non-small-cell lung cancer Quimioterapia adjuvante para câncer de pulmão não pequenas

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "non-small-cell lung cancer Quimioterapia adjuvante para câncer de pulmão não pequenas"

Transcription

1 Adjuvant chemotherapy for non-small-cell lung cancer Quimioterapia adjuvante para câncer de pulmão não pequenas células Daniel B. Costa, MD, PhD, MMSc Division i i of Hematology/Oncology l Beth Israel Deaconess Medical Center Harvard Medical School

2 Disclosure slide Consulting fees from: -Pfizer -Roche -AstraZeneca

3 Major types of primary lung cancers Neuro-endocrine tumors (carcinoid) < 5 % Non-small cell lung cancers (NSCLC) 80% Small cell lung cancer (SCLC) 15 %

4 Etiology of non-small cell lung cancer (NSCLC) Smoking - Nicotine-based cigarettes carry carcinogens such as benzo[a]pyrene and nitrosamine Asbestos Radon Radiation therapy - Genetic predisposition - _ genes related to smoking addiction and effects of nicotine (CHRNA3( and CHRNA5) _variants at 13q31.3 alter the expression of GPC5, and are associated with susceptibility to lung cancer in never smokers _ genes related to the metabolism of carcinogens (GST) _ genes related with cellular differentiation and suppression of malignant transformation

5 Major histologies in NSCLC squamous cell carcinoma adenocarcinoma

6 1. Adjuvant systemic cisplatin-based chemotherapy in completely l resected stages IB- IIIA non-small cell lung cancer 2. Novel approaches to improve upon adjuvant chemotherapy - biomarkers for patient and chemotherapy selection - VEGF-targeted (angiogenesis) therapies (registration trial by ECOG: E1505) - selection of specific patients/tumors that can be targeted with novel therapies (EGFR TKIs and ALK TKIs)

7 Staging system (TNM) for NSCLC non-small-cell lung cancer (NSCLC) lung cancer in the 1980s and 1990s: all NSCLCs are the all NSCLCs are the same

8 Staging system (TNM) and survival: NSCLC Stage 5yr survival yr survival IA 61% >75-80% IB 38% 64% IIA 34% IIB 24% 39% IIIA 13% 26% IIIB 5% <10% IV 1% <3% Adapted from Mountain, CF, Chest 1997; 11:1710 and Pisters KMW, J Clin Oncol 2008.

9 Staging system (TNM) for NSCLC and evidencebased therapeutic decisions

10 Standard-of-care therapies by stage for NSCLC Stage I: lobectomy (surgery) radiotherapy (non-surgical cases) Stage II: lobectomy (surgery) + adjuvant cisplatindoublet (chemotherapy) Stage III: concurrent cisplatin-doublet i (chemotherapy) + radiotherapy (XRT) or adjuvant chemotherapy Stage IV: palliative therapy. 1 st line cis or carboplatin- doublet; 2 nd -3 rd line docetaxel (chemo), pemetrexed (chemo), erlotinib (EGFR TKI), crizotinib (ALK TKI)

11 Role of post-operative (adjuvant) cytotoxic chemotherapy for NSCLC: historical perspective (1) - From the 1950s to 1990s, surgery alone was the standard treatment for patients with stage I-IIIA non-small cell lung cancer (NSCLC); - Lack of surgical resection, even in stage I NSCLC, pertained a poor prognosis. Long term survival of non-treated stage I patients was below 10% at 5 years; - However, even with complete surgical resection the 5-year survival rates of stage IB to IIIA NSCLC continued to be disappointing; To improve survival clinicians examined the use of -To improve survival, clinicians examined the use of chemotherapy and radiation in the pre and post-operative setting

12 Role of post-operative (adjuvant) cytotoxic chemotherapy for NSCLC: C historical perspective e (2) Adjuvant chemotherapy in other completely resected solid malignancies Type of cancer 5-Year Survival 5-Year Survival (surgery plus (node positive) (surgery alone) adjuvant chemotherapy) Breast cancer ~ 60-70% ~ 75-80% Colon cancer ~ 55-65% ~ 75-80%

13 Role of post-operative (adjuvant) cytotoxic chemotherapy for NSCLC: historical perspective (3) - First trials of f adjuvant chemotherapy started in 1970s; - First trials of cisplatin-based adjuvant chemotherapy in the 1980s; - Small trials (<150 patients), poor design, flawed staging, number of patients too small to detect benefit; - In 1995, meta-analysis of 52 small randomized trials showed a possible 5% benefit at 5 years for cisplatin-based chemotherapy after complete surgical resection of stages IB-IIIA NSCLC; Renewed interest in the role of adjuvant chemotherapy in the 1990s - Renewed interest in the role of adjuvant chemotherapy in the 1990s and 2000s

14 Systemic chemotherapy for stage IV NSCLC ECOG 1594 (defined standard of care in late 1990s/early 2000s) chemotherapy combinations ECOG1594 (2002) - response rate (RR) 17-23% - progression-free survival (PFS) 3.5 mths - median overall survival (OS) 8 mths Schiller JH., et al. N Engl J Med Jan 10;346(2):92-8.

15 Role of post-operative (adjuvant) cytotoxic chemotherapy for NSCLC: historical perspective (4) Late 1990s and early 2000s: Four (4) large randomized d trials comparing placebo vs platinum-based chemotherapy in resected stages IB to IIIA NSCLC were launched in the late 1990s and early 2000s Trials: IALT (Europe), ANITA (Europe), JBR.10 (Canada-USA), CALGB 9623 (USA) Best studied chemotherapy doublet: cisplatin/vinorelbine

16 Role of post-operative (adjuvant) cytotoxic chemotherapy for NSCLC: IALT trial results (2004; resected stages I-III) - Chemotherapy associated with higher survival rate than observation (44.5% vs. 40.4% 4% at 5 years); HR 0.86 (95% CI, ; P<0.03) Adapted from The International Adjuvant Lung Cancer Trial Collaborative Group N Engl J Med 2004; 350:

17 Role of post-operative (adjuvant) cytotoxic chemotherapy for NSCLC: JBR.10 trial results (2005; resected stages IB-II) chemotherapy: 50 mg/m2 of cisplatin on days 1 and 8 every 4 weeks for 4 cycles and 25 mg/m2 of vinorelbine weekly for 16 weeks - 5-year survival rates were: 69% for cisplatin/ vinorelbine 54% for observation, (p=0.03) Adapted from Winton et al. N Engl J Med 2005; 352:2589.

18 Role of post-operative (adjuvant) cytotoxic chemotherapy for NSCLC: CALBG9633 trial results (2006; resected stage IB 6 th TNM) chemotherapy: carboplatin 6 AUC and paclitaxel 200 mg/m2 D1 21-day cycle x 4 T 4cm T < 4cm Adapted from Strauss et al. JCO November 1, 2008 vol. 26 no

19 Summary of key trials of adjuvant platinum-based chemotherapy vs placebo in completely resected NSCLC: all favor chemotherapy for stages II and IIIA Ti Trial Stages Overall benefit Stage IB Stage II Stage IIIA (hazard ratio) IALT I-III 0.86 (0.76 to 0.95 (0.74 to 0.93 (0.72 to 0.79 (0.66 to ,867pts 0.98) 1.23) 120) 1.20) 0.95) JBR ANITA 2006 CALBG IB-IIA 482pts IB-IIIA 829pts IB 344pts 0.69 (0.52 to 0.91) 0.80 (0.66 to 0.96) 0.80 (0.60 to 1.07) 0.79 (0.77 to 1.95) 1.10 (0.76 to 1.57) 0.80 (0.60 to 1.07) 0.59 (0.42 to 0.85) 0.71 (0.49 to 1.03) 0.69 (0.53 to 0.90) LACE meta- I-IIIA IIIA 0.89(0.82 to analysis 4,584pts 0.96) 0.93 (0.78 to 1.10) 083(073t 0.83 (0.73 to 083(073t 0.83 (0.73 to 0.95) 0.95) Adapted from Pignon et al. JCO July 20, 2008 vol. 26 no

20 Summary of key trials of adjuvant platinum-based chemotherapy vs placebo in completely resected NSCLC: Lung Adjuvant Cisplatin Evaluation (LACE) Adapted from Pignon et al. JCO July 20, 2008 vol. 26 no

21 Decision Aid Tool for Resected Stage II NSCLC

22

23 2007 Recommendations for Adjuvant Treatment of Stages I-IIIA IIIA NSCLC: Adjuvant Radiotherapy Stages IA/B and IIA/B: Adjuvant radiation is not recommended. Stage IIIA: Adjuvant radiation therapy is not recommended for routine use because of the lack of prospective, randomized clinical trial data evaluating its efficacy. A clinical trial is underway to determine the advisability of its routine use. Recommendations apply only to completely resected tumors.

24 Post-operative (adjuvant) cytotoxic chemotherapy for NSCLC: choice of chemotherapy use of f modern platinum-doublet t schemes Cisplatin D1/Vinorelbine D1, D8 of 21 day cycle X 4 (adenocarcinoma/squamous cell carcinoma) side-effects: Nausea and vomiting (20-30%) Neutropenia (70%), neutropenic fever and severe infection Neuropathy (10%), nephrotoxicity (5%), hair loss uncommon (<10%) Cisplatin D1/Gemcitabine D1, D8 of 21 day cycle X 4 (adenocarcinoma/squamous cell carcinoma) side-effects: Nausea and vomiting (20-30%) Neutropenia (50%), thrombocytopenia (40%), Rash (15%) Neuropathy (10%), nephrotoxicity (5%), hair loss uncommon (<20%) Cisplatin D1/Docetaxel D1 of 21 day cycle X 4 (adenocarcinoma/squamous cell carcinoma) side-effects: Nausea and vomiting (20-30%) Neutropenia (70%), anemia (40%), myalgias (20%) Neuropathy (20%), nephrotoxicity (5%), hair loss common (>99%) Cisplatin D1/Pemetrexed D1 of 21 day cycle X 4 (adenocarcinoma) side-effects: Nausea and vomiting (20-30%) Neutropenia (10%), anemia (20%) Neuropathy (10%), nephrotoxicity (5%), hair loss uncommon (<5%)

25 How to provide adjuvant platinum-based chemotherapy for resected NSCLC: (proposed flow chart from Harvard-affiliated hospitals) NSCLC (complete surgical resection - R0) 7 th TNM stage: Stage IA/IB < 4cm post-operative surveillance (consider clinical trial) * consider carboplatin when cisplatin contraindicated Stage IB > 4cm offer platinum-based* chemotherapy Stage II Stage IIIA -adenocarcinoma: cisplatin/pemetrexed p -squamous cell carcinoma: cisplatin/vinorelbine cisplatin/gemcitabine cisplatin/docetaxel + (consider clinical trial)

26 1. Adjuvant systemic cisplatin-based chemotherapy in completely l resected stages IB- IIIA non-small cell lung cancer 2. Novel approaches to improve upon adjuvant chemotherapy - biomarkers for patient and chemotherapy selection - VEGF-targeted (angiogenesis) therapies (registration trial by ECOG: E1505) - selection of specific patients/tumors that can be targeted with novel therapies (EGFR TKIs and ALK TKIs)

27 Potential predictive biomarkers for cytotoxic chemotherapies approved for NSCLC (ongoing clinical studies) chemotherapy mechanism of action tumor biomarker cisplatin docetaxel DNA crosslink anti-mitotic microtubule ERCC1, BRCA1 BRCA1 gemcitabine anti-metabolite pyrimidine idi analog RRM1 anti-metabolite TS Gazdar A. N Engl J Med. 2007;356(8):771-3 pemetrexed multi-target (thymidilate Besse B. et al. J Clin Oncol 2013 folate antagonist synthase) Rossel R. et al. PLoS One. 2009;4(5):e5133

28 IALT- ERCC1 as a predictive and prognostic marker IALT-Bio (designed d to examine tumor markers within the main study) ERCC1 IHC is not reproducible (no clinical use for IHC to select patients) Adapted from Olaussen et al. N Engl J Med Sep Adapted from Friboulet et al. N Engl J Med;368:

29 Potential predictive biomarkers for cytotoxic chemotherapies for NSCLC using mrna expression profiles (ongoing clinical studies)

30 Rationale for targeting VEGF in adjuvant studies of NSCLC ECOG 4599 (approved bevacizumab in 2005 for advanced non-squamous histology) - Monoclonal antibody against VEGF. Bevacizumab (Avastin ) -- recombinant humanized monoclonal Ab (human IgG1 + antigen-binding from a murine Ab) -- Bevacizumab may enhance chemotherapeutic options due to normalization of tumor vasculature -- Bevacizumab improves outcomes in stage IV colon cancer, NSCLC and renal cell carcinoma chemotherapy + bevacizumab vs - RR 35% - PFS 6.2 mths - OS 12 mths chemotherapy - RR 15% ECOG 4599 (2005) - PFS 4.5 mths - OS 10.3 mths Sandler A. et al. N Engl J Med Dec 14;355(24):

31 Does bevacizumab add to the survival advantage of standard adjuvant chemotherapy in resected NSCLC? ECOG 1505 cisplatin-based chemotherapy x 4 Resected NSCLC (cisplatin-gemcitabine) any histology (cisplatin-docetaxel) t l) 6thTNM (cisplatin-vinorelbine) stage IB (> 4cm) (cisplatin-pemetrexed) pemetrexed) stage II (N1 nodes) stage IIIA (N2 nodes) cisplatin-based chemotherapy Randomized phase III trial x 4 target: 1500 pts + primary end-point: overall bevacizumab b 15 mg/kg q 3wks survival up to 1 year (awaiting results)

32 Does immunotherapy (MAGE-A3 vaccine) improve outcomes of adjuvant therapy in NSCLC? MAGRIT phase III clinical trial The large Phase III study involving more than lung cancer patients found that the experimental therapy did not help The large Phase III study, involving more than 2,000 lung cancer patients, found that the experimental therapy did not help patients live longer without their disease recurring.

33 Lung adenocarcinomas in 2014: a disease of oncogenes (EGFR, KRAS mutations; ALK and ROS1 translocations) EGFR mutations (~15%) ROS1 translocations (~6%) other/ unknown other/unknown KRAS mutations (~25%) ALK translocations ti (~20%) EGFR mutations (~50%) ALK translocations ROS1 (~5%) translocations (~2%) KRAS All lung adenocarcinomas Never smokers with lung adenocarcinomas

34 KRAS mutations: are not clinically-useful as a predictive or prognostic marker in the adjuvant setting Goldberg et al Lancet Oncology 2013 Jan;14(1):3-5. Cuffe et al J Thor Oncol 2012 Jun;7(6):963

35 Epidermal growth factor receptor (EGFR) pathway in epithelial malignancies: EGFR tyrosine kinase inhibitors (TKIs) in clinical practice gefitinib AstraZeneca erlotinib OSI Pharmaceuticals Genentech - Roche Side-effect profile in humans: 1) Skin rash ~50-80% pts 2) Diarrhea ~ 20-50% pts 3) Anorexia ~ 10-15% pts 4) Interstitial Lung Disease <1-5% Ciardiello F, et al. N Engl J Med 2008; 358:

36 EGFR TKIs as first line therapy for EGFR mutated NSCLC: Gefitinib (NEJ 002) and erlotinib (EURTAC) vs chemotherapy N-lobe exon 19 deletions T790 C-helix G719 P-loop exon 20 insertions L858 L861 NEJ 002 erlotinib l ti ib activation loop C-lobe Adapted from Yasuda, Kobayashi, Costa DB. Lancet Oncology 2012; 13(1):e23-31 EURT TAC Maemondo M., et al. N Engl J Med Jun 24;362(25): Rossel R., et al. Lancet Oncol Mar;13(3):

37 Ongoing clinical trials for use of EGFR TKIs (gefitinib and erlotinib) for EGFR L858R or exon 19 deletions mutated NSCLCs as adjuvant chemotherapy ASCO 2014 Presentation: Median follow-up of 3y 2y-DFS from enrollment is 90% (97% stage 1, 73% stage 2, 92% stage 3). 24 pts have recurred, only 2 during erlotinib treatment and the others after stopping erlotinib ib (median time to recurrence 11.7m after stopping erlotinib). 46% of recurrences were at a single site, 17% CNS only. 63% (n=15) of recurring pts underwent repeat biopsy, with only 1 pt having T790M detected. 71% (n=17) of recurrent pts were retreated t with erlotinib ibwith 75% still on erlotinib (range 2-42+m). ASt Study of fel Erlotinib ib(t (Tarceva) After Surgery With or Without t Adjuvant Chemotherapy in Non-Small Cell Lung Carcinoma (NSCLC) Patients Who Have Epidermal Growth Factor Receptor (EGFR) Positive Tumors (RADIANT) Phase III trial (n>1000), , 2013 expect results soon ( ) 2015)

38 Retrospective studies for use of EGFR TKIs (gefitinib and erlotinib) for EGFR L858R or exon 19 deletions mutated NSCLCs as adjuvant chemotherapy (data is inconclusive) Janjigian et al J Thor Oncol 2011 Mar;6(3):569

39 How to provide adjuvant platinum-based chemotherapy for resected NSCLC: (proposed flow chart from Harvard-affiliated hospitals) NSCLC (complete surgical resection - R0) 7 th TNM stage: Stage IA/IB < 4cm post-operative surveillance (consider clinical trial) * consider carboplatin when cisplatin contraindicated Stage IB > 4cm offer platinum-based* chemotherapy Stage II Stage IIIA (in 2014: role of tumor markers are unclear) -adenocarcinoma: cisplatin/pemetrexed p -squamous cell carcinoma: cisplatin/vinorelbine cisplatin/gemcitabine cisplatin/docetaxel + (consider clinical trial)

Maintenance therapy in in Metastatic NSCLC. Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai

Maintenance therapy in in Metastatic NSCLC. Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai Maintenance therapy in in Metastatic NSCLC Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai Definition of Maintenance therapy The U.S. National Cancer Institute s

More information

New Trends & Current Research in the Treatment of Lung Cancer, Pt. II

New Trends & Current Research in the Treatment of Lung Cancer, Pt. II New Trends & Current esearch in the Treatment of Lung Cancer, Pt. II Howard (Jack) West, MD President & CEO, GACE Medical Director, Thoracic Oncology Program Swedish Cancer Institute Seattle, WA Cancer

More information

Adjuvant Therapy Non Small Cell Lung Cancer. Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015

Adjuvant Therapy Non Small Cell Lung Cancer. Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015 Adjuvant Therapy Non Small Cell Lung Cancer Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015 No Disclosures Number of studies Studies Per Month 12 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3

More information

Non-Small Cell Lung Cancer

Non-Small Cell Lung Cancer Non-Small Cell Lung Cancer in East tasia Chia-Chi (Josh) Lin, MD, PhD 林 家 齊 Director of Phase I Center, e Department of Oncology, National Taiwan University Hospital Clinical Associate Professor, Department

More information

Treatment Paradigm in NSCLC Treatment

Treatment Paradigm in NSCLC Treatment Treatment Paradigm in NSCLC Treatment Era of Targeted Therapy Aumkhae Sookprasert, MD Medicine Department, KKU Which factors taken to be account in NSCLC treatment? 1. Staging 2. ECOG performance status

More information

Harmesh Naik, MD. Hope Cancer Clinic HOW DO I MANAGE STAGE 4 NSCLC IN 2012: STATE OF THE ART

Harmesh Naik, MD. Hope Cancer Clinic HOW DO I MANAGE STAGE 4 NSCLC IN 2012: STATE OF THE ART Harmesh Naik, MD. Hope Cancer Clinic HOW DO I MANAGE STAGE 4 NSCLC IN 2012: STATE OF THE ART Goals Discuss treatment options for stage 4 lung cancer: New and old Discuss new developments in personalized

More information

REPORT ASCO 2002 ORLANDO : LUNG CANCER Johan F. Vansteenkiste, MD, PhD, Univ. Hospital and Leuven Lung Cancer Group

REPORT ASCO 2002 ORLANDO : LUNG CANCER Johan F. Vansteenkiste, MD, PhD, Univ. Hospital and Leuven Lung Cancer Group REPORT ASCO 2002 ORLANDO : LUNG CANCER Johan F. Vansteenkiste, MD, PhD, Univ. Hospital and Leuven Lung Cancer Group In the 2002 edition of the ASCO meeting, a total of 315 abstracts in the field of respiratory

More information

REPORT ASCO 2011 CHICAG0 : RESPIRATORY ONCOLOGY Johan Vansteenkiste / Christophe Dooms, Univ. Hospital Leuven and Leuven Lung Cancer Group

REPORT ASCO 2011 CHICAG0 : RESPIRATORY ONCOLOGY Johan Vansteenkiste / Christophe Dooms, Univ. Hospital Leuven and Leuven Lung Cancer Group 1 REPORT ASCO 2011 CHICAG0 : RESPIRATORY ONCOLOGY Johan Vansteenkiste / Christophe Dooms, Univ. Hospital Leuven and Leuven Lung Cancer Group 10 MESSAGE HIGHLIGHTS Early stage non-small cell lung cancer

More information

Pharmacogenomic Approaches. Luis Paz-Ares Hospital Universitario Virgen del Rocio Seville, Spain

Pharmacogenomic Approaches. Luis Paz-Ares Hospital Universitario Virgen del Rocio Seville, Spain Pharmacogenomic Approaches Luis Paz-Ares Hospital Universitario Virgen del Rocio Seville, Spain Pharmacogenetics & Pharmacogenomics Medicine tailored to the individual Genetic information, including the

More information

ALCHEMIST (Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials)

ALCHEMIST (Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials) ALCHEMIST (Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials) 3 Integrated Trials Testing Targeted Therapy in Early Stage Lung Cancer Part of NCI s Precision Medicine Effort in

More information

Management of stage III A-B of NSCLC. Hamed ALHusaini Medical Oncologist

Management of stage III A-B of NSCLC. Hamed ALHusaini Medical Oncologist Management of stage III A-B of NSCLC Hamed ALHusaini Medical Oncologist Global incidence, CA cancer J Clin 2011;61:69-90 Stage III NSCLC Includes heterogeneous group of patients with differences in the

More information

Targeted Therapy What the Surgeon Needs to Know

Targeted Therapy What the Surgeon Needs to Know Targeted Therapy What the Surgeon Needs to Know AATS Focus in Thoracic Surgery 2014 David R. Jones, M.D. Professor & Chief, Thoracic Surgery Memorial Sloan Kettering Cancer Center I have no disclosures

More information

Sur les nouveaux médicaments et les perspectives qu ils offrent (traitement à la carte et survie longue)

Sur les nouveaux médicaments et les perspectives qu ils offrent (traitement à la carte et survie longue) Sur les nouveaux médicaments et les perspectives qu ils offrent (traitement à la carte et survie longue) Professeur Jean Trédaniel Unité de cancérologie thoracique Hôpital Saint-Louis Comparison of Four

More information

SYSTEMIC THERAPY FOR STAGE IV NON-SMALL CELL LUNG CANCER: AMERICAN SOCIETY OF CLINICAL ONCOLOGY CLINICAL PRACTICE GUIDELINE UPDATE

SYSTEMIC THERAPY FOR STAGE IV NON-SMALL CELL LUNG CANCER: AMERICAN SOCIETY OF CLINICAL ONCOLOGY CLINICAL PRACTICE GUIDELINE UPDATE Which patients with stage IV NSCLC should be treated with chemotherapy? NSCLC with nonsquamous cell carcinoma, negative or unknown EGFR-sensitizing mutation and ALK gene rearrangement status, and PS 0-1

More information

SAKK Lung Cancer Group. Current activities and future projects

SAKK Lung Cancer Group. Current activities and future projects SAKK Lung Cancer Group Current activities and future projects SAKK Lung Cancer Group Open group of physicians interested in lung cancer Mostly Medical Oncologists, but also Thoracic Surgeons Radiation

More information

NCCN Non-Small Cell Lung Cancer V.1.2011 Update Meeting 07/09/10

NCCN Non-Small Cell Lung Cancer V.1.2011 Update Meeting 07/09/10 Guideline Page and Request NSCL-3 Stage IA, margins positive delete the recommendation for chemoradiation. Stage IB, IIA, margins positive delete the recommendation for chemoradiation + Stage IIA, Stage

More information

Lung Cancer: More than meets the eye

Lung Cancer: More than meets the eye Lung Cancer Education Program November 23, 2013 Lung Cancer: More than meets the eye Shantanu Banerji MD, FRCPC Presenter Disclosure Faculty: Shantanu Banerji Relationships with commercial interests: Grants/Research

More information

Adjuvant Chemotherapy of Non-Small Cell Lung Cancer

Adjuvant Chemotherapy of Non-Small Cell Lung Cancer Review Article 2012 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran ISSN: 1735-0344 Tanaffos 2012; 11 (1): 12-17 TANAFFOS Adjuvant Chemotherapy of Non-Small Cell Lung Cancer

More information

Successes and Limitations of Targeted Cancer Therapy in Lung Cancer

Successes and Limitations of Targeted Cancer Therapy in Lung Cancer Successes and Limitations of Targeted Cancer Therapy in Lung Cancer Kenichi Suda a, b Tetsuya Mitsudomi a a Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama,

More information

Lung Cancer and Mesothelioma

Lung Cancer and Mesothelioma Lung Cancer and Mesothelioma Robert Kratzke, M.D. John C. Skoglund Professor of Lung Cancer Research Section of Heme/Onc/Transplant Department of Medicine University of Minnesota Medical School Malignant

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Molecular Analysis for Targeted Therapy for Non-Small Cell Lung File Name: Origination: Last CAP Review: Next CAP Review: Last Review: molecular_analysis_for_targeted_therapy_for_non_small_cell_lung_cancer

More information

Non Small Cell Lung Cancer: Scientific Discoveries and the Pursuit of Progress

Non Small Cell Lung Cancer: Scientific Discoveries and the Pursuit of Progress Non Small Cell Lung Cancer: Scientific Discoveries and the Pursuit of Progress Lung Cancer Accounts for 14% of All New Cancer Diagnoses in the United States 1 Lung cancer is the second most common malignancy

More information

Overview of Ovarian Cancer. Dr. Sinead Noonan 13/03/2012

Overview of Ovarian Cancer. Dr. Sinead Noonan 13/03/2012 Overview of Ovarian Cancer Dr. Sinead Noonan 13/03/2012 Ovarian Cancer 4 th most common cause of cancer death in women 15,000 deaths/year in the US Each year 300 new cases in Ireland 80% epithelial cell

More information

REPORT PERSPECTIVES IN LUNG CANCER 2010 AMSTERDAM

REPORT PERSPECTIVES IN LUNG CANCER 2010 AMSTERDAM REPORT PERSPECTIVES IN LUNG CANCER 2010 AMSTERDAM Valerie Van Damme, Isabelle Wauters, Johan Vansteenkiste Univ. Hospital Leuven and Leuven Lung Cancer Group Introduction Perspectives in Lung Cancer (PILC)

More information

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost Effectiveness

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost Effectiveness Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost Effectiveness Investigators: Paul G. Shekelle, MD, PhD, Director Alicia R. Maher, MD Clinical

More information

Summary ID# 13095. Clinical Study Summary: Study H3E-EW-B012

Summary ID# 13095. Clinical Study Summary: Study H3E-EW-B012 Page 1 Summary ID# 13095 Clinical Study Summary: Study H3E-EW-B012 First-line Treatment of Non-Small Cell Lung Cancer under Routine Conditions: Observational Study on Overall Survival Date summary electronically

More information

( targeted therapy ) ( oncogenesis ) ( epidermal. growth factor receptor tyrosine kinase inhibitor EGFR-TKI ) ( epidermal growth

( targeted therapy ) ( oncogenesis ) ( epidermal. growth factor receptor tyrosine kinase inhibitor EGFR-TKI ) ( epidermal growth 2008 19 8-13 growth factor receptor tyrosine kinase inhibitor EGFR-TKI ) ( targeted therapy ) ( oncogenesis ) ( epidermal factor receptor monoclonal antibody EGFR-moAb ) growth factor monoclonal antibody

More information

Targeted therapies and brain metastases in lung cancer patients. Benjamin Besse, MD, PhD. Medical Oncologist. 19 septembre 2014

Targeted therapies and brain metastases in lung cancer patients. Benjamin Besse, MD, PhD. Medical Oncologist. 19 septembre 2014 Targeted therapies and brain metastases in lung cancer patients Benjamin Besse, MD, PhD Medical Oncologist 19 septembre 2014 Targeted therapies and brain mets! Brain mets in NSCLC! Specific targeted therapies!

More information

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness Department of Veterans Affairs Health Services Research & Development Service Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness

More information

Advancing Personalized Therapy for Advanced Non-Small Cell Lung Cancer

Advancing Personalized Therapy for Advanced Non-Small Cell Lung Cancer GUIDING THE WAY White Paper Advancing Personalized Therapy for Advanced Non-Small Cell Lung Cancer is a serum proteomic test for patients with advanced non-small cell lung cancer that helps healthcare

More information

Developments in Biomarker Identification and Validation for Lung Cancer

Developments in Biomarker Identification and Validation for Lung Cancer Developments in Biomarker Identification and Validation for Lung Cancer Alexandre Passioukov, MD, PhD Alexandre.Passioukov@eortc.be Contents Introduction Lung cancer pathogenesis NSCLC treatment options

More information

Non-Small Cell Lung Cancer

Non-Small Cell Lung Cancer Non-Small Cell Lung Cancer John delcharco, MD (Statistics based on CVMC data 2009-2013) Statistics Lung cancer is the leading cause of cancer deaths in the United States. The American Cancer Society estimates

More information

Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non-Small Cell Lung Cancer Guideline

Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non-Small Cell Lung Cancer Guideline Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non-Small Cell Lung Cancer Guideline Cancer Care Ontario and American Society of Clinical Oncology Introduction The Cancer

More information

Adjuvant Chemotherapy After Complete Resection of Non-Small Cell Lung Cancer

Adjuvant Chemotherapy After Complete Resection of Non-Small Cell Lung Cancer REVIEW ARTICLE Adjuvant Chemotherapy After Complete Resection of Non-Small Cell Lung Cancer Eckart Laack, Carsten Bokemeyer, Dieter Kurt Hossfeld SUMMARY Introduction: In non-small cell lung cancer (NSCLC)

More information

Pharmacogenomic markers in EGFR-targeted therapy of lung cancer

Pharmacogenomic markers in EGFR-targeted therapy of lung cancer Pharmacogenomic markers in EGFR-targeted therapy of lung cancer Rafal Dziadziuszko, MD, PhD University of Colorado Cancer Center, Aurora, CO, USA Medical University of Gdansk, Poland EMEA Workshop on Biomarkers,

More information

National Clinical Trials Network Groups Update Fall 2014

National Clinical Trials Network Groups Update Fall 2014 National Clinical Trials Network Groups Update Fall 2014 Walter J Curran, Jr, MD An NRG Oncology Group Chair Executive Director Winship Cancer Institute of Emory University Atlanta, GA NCTN Groups Update

More information

Medication Policy Manual. Topic: Alimta, pemetrexed Date of Origin: May 12, 2010

Medication Policy Manual. Topic: Alimta, pemetrexed Date of Origin: May 12, 2010 Medication Policy Manual Policy No: dru213 Topic: Alimta, pemetrexed Date of Origin: May 12, 2010 Committee Approval Date: February 17, 2015 Next Review Date: February 2016 Effective Date: March 1, 2015

More information

Câncer de Pulmão. Benefício e emprego das novas drogas. XIV Congresso da Sociedade Brasileira de Radioterapia

Câncer de Pulmão. Benefício e emprego das novas drogas. XIV Congresso da Sociedade Brasileira de Radioterapia + Câncer de Pulmão Benefício e emprego das novas drogas XIV Congresso da Sociedade Brasileira de Radioterapia Maikol Kurahashi, MD. Oncologia Clínica Hospital Santa Casa de Curitiba Declaração de conflitos

More information

National Horizon Scanning Centre. Vandetanib (Zactima) for advanced or metastatic non-small cell lung cancer. December 2007

National Horizon Scanning Centre. Vandetanib (Zactima) for advanced or metastatic non-small cell lung cancer. December 2007 Vandetanib (Zactima) for advanced or metastatic non-small cell lung cancer December 2007 This technology summary is based on information available at the time of research and a limited literature search.

More information

Lung cancer is the leading cause of cancer-related death in the United

Lung cancer is the leading cause of cancer-related death in the United Evolving Treatment Paradigms in Non-Small Cell Lung Cancer MARGARET E. M. VAN METER, MD Medical Oncology Fellow Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston,

More information

Emerging Drug List GEFITINIB

Emerging Drug List GEFITINIB Generic (Trade Name): Manufacturer: Gefitinib (Iressa ) formerly referred to as ZD1839 AstraZeneca NO. 52 JANUARY 2004 Indication: Current Regulatory Status: Description: Current Treatment: Cost: Evidence:

More information

Evolving Treatment Paradigms in Non-Small Cell Lung Cancer

Evolving Treatment Paradigms in Non-Small Cell Lung Cancer PRINTER-FRIENDLY VERSION AT PHARMACYPRACTICE NEWS.COM Evolving Treatment Paradigms in Non-Small Cell Lung Cancer CALEB T. CHU, MD, MPH Postdoctoral Fellow Department of Thoracic/Head and Neck Medical Oncology

More information

Lung Cancer: New Biological Insights and Recent Therapeutic Advances

Lung Cancer: New Biological Insights and Recent Therapeutic Advances CA CANCER J CLIN 2011;61:91 112 Lung Cancer: New Biological Insights and Recent Therapeutic Advances Suresh S. Ramalingam, MD 1 ; Taofeek K. Owonikoko, MD, PhD 2 ; Fadlo R. Khuri, MD 3 Abstract Approximately

More information

Chapter 7: Lung Cancer

Chapter 7: Lung Cancer Chapter 7: Lung Cancer Contents Chapter 7: Lung Cancer... 1 Small Cell... 2 Good PS + Limited stage... 2 Cisplatin/etoposide... 2 Concurrent chemotherapy + XRT... 2 Good / Intermediate PS... 2 Carboplatin

More information

Future Directions in Clinical Research. Karen Kelly, MD Associate Director for Clinical Research UC Davis Cancer Center

Future Directions in Clinical Research. Karen Kelly, MD Associate Director for Clinical Research UC Davis Cancer Center Future Directions in Clinical Research Karen Kelly, MD Associate Director for Clinical Research UC Davis Cancer Center Outline 1. Status of Cancer Treatment 2. Overview of Clinical Research at UCDCC 3.

More information

Medical Policy Manual. Date of Origin: August 2010. Topic: Molecular Analysis for Targeted Therapy of Non- Small Cell Lung Cancer (NSCLC)

Medical Policy Manual. Date of Origin: August 2010. Topic: Molecular Analysis for Targeted Therapy of Non- Small Cell Lung Cancer (NSCLC) Medical Policy Manual Topic: Molecular Analysis for Targeted Therapy of Non- Small Cell Lung Cancer (NSCLC) Section: Genetic Testing Policy No: 56 Date of Origin: August 2010 Last Reviewed Date: December

More information

Systemic Therapy for Stage IV Non-Small Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

Systemic Therapy for Stage IV Non-Small Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update Systemic Therapy for Stage IV Non-Small Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update Introduction The purpose of this guideline update is to revise the 2011

More information

Systemic and Targeted Therapies for Early-Stage Lung Cancer

Systemic and Targeted Therapies for Early-Stage Lung Cancer Incorporation of molecular markers and targeted therapy in the treatment of advanced non small-cell lung cancer has improved outcomes and may be beneficial in the adjuvant treatment of this disease. Dorothy

More information

NON-SMALL CELL LUNG CANCER STAGE IV

NON-SMALL CELL LUNG CANCER STAGE IV NON-SMALL CELL LUNG CANCER STAGE IV Effective Date: November, 2013 The recommendations contained in this guideline are a consensus of the Alberta Provincial Thoracic Tumour Team synthesis of currently

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: PS Inj - Alimta Therapeutic Class: Antineoplastic Agents Therapeutic Sub-Class: Antifolates Client: PS Inj Approval Date: 8/2/2004 Revision Date: 12/5/2006 I. BENEFIT

More information

Shifting the Paradigm for Maintenance Therapy for Non small-cell Lung Cancer

Shifting the Paradigm for Maintenance Therapy for Non small-cell Lung Cancer J Hong Kong Col Radiol. 2010;13(Suppl):S16-21 ORIGINAL ARTICLE Shifting the Paradigm for Maintenance Therapy for Non small-cell Lung Cancer VHF Lee Department of Clinical Oncology, Queen Mary Hospital,

More information

Treatment for Lung Cancer: Drug Therapy

Treatment for Lung Cancer: Drug Therapy Treatment for Lung Cancer: Drug Therapy Living in the Molecular Age: Advances Drug Therapy of Lung Cancer John C. Morris, M.D. Division of Hematology-Oncology November 1, 2014 Non-small cell lung cancer:

More information

Published Ahead of Print on April 11, 2011 as 10.1200/JCO.2010.31.8923. J Clin Oncol 29. 2011 by American Society of Clinical Oncology

Published Ahead of Print on April 11, 2011 as 10.1200/JCO.2010.31.8923. J Clin Oncol 29. 2011 by American Society of Clinical Oncology Published Ahead of Print on April 11, 2011 as 10.1200/JCO.2010.31.8923 The latest version is at http://jco.ascopubs.org/cgi/doi/10.1200/jco.2010.31.8923 JOURNAL OF CLINICAL ONCOLOGY A S C O S P E C I A

More information

CANCER PULMON: ESTADIOS INICIALES POSTMUNDIAL PULMON DENVER 2015. 8-10-2015.Manuel Cobo Dols S. Oncología Médica HU Málaga Regional y VV

CANCER PULMON: ESTADIOS INICIALES POSTMUNDIAL PULMON DENVER 2015. 8-10-2015.Manuel Cobo Dols S. Oncología Médica HU Málaga Regional y VV CANCER PULMON: ESTADIOS INICIALES POSTMUNDIAL PULMON DENVER 2015 8-10-2015.Manuel Cobo Dols S. Oncología Médica HU Málaga Regional y VV Meta-analisis LACE: adyuvancia vs no adyuvancia Pignon JP, et al.

More information

SEARCH METHODOLOGY SEARCH STRATEGY #1 (SYSTEMATIC REVIEWS): PubMed 1966-3/16/2012 Cochrane Database of Systematic Reviews All years

SEARCH METHODOLOGY SEARCH STRATEGY #1 (SYSTEMATIC REVIEWS): PubMed 1966-3/16/2012 Cochrane Database of Systematic Reviews All years Appendix A. Search Strategy for Systematic Reviews and Cost-Effectiveness Analyses (Search #1) TREATMENT OF METASTATIC NON-SMALL-CELL LUNG CANCER SEARCH METHODOLOGY SEARCH STRATEGY #1 (SYSTEMATIC REVIEWS):

More information

Non-small cell lung cancer, advanced or metastatic, switch-therapy after gemcitabine/carboplatin

Non-small cell lung cancer, advanced or metastatic, switch-therapy after gemcitabine/carboplatin COMPENDIA TRANSPARENCY TRACKING FORM DRUG: Docetaxel INDICATION: Non-small cell lung cancer, advanced or metastatic, switch-therapy after gemcitabine/carboplatin COMPENDIA TRANSPARENCY REQUIREMENTS 1 Provide

More information

Current Progress for Non-Small Cell Lung Cancer Treatment

Current Progress for Non-Small Cell Lung Cancer Treatment Chemotherapy : Mechanisms of Action Current Progress for Non-Small Cell Lung Cancer Treatment Topo inhibitors Alkylators CHR Tubulin active agents Topo I,II Pt Wen-Pin Su, M.D./ Prof. Wu-Chou Su National

More information

Lung Cancer Research: From Prevention to Cure!

Lung Cancer Research: From Prevention to Cure! Lung Cancer Research: From Prevention to Cure! Ravi Salgia, M.D, Ph.D Associate Professor of Medicine Director, Thoracic Oncology Research Program Department of Medicine Section of Hematology/Oncology

More information

NON-SMALL CELL LUNG CANCER

NON-SMALL CELL LUNG CANCER NON-SMALL CELL LUNG CANCER Executive Summary In 2012, an estimated 1.8 million people were diagnosed with lung cancer resulting in 1.6 million deaths (http://globocan.iarc.fr/pages/fact_sheets_cancer.aspx).

More information

POLICY A. INDICATIONS

POLICY A. INDICATIONS Alimta (pemetrexed) Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage Original Effective Date: 09/01/2007 Current Effective Date: 10/01/2015 POLICY A. INDICATIONS The indications below

More information

EGFR gene mutations Ex 19 Ex 21 Paez et al, Science 2004

EGFR gene mutations Ex 19 Ex 21 Paez et al, Science 2004 Evolution of knowledge in NSCLC Pao and Girard, Lancet Oncology 2011 Fattori da considerare nella scelta terapeutica del NSCLC nel 2012 Stadio di malattia PS Età Comorbidità Compliance e desiderio del

More information

Non-small Cell Lung Cancer

Non-small Cell Lung Cancer Non-small Cell Lung Cancer Eva Szabo, MD Division of Cancer Prevention, NCI TRACO 11-2-15 Outline US Lung Cancer Statistics Tobacco use and lung cancer Risk Factors Tobacco, tobacco, tobacco (85% lung

More information

cure toadvances in Lung Cancer A Patient s Guide

cure toadvances in Lung Cancer A Patient s Guide A Patient s Guide toadvances in Lung Cancer The Biology of Lung Cancer New Methods for Detection The Latest Treatment Options Questions to Ask Your Doctor Resources cure C ancer U pdates, R esearch & E

More information

Proposal for Tyrosine Kinase Inhibitors for Non Small Cell Lung Cancer

Proposal for Tyrosine Kinase Inhibitors for Non Small Cell Lung Cancer 31 May 2012 Proposal for Tyrosine Kinase Inhibitors for Non Small Cell Lung Cancer PHARMAC is seeking feedback on a proposal to: fund gefitinib (Iressa) as a first line treatment for patients with locally

More information

Prognostic and Predictive Factors in Oncology. Mustafa Benekli, M.D.

Prognostic and Predictive Factors in Oncology. Mustafa Benekli, M.D. Prognostic and Predictive Factors in Oncology Mustafa Benekli, M.D. NCI Definitions ESMO Course -Essentials of Medical Oncology -Istanbul 2 Prognostic factor: NCI Definition A situation or condition, or

More information

targeted therapy a guide for the patient

targeted therapy a guide for the patient targeted therapy FOR LUNG CANCER a guide for the patient TABLE OF CONTENTS lung cancer basics... 2-3 Gene changes... 4-5 Testing... 7-8 Targeted therapy... 9-11 Drugs Targeting EGFR... 12 Drugs Targeting

More information

Thorakale Onkologie. ASCO 2013 Aktuelle Studien TZ Berlin Buch 12.6.2013

Thorakale Onkologie. ASCO 2013 Aktuelle Studien TZ Berlin Buch 12.6.2013 Triple negativ Thorakale Onkologie ASCO 2013 Aktuelle Studien TZ Berlin Buch 12.6.2013 Driver Oncogene Mutations in non sq-nsclc Genome Res. 2012 November; 22(11): 2109 2119 8021: Detection of EGFR-activating

More information

Understanding series. new. directions. 1-800-298-2436 LungCancerAlliance.org. A guide for the patient

Understanding series. new. directions. 1-800-298-2436 LungCancerAlliance.org. A guide for the patient Understanding series LUNG CANCER: new treatment directions 1-800-298-2436 LungCancerAlliance.org A guide for the patient TABLE OF CONTENTS What s New in lung cancer? Advancements...4 Changes in genes that

More information

Activity of pemetrexed in thoracic malignancies

Activity of pemetrexed in thoracic malignancies Activity of pemetrexed in thoracic malignancies Results of phase III clinical studies of pemetrexed in malignant pleural mesothelioma and non-small cell lung cancer show benefit P emetrexed (Alimta) is

More information

Is the third-line chemotherapy feasible for non-small cell lung cancer? A retrospective study

Is the third-line chemotherapy feasible for non-small cell lung cancer? A retrospective study Turkish Journal of Cancer Volume 34, No.1, 2004 19 Is the third-line chemotherapy feasible for non-small cell lung cancer? A retrospective study MUSTAFA ÖZDO AN, MUSTAFA SAMUR, HAKAN BOZCUK, ERKAN ÇOBAN,

More information

Elderly Patients with Advanced Non-Small Cell Lung Cancer: What Treatment?

Elderly Patients with Advanced Non-Small Cell Lung Cancer: What Treatment? 4 The Open Lung Cancer Journal, 2011, 4, 4-9 Open Access Elderly Patients with Advanced Non-Small Cell Lung Cancer: What Treatment? Antonio Rossi * Division of Medical Oncology, S.G. Moscati Hospital,

More information

Personalizing Treatment for NSCLC

Personalizing Treatment for NSCLC Educational Objectives At the conclusion of this activity, participants should be able to demonstrate the ability to: Review strategies for molecular evaluation of NSCLC Discuss formulation of treatment

More information

KRAS Mutation Analysis in Non-Small Cell Lung Cancer (NSCLC) Original Policy Date

KRAS Mutation Analysis in Non-Small Cell Lung Cancer (NSCLC) Original Policy Date MP 2.04.43 KRAS Mutation Analysis in Non-Small Cell Lung Cancer (NSCLC) Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013

More information

Name of Policy: Molecular Analysis for Targeted Therapy of Non-Small-Cell Lung Cancer (NSCLC)

Name of Policy: Molecular Analysis for Targeted Therapy of Non-Small-Cell Lung Cancer (NSCLC) Name of Policy: Molecular Analysis for Targeted Therapy of Non-Small-Cell Lung Cancer (NSCLC) Policy #: 468 Latest Review Date: October 2015 Category: Laboratory Policy Grade: B Background/Definitions:

More information

Dr Peter Briggs Medical Oncologist. Lung Cancer & Mesothelioma: is it worth treating?

Dr Peter Briggs Medical Oncologist. Lung Cancer & Mesothelioma: is it worth treating? Dr Peter Briggs Medical Oncologist Lung Cancer & Mesothelioma: is it worth treating? GOALS OF CANCER THERAPY CURE Good chance Medium chance Low chance PALLIATION Life prolonging Symptomatic improvement

More information

Treatment of Stage IV Non-small Cell Lung Cancer

Treatment of Stage IV Non-small Cell Lung Cancer CHEST Supplement DIAGNOSIS AND MANAGEMENT OF LUNG CANCER, 3RD ED: ACCP GUIDELINES Treatment of Stage IV Non-small Cell Lung Cancer Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest

More information

Pancreatic Cancer: FDA Approved Treatments and Clinical Trials

Pancreatic Cancer: FDA Approved Treatments and Clinical Trials Pancreatic Cancer: FDA Approved Treatments and Clinical Trials Vincent J Picozzi MD MMM Virginia Mason Medical Center Seattle WA 1 Pancreatic cancer is the hardest cancer of all to treat 2 Pancreatic cancer:

More information

Avastin: Glossary of key terms

Avastin: Glossary of key terms Avastin: Glossary of key terms Adenocarcinoma Adenoma Adjuvant therapy Angiogenesis Anti-angiogenics Antibody Antigen Avastin (bevacizumab) Benign A form of carcinoma that originates in glandular tissue.

More information

Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer

Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer Dan Vogl Lay Abstract Early stage non-small cell lung cancer can be cured

More information

GENETIC PROFILES AND TARGETED TREATMENT OF CANCER - PERSONALIZED MEDICINE

GENETIC PROFILES AND TARGETED TREATMENT OF CANCER - PERSONALIZED MEDICINE GENETIC PROFILES AND TARGETED TREATMENT OF CANCER - PERSONALIZED MEDICINE Branko Zakotnik MD, PhD Department of Medical Oncology Institute of Oncology Ljubljana 1 I have no conflict of interest to declare

More information

Pulmonary and Critical Care Regional Symposium April 25, 2015

Pulmonary and Critical Care Regional Symposium April 25, 2015 Pulmonary and Critical Care Regional Symposium April 25, 2015 2015: Molecular Medicine, Resistance Mutations and Immunotherapy. Keeping Up With The Latest in NSCLC Barbara J. Gitlitz MD Associate Professor

More information

Chemotherapy in Advanced Non-Small Cell Lung Cancer: Optimal Treatment Approach for Elderly and Patients With Poor Performance Status

Chemotherapy in Advanced Non-Small Cell Lung Cancer: Optimal Treatment Approach for Elderly and Patients With Poor Performance Status Chemotherapy in Advanced Non-Small Cell Lung Cancer: Optimal Treatment Approach for Elderly and Patients With Poor Performance Status Tracey L. Evans, MD Abstract In spite of advances in molecular profiling

More information

PARP Inhibitors in Lung Cancer. Primo N. Lara, Jr., MD Professor of Medicine UC Davis Comprehensive Cancer Center

PARP Inhibitors in Lung Cancer. Primo N. Lara, Jr., MD Professor of Medicine UC Davis Comprehensive Cancer Center PARP Inhibitors in Lung Cancer Primo N. Lara, Jr., MD Professor of Medicine UC Davis Comprehensive Cancer Center Poly (ADP-ribose) Polymerase (PARP): Mechanism of Action PARPs: family of enzymes that repair

More information

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER BY Ali Shamseddine, MD (Coordinator); as04@aub.edu.lb Fady Geara, MD Bassem Shabb, MD Ghassan Jamaleddine, MD CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT

More information

Third-line or fourth-line chemotherapy in non-small-cell lung cancer patients with relatively good performance status

Third-line or fourth-line chemotherapy in non-small-cell lung cancer patients with relatively good performance status Available online at www.sciencedirect.com Journal of the Chinese Medical Association 74 (2011) 209e214 Original Article Third-line or fourth-line chemotherapy in non-small-cell lung cancer patients with

More information

Lung Cancer Treatment: What should we expect from the specialists?

Lung Cancer Treatment: What should we expect from the specialists? Lung Cancer Treatment: What should we expect from the specialists? Peter Baik, DO Thoracic Surgery Cancer Treatment Centers of America Oklahoma Osteopathic Association 2015 Summer CME Seminar Financial

More information

DECISION AID SET. STAGE IV Non-Small Cell Lung Cancer (NSCLC)

DECISION AID SET. STAGE IV Non-Small Cell Lung Cancer (NSCLC) DECISION AID SET STAGE IV Non-Small Cell Lung Cancer (NSCLC) Dear Clinician: This set of DECISION AIDS is based on ASCO s Clinical Practice Guideline Update on Chemotherapy for Stage IV NSCLC (2009). ASCO

More information

Adjuvant cisplatin-based chemotherapy in non-small-cell lung cancer: new insights into

Adjuvant cisplatin-based chemotherapy in non-small-cell lung cancer: new insights into Annals of Oncology Advance Access published September 5, 2014 1 Adjuvant cisplatin-based chemotherapy in non-small-cell lung cancer: new insights into the effect on failure type via a multistate approach

More information

Genomic Medicine The Future of Cancer Care. Shayma Master Kazmi, M.D. Medical Oncology/Hematology Cancer Treatment Centers of America

Genomic Medicine The Future of Cancer Care. Shayma Master Kazmi, M.D. Medical Oncology/Hematology Cancer Treatment Centers of America Genomic Medicine The Future of Cancer Care Shayma Master Kazmi, M.D. Medical Oncology/Hematology Cancer Treatment Centers of America Personalized Medicine Personalized health care is a broad term for interventions

More information

Lung Cancer. Advances in Lung Cancer Treatment

Lung Cancer. Advances in Lung Cancer Treatment Lung Cancer Advances in Lung Cancer Treatment Treatment for lung cancer is changing rapidly. There are new therapies that target specific molecular changes that drive the growth and spread of the lung

More information

Cetuximab (Erbitux) MM.04.005 05/10/2005. HMO; PPO; QUEST Integration 01/01/2015 Section: Prescription Drugs Place(s) of Service: Office: Outpatient

Cetuximab (Erbitux) MM.04.005 05/10/2005. HMO; PPO; QUEST Integration 01/01/2015 Section: Prescription Drugs Place(s) of Service: Office: Outpatient Cetuximab (Erbitux) Policy Number: Original Effective Date: MM.04.005 05/10/2005 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 01/01/2015 Section: Prescription Drugs Place(s)

More information

Lung cancer. What is lung cancer?

Lung cancer. What is lung cancer? Lung cancer What is lung cancer? Lung cancer affects cells in an area of your lung. It usually starts in the lining of the main air tubes called the bronchi and bronchioles (see graphic below). A cancer

More information

Corporate Presentation June 2, 2015

Corporate Presentation June 2, 2015 Corporate Presentation June 2, 2015 SAFE HARBOR STATEMENT This presentation contains forward-looking statements. Although the Company believes its expectations are based on reasonable assumptions, these

More information

Targeted agents in lung cancer: EGFR TKI and beyond

Targeted agents in lung cancer: EGFR TKI and beyond Targeted agents in lung cancer: EGFR TKI and beyond David CL Lam, MBBS, PhD, MD, FCCP, FACP, FRCP, FAPSR Clinical Assistant Professor Department of Medicine University of Hong Kong 13 Nov, 2014 The Changing

More information

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY Original Issue Date (Created): 9/1/2011 Most Recent Review Date (Revised): 1/27/2015 Effective Date: 11/2/2015 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS

More information

Malignant Mesothelioma State of the Art

Malignant Mesothelioma State of the Art Malignant Mesothelioma State of the Art Paul Baas The Netherlands Cancer Institute August 12, 2011, Carlsbad, CA Summary Diagnosis; epithelial type subdivided Pleiomorphic vs other Staging: IASLC-IMIG

More information

SMALL. 1-800-298-2436 LungCancerAlliance.org

SMALL. 1-800-298-2436 LungCancerAlliance.org UNDERSTANDING Non- SMALL CELL LUNG CANCER 1-800-298-2436 LungCancerAlliance.org A guide for the patient I ANATOMY OF THE LUNGS The following image shows different parts that make up the lungs. Please use

More information

To Treat or Not to Treat: When Is Adjuvant EGFR TKI Therapy Appropriate?

To Treat or Not to Treat: When Is Adjuvant EGFR TKI Therapy Appropriate? To Treat or Not to Treat: When Is Adjuvant EGFR TKI Therapy Appropriate? Ramsey Asmar, MD, and Balazs Halmos, MD Abstract The use of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI)

More information

Epithelial Ovarian Cancer

Epithelial Ovarian Cancer Epithelial Ovarian Cancer Fred Ueland, MD University of Kentucky Gynecologic Oncology Epithelial Ovarian Cancer Radiotherapy Ovarian Cancer Radiotherapy Ovarian cancer is usually radiosensitive Whole abdominal

More information

Mesothelioma. Malignant Pleural Mesothelioma

Mesothelioma. Malignant Pleural Mesothelioma Mesothelioma William G. Richards, PhD Brigham and Women s Hospital Malignant Pleural Mesothelioma 2,000-3,000 cases per year (USA) Increasing incidence Asbestos (50-80%, decreasing) 30-40 year latency

More information