Page 177 - Hospital Authority Convention 2017

Masterclasses
Masterclasses

M13.1 Respiratory Medicine 13:15 Room 221

Is Advanced Lung Cancer Becoming a Chronic Disease?
Ho J
Department of Medicine, The University of Hong Kong, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
Lung cancer, mostly non-small cell lung cancer (NSCLC), has been the top cancer killer in Hong Kong over the past two
decades. The majority of patients with lung cancer present late with metastatic disease that does not allow curative surgical
treatment. Recent advances in lung cancer therapeutics (especially for NSCLC) have enabled advanced lung cancer patients
to survive much longer with preserved quality of life. Traditionally, systemic chemotherapy carries prohibitory side effects
that do not allow prolonged administration beyond four to five months. At the turn of the millennium, newer generation
chemotherapy emerged with better efficacy and adverse effects profile, thus allowing continued administration (maintenance
chemotherapy) even for years. Discovery of targeted therapies is undoubtedly a major breakthrough in treatment of
advanced NSCLC in the past decade. A growing list of potential targets for specific anticancer treatments is now evident
that would facilitate personalised choice of the most effective therapeutic options. It is now the standard of care to look
for potentially actionable targets, e.g. epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase
(ALK) rearrangement, at diagnosis of advanced NSCLC. There are now three generations of EGFR or ALK targeted therapies
clinically available, which can help to overcome the hurdles with acquired drug resistance. In recent two to three years,
immunotherapy has emerged as a novel anticancer approach especially in lung cancer. The mechanism of reactivating the
endogenous immune system against lung cancer cells carries the advantage of sustained anticancer effects, resulting in
prolonged survival in a selected subgroup of lung cancer patients. With the rapidly expanding armamentaria of lung cancer
therapeutics and practice of precision medicine, it is now a common scenario to see advanced lung cancer patients coming
for clinic follow-up for years, similar to patients with many other chronic diseases.

M13.2 Respiratory Medicine 13:15 Room 221

Health Risks of Obstructive Sleep Apnea
Ip MSM
Department of Medicine, The University of Hong Kong, Hong Kong

What is obstructive sleep apnoea (OSA) and why does it cause health risks:
Obstructive sleep apnoea refers to the occurrence of recurrent episodes of functional obstruction of the upper airway during
sleep. These obstructive episodes cause intermittent hypoxaemia (despite normal lungs) and sleep fragmentation. Further
downstream, systemic sequelae of neurohumeral activation, oxidative stress and inflammation may occur.
Situation in Hong Kong:
Data in early 2000s showed that about 8% of men and 4% of women had OSA, while at least half of them were symptomatic. Wednesday, 17 May
Ethnic craniofacial morphology may contribute to the occurrence of OSA despite our lower levels of obesity.

Health risks:
Neurocognitive impairment
Excessive daytime sleepiness is a cardinal symptom of OSA, though it does not correlate tightly with the severity of OSA.
Untreated OSA with daytime sleepiness in drivers may lead to traffic accidents. Neurocognitive impairment, irritability and
impaired quality of life have been noted.
Cardiovascular and cerebrovascular diseases
There is consistent evidence for an adverse effect of moderate/severe OSA on blood pressure, and OSA is now included in
the list of “secondary” causes of hypertension. Treatment of OSA should always be considered in the armamentarium of anti-
hypertensive therapy as it carries health benefits beyond lowering of blood pressure.

Clinically, independent associations have been repeatedly reported between OSA and stroke, congestive heart failure, and
atrial fibrillation, but a definitive conclusion cannot be drawn due to limitations in the available data .

Insulin resistance and diabetes mellitus
Mounting evidence suggests that OSA may have, independent of obesity, adverse effect on insulin resistance and glucose
metabolism. Nonetheless, such adverse effects may pale beside that conferred by lifestyle habits of diet or physical exercise.
Several longitudinal cohort studies show that OSA is associated with incident diabetes, but treatment of OSA has not been
consistently demonstrated to improve glycaemic status.
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