Volume 8, Issue 2
Newly Elected ITMIG Officers Begin Their 2018-2020 Terms
As per ITMIG bylaws, every two years the organization goes through a process to elect the offices of President, Vice President, Secretary and Treasurer. This year, Bob Korst and Anja Roden will be stepping down as President and Vice President, respectively. Coinciding with the time of the 2018 Annual Scientific Meeting in Seoul, Edith Marom will assume the responsibilities of President while Andreas Rimner will become the new Vice President. ITMIG thanks Bob and Anja for their hard work over the past four years.
In addition, Paul Van Schil will be stepping down as Treasurer and as Chair of the Finance and Development Committee to be replaced by Josh Sonett for the next two years. Thanks to Paul for his dedication to ITMIG and welcome to Josh who is new to ITMIG leadership.
ITMIG Annual Meeting: Seoul, Korea, October 25-27th 2018
A very successful 9th Annual ITMIG meeting was held in in late October in Seoul, South Korea. This was held jointly with the Korean Society of Thoracic & Cardiovascular Surgeons which was incidentally celebrating its 50th anniversary. Although the ITMIG and KTCVS meetings were held jointly, the meetings and programmes were separate and each had their own identity. Registrations for ITMIG itself included 63 overseas registrants, 337 domestic Koreans and 2 patient advocates. Participants came from 21 different countries. The main meeting was preceded by four ITMIG Committee Meetings open to the public: Education, Database, Biology/Pathology and Steering Committees. Highlights from these committee meetings include:
- As of this meeting, Brett Carter and Mirella Marino are co-chairing the Education Committee.
- Availability of education modules on ITMIG website: itmig.org/education-and-research/education-modules/
- Update of ITMIG’s Standards and Definitions with 8th edition TNM stagingchampioned by Ariel Kerpel from the Chaim Sheba Medical Center.
- Thoracic surgery videos championed by Vincent Fang are online awaiting narration.
- ITMIG Tumor Board continues. From 2018 these cases are submitted online. Please encourage colleagues to submit any and all perplexing or challenging cases. The team of experts will convene, discuss and form recommendations for therapy; all free of charge.
- The Mediastinal Workgroup championed by Anja Roden is awaiting further statistics from her statistician.
- Mirella Marino’s Pathology Library is almost ready to be added online. New pathology educational projects will be championed under her leadership.
- Frank Detterbeck will champion a symposium on minimally invasive surgery.
- Institut Curie and Prospective Data Bank start up is nearly complete.
- Brian Louie’s project and XY and data transfer, SAS files have been received.
- DUA with IASLC and CRAB – Kari Chansky.
- DUA from CRAB for Brian’s project received and awaiting signature from Bob Korst.
- CRAB is ready to receive data from ITMIG for the Thymic Staging Project.
- Rimner and Alberto and data transfer and PHI and permission to forward that data.
- As per the original DUAs, permission for limited data sets were obtained for research purposes by ITMIG. Study PIs are conducting the research as ITMIG investigators and are working with only the limited data set.
- Committee leadership changes
- Nicolas Girard will succeed as Chair of the Database Committee; Usman Ahmad will serve as Co-Chair.
- Retrospective queue
- Andreas Rimner has received the data for his project on PORT in TC and can begin working on it.
- Can begin greenlighting remaining projects in the queue under the new workflow and local statistical support
- Prospective Data: Submissions encouragement and engagement
- Will need to announce once the new Prospective Data Bank at Institut Curie is operational.
- Ruffini survey to ITMIG members
- Enrico Ruffini announced and presented this at the meeting. Survey has been circulated to all ITMIG members.
- Presentation of an ITMIG Regional Champion Project: Thierry Jo Molina (France) on behalf of the RYTHMIC pathology Network.
- International Evaluation of Interobserver Reproducibility of the recently implemented ITMIG/IASLC Staging in Thymic Epithelial Tumours.
- Crucial for us to share and validate within the ITMIG common and reproducible criteria to assess thymoma stages on slides, Via Production of images or slides and reproducibility study.
- Selection of digitalized slides during the RYTHMIC procedure of the discordant cases between French experts considering stages. Creation of an international group through the ITMIG: US (A. Roden; A. Moreira, B. Travis, Jason Chang); GER (A. Marx, P. Ströbel), UK (A. Nicholson), ITA (M. Marino), POL (Malgorzata Szolkowska), JPN (Shigeki Shimizu), CHN (Chen Gang), FRA (T. Molina on behalf of French RYTHMIC pathologists with L).
- Confirmation of the difficulty to be concordant on slides when voting separately Chalabreysse, V. de Montpreville, V Secq,…)
- Creation of a RYTHMIC International Workshop on the teleslide (Tribvn software) and discussion of the slides through WebEx conferences.
- 1st WebEx October 12th 2018
- One hour discussion of four cases addressing the question of mediastinal pleura, pericardium and lung invasion. through the workshop and interest of better defining together on slides elementary lesions to be more concordant.
- Agreement that the cases although difficult were not exceptional and linked to the practice.
- Questions raised: histologically defined adherence vs invasion, input of the elastin stains, and how to consider visceral pleura invasion in the pTN (as lung and mediastinal pleura are defined).
- Preliminary steps at this stage but interest of most participants to this project.
- Importance to renew regularly the discussion within the group to maintain dynamic progress on agreement on slides considering stages of disease. (WebEx to be scheduled regularly in the future).
- ITMIG membership was updated. ITMIG currently has 159 active, dues paying members and 98 active, non-paying members (nonprofessional members).
- An ITMIG Prospective Database update: It currently has data from over 1000 patients, but is currently offline due to its transition to Institut Curie since cceHub was dissolved. The Database hopes to be back online soon.
- The ITMIG Statistical Core has been dissolved due to bottleneck and financial issues. The new model going forward will involve local statisticians to perform the statistical analyses for the Prospective Data Bank. Project leaders will have to use local relationships and funding when necessary.
- ITMIG will hold its first patient-directed WebEx event on Oct 30, 2018. This will involve a 15 minute educational presentation about ITMIG, followed by a question and answer session. The ITMIG panel will consist of Drs. Korst, Wakelee, Falkson, Roden and Marom.
- ITMIG will hold an online fundraising drive at the end of this year to coincide with the ITMIG WebEx events. Email and Facebook will be used to publicize this drive.
- The 2019 ITMIG Annual Meeting will be held in Toronto, Canada, October 10-12. SAVE TE DATE.
- The Prospective Database is progressing under Nicolas Girard. There may be a few administrative obstacles in terms of data security and the new GDPR. Getting the database back up and running is a key priority for ITMIG.
- ITMIG’s interface with professionals and with patients through social media and general profile needs to be improved.
- As part of this we look forward to ITMIG’s first WebEx with patients, hosted by Bob Korst. This will be on October 30th. If successful, it should create a model that can be replicated elsewhere for patients and caregivers.
Following committee meetings, invited speakers visited Asan Medical Center and were impressed with their volume and sophisticated level of medicine performed there.
The Annual Meeting program was wide and varied, covering all aspects of the presentation, imaging, diagnosis and treatment of patients with thymic malignancies. The invited lectures sessions were all well attended and consisted of sessions on:
- Presentations from KART (Korean Association for Research on the Thymus)
- Clinical decision making for a minimally invasive approach x Developing a minimally invasive program for invasive tumors
- The importance of node dissection in the era of minimally invasive surgery
- Advances in imaging thymoma
- Pleural disease: The approach from the medical radiation oncology and surgical view point
- Medical Oncology & Basic Science session covering the latest data systemic therapy including immune checkpoint inhibitors, next generation sequencing, and the biology of thymic tumors
An emphasis was placed on several topics of interest:
- MRI imaging which is gaining greater acceptance as a useful working tool for avoiding unnecessary thymectomy for benign disease that can be diagnosed with MRI but not with CT.
- There is rapid development in the different minimally invasive surgical approaches. Aside from learning about the advantages of different surgical approaches, the importance of appropriate training and experience was stressed. Whilst minimally invasive surgery appears to be associated with improved patient outcomes, the point was well made that the operation carried out must not compromise margins or affect the quality of lymph node assessment.
- Exciting developments in personalized targeted therapies, Next Generation Sequencing and other profiling bring much hope for better treatment. Yet the immunological issues associated with thymic malignancies, which carry with them severe and high rates of adverse outcomes, were shown and stressed. This led to the recommendation that despite good tumor response from immune therapy, this type of treatment should only be considered in a large center as part of a clinical trial.
- Networking and sharing: Perhaps the greatest part of the meeting was its atmosphere. All ITMIG participants showed enthusiasm to share experiences and data and to learn from each other.
The Tumor Board attracted a particularly large crowd which elicited great audience engagement, differing educated opinions and stimulated a lively discussion.
The two abstract sessions and the poster sessions witnessed the presentation of clinical and laboratory research from 15 different nations across Europe, Asia & North America. There were 15 oral presentations and 21 posters.
The prize winners were announced at the end of the meeting. The winners were:
The ITMIG Masaoka Award for Best Oral Presentation:
Jae Kwang Yun, Asan Medical Centre, Ulsan University College of Medicine, Korea for “Tumor size as a prognostic factor in limited stage thymic epithelial tumors: a multicenter analysis”.
The ITMIG Rosai Award for Best Poster Presentation:
Margaret Ottaviano, Rare Tumours Reference Center, University Federico II of Naples, Italy for “Cetuximab in pre-treated thymic epithelial tumors: a monocentric real life experience in selected population”.
The Barbara Niebauer Award for Best Paper on Thymic Carcinoma:
Jumpei Kashima, Tokyo Metropolitan Cancer & Infectious Diseases Center Komagome Hospital, Japan for “CD70 in thymic carcinoma: a promising diagnostic marker”.
In addition, seven Travel Awards were granted to trainees or fellows from a variety of nations to assist in enabling them to present at ITMIG 2019.
Abstracts of the invited lecturers and the oral presentations are available in Mediastinum 2018; 2:AB001-AB028.
No words can describe the hospitality of our Korean hosts, who organized the meeting. The Gala Dinner celebrating their 50th Anniversary will be something we will remember for many years. It was impressive, touching and entertaining all at the same time.
ITMIG 2019 will be held in Toronto from October 10-12. Dr. Conrad Falkson will be chairing and hosting the meeting.
Joint ITMIG/Astro Session by Andreas Rimner
On Monday, October 22, 2018, the first joint ITMIG/ASTRO session took place at the Annual Meeting of the American Society for Radiation Oncology in San Antonio, Texas. This multidisciplinary education session on the increasing role of radiation therapy and multidisciplinary management of thymic malignancies highlighted recent advances in the staging, WHO classification, surgical, oncologic and radiotherapeutic management of thymic malignancies. Dr. Robert Korst, current president of ITMIG, set the stage by discussing surgical advances and clinical staging of thymic tumors. Dr. Alexander Marx from the University of Mannheim provided new insights into the new pathological staging system, WHO classification and molecular profiles of thymic malignancies. Dr. Arun Rajan from the NCI reviewed the current systemic treatment options, including standard chemotherapies and novel targeted agents as well as the promise and challenges of immunotherapy. Dr. Andreas Rimner moderated the session and gave an overview of the currently available literature on the role of postoperative radiation therapy. Dr. Charles Simone completed the talks by demonstrating the value of proton therapy for thymic tumors. To finish the session, an engaged audience provided a spirited discussion. Feedback was uniformly positive with many audience members requesting that this session be repeated at future ASTRO meetings.
Education Committee by Edith Marom
Since our last newsletter the Education Committee has made progress in several domains. Education modules were placed on ITMIG’s website in the field of medical oncology, neurology, pathology, radiation oncology and thoracic surgery. They can be found online at: itmig.org/education-and-research/education-modules/. ITMIG’s Standards and Definitions were translated to Italian.
For the Mediastinal Working Group, spearheaded by Dr. Anja Roden, statistical work is still ongoing in the Mediastinal Compartment Project. The Thoracic Surgery Video Project, spearheaded by Dr. Vincent Fang, is ongoing at full speed. These projects will result in educational videos and discussions centered around surgical approach and technique.
In April and June we had two interesting Tumor Board conferences calls. A live tumor board was held during our Annual Conference in Seoul. As a reminder, these are multidisciplinary working tumor boards. Cases are submitted from clinicians around the world faced with any clinical question. The multidisciplinary team is formed from experts in thymic malignancies who are ITMIG members in the fields of thoracic surgery, medical oncology, radiation oncology, pathology and diagnostic radiology. Cases are submitted ahead of time for review and displayed online for the viewing and participation of all attendees, as diagnostic imaging and pathology slides are reviewed, followed by management and follow-up recommendations. This service is provided free of charge for the requesting clinician. Please contact Pam Bruce at email@example.com for further instructions on how to submit a Tumor Board case and arrange for an ITMIG multidisciplinary tumor board.
ITMIG will hold an online fundraising drive at the end of this year to coincide with the ITMIG WebEx events. Email and Facebook will be used to publicize this drive. The new link for this giving event will be emailed to members ASAP.
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