An update in Mesothelioma and Thymoma Management

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1 An update in Mesothelioma and Thymoma Management ASCO 2014 update Khalid Alsaleh King Saud University FRCPC, FACP, MSc

2 Mesothelioma

3 Outline

4 Outline Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

5 Mesothelioma Treatment Algorithm Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

6 P/D v. EPP: Less Surgery May Be Better Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

7 Evaluation of Mesothelioma in a Phase III Study of ALIMTA with CISplatin: 3 Month Survival Advantage Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

8 Rare Responses with 2nd Line Chemotherapy Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

9 Outline Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

10 Three Common Somatic Aberrations in Mesothelioma: CDKN2A, NF2, BAP1 Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

11 Outline Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

12 Partial List of Ongoing Clinical Trials Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

13 mtor/pi3k Signaling Pathway Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

14 Response to Dual PI3K/mTOR Inhibition with GDC0980 Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

15 FAK Inhibition Effective with Merlin Loss Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

16 Randomized Phase II Study of Defactinib Maintenance (ASCO #TPS7611) Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

17 CTLA-4 Therapy in Mesothelioma Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

18 Ongoing Randomized Phase II Tremelimumab Trial Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

19 Mesothelin as a Therapeutic Target Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

20 CRS-207 Stimulates Cellular Immunity to Mesothelin (ASCO #7532) Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

21 Response to Anti-Mesothelin Immunotoxin SS1P and Immune Suppression Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

22 Conclusions/Future Directions Presented By Marjorie Zauderer at 2014 ASCO Annual Meeting

23 Thymoma

24 Outline/Learning Objectives<br />

25 Thymic Epithelial Tumors

26 Thymomas - General Characteristics

27 Incidence

28 The incidence of Thymic Malignancy is increasing

29 PubMed Literature Search Thymoma<br />January 1989-December 2009 (n=1991 papers)

30 ITMIG

31 International Thymic Malignancies Interest Group (ITMIG) Mission

32 ITMIG Membership

33 ITMIG Status

34 Slide 14

35 Slide 15

36 ITMIG Retrospective Data-Map

37 Slide 17

38 Slide 18

39 Slide 19

40 Slide 20

41 Staging

42 Slide 22

43 Prognostic Value of Masaoka Stage

44 Prognostic Value of Masoaka Stage

45 ITMIG-IASLC Stage Classification Project

46 ITMIG-IASLC Stage Classification Proposal

47 ITMIG Node Map

48 Histological Classification

49 Slide 30

50 WHO 2004 histological classification of TETs

51 WHO classification: survival implications

52 Histologic Classification

53 Molecular Biology

54 Slide 35

55 Slide 36

56 Genetic Alterations

57 Slide 38

58 Gene Signatures

59 Slide 40

60 Slide 41

61 Gene signatures

62 Treatment

63 Thymoma - 5-year survival

64 Treatment - Early Stage Thymic Malignancy

65 Treatment - Locally Advanced

66 Slide 47

67 Thymoma - surgery

68 Five year Survival: Stage III/IV

69 Slide 50

70 Thymoma - radiotherapy

71 Slide 52

72 Prospective Chemotherapy Trials

73 Treatment

74 Thymic Malignancies Treatment Summary

75 Challenges in research

76 Targeted Therapies

77 Genetic Abnormalities in Thymic Malignancies

78 Targeted therapies in Thymic Malignancies

79 Sunitinib in TETs: Best response to treatment

80 Custom Trial

81 Slide 62

82 Slide 63

83 Epigenetic Gene mutations in TC

84 Slide 65

85 Conclusions

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