December
 2014
 









Volume
 4, 
Issue
 2


IN
 MEMORIAM: 
PROFESSOR
 AKIRA 
MASAOKA
 by
 M.
Okumura

 

Dr. Akira Masaoka

I regret to inform ITMIG members that Dr. Akira Masaoka passed away on November 2, 2014.

Dr. Masaoka was born in Osaka City in 1930. He graduated from Osaka University in 1954, and began his career as a surgeon in the Department of Surgery chaired by Professor Yoshio Ozawa at Osaka University Hospital. During this time, Dr. Masaoka became engaged in clinical and research activities associated with thymic diseases. He found extrathymic rests of thymic tissue in the mediastinum, which led to the establishment of the trans-sternal extended thymectomy approach as a treatment option for myasthenia gravis.

Another significant accomplishment was the proposal of a clinico-pathologic staging system for thymic tumors that depends on local tumor invasion and distant spread to the pleura, lymph nodes and distant organs. This staging system was globally adopted and remained the standard for over 30 years.

Dr. Masaoka moved from Osaka University to Nagoya City University as Professor in 1980. He established the Japanese Association for Research of the Thymus (JART) in 1982 and chaired the first annual conference. He also contributed to the establishment of the Japanese Association of Chest Surgery (JACS) and served as the President of the JACS second annual conference in 1985. The Japanese Society of General Thoracic Surgery will forever recognize Dr. Masaoka’s accomplishments.

After his Professorship at Nagoya City University, Dr. Masaoka returned to Osaka as the Principal of Osaka Chuo Hospital in 1996 and retired in 2002. In addition to his clinical accomplishments, Dr. Masaoka was a talented musician. He was an excellent pianist, as well as composer. He composed several operas and performed in recitals after his retirement.

Note from Frank Detterbeck and Bob Korst: Everyone in ITMIG and the thymic community owes much of the progress that has been made to Dr. Masaoka. We join in mourning his loss.

 

 

ITMIG 
LEADERSHIP 
CHANGES
 by B. Korst

 

2014 marks the year the ITMIG leadership changes, voted on in 2013-2014 by the membership, were implemented. Several officers as well as councilors (voting members of the Steering Committee)
“turned over” after the Antwerp meeting in September. The new officers are: Bob Korst as President (replacing Frank Detterbeck); Anja Roden as Vice President (replacing Nicolas Girard); Pier Luigi Filosso as Secretary (replacing Enrico Ruffini) and Faiz Bhora as Treasurer (replacing Jim Huang). Incoming councilors include Vincent Fang (replacing Dan Gomez) and Norihiko Ikeda (replacing Jun Nakajima). Councilors elected to a second term include Heather Wakelee and Mirella Marino. Frank Detterbeck remains on the Steering Committee as Immediate Past President, as well as Pam Bruce as the ITMIG Executive Director.


 

Bob Korst

Bob Korst, President

Anja Roden

Anja 
Roden,
 Vice
President

Pier Luigi Filosso

Pier
 Luigi 
Filosso, 
Secretary

Faiz Bhora

Faiz 
Bhora, 
Treasurer


 

 

2014 
ANNUAL 
MEETING
 by
 F. 
Detterbeck


 

Frank
 Detterbeck


The 2014 Annual ITMIG meeting was held in Antwerp, Belgium on September 5th and 6th with a series of workshops and committee meetings taking place on Sept 4th. The meeting featured 16 oral abstracts and 38 posters, as well as updates on ongoing and completed ITMIG activities. The first day featured stimulating sessions on the immunology of thymic cancers as well as a “European session” jointly sponsored by the European Society of Thoracic Surgeons (ESTS) and the European Association for Cardiothoracic Surgery (EACTS). This latter session focused on a debate among surgical approaches to thymic resection (open, VATS or Robotic). The 2nd day was marked by sessions on neurology, multimodality therapy and innovative lectures on tumor growth kinetics and how cancer mirrors aspects of stem cell differentiation. Finally Meinoshin Okumura delivered a fascinating lecture on the history of thymic surgery. ITMIG was happy to welcome the participation throughout the meeting of an increasing number of industry sponsors (Medela, Myriad Genetics, Eli Lilly, Biomet, Celgene, Carefusion, Covidien, Kimberly-Clark, Scanlon, Storz and Thoramet). Several awards were given: ITMIG Masaoka Award for the best oral paper- Sukhmani Kaur Padda; ITMIG Rosai Award for the best poster presentation- Johan Coolen; ITMIG Barbara Neibauer Award- Andreas Rimner. Travel awards went to: Manoj Kumar Behera, India- 500 Euro; Sukhmani Kaur Padda, USA- 200 Euro; Giovanni Leuzzi, Italy- 150 Euro; Ricky Vaja, UK- 150 Euro; Mkrtich Mkrtchyan, Armenia- 500 Euro.

 

 

 

 

2015
 ANNUAL 
MEETING
 by
 F.
 Detterbeck

 

Vincent 
Fang

Plans are well underway for the 2015 Annual meeting that will take place in October, 2015, in Shanghai, China. The Program Committee has been formed, and is comprised of Vincent Fang, Chair; Conrad Falkson,
 Frank Detterbeck, Anja Roden, Nicolas Girard, Pier Luigi Filosso, Sanghoon Jueon, and Nori Ikeda. The first Program Committee conference call occurred in November, 2014, when a preliminary agenda was discussed and deas for topics were entertained. The meeting will be hosted by the Shanghai Chest Hospital, one of the leading thoracic institutions in China. The date and site will be announced soon.


 

 

 

 

RESEARCH
 PUBLICATIONS
 FROM
 ITMIG
 by
 M. 
Ebright 

and
 J.
 Huang

 

The use of the International ITMIG Database as a resource for research was a major impetus for its creation and a Request for Applications (RFA) was issued in September of 2013. Many excellent submissions were received and approved.

To date, three projects have been completed and published:

  • Outcomes of Thymic Carcinoma, Ahmad, JTCVS
  • Outcomes of Neuroendocrine Tumors, Filosso, JTCVS
  • Impact of Histology, Weiss, JTO

Drs. Ahmad and Filosso presented their project results earlier this year at the Annual Meeting of the American Association for Thoracic Surgery (AATS) in Toronto.

Ongoing projects currently include an analysis of minimally invasive versus open approaches to thymectomy, led by Drs. Bryan Burt (Baylor) and Walter Scott (Fox Chase), and an analysis of postoperative radiation in resected patients, led by Drs. Daniel Gomez (MD Anderson) and Andreas Rimner (MSKCC). Each of these projects is being conducted in cooperation with our Statistical Core, spearheaded by Dr. Xiaopan Yao (Yale) with data management provided by Drs. Alberto Antonicelli and In Kyu Park. We have been extremely fortunate to have their time and assistance that they have graciously donated. Based on the success of our initial run, we hope to announce a second RFA in 2015. We look forward to more excellent proposals.

Summary of Publications:

  • Ahmad U, Yao X, Detterbeck F, Huang J, Antonicelli A, Filosso PL, Ruffini E, Travis W, Jones D, Zhan Y, Lucchi M, Rimner A. Thymic Carcinoma Outcomes and Prognosis: Results of an International Analysis. J Thorac Cardiovasc Surg. 2014 Oct 5 [Epub ahead of print]
  • Filosso PL, Yao X, Ahmad A, Zhang Y, Huang J, Ruffini E, Travis W, Lucchi M, Rimner A, Guerrera F, Detterbeck F. Outcome of Primary Neuroendocrine Tumors of the Thymus: A Joint Analysis of the International Thymic Malignancy Interest Group (ITMIG) and the European Society of Thoracic Surgeons (ESTS) Database. J Thorac Cardiovasc Surg. 2014 Sep 16 [Epub ahead of print]
  • Weis CA, Yao X, Deng Y, Detterbeck F, Marino M, Nicholson AG, Huang J, Strobel P, Antonicelli A, Marx A. The Impact of Thymoma Histotype on Prognosis in a Worldwide Database. J Thorac Oncol. 2014 October 6 [Epub ahead of print]

 

 

2ND 
JTO 
SUPPLEMENT
 by
 F.
 Detterbeck

 

A 2nd ITMIG supplement to the Journal of Thoracic Oncology was published in September, 2014. This marks another milestone for ITMIG in working to create foundations for collaboration as well as to foster better care for patients around the world. The supplement features the proposals for the first official stage classification system for the 8th edition of the AJCC/UICC stage classification manual, which are due to take effect in 2016. This is the result of a partnership between IASLC (International Association for the Study of Lung Cancer) and ITMIG, and a three year effort by the Staging and Prognostic Factors Committee. The supplement also has several articles with practical guidance on approaching patients with anterior mediastinal masses as well as review articles on particular immunologic, neurologic and genetic features of thymic malignancies.

 

 

ITMIG 
RESTRUCTURING 
by 
B. 
Korst

 

As we approach the 5th anniversary of the formation of ITMIG, it is an appropriate time to reflect on our strengths and weaknesses in order to determine if any changes should be made to our structure. Currently, ITMIG calls for four committees that report to the Steering Committee: Research/Infrastructure, Education, Communication and Finance/Development. Reporting to the R/I Committee have been the Research and Database Committees, both of which have been very active, however, the R/I Committee itself has not gained a lot of traction. In addition, the Research Committee has primarily focused on clinical trial opportunities; the Database Committee has been involved in both the database infrastructure and the completion of research projects utilizing the retrospective database. New ITMIG research interest groups have sprouted, including the Biology Group chaired by Nicolas Girard, the Thymic Carcinoma Workgroup chaired by Andreas Rimner, originally part of the Education Committee as well as the GLOBAL ASSET (Global Longitudinal Observation with Bayesian Analysis Leading to A Scientifically Structured Evolution of Treatment) project led by Frank Detterbeck. ITMIG is pioneering this innovative research approach particularly suited to a rare disease. Considering how ITMIG research has grown and taken many forms, all essentially working in isolation, it seems reasonable to coordinate these research efforts under the umbrella of the Research/Infrastructure Committee with Anja Roden as Chair, with all research reporting to the R/I Committee. This would facilitate collaboration between research groups so that everyone is kept abreast of other projects, with the R/I Committee itself making strategic decisions. These and other changes to the ITMIG organizational structure are being discussed at the Steering Committee level, but will eventually come to the entire ITMIG membership for a vote prior to implementation.

 

 

 

 

COMMITTEE 
UPDATES

 

 

 

Research 
and 
Infrastructure 
Committee


 

The R/I committee, led now by Anja Roden with continued involvement by Nicolas Girard, is undergoing reorganization as described above. This should help to coordinate and streamline the many ongoing activities, some of which are highlighted below:

 

Research Committee

Heather
 Wakelee


The Research Committee led by Heather Wakelee, continues to be actively focused on initiating clinical trial- a huge undertaking in a rare disease. The proposal for a randomized trial of adjuvant radiation continues to move along, but the complexity of trying to initiate such a trial on multiple continents with multiple clinical research organizations is a challenge. There continues to be support and enthusiasm within the Research Committee and progress towards initiating this trial. The concept, spear- headed by Joe Friedberg, of a multicenter study investigating intrapleural therapy for stage IVa thymoma is also continuing to make progress. Finally, a list of ongoing institutional clinical trials is being compiled and will be posted on the ITMIG website.

 

Research Fund

The Richard Ossey Research Fund has built up enough funds to begin investing in research projects. A decision was made to use a portion of the available money for upgrades and maintenance of the prospective database. Promoting this database represents the next quantum leap forward in developing a robust infrastructure for research in thymic disease.

 

Prospective Database

The prospective database is gradually accruing cases. This is a difficult activity in a rare disease, and requires ongoing commitment from participating centers. Without the engagement of ITMIG members this would not be possible; however, the infrastructure of ITMIG must support the ef- fort. In order to better meet this need, work has begun to update and upgrade the prospective database. A system of internal audits for completeness, integrated with a system of feedback and reminders is required. Planning has been ongoing; the actual process of creating this system has been initiated.

 

Formation of Biology Committee

Nicolas
 Girard

A key tool for progress in the science underlying thymic malignancies is a better understanding of the cellular and genetic biology of thymic diseases. ITMIG mounted a very successful drive to collect high qual- ity fresh frozen tissues from multiple sites that are undergoing DNA sequencing as part of the NIH TCGA (The Cancer Genome Atlas) pro- ject. Results of this project will not be available until later in 2015. To best continue fostering basic science research, a biology committee has been formed, led by Nicolas Girard (nicolas.girard@chu-lyon.fr). This committee is just getting underway.

 

 

Education
 Committee


 

The ITMIG Education Committee has been very active over the past year under the leadership of Edith Marom. With its primary project (the 2nd Journal of Thoracic Oncology Supplement) now completed, the Committee has begun focusing on other initiatives for 2015 and beyond.

 

Virtual Tumor Board (VTB)

A group of interested ITMIG members, led by Benny Weksler, has been assembled to begin the process of establishing a VTB for thymic tumors; the board will convene on a regular basis. Initial discussions have focused on the format of the events; e.g., prospective or retrospective cases; live or archived events; the infrastructure necessary to carry out this project such as a website with image sharing capabilities. The goals of the VTB are also under discussion. Should these be purely educational events or should we be rendering treatment advice for prospective patients. Any interested parties should contact Benny (bweksler@uthsc.edu) to get involved in the planning stage.

 

Pathology Image Library

Mirella 
Marino

The Education Committee is seeking to assemble a library of representative pathology images under the direction of Mirella Marino to be posted on the ITMIG website. The goal of this project is to provide reference images to pathologists that typically do not see many thymic tumor specimens in a given year. By providing these references, ITMIG hopes to be able to help standardize the histologic interpretation of these rare tumors. Any pathologists interested in assisting with this endeavor should contact Mirella (marino@ifo.it).

 

 

Online Case Presentations

Edith
 Marom

The Education Committee is developing discipline specific, educational modules regarding thymic tumors that will be posted on the ITMIG website. The objective is to provide modules in a case- oriented format, complete with multiple choice questions. These modules will be available in all major disciplines that are involved in the management of patients with thymic neoplasms - including thoracic surgery, diagnostic imaging, medical oncology, pathology and radiation oncology. Brandon Tieu has begun construction of the thoracic surgery modules, while Anja Roden has agreed to begin work on the pathology section. To become involved, please contact Edith Marom (edith.marom@gmail.com).

 

 

Surgical Videos

With the advent of minimally invasive techniques, the surgical approach to thymic tumors is rapidly evolving. In addition to the classical median sternotomy, thoracoscopic approaches through either hemithorax or both hemithoraces have become commonplace for smaller tumors. The cervical approach is also being used for tumor resection. In addition, many different combined approaches are being advocated by some experts. Finally, robotic technology is available to facilitate the minimally invasive surgical approach to thymic tumors which may or may not have advantages over traditional “straight stick ”thoracoscopy. Given the complexity of the technical aspects of thymic tumor resection, the Education Committee has decided to support the placement of surgical videos on the ITMIG website. These videos outlining the nuances of different approaches should be abbreviated and narrated as necessary to allow for ease in interpretation by viewers. Interested contributors should contact Edith Marom (edith.marom@gmail.com) or Vincent Fang (vwtfang@hotmail.com).

 

 

Communication
 Committee



 

The ITMIG Communication Committee chaired by Pier Luigi Filosso, has become very active since the 2014 Annual Meeting in Antwerp and has identified a number of important goals for the next year, many of which are already underway:

 

ITMIG Newsletter Editorial Committee

An integral part of the Communication Committee’s goals is to keep its members informed with up-to-date information regarding ITMIG activities. The vehicle by which this will be accom- plished is the ITMIG newsletter, or ITMIG News. A committee has been formed to facilitate the production of the newsletter on a semi-annual basis. Chaired by Michael Ebright and Bob Korst, other members include Frank Detterbeck, Nuria Novoa, and Dea Williams (one of our patient advocate members). The format of the newsletter will be standardized with contributions made by committee chairs. Dates of publication will be in June and December. ITMIG News will be sent via email to all ITMIG members and will also be posted on the ITMIG website.

 

Membership Committee Initiatives

Boris 
Sepesi


Marlies
 Keijzers

The Membership Committee is currently co- chaired by Marlies Keijzers and Boris Sepesi. The overarching goals of the Membership Com- mittee for 2015 involve increasing the number of ITMIG members that pay dues, as well as facili- tating engagement of existing and new members. Currently, less than 20% of members pay their annual dues and this represents a major source of lost revenue for ITMIG. Traditionally, ITMIG has not aggressively pursued dues payments. In 2015, as a change in policy and a first step to addressing this problem, invoices and reminders will be mailed to members to facilitate late pay- ment of dues. Online payment will also be facilitated by the new ITMIG website feature shown below- a “Pay Membership Dues” button on the front page:

 

 

 

Regional Champions

As a means to reach out to different regions around the globe, ITMIG has formed an expanding group of Regional Champions. Spearheaded by Anja Roden, the purpose of this group is to raise regional awareness of ITMIG, devise ways to work together with other regional thymoma inter- est groups, facilitate membership in ITMG and engage members from different regions to participate in ITMIG activities and data collection. An initial conference call took place in No- vember, with representatives from the United Kingdom, Turkey, Poland, Israel, Canada, France, Russia, Denmark, China, and Japan on the call. The group is open to new members and inter- ested parties should contact Anja Roden (Roden.Anja@mayo.edu).

 

Website Development

ITMIG has launched a new website! You'll find it at the same address (www.ITMIG.org) -newly designed. The new design allows for easy navigation with multiple links to ITMIG publications and associated documents. Members may log in to view and participate in “members only” activities and there is a section for patients and families. Although the site is now live, significant work is still needed to help populate the site with information and educational activities. Members with website experience are urged to contact Pam Bruce (pbruce@thymic.org) who is leading the website development team.

 

 

Finance/Development
Committee


The Finance and Development Committee is led by Faiz Bhora and has added new members for 2015. Goals for 2015 include the cultivation of existing and new industry relationships, obtaining funding for the 2015 Annual Meeting, evaluation of potential peer-reviewed funding sources and outreach and communication with past and potential future donors. In addition, the new Patient Advocates Committee led by Bob Korst and reporting to the Finance and Development Commit- tee will engage patient advocates and representatives to become more active in ITMIG activities. The Committee has monthly conference calls and has been successful in enlisting patients’ and family members’ assistance in several ITMIG activities. New members are always welcome; anyone interested should reach out to Bob Korst
(korsro@valleyhealth.com).