Abstract 23: Will novel systemic treatments alter the benefit of lung cancer screening?: A microsimulation study

Abstract Background: The U.S. Preventive Services Task Force has recently updated its 2013 lung cancer screening guidelines with low-dose computed tomography. In the last decade, population level mortality for advanced non-small cell lung cancer fell significantly due to the novel targeted and immunotherapy-based treatments. Moreover, with detection of new molecular targets, these therapies are expected to become the ultimate curative options. However, how these treatments might impact the benefits of lung cancer screening is unknown. Methods: We utilize a computer microsimulation modeling framework to screen the U.S. population aged 50 to 80 who had a 20 pack-year smoking history and currently smoked or had quit within the past 15 years under both standard treatments (chemotherapy and radiotherapy) and novel treatments (immunotherapy and targeted therapy) settings. The corresponding mortality reductions associated with the stage shift via low-dose computed screening are projected for each setting. Results: Over 25 years, risk-targeted screening saves 243 lives per 20,000 under standard therapies (12% mortality reduction) and 99 per 20,000 under fully adopted novel therapies (6% mortality reduction). Under standard treatment, 1.28 cancers are over-diagnosed per life saved; under fully adopted novel therapies, this increases to 3.46. Over 25 years the number needed to screen to avert one death is 82 under standard treatment and 202 under fully adopted novel therapies. Conclusions: Ongoing transition from chemotherapy and radiotherapy to novel immunotherapies and targeted therapies may reduce the expected lives saved by low-dose computed tomography screening. Screening recommendations might need to be reconsidered as novel treatments become widespread. Citation Format: Kemal Caglar Gogebakan, Jane Lange, Christopher Slatore, Ruth Etzioni. Will novel systemic treatments alter the benefit of lung cancer screening?: A microsimulation study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 23.