Tratamiento del Cáncer de Pulmón. Donde estamos ahora?

Size: px
Start display at page:

Download "Tratamiento del Cáncer de Pulmón. Donde estamos ahora?"

Transcription

1 Tratamiento del Cáncer de Pulmón Donde estamos ahora?

2 Evolución del tratamiento del CPNM avanzado Evolución del tratamiento en el CPNM -Umbral terapéutico Supervivencia Global Platinum doublet with Pemetrexed Maintenance JMEN 15,5 m Ŧ SATURN 12 m Ŧ PARAMOUNT 16,9 m* EGFR+ First line TKI 23 m EML-ALK translocation Crizotinib 20,7 m (p not significant, preliminary data) or BSC 2-4 m Platinum doublet 6-8 m Platinum doublet with 3 rd generation drug 8-10 m Platinum triplet with 3 rd generation drug and Bevacizumab m < 1970s 1980s Ŧ From randomization *From induction

3 Cáncer de Pulmón dónde estamos ahora?

4 ALIMTA, Histology and Survival Overall survival was statistically superior for cisplatin/pemetrexed versus cisplatin/gemcitabine in patients with adenocarcinoma (n = 847; 12.6 v 10.9 months, respectively) In patients with squamous cell histology, there was a significant improvement in survival with cisplatin/gemcitabine versus cisplatin/pemetrexed (n = 473; 10.8 v 9.4 months, respectively). CP, cisplatin/pemetrexed; CG, cisplatin/gemcitabine; HR, hazard ratio Scagliotti, JCO 26:3543, 2008

5 Major Themes in Therapy of Advanced NSCLC 2013: Interrelationships Among Histology, Maintenance Therapy, and Predictive Biomarkers Histology Maintenance Predictive Biomarkers Factors are interlinking and not independent

6 Overview of Predictive Analyses used in NSCLC First-line/Maintenance therapy Avastin (bevacizumab) and ALIMTA (pemetrexed) Adenocarcinoma vs Squamous Cell Carcinoma (IHC) Chemotherapy Platinum-based drugs ERCC1 (IHC or gene expression) Gemcitabine RRM1 (IHC or gene expression) ALIMTA TS (IHC or gene expression) Biologic Small molecule, EGFR-directed TKI: Tarceva and Iressa EGFR mutation (gene sequencing or allele-specific) KRAS (Molecular) ALK-directed crizotinib ALK-EML4 translocation ALK rearrangement

7 Adenocarcinoma: Incidencia de mutaciones drivers Mutation found in 54% (280/516) of tumours completely tested (CI 50-59%) Kris et al. J Clin Oncol 29: 2011 (suppl; abstr 7506)

8 Epidermoid NSCLC

9 Li T et al. JCO 2013;31: Evolution of non small-cell lung cancer (NSCLC) subtyping from histologic to molecular based.

10 Potential Druggable Molecular Targets? AKT1 NRAS MEK1 MET AMP HER2 PIK3CA 2% BRAF 2% Double Mutants 3% Lung Cancer Molecular Consortium Lung Adenocarcinomas No Mutation Detected EML4-ALK 7% EGFR 17% KRAS 22% Mutations found in 54% (280/516) Emerging Druggable Targets in NSCLC-Squamous Subtype Gene Event Type Frequency, % FGFR1 Amplification FGFR2 Mutation 5 PIK3CA Mutation 9 PTEN Mutation deletion 18 CCND1 Amplification 8 CDKN2A Deletion/mutation 45 PDGFRA Amplification mutation 9 EGFR Amplification 10 MCL1 Amplification 10 BRAF Mutation 3 DDR2 Mutation 4 ERBB2 Amplification 2 Kris MG, et al. ASCO CRA7506. Johnson BE, et al. IASLC WCLC Abstract O16.01 Hammerman P, et al. IASLC WCLC Abstract PRS.1

11 Cuántos Genes Mut-Driver existen? Vogelstein B et al. Science 2013 Aunque se han estudiado genes que codifican proteínas de 3284 tumores con un total de mutaciones solo 125 genes son mut driver, de estos 71 son supresores de tumores y 54 oncogenes

12 Cuántos Genes están sutilmente mutados en un Cáncer Humano típico? Vogelstein B et al. Science 2013

13 Major Themes in Therapy of Advanced NSCLC 2012: Interrelationships Among Histology, Maintenance Therapy, and Predictive Biomarkers Histology Maintenance Therapy Predictive Biomarkers Looking Forward to 2015: Moving From Empiric to Individualized From One Size Fits All to Tailored and Individualized Therapy

14

15 2. BIOPSIA PACIENTE 1 Localización de las biopsias y regiones extraídas a partir de la nefrectomía y metastasectomía. G indica el grado de tumor. Análisis de 9 regiones diferentes de un tumor de riñón, incluidas tres metástasis Secuenciación de todo el ADN de cada zona, además de comprobar alteraciones en el número y forma de los cromosomas.

16

17 Secuencia terapéutica

18 NCCN Guidelines Update for NSCLC Non-Small Cell Lung Cancer NCCN Guidelines recommend that molecular diagnostic studies be included in the pathologic evaluation of NSCLC. Histologic type should be established before EGRF testing EGFR mutation testing should be performed on adenocarcinoma, large cell carcinoma, and NSCLC not otherwise specified Testing is not recommended for squamous cell carcinoma, which has a mutation rate of ~3.6% KRAS mutations are associated with intrinsic TKI resistance, and KRAS testing should be used for the selection of patients as candidates for TKI therapy EGFR mutations are generally exclusive of ALK rearrangements; ALK testing should not be considered for those who test positive for a mutation NCCN Non-Small Cell Lung Cancer Clinical Practice Guidelines in Oncology (Version )

19 Tsao Algorithm: Histology and Molecular Profiling NSCLC PATIENT Non-SCC SCC Neuroendocrine Adenocarcinoma Avoid pemetrexed or bevacizumab Platinum-etoposide; Switch Maintenance: pemetrexed, erlotinib EGFR mutation EML 4 ALK, ROS1 EGFR wild-type Consider 2 nd line EGFR TKI or maintenance erlotinib (BR.21, SATURN) EGFR TKI 1 st or 2 nd line Maintenance (IPASS, BR.21, SATURN) crizotinib Platinum-doublet-bevacizumab Platinum-pemetrexed Non-platinum or platinum based doublet Switch Maintenance: pemetrexed, erlotinib (E4599, AVAiL, Pointbreak, SATURN, JMEN)

20 Potential Future of NSCLC - Molecular Profiling Adenocarcinoma EGFR mutation BRAF mutation PI3K mutant Met + KRAS mutant EGFR TKI EML 4 ALK or ROS1 mutant BRAF inhibitor PI3K inhibitor Resistance rebiopsy T790M irreversible EGFR TKI MET upregulation Met inhibitor crizotinib Resistance rebiopsy Novel agent Resistance rebiopsy Novel agent Met inhibition MEK inhibitor combination Resistance rebiopsy Hsp90 inhibitor novel agent targeting ALK resistance mutation Resistance rebiopsy Novel agent Resistance rebiopsy Novel Agent Platinum-doublet-bevacizumab Platinum-pemetrexed + bevacizumab Non-platinum or platinum based doublet Switch Maintenance: pemetrexed, erlotinib (E4599, AVAiL, Pointbreak, SATURN, JMEN)

21 Nuevos fármacos en Cáncer de Pulmón Individualización terapéutica Conocimiento de mecanismos de resistencia Tratamientos a la medida Biomarcadores de cada paciente Nuevos agentes dirigidos Cambios de estrategia. Mantenimiento?

22 Mantenimiento Tenemos que revisar el concepto?

23 Only ~50% of patients in clinical trials go on to receive second-line therapy Maintenance therapy could delay disease progression and provide active treatment for more patients Socinski et al Belani et al Brodowicz et al von Plessen et al Barata et al Park et al Ciuleanu et al Pirker et al Scagliotti et al Fidias et al Patients receiving 2nd-line therapy (%) 1. JCO 2002; 2. JCO 2003; 3. Lung Cancer 2006; 4. Br J Cancer 2006; 5. WCLC 2007; 6. JCO 2007; 7. Lancet 2009; 8. ASCO 2008; 9. JCO 2008; 10. JCO 2009

24 Objetivos de la terapia de mantenimiento: Prolongar el control de la enfermedad Objectivos 1 Mantener la tolerabilidad Mejorar la Supervivencia Global La Tolerabilidad es importante en el ámbito de mantenimiento, en el que el tratamiento se continúa hasta progresión de la enfermedad. 1,2 1. Paz-Ares et al. Lancet Oncol 2012;13:247.

25 Switch maintenance Concept Immediate introduction of a new agent after induction chemotherapy can overcome an emerging resistance 9 Potential advantages All patients receive one additional treatment 3 Bypass potential resistance to the cytotoxic agent used in the induction treatment Downsides Loss of a 2 nd -line option at the onset of disease progression Uncertainty about the efficacy and tolerability of the maintenance agent

26 Evolución del paradigma en el tratamiento de CPNM 1 Paradigma Anterior Doblete basado en platino Intervalo libre de tratamiento Progresión Monoterapia de segunda linea Periodo libre de progresión Sólo BSC Tratamiento hasta la progresión Nuevo Paradigma Doblete o triplete basado en platino Tratamiento de mantenimiento (monoterapia o combinación) Más tiempo hasta la progresión Progresión Siguientes líneas de tratamiento CPNM: cáncer de pulmón no microcítico; BSC: mejores cuidados de soporte (Best supportive care). 1. Hensing et al. Lung Cancer 2005;47(2):253.

27 Options for maintenance chemotherapy Continuing CT for more cycles than standard Predefined number of extra cycles / Until progression Induction chemotherapy Continuing only the non-platinum component Switching to a different cytotoxic CT agent

28 Options for maintenance targeted therapy Continuing the same targeted therapy that was concurrently administered with induction CT (x 4-6 cycles) Induction CT +/- targeted therapy Adding a 2 nd targeted therapy after completion of induction treatment Switching to a new targeted therapy after induction CT

29 Maintenance Therapy Terminology: A Rose by Any Other Name? Platinum-based doublet chemotherapy: 4 cycles of induction eg, cisplatin + agent A Same agent A until PD or toxicity Continuation maintenance Different agent C until PD or toxicity Switch maintenance

30 General design scheme of clinical trials evaluating maintenance therapy in advanced NSCLC Prolongation of treatment Duration Duration of disease of disease control: control: PFS benefit PFS benefit Tumour status assessments Overall survival benefit Maintenance Prog 2 nd -line 1 st -line platinumbased doublet x 4 cycles Objective response or stabilisation 1:1 or 2:1 Placebo or observation Prog 2 nd -line Progression-free survival Overall survival

31 2º PART Maintenance chemotherapy: Points to Ponder Definition of maintenance varies Benefit for pemetrexed confined to non-squamous histology Many patients never received second-line therapy! Survival in control arms may have diminished due to lack of life-prolonging second line therapy The interpretation of the results is hampered by the heterogeneity of studies and the different maintenance approaches used (continuation vs. switch) Heterogeneity in design and results.

32 Summary of Switch Maintenance Trials Fidias [1] Ciuleanu [2] Cappuzzo [3] Miller [4] Perol [5] Zhang [6] Agent/Control Arm N PFS Salvage Treatment, % Docetaxel Delayed docetaxel Pemetrexed Placebo Erlotinib Placebo Erlotinib + bevacizumab Placebo + bevacizumab Erlotinib Observation Gefitinib Placebo mos HR: mos P = mos HR: mos P < wks HR: wks P < mos HR: mos P = mos HR: mos P = mos HR: mos P <.0001 OS HR: P = HR: P = HR: P = HR: P = NA HR:.91 NA HR: P = Fidias P, et al. J Clin Oncol. 2010;28: Ciuleanu T, et al. Lancet. 2009;374: Cappuzzo F, et al. Lancet Oncol. 2010;11: Miller VA, et al. ASCO Abstract LBA Perol M, et al. ASCO Abstract Zhang L, et al. ASCO Abstract LBA7511. J Thorac Oncol. 2012;7:

33 Continuation Maintenance Trials Study Yr Induction Therapy Maintenance Therapy Median PFS, Mos Brodowicz [1] 2006 Gemcitabine 1250 mg/m 2 on Days 1, 8 + cisplatin 80 mg/m 2 on Day 1 x 4 Belani [2] 2010 Gemcitabine 1000 mg/m 2 on Days 1, 8 + carboplatin AUC 5 on Day 1 x 4 Perol [3] 2010 Gemcitabine 1250 mg/m 2 on Days 1, 8 + cisplatin 80 mg/m 2 on Day 1 x 4 Gemcitabine 1250 mg/m 2 on Days 1,8 BSC Gemcitabine 1000 mg/m 2 on Days 1,8 BSC Gemcitabine 1000 mg/m 2 on Days 1,8 BSC (P <.001) (P =.575) (P <.0001) Median OS, Mos (P =.838) NR NR Main Grade 3/4 Toxicities Maintenance Gem: ANC 14.9%, Plts 1.7%; blood transfusion: 20% gemcitabine vs 6.3% BSC ANC: 15% chemo, 2% BSC; Plts: 9% chemo, 4% BSC; fatigue: 5% chemo, 2% BSC At least 1 grade 3/4 AE: chemotherapy 27.9%, observation 2.6% Paz Ares [4] 2011 Pemetrexed 500 mg/m 2 on Day 1 + cisplatin 75 mg/m 2 on Days 1 x 4 Pemetrexed 500 mg/m 2 on Day 1 BSC (P =.00006) 13.8 NR 11.1 NR Fatigue: 4.2% pem, 0.6% BSC; Anemia: 4.5%, 0.6% BSC; ANC: 3.6% pem, 0 BSC 1. Brodowicz T, et al. Lung Cancer. 2006;52: Belani CP, et al. ASCO Abstract Perol M, et al. ASCO Abstract Paz-Ares LG, et al. ASCO Abstract CRA7510. J Thorac Oncol. 2012;7:

34 Maintenance and Benefit

35 Issues to Consider Regarding Maintenance Therapy The big question about maintenance therapy is WHO to treat and WHEN to treat If 6 cycles of platinum chemotherapy are given, are the maintenance data still relevant? If a patient achieves no response (SD) and remains symptomatic, is subsequent therapy maintenance or early second-line therapy? If a patient achieves response and becomes asymptomatic, is maintenance therapy always better than watch and wait? What about the underlying molecular profile of the patient? In the emerging era of personalized therapy, these decisions should be made on an individual basis: One size does not fit all

36 Problems of Maintenance therapy Why can continuation of a single agent until progresion provide survival benefit in spite of the completely negative results of continuous administration of a platinum doublet? Why did control patients not recieved second-line therapy? Cost, Toxicity and inconvenience are problems Many patients desire a drug holiday No clear benefit on OS by pure maintenance therapy PFS is apropiate for the evaluation of the effect of maintenance therapy?

37 Are four cycles of chemotherapy Truly adequated? SLP Yu Yang Soon et al. J Clin Oncol 27: SG

38 Did the control group perform adequately? J Thorac Oncol. 2012;7:

39 Benefits of Maintenance and Response Status J Thorac Oncol. 2012;7:

40 Who actually benefits? Stable disease is sometimes early progresion J Thorac Oncol. 2012;7:

41 Questions to be answered Some of them used PFS, while others used OS as primary end- point. 1. The use of PFS has the advantages of eradicating the confounding impact of post-study treatment, while usually requires smaller sample size compared with OS analysis 2. PFS is more subject to inter-observer bias, subject to testing intervals and small absolute improvements in PFS may not translate into OS improvement. 3. OS is a more definitive endpoint, but requires larger patient cohorts to demonstrate differences and there can be considerable variability in the rate and type of poststudy therapies that could have an impact on the final results. 4. All studies using PFS demonstrated a statistically significant difference in favor of maintenance treatment, while studies with OS as an end-point were negative

42 Questions to be answered 2 Second question is which strategy is more effective; the continuation or the switch maintenance. Metanalysis by Behera et al: switch maintenance therapy was associated with significant OS and PFS (OS: HR 0.86, 95% CI , p-value = ; PFS: HR 0.71, 95% CI , p- value <0.0001). Despite a modest improvement in PFS (HR: 0.92, 95% CI , p-value = 0.007), continuation maintenance therapy was not associated with OS benefit (HR: 0.92, 95% CI , p-value = 0.33). The two trials that demonstrated PFS and OS benefit were both switch maintenance trials Third question is the selection of patients who should be treated with maintenance treatment. The major disadvantage of maintenance treatment is that it commits patient to treatment and does not allow treatment breaks in a disease in which the primary goal of treatment is palliation. Although maintenance treatment in all studies was overall well tolerated, it should be noted that the incidence of grade III/IV toxicities were higher in the maintenance arm.

43 Cost-Effectiveness and QoL of Maintenance Therapy for Advanced NSCLC

44 Coste-efectivo Perspectiva desde el Sistema Sanitario Español Monthly-perpatient cost 1 ICER vs BSC 1 SWITCH ERLOTINIB (SATURN) /LYG PEMETREXED (JMEN) /LYG CONTINUATION PEMETREXED (PARAMOUNT) No studies Perspectiva desde Sistema Sanitario NICE 2 ICER vs BSC MEETS END-of- LIFE CRITERIA RECOMMENDED SWITCH ERLOTINIB /QALY squa. SD /QALY non-squa. SD YES NO PEMETREXED /QALY YES YES CONTINUATION PEMETREXED TA in process In process In process TA: Technology Appraisal 1. Nuitjen et al, Lung cancer 2012,

45 SATURN Estudio SATURN Supervivencia según respuesta a la 1ª Línea Evolución de la Calidad de vida (QoL) 1 Time to deterioration in HRQoL in the SD population (FACT-L) Impacto de Erlotinib como tratamiento secuencial de mantenimiento en la QoL 1. Juhasz et al, Eur J Cancer ,

46 PARAMOUNT Datos de QoL EQ-5D index scores: Items mantenidos a través de todo el treatmento Improvement Mean score 0.7 Pemetrexed Placebo Induction cycles Maintenance cycles * p 0.05, within-group change from baseline. p 0.05, comparing the difference in mean changes from baseline between treatment arms. 1. Adapted from Gridelli C et al J Thorac Oncol. 2012;7(11):

47 Maintenance Pemetrexed

48 Personalized maintenance therapy

49 Optimal design of a switch maintenance trial J Thorac Oncol. 2012;7:

50 Predictores de beneficio para el tratamiento de mantenimiento Opciones de tratamiento a la progresión Preferencia de los pacientes Respuesta a la primera línea de inducción Histology Molecular Chacteristics Performance status Objetivos del tratamiento Gerber et al, J Clin Oncol 2013, 31, 8, 1009

51 SLCG 2013 We are working on..

52 New international BREC (BRCA1 Expression Customization) CONTROL Docetaxel/Cis Advanced NSCLC 1:1 T1 RAP80 (T1-T3 BRCA1) Gem/Cis EXPERIMENTAL T2-T3 RAP80 (T1-T2 BRCA1) Docetaxel/Cis T2-T3 RAP80 (T3 BRCA1) Docetaxel

53 ETOP 2-11 BELIEF An open-label phase II trial of erlotinib and bevacizumab in patients with advanced non-small cell lung cancer and activating EGFR mutations BELIEF Bevacizumab and ErLotinib In EGFR mut+ NSCLC A clinical trial of ETOP coordinated by the SLCG In cooperation with Hoffmann-La Roche Chair: R Rosell Co-Chair: R Stahel Co-Chair Translational Research: M. A Molina 53 ETOP 2-11 BELIEF Center Training 2013

54 54 ETOP 2-11 BELIEF Center Training 2013 EURTAC cutoff January 2013

55 G1: Erlotinib and T790M present (n=34) G2: Erlotinib and T790M absent (n=16) G3: Chemotherapy and T790M present (n=28) G4:Chemotherapy and T790M absent (n=17) G2 G G3 G1 Patients at risk 55 ETOP 2-11 BELIEF Center Training 2013 EURTAC cutoff January 2013

56 BELIEF Trial design 56 ETOP 2-11 BELIEF Center Training 2013

57 Objectives Long-term outcome of patients with advanced non-squamous NSCLC harbouring EGFR mutations with or without T790M mutation at diagnosis and treated with the combination of erlotinib and bevacizumab. Efficacy and tolerability of the combination Correlation of BIM mrna and mrna expression of camp-related genes and T790M with progression-free survival EGFR mutations including T790M mutation in serum longitudinally Molecular biomarkers related to EGFR TKI and bevacizumab 57 ETOP 2-11 BELIEF Center Training 2013

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

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

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

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

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

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

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

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

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

Stato dell arte e prospettive delle terapie a bersaglio molecolare nel carcinoma polmonare

Stato dell arte e prospettive delle terapie a bersaglio molecolare nel carcinoma polmonare Stato dell arte e prospettive delle terapie a bersaglio molecolare nel carcinoma polmonare Giorgio V. Scagliotti Università di Torino Dipartimento di scienze cliniche & biologiche giorgio.scagliotti@unito.it

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Second-Line Therapy in Non Small-Cell Lung Cancer: The DELTA Between Different Genotypes Widens

Second-Line Therapy in Non Small-Cell Lung Cancer: The DELTA Between Different Genotypes Widens VOLUME 32 NUMBER 18 JUNE 20 2014 JOURNAL OF CLINICAL ONCOLOGY ONCOLOGY GRAND ROUNDS Second-Line Therapy in Non Small-Cell Lung Cancer: The DELTA Between Different Genotypes Widens Alona Zer and Natasha

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

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

Carcinoma papilar renal, cromófobo y otras histologías. Maria José Méndez Vidal Servicio de oncología Medica Hospital Reina Sofía Córdoba

Carcinoma papilar renal, cromófobo y otras histologías. Maria José Méndez Vidal Servicio de oncología Medica Hospital Reina Sofía Córdoba Carcinoma papilar renal, cromófobo y otras histologías. Maria José Méndez Vidal Servicio de oncología Medica Hospital Reina Sofía Córdoba Europe 121 629 new cases RCC 2012, 75 676 affected men Slide 3

More information

Clinical development of AZD9291 in non-small cell lung cancer

Clinical development of AZD9291 in non-small cell lung cancer Clinical development of AZD9291 in non-small cell lung cancer Rachael Lawrance (AstraZeneca) PSI One Day Meeting: The Innovative, Challenging and Diversified World of Respiratory Disease 13 Nov 2015 Overview

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

Piano Generale di Emergenza Presidio Ospedaliero di Livorno Viale Alfieri 36

Piano Generale di Emergenza Presidio Ospedaliero di Livorno Viale Alfieri 36 Aprile 2011 EGFR-TKIs for the treatment of advanced NSCLC with EGFR mutations Piano Generale di Emergenza Presidio Ospedaliero di Livorno Viale Alfieri 36 Federico Cappuzzo Istituto Toscano Tumori Ospedale

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

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

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

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

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

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

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

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

Management des patients atteints de cancer bronchique triple négatif

Management des patients atteints de cancer bronchique triple négatif Management des patients atteints de cancer bronchique triple négatif Réunion de formation du GFPC Paris, 12 Décembre 2013 Fabrice BARLESI, MD, PhD Multidisciplinary Oncology & Therapeutic Innovations INSERM

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

Ovarian Cancer and Modern Immunotherapy: Regulatory Strategies for Drug Development

Ovarian Cancer and Modern Immunotherapy: Regulatory Strategies for Drug Development Ovarian Cancer and Modern Immunotherapy: Regulatory Strategies for Drug Development Sanjeeve Bala, MD, MPH Ovarian Cancer Endpoints Workshop FDA White Oak September 3, 2015 Overview Immune agents from

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

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

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

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

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

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

More information

Lung cancer remains the leading cause of cancer-related death in the. Evolving Treatment Paradigms in Non-Small Cell Lung Cancer

Lung cancer remains the leading cause of cancer-related death in the. Evolving Treatment Paradigms in Non-Small Cell Lung Cancer PRINTER-FRIENDLY VERSION AT CLINICALONCOLOGY.COM Evolving Treatment Paradigms in Non-Small Cell Lung Cancer KATHRYN F. MILEHAM, MD Staff Oncologist HEATHER D. BROOKS, MD Staff Oncologist EDWARD S. KIM,

More information

Come è cambiata la storia naturale della malattia

Come è cambiata la storia naturale della malattia Malattia Metastatica del Carcinoma del Grosso Intestino Tecniche e terapie Innovative Come è cambiata la storia naturale della malattia Antonio Frassoldati Oncologia Clinica - Ferrara 29 ottobre 2011 Colorectal

More information

Breast and Lung Cancer Biomarker Research at ASCO: Changing Treatment Patterns

Breast and Lung Cancer Biomarker Research at ASCO: Changing Treatment Patterns July 2013 Edition Vol. 7, Issue 7 Breast and Lung Cancer Biomarker Research at ASCO: Changing Treatment Patterns By Julie Katz, MPH, MPhil Biomarkers played a prominent role in the research presented in

More information

Targeting angiogenesis in NSCLC: Clinical trial update Martin Reck Lung Clinic Grosshansdorf Grosshansdorf, Germany

Targeting angiogenesis in NSCLC: Clinical trial update Martin Reck Lung Clinic Grosshansdorf Grosshansdorf, Germany Targeting angiogenesis in NSCLC: Clinical trial update Martin Reck Lung Clinic Grosshansdorf Grosshansdorf, Germany This presentation was selected by the 15 th World Conference on Lung Cancer Program Committee

More information

Lessons learned from gefitinib and crizotinib clinical trials in NSCLC

Lessons learned from gefitinib and crizotinib clinical trials in NSCLC Lessons learned from gefitinib and crizotinib clinical trials in NSCLC Shun Lu Shanghai Lung Cancer Center Shanghai Chest Hospital affiliated to Jiao Tong University New Era of Cancer Care: Genomic Era

More information

Update on Targeted Therapies of NSCLC

Update on Targeted Therapies of NSCLC Update on Targeted Therapies of NSCLC Tanja Cufer, MD, PhD University Clinic Golnik Medical Faculty Ljubljana, Slovenia Bled 2014 1 Systemic Therapy of Advanced NSCLC: Chemotherapy Range Cht improves survival

More information

Lung Cancer Genomics and Patient Individualization

Lung Cancer Genomics and Patient Individualization Lung Cancer Genomics and Patient Individualization Ming Sound Tsao, MD, FRCPC Qasim Choksi Chair in Lung Cancer Translational Research University Health Network OCI/PMH Leading Causes of Deaths (WHO) In

More information

TERAPIA DI MANTENIMENTO NEL NSCLC. Dr Giuseppe L. Banna Oncologia Medica A.O. Cannizzaro Catania

TERAPIA DI MANTENIMENTO NEL NSCLC. Dr Giuseppe L. Banna Oncologia Medica A.O. Cannizzaro Catania TERAPIA DI MANTENIMENTO NEL NSCLC Dr Giuseppe L. Banna Oncologia Medica A.O. Cannizzaro Catania Conflitti di interesse Ai sensi dell art. 3.3 del Regolamento applicativo dell Accordo Stato- Regioni 05.11.2009,

More information

Tailoring Treatment Plans to Improve Outcomes in the Management of NSCLC

Tailoring Treatment Plans to Improve Outcomes in the Management of NSCLC Tailoring Treatment Plans to Improve Outcomes in the Management of NSCLC Martin J. Edelman, MD 1 Educational Objectives Review efficacy and safety data for current and emerging targeted agents and chemotherapy

More information

Treatment Paradigms in Advanced Non Small-Cell Lung Cancer

Treatment Paradigms in Advanced Non Small-Cell Lung Cancer Treatment Paradigms in Advanced Non Small-Cell Lung Cancer Caroline E. McCoach, MD, PhD, and Karen Kelly, MD Dr McCoach is a clinical research fellow and Dr Kelly is a professor of medicine, an associate

More information

Nieuwe patientenselectie met longcarcinoom als rolmodel voor de medisch oncoloog

Nieuwe patientenselectie met longcarcinoom als rolmodel voor de medisch oncoloog Nieuwe patientenselectie met longcarcinoom als rolmodel voor de medisch oncoloog Egbert F. Smit MD PhD Dept. Pulmonary Diseases Vrije Universiteit VU Medical Centre Amsterdam, The Netherlands ASCO 2013

More information

ASCO 2014: Promise and Progress in the Treatment of Lung Cancer

ASCO 2014: Promise and Progress in the Treatment of Lung Cancer ASCO 2014: Promise and Progress in the Treatment of Lung Cancer Fadlo Raja Khuri, MD Professor and Chair Department of Hematology & Medical Oncology, Deputy Director Winship Cancer Institute of Emory University

More information

Mechanisms of primary/secondary resistance to EGFR inhibitors

Mechanisms of primary/secondary resistance to EGFR inhibitors UNIVERSITY OF OF TORINO DEPARTMENT OF ONCOLOGY Mechanisms of primary/secondary resistance to EGFR inhibitors Silvia Novello University of Torino Italy Department of Oncology silvia.novello@unito.it www.womengainstlungcancer.eu

More information

Nuevas tecnologías basadas en biomarcadores para oncología

Nuevas tecnologías basadas en biomarcadores para oncología Nuevas tecnologías basadas en biomarcadores para oncología Simposio ASEBIO 14 de marzo 2013, PCB Jose Jimeno, MD, PhD Co-Founder / Vice Chairman Pangaea Biotech SL Barcelona, Spain PANGAEA BIOTECH BUSINESS

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

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

Public-Private Partnerships in early phase clinical research: Spurring access to innovative therapeutics

Public-Private Partnerships in early phase clinical research: Spurring access to innovative therapeutics EPAAC WP8 Research Forum - 2 July, Sofitel Hotel Europe, Brussels Public-Private Partnerships in early phase clinical research: Spurring access to innovative therapeutics JY Blay, Past President EORTC

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

Clinical Use of Molecular Diagnos@cs in the Treatment of Lung Cancer

Clinical Use of Molecular Diagnos@cs in the Treatment of Lung Cancer Clinical Use of Molecular Diagnos@cs in the Treatment of Lung Cancer Tianhong Tina Li, MD, PhD (thli@ucdavis.edu) Associate Professor of Clinical Medicine, School of Medicine Disclosures Grants/Research

More information

A clinicians view on NGS of (lung) cancer

A clinicians view on NGS of (lung) cancer A clinicians view on NGS of (lung) cancer oliver.gautschi@onkologie.ch 14.1.2015 Predictive Role of Biomarkers for Lung Cancer Therapy Chemotherapy: not confirmed Anti-Angiogenic-Therapy: not confirmed

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

DECISION AND SUMMARY OF RATIONALE

DECISION AND SUMMARY OF RATIONALE DECISION AND SUMMARY OF RATIONALE Indication under consideration Clinical evidence Crizotinib as 2nd line treatment for patients with anaplastic lymphoma kinase (ALK) positive lung cancer Score The application

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

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

Genomic Clinical Trials: NCI Initiatives

Genomic Clinical Trials: NCI Initiatives Genomic Clinical Trials: NCI Initiatives James H. Doroshow, M.D. Deputy Director for Clinical and Translational Research National Cancer Institute National Cancer Advisory Board Washington, DC December

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

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

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

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

Targeterbare mutationer / biomarkører Status og udfordringer for patologien

Targeterbare mutationer / biomarkører Status og udfordringer for patologien Targeterbare mutationer / biomarkører Status og udfordringer for patologien Birgit Guldhammer Skov overlæge, dr.med. Patologi afdelingen Rigshospitalet Biomarkers lung cancer Last 3-5 years More and more

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

Metastatic Non Small Cell Lung Cancer Management: Novel Targets and Recent Clinical Advances

Metastatic Non Small Cell Lung Cancer Management: Novel Targets and Recent Clinical Advances Metastatic Non Small Cell Lung Cancer Management: Novel Targets and Recent Clinical Advances Jonathan W. Riess, MD, and Heather A. Wakelee, MD Dr. Riess is a Fellow and Dr. Wakelee is an Assistant Professor

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

Cáncer de Pulmón n con Mutación de EGFR: Una Entidad Clínica y Patológica Distinta

Cáncer de Pulmón n con Mutación de EGFR: Una Entidad Clínica y Patológica Distinta Cáncer de Pulmón n con Mutación de EGFR: Una Entidad Clínica y Patológica Distinta Luis Paz-Ares Hospital Universitario Virgen del Rocio Seville, Spain Advanced NSCLC: chemotherapy has reached a therapeutic

More information

REFERENCE CODE GDHC212DFR PUBLICAT ION DATE JUNE 2013 GSK1572932A (NON-SMALL CELL LUNG CANCER) FORECAST AND MARKET ANALYSIS TO 2022

REFERENCE CODE GDHC212DFR PUBLICAT ION DATE JUNE 2013 GSK1572932A (NON-SMALL CELL LUNG CANCER) FORECAST AND MARKET ANALYSIS TO 2022 REFERENCE CODE GDHC212DFR PUBLICAT ION DATE JUNE 2013 GSK1572932A (NON-SMALL CELL LUNG CANCER) GSK1572932A (NON-SMALL CELL LUNG CANCER) - Executive Summary GSK1572932A (MAGE-A3): Key Metrics in NSCLC Markets

More information

Targeted Treatment and Molecular Biomarkers in Lung Cancer

Targeted Treatment and Molecular Biomarkers in Lung Cancer Targeted Treatment and Molecular Biomarkers in Lung Cancer Ming Sound Tsao, MD, FRCPC Choksi Chair in Lung Cancer Translational Research Princess Margaret Hospital University of Toronto Uppsula, September

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

Innovation: Present Meets Future

Innovation: Present Meets Future Innovation: Present Meets Future SOCIAL INNOVATION Leading Innovation in the Cooperative Group Setting Craig Nichols, M.D. BEST OF SWOG Barlogie-Salmon Myeloma Committee Robert Z. Orlowski, M.D., Ph.D.

More information

Technology appraisal guidance Published: 16 December 2015 nice.org.uk/guidance/ta374

Technology appraisal guidance Published: 16 December 2015 nice.org.uk/guidance/ta374 Erlotinib and gefitinib for treating non- small-cell lung cancer that has progressed after prior chemotherapy Technology appraisal guidance Published: 16 December 2015 nice.org.uk/guidance/ta374 NICE 2015.

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

Immuno-Oncology 2015: A New Landscape in Lung Cancer

Immuno-Oncology 2015: A New Landscape in Lung Cancer Immuno-Oncology 2015: A New Landscape in Lung Cancer David R. Spigel, M.D. Lung Cancer Program Director Sarah Cannon Research Institute/Tennessee Oncology, PLLC Nashville, TN Off-Label Use Disclosure(s)

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

Targeted Therapies in Lung Cancer

Targeted Therapies in Lung Cancer Targeted Therapies in Lung Cancer I Edited by: Simona Carnio Thoracic Oncology Division - St Luigi Hospital Orbassano (TO) - Italy Silvia Novello Department of Oncology - University of Torino - Italy Why

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

Médecine de précision médecine personnalisée en Oncologie. Fabien Calvo, Directeur Recherche et Innovation, INCa, Directeur ITMO Cancer, AVIESAN

Médecine de précision médecine personnalisée en Oncologie. Fabien Calvo, Directeur Recherche et Innovation, INCa, Directeur ITMO Cancer, AVIESAN Médecine de précision médecine personnalisée en Oncologie Fabien Calvo, Directeur Recherche et Innovation, INCa, Directeur ITMO Cancer, AVIESAN Successful targeted drug development Rapid identification

More information

Trials in Elderly Melanoma Patients (with a focus on immunotherapy)

Trials in Elderly Melanoma Patients (with a focus on immunotherapy) Trials in Elderly Melanoma Patients (with a focus on immunotherapy) Where we were Immunotherapy Trials: past and present Relevance for real world practice Where we are SIOG October 2012 James Larkin FRCP

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

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

Cancer Treatment Reviews

Cancer Treatment Reviews Cancer Treatment Reviews 38 (2012) 416 430 Contents lists available at SciVerse ScienceDirect Cancer Treatment Reviews journal homepage: www.elsevierhealth.com/journals/ctrv Antitumour Treatment EGFR-mutated

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

How valuable is a cancer therapy? It depends on who you ask.

How valuable is a cancer therapy? It depends on who you ask. How valuable is a cancer therapy? It depends on who you ask. Comparing and contrasting the ESMO Magnitude of Clinical Benefit Scale with the ASCO Value Framework in Cancer Ram Subramanian Kevin Schorr

More information