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IntroductionLung cancer screening by Low-Dose CT (LDCT) has been shown to reduce mortality, and the harm-benefit balance of screening is optimised by screening those at higher risk. The Lung Screen Uptake Trial is a UK based randomised controlled trial of standard versus enhanced invitation methods for LDCT screening in more deprived communities.MethodsPatients aged 60 to 75, at higher risk of lung cancer by virtue of their recorded smoking history, were invited to a ‘lung health check appointment’ on behalf of their GP. Attendees at one of two secondary care sites, underwent a nurse consultation that included a lung cancer risk assessment. Participants were eligible for LDCT if they met any of the following three criteria: NLST-like criteria* (≥30 pack-year smoking history and given up ≤15 years ago); PLCOm2012score ≥1.51%; or LLP score ≥2.5%. This abstract focuses on the performance of the different eligibility criteria.ResultsAt the time of analysis, 1997 individuals had been invited to screening and 936 attended and were enrolled into the study. 854 participants were eligible for LDCT by fulfilling any of the 3 criteria above, and 718 went on to have LDCT. The mean age of participants was 66.0 (SD 4.16), 54.4% were male and the mean smoking pack-year history was 39.7 (SD 24.9). After a median of 9.7 months follow up, 17 lung cancers were confirmed. Ten suspicious pulmonary nodules are undergoing diagnostic work up under the lung cancer multidisciplinary team (MDT) and 80 indeterminate nodules are under CT surveillance. The distribution of these cancers and nodules by eligibility criteria is shown in Table 1.Abstract S14 Table 1Number of cancers and nodules by eligibility criteria *NLST criteria but with modified age range of 60 to 75 yearsPLCOm2012positiveLLP positiveNLST-like* positiveTotal in cohortHad CT576661493718Indeterminate nodules64745880Suspicious nodule referred to MDT89710Confirmed cancers17161317ConclusionsUsing the NLST-like* criteria to determine eligibility would mean the fewest number screened, with 4 fewer cancers detected. The PLCOm2012score was the most reliable way to detect cancers and resulted in less individuals screened than with use of the LLP score. Further follow up and review of the data is required to fully establish the most effective tool for determining eligibility into LDCT screening though the PLCOm2012score shows the most promise with the available data.

RationaleRecent data have demonstrated the superiority of Pembroluzimab over chemotherapy for patients with advanced NSCLC and high (≥50% expression) of PD-L1.1 This has resulted in NICE approving Pembroluzimab as a first line treatment option for patients with advanced NSCLC in June 2017. The original trial however excluded patients with PD-L1 testing on EBUS samples. We therefore conducted a large, multicentre study to clarify whether specimens obtained by EBUS-TBNA were suitable for testing PD-L1 in patients with NSCLC.MethodsNSCLC samples acquired by EBUS-TBNA (29.4%), percutaneous biopsy (31.2%), endobronchial biopsy (13.8%), surgical (21.4%) or other techniques (4.1%) were recorded from 435 consecutive patients with known or suspected lung cancer across 5 centres in England between January 2015 and December 2016.ResultsPD-L1 assessment (using the 22 C3 assay in all cases) was possible in 92.2% of patients undergoing EBUS and there was no difference in success of PD-L1 testing according to modality of tissue acquisition (p=0.18). The frequency of complications from EBUS-TBNA was similar to endobronchial or percutaneous techniques but lower than surgical procedures (5.0% vs 13.8%; p=0.03). PD-L1 expression in the cohort was high (≥50%) in 28.5%, weak (≥1%–50%) in 28.2%, whilst 43.3% of patients were PD-L1 negative. The only statistically significant predictor for PD-L1 expression in multivariate analysis was the presence of brain metastasis at diagnosis (OR 2.02; CI 1.04–3.90). 47 patients (11.4%) were treated with immunotherapy and the response rate was 16.2%. All patients that responded to immunotherapy had high (≥50%) expression of PD-L1.ConclusionsThis large multicentre study demonstrates for the first time that samples obtained by EBUS-TBNA in routine practice are suitable for PD-L1 testing in patients with NSCLC. The presence of brain metastases at diagnosis predicts high PD-L1 expression in this cohort and this new finding should be tested in future clinical trials.ReferenceReck M, Rodrguez-Abreu D, Robinson AG, et al. Pembrolizumab versus Chemotherapy for PD-L1Positive NonSmall-Cell Lung Cancer. N Engl J Med2016;375(19):1823-33. doi:10.1056/NEJMoa1606774

IntroductionLung Cancer screening by Low-Dose CT (LDCT) has been shown to reduce mortality, though exactly how best to implement this is unclear. Uptake to screening trials has generally been low, particularly in those at highest risk of lung cancer. The Lung Screen Uptake Trial is a UK based dual centre LDCT randomised controlled screening trial of a modified invitation strategy versus a standard approach in a population with high levels of socioeconomic deprivation.MethodsPatients were identified as ‘high-risk’ primarily by age and smoking history on a predesigned EMIS-Web search and subsequently invited on behalf of their general practitioner (GP) to a ‘lung health check’ appointment. Those attending were offered enrolment into the study and a LDCT if they met the required threshold of lung cancer risk. This abstract focuses on the mode of recruitment via general practice.ResultsPotentially eligible participants were recruited from 16 GP surgeries serving a population of 1 55 034. Of these, 8.7% were in the required age range of 60–75% and 98.9% of those had smoking status recorded. A mean of 32.2% (SD 3.8) of those aged 60–75 had been recorded as a current smoker in the preceding 15 years. A total of 1997 patients, who had been recorded as current smokers within the past 5 years were invited. Uptake to the study was 50.3% (n=1005) of all those invited. 765 underwent a LDCT examination (figure 1). In 10.3% of patients the smoking history was confirmed to be too light for CT screening, despite GP records suggesting otherwise.ConclusionsSmoking status was found to be very well recorded in primary care records, providing a feasible method for initial selection of those eligible for screening. However we also showed the importance of confirmation of smoking history, something that might be done prior to invitation in screening programmes. This study observed a high rate of attendance when compared to previous LDCT screening trials. The explanation for this observed difference is likely to be multifactorial, though one key factor, unique to this study, is that the invitation to participate came from patients’ own GP.[Figure]