, the bureaucracy is causing delays in having access. Thank you. I also have another question. I don't know whether you have the answer to, or maybe you have the data, but you have not had a chance to show on the slides. Is it different between different specialties? Was there like a difference in knowledge or awareness of the biomarker testing? I'm talking about surgeons versus oncologists versus, you know, a respiratory physician, because just kind of in our meetings, it seems like some specialties may just go ahead with surgery, you know, and be less aware, perhaps, or less keen to set the biomarker testing. What's your feeling about the survey, the feedback that you got from the different specialties? Sure. We do have that information. And in the larger manuscript, we are going to parse some of that out. What I have seen so far is that there's not striking differences between specialties, as we might expect. And one thing I think we have to keep in mind when we look at these results is these people that replied to the survey, replied to an ISLC survey about biomarker testing. And so I think we may see less differences because we're really getting people that are already a little bit plugged in. But that's a little bit scary when we look at some of the gaps that we're seeing in knowledge and awareness, even within the people that responded. So my hypothesis is that it's probably that some of the gaps are probably bigger because we're a little bit biased towards people that are more in the know and more plugged in. So, yeah, I guess it remains to be seen if we see any striking differences between types of providers. But so far, I haven't seen anything of note. Great. Thanks for the additional data. I was just thinking, you know, in terms of accessibility, in fact, it's, you know, obviously access to technology, but also access physically sometimes in some Asian countries where, you know, there are no roads that go to some of these district hospitals or, you know, rural hospitals to do that. And I was just wondering whether you can actually work with Dr. Huang to send some mobile units to some of the lesser accessible areas to do some biomarker testing for some of the rural hospitals. Do you think that's feasible in some places in Asia, maybe? I think in concept where we have sort of health care deserts or larger health care gaps, trying to partner with a multifaceted approach, so trying to improve care in multiple ways, certainly they shouldn't be done in silos. So anytime we can all partner together to try to improve different types of care in an area that's underserved or has a lot of needs would be great. I don't know specifically about the feasibility of that specific initiative, but I do think it's we need to think about the broader landscape of health care delivery and where we fit in and not think, you know, in a silo because we don't want to we want to work together when we can, you know, and save resources. Thank you for the great discussion. And I'd like to close this webinar so that Professor Huang, could you turn on your video right now? And so is there any questions? Still, we don't have any questions in the Q&A box. And if any webinar faculties have questions to each other, please share the Q&A during these minutes. Is there any questions from the faculties for this webinar? No. So I'd like to finalize this webinar. So could you please share the CMA credit slide deck? Thank you. So to claim the credit for this webinar, you can complete and submit the evaluation form linked from the thank you email you will receive after this webinar. Or you can scan the QR code here and on this slide to complete or submit the evaluation form immediately and you can get the CMA credit. So next slide, please. And also to discover the more educational activities being offered by ISLC, please visit the website at islc.org. And if you can scan this QR code, you can directly get to the ISLC website. Thank you for joining us today. Thank you for your cooperation.

ISLC webinar

lung cancer

neoadjuvant nivolumab

Checkmate 816

mobile low-dose CT

AI screening

biomarker testing

global disparities

healthcare policies