Targeted therapy in NSCLC: do we progress? Prof. Dr. V. Surmont. Masterclass 27 september 2018
|
|
|
- Ami Hancock
- 5 years ago
- Views:
Transcription
1 Targeted therapy in NSCLC: do we progress? Prof. Dr. V. Surmont Masterclass 27 september 2018
2 Outline Introduction EGFR TKI ALK TKI TKI for uncommon driver mutations Take home messages
3
4 The promise of genotype directed therapy EGFR mutation Erlotinib or gefitinib ALK (or ROS) Crizotinib, other ALK TKIs NSCLC Treatment C Treatment D
5
![[TITLE]](/docs-images/94/119405917/images/6-0.jpg)
6 [TITLE]
7
8
9 Succes Failure-resistance 9 /
10 EGFR TKI first generation second generation third generation
11 EGFR receptor and EGFR mutations 10-15% NSCLC woman adenoca never smoker 11 /
12 12 / VOETTEKST
13 EGFR pathway and resistance mechanisms 13 / Cancer Discovery, 2014c
14 Tyrosine kinase inhibitors
15 15 / EGFR TKI
16 first generation TKI
17 Pivotal trials with first generation EGFR TKI 17 / Translational Lung Cancer Research 2015
18 18 /
19 19 / Skin toxicity
20 Case presentation women, 57 years never smoker weight loss, malaise january 2009: diagnosis of stage IV adenocarcinoma left upper lobe with liver and bone metastases
21 Mutation in exon 19 (liver biopsy)
22 After 6 weeks Tarceva confirmed CR for 2 years
23
24 second generation TKI
25 25 / second generation EGFR TKI: afatinib
26 LUX-LUNG 7: afatinib versus gefitinib Patients with Advanced adenocarcinoma of the lung Documented common EGFR mutations (del19 or L858R) First line (no prior treatment) Global study: 57 sites (currently recruiting) N = 264 Randomization Afatinib 40 mg Gefitinib 250 mg Coprimary endpoints: PFS, TTF and OS ClinicalTrials.gov. NCT
27 11 m vs 10.9 m RR: 73% vs 56% 27 / A:exon 21 B:exon 19
28 28 /
29 third generation TKI
30 30 /
31 31 / N Engl J Med 2017; 376:
32 FLAURA: osimertinib vs first generation EGFR-TKI 32 /
33 erlotinib, gefitinib osimertinib 33 /
34 34 /
35 35 /
36 36 /
37 ALK TKI crizotinib next generation TKI sequence
38 ALK positive NSCLC Guidelines recommend testing for ALK gene rearrangements in all patients with adenocarcinoma or in whom adenocarcinoma cannot be excluded. ALK Rearrangements - 3-5% of NSCLC - adenocarcinoma - younger patients - never smokers
39 39 /
40 Rapid clinical development and success in a short time Solomon & Soria Ann Oncol 2016
41 crizotinib
42 42 /
43 Crizotinib superior to standard chemotherapy PFS probability (%) st Line therapy 2nd Line therapy Pfizer 1014: Crizotinib vs. Platinum/Pemetrexed Crizotinib (N=172) Chemotherapy (N=172) Events, n (%) 100 (58) 137 (80) Median, months HR (95% CI) 0.45 ( ) P b < Pfizer 1007: Crizotinib vs. Chemotherapy No. at risk Crizotinib Chemotherapy Time (months) ORR: Crizotinib 65% vs. Chemo 20% Mediaan PFS 7.7 m vs. 3 m Mok et al. ASCO 2014, abstr 8002 Shaw et al., NEJM 2013
44
45 45 /
46 46
47 47 /
48 But acquired resistance to ALK inhibitors April 2009 September 2010 Progression following initial Crizotinib 1L??? September 2011
49 Slide 17 Presented By Christine Lovly at 2015 ASCO Annual Meeting
50 15% 20-40% 30% Slide 18 Presented By Christine Lovly at 2015 ASCO Annual Meeting
51 51 /
52 Next generation ALK TKI
53 Next generation ALK inhibitors Ceritinib Alectinib Brigatinib LorlatinibBriga 53 /
54 ceritinib
55 ALK TKI : Toxicity Perol, ESMO 2016
56 alectinib
57 Alectinib, a potent CNS-active ALK inhibitor ALK secondary mutation Crizotinib Alectinib G1123S - Sensitive I1151Tins Resistant Resistant L1152P/R Resistant Sensitive C1156Y/T Resistant Sensitive I1171T/N Resistant Resistant F1174L/C Resistant Sensitive V1180L Resistant Resistant L1196M Resistant Sensitive G1202R Resistant Resistant S1206Y Resistant Sensitive G1269A/S Resistant Sensitive
58 ORR ORR 48% 48% SD: 32% SD: 32% PD: 16%% PD: 16%
59 NR 11.1 m 59 / VOETTEKST N Engl J Med 2017; 377:
60 60 / N Engl J Med 2017; 377:
61 brigatinib
62 RR 45% RR 54% Robust PFS 62 / VOETTEKST
63 Best Change From Baseline in Target Lesions (%) ORR Brain Mets to brigatinib Phase 1/ ALTA, Arm A 90 mg qd ALTA, Arm B 90 mg 180 mg qd b 0 20 Confirmed ORR, n (%) 8 (53) 0 20 Confirmed ORR, n (%) 12 (46) 0 20 Confirmed ORR, n (%) 12 (67) 40 a a Progressive disease Stable disease c Confirmed partial response Confirmed complete response Last scan date: 8 October 2015 (phase 1/2), 13 July 2016 (ALTA); dotted line at 30% indicates threshold for partial response per RECIST v1.1 a Crizotinib-naive patients (n=2); b 180 mg qd with 7-d lead-in at 90 mg; c Includes single responses not confirmed OA08.06: Brigatinib Activity in Patients With ALK+ NSCLC and Intracranial CNS Metastases Scott N Gettinger
64 lorlatinib
65 65 /
66 Response to Lorlatinib in a patient with an ALK G1202R Mutation ALK+ NSCLC Post crizotinib, ceritinib, and alectinib Started lorlatinib at 75 mg QD on April 23, 2015 Baseline 11 months on lorlatinib Reduced to 50 mg QD on May 14, 2015 * Continues on treatment
67 Clinical Responses to Lorlatinib in Patients with ALK G1202R Mutation Patient 1 Patient 2 19 Nov Jan Dec Sep 2015 Post crizotinib and ceritinib Post crizotinib and alectinib Started at 75 mg QD on 21 Nov Started 100 mg QD on 24 Dec 2014
68 ALK TKI : Toxicity Perol, ESMO 2016
69 optimal sequence
70 Role for Multiple Sequential ALK Inhibitors 1L Crizotinib 2L 2 ND Generation Ceritinib ALKi e.g Ceritinib Alectinib Brigatinib 3L PD??? CNS progression? Resistant mutation?
71 Sequence is associated with prolonged survival Median combined PFS: 18.2 months Median OS: 51.1 months Median combined PFS: 17.4 months Median OS: 49.4 months Gainor Clin Cancer Res 2015; Watanabe Clin Lung Cancer 2016
72 What is the optimal first-line treatment? 1L Crizotinib 2L Next gen ALK TKI 1L Next gen ALK TKI Sequence (J-)ALEX: alectinib vs crizotinib ALTA-1L: brigatinib vs. crizotinib (recruiting) exalt3: ensartinib vs. crizotinib (recruiting) CROWN: lorlatinib vs. crizotinib (recruiting)
73 73 /
74
75 Current practice in Belgium first line: Alectinib (1 september 2018) second line: crizotinib after failure crizotinib ceritinib alectinib lorlatinib Medical Need Evolving landscape Evolving landscape!e
76 Case Female 51 yr 18 py, stop 2003 April 2011 ct3n3m1b NSCLC (stage IV) adenocarcinoma LUL with mediastinal lymphadenopathy, liver metastases and pericarditis carcinomatosa (proven)
77 the choice at that time First line cisplatinum / pemetrexed SD after 4 cycles July 2011: hospitalization in France with PD
78 second line treatment July 2011 start crizotinib 250 mg BID in medical need program
79 T1 T1+gado September 2013 A symptomatic brain metastasis frontal right 1 cm with oedema T2 T2*
80 the choice at that time A symptomatic brain metastasis frontal right 1 cm with oedema SABRT + WBRT Continuation of crizotinib 250 mg BID
81 enlargement of lymph nodes April 2014 Progressive disease After 3y10m crizotinib Continuation until end of June 2014 Screening for ASCEND-5 Randomisation between second line chemotherapy and ceritinib
82 third line ceritinib First response evaluation: partial response Liver toxicity, dose adjustments After 1y4m headache and nausea: new symptomatic brain metastases PD also in the lungs TT needle rebiopsy showed: ALK G1202R Mutation
83 the choice at that time (re)wbrt lorlatinib
84 Lorlatinib since december
85 Case April 2011 NSCLC adenocarcinoma ALK+ stage IV, ct3n3m1b 3 m cisplatinum / pemetrexed: SD after 2y3m oligoprogression brain: SABRT (+WBRT) + crizotinib continuation in total 3y10m on crizotinib 1y4m ceritinib:pr PD October 2015 in brain and lungs: R/ WBRT followed by lorlatinib 2018: ongoing SD
86 86 /
87
88 TKI for uncommon mutations BRAF V600E MET exon 14
89 Dabrafinib plus Trametinib for BRAF V600E 89 /
90 male 63 years BRAF V600E mutation, WHO / July 2017 September 2017
91 MET-inhibitors in MET exon 14 mutant NSCLC 91 /
92 male, 73 years stage IV NSCLC, adenocarcinoma liver and bone mets R/ platinum-pem with PD after 4 cycles nivolumab with PD start MET-TKI in clinical trial a After 4 cutamtalen 92 /
93 In summary, promizing new drugs for old or new targets NGS is important Refer these patients for trials Presented By David Planchard at 2018 ASCO Annual Meeting
94 Take home messages EGFR TKI first, second and third generation optimal sequens? rebiopsy, liquid biospy future perspectives: third generation TKI (EGF816, ASP8273 ), combo with anti-angiogenesis, chemo, checkpoint inhibitors, adjuvant setting.. ALK TKI first, next generation TKI optimal sequens? rebiopsy, liquid biopsy future perspectives: new combinations: with anti-angiogenesis, Hsp90 inhibitors, checkpoint inhibitors, adjuvant setting uncommon mutations important to detect 94 / refer for clinical trials
95
Lung Cancer Case. Since the patient was symptomatic, a targeted panel was sent. ALK FISH returned in 2 days and was positive.
Lung Cancer Case Jonathan Riess, M.D. M.S. Assistant Professor of Medicine University of California Davis School of Medicine UC Davis Comprehensive Cancer Center 63 year-old woman, never smoker, presents
State of the Art Treatment of Lung Cancer Ravi Salgia, MD, PhD
State of the Art Treatment of Lung Cancer Ravi Salgia, MD, PhD Professor and Chair Arthur & Rosalie Kaplan Chair Medical Oncology and Therapeutics Research Nothing to disclose DISCLOSURE Objectives Lung
Molecular Targets in Lung Cancer
Molecular Targets in Lung Cancer Robert Ramirez, DO, FACP Thoracic and Neuroendocrine Oncology November 18 th, 2016 Disclosures Consulting and speaker fees for Ipsen Pharmaceuticals, AstraZeneca and Merck
Targeted therapies for advanced non-small cell lung cancer. Tom Stinchcombe Duke Cancer Insitute
Targeted therapies for advanced non-small cell lung cancer Tom Stinchcombe Duke Cancer Insitute Topics ALK rearranged NSCLC ROS1 rearranged NSCLC EGFR mutation: exon 19/exon 21 L858R and uncommon mutations
Opzioni terapeutiche nel paziente ALK-traslocato
Opzioni terapeutiche nel paziente ALK-traslocato Giulio Metro S.C. Oncologia Medica Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia Carcinoma del polmone non microcitoma: quali
OTRAS TERAPIAS BIOLÓGICAS EN CPNM: Selección y Secuencia Óptima del Tratamiento
OTRAS TERAPIAS BIOLÓGICAS EN CPNM: Selección y Secuencia Óptima del Tratamiento Dolores Isla Servicio de Oncología Médica HCU Lozano Besa de Zaragoza 2008 Selection Factors in Advanced NSCLC ( 8y ago)
Recent Advances in Lung Cancer: Updates from ASCO 2017
Recent Advances in Lung Cancer: Updates from ASCO 2017 Charu Aggarwal, MD, MPH Assistant Professor of Medicine Division of Hematology-Oncology Abramson Cancer Center University of Pennsylvania 6/15/2017
Targeted Therapy for NSCLC: EGFR and ALK Fadlo R. Khuri, MD
EGFR and ALK Fadlo R. Khuri, MD President, American University of Beirut Professor of Medicine July 26, 2018 A great year end! Targeted Therapy for NSCLC: Evolving Landscape of Lung Adenocarcinoma NSCLC
Personalized Treatment Approaches for Lung Cancer
Personalized Treatment Approaches for Lung Cancer California Thoracic Society 2018 Annual Carmel Conference January 27, 2018 Matthew Gubens, MD, MS Associate Professor of Medicine Chair, Thoracic Oncology
Incorporating Immunotherapy into the treatment of NSCLC
Incorporating Immunotherapy into the treatment of NSCLC Suresh S. Ramalingam, MD Roberto C. Goizueta Chair for Cancer Research Assistant Dean for Cancer Research Deputy Director, Winship Cancer Institute
Drug Resistance in ALK- and ROS1-Rearranged Lung Cancers. Alice T. Shaw, MD PhD Director, Center for Thoracic Cancers September 16, 2017
Drug Resistance in ALK- and ROS1-Rearranged Lung Cancers Alice T. Shaw, MD PhD Director, Center for Thoracic Cancers September 16, 2017 ALK and ROS1 are Related Tyrosine Kinases, and Both are Targeted
Virtual Journal Club: Front-Line Therapy and Beyond Recent Perspectives on ALK-Positive Non-Small Cell Lung Cancer.
Virtual Journal Club: Front-Line Therapy and Beyond Recent Perspectives on ALK-Positive Non-Small Cell Lung Cancer Reference Slides ALK Rearrangement in NSCLC ALK (anaplastic lymphoma kinase) is a receptor
Practice changing studies in lung cancer 2017
1 Practice changing studies in lung cancer 2017 Rolf Stahel University Hospital of Zürich Cape Town, February 16, 2018 DISCLOSURE OF INTEREST Consultant or Advisory Role in the last two years I have received
Cancer de Pulmón ALK+: Nueva generación de inhibidores. Incremento de supervivencia
Cancer de Pulmón ALK+: Nueva generación de inhibidores. Incremento de supervivencia Carlos Camps Jefe Servicio Oncología Médica Hospital General Universitario Valencia Profesor Titular Medicina Lab Oncologia
D Ross Camidge, MD, PhD
i n t e r v i e w D Ross Camidge, MD, PhD Dr Camidge is Director of the Thoracic Oncology Clinical Program and Associate Director for Clinical Research at the University of Colorado Cancer Center in Aurora,
Targeted/Immunotherapy & Molecular Profiling State-of-the-art in Cancer Care
Targeted/Immunotherapy & Molecular Profiling State-of-the-art in Cancer Care Manmeet Ahluwalia, MD, FACP Miller Family Endowed Chair in Neuro-Oncology Director Brain Metastasis Research Program Cleveland
Lung Cancer Update 2016 BAONS Oncology Care Update
Lung Cancer Update 2016 BAONS Oncology Care Update Matthew Gubens, MD, MS Assistant Professor Chair, Thoracic Oncology Site Committee UCSF Helen Diller Family Comprehensive Cancer Center Disclosures Consulting
Treatment of ALK Positive Advanced NSCLC Fiona Blackhall PhD FRCP Medical Oncologist Manchester, UK
Treatment of ALK Positive Advanced NSCLC Fiona Blackhall PhD FRCP Medical Oncologist Manchester, UK ESMO The Christie Preceptorship in Lung Cancer March 2017 2017 : Similar incidence in women & men ADC
Optimum Sequencing of EGFR targeted therapy in NSCLC. Dr. Sema SEZGİN GÖKSU Akdeniz Univercity, Antalya, Turkey
Optimum Sequencing of EGFR targeted therapy in NSCLC Dr. Sema SEZGİN GÖKSU Akdeniz Univercity, Antalya, Turkey Lung cancer NSCLC SCLC adeno squamous EGFR ALK ROS1 BRAF HER2 KRAS EGFR Transl Lung Cancer
Improving outcomes for NSCLC patients with brain metastases
Improving outcomes for NSCLC patients with brain metastases Martin Schuler West German Cancer Center, Essen, Germany In Switzerland, afatinib is approved as monotherapy for patients with non-small cell
INNOVATION IN LUNG CANCER MANAGEMENT. Federico Cappuzzo Department of Oncology-Hematology, AUSL della Romagna, Ravenna, Italy
INNOVATION IN LUNG CANCER MANAGEMENT Federico Cappuzzo Department of Oncology-Hematology, AUSL della Romagna, Ravenna, Italy FIRST-LINE THERAPY FOR METASTATIC NSCLC IN 216 Stratification for EGFR, ALK
CURRENT STANDARD OF CARE OF LUNG CANCER. Maroun El-Khoury, MD Consultant Oncologist/Hematologist American Hospital Dubai President of Medical staff
CURRENT STANDARD OF CARE OF LUNG CANCER Maroun El-Khoury, MD Consultant Oncologist/Hematologist American Hospital Dubai President of Medical staff Biopsy: Establish Diagnosis, Determine Histologic Subtype,
Targeted Therapies for Advanced NSCLC
Targeted Therapies for Advanced NSCLC Current Clinical Developments Friday, June 3, 2016 Supported by an independent educational grant from AstraZeneca Not an official event of the 2016 ASCO Annual Meeting
Joachim Aerts Erasmus MC Rotterdam, Netherlands. Drawing the map: molecular characterization of NSCLC
Joachim Aerts Erasmus MC Rotterdam, Netherlands Drawing the map: molecular characterization of NSCLC Disclosures Honoraria for advisory board/consultancy/speakers fee Eli Lilly Roche Boehringer Ingelheim
Management Guidelines and Targeted Therapies in Metastatic Non-Small Cell Lung Cancer: An Oncologist s Perspective
Management Guidelines and Targeted Therapies in Metastatic Non-Small Cell Lung Cancer: An Oncologist s Perspective Julie R. Brahmer, M.D. Associate Professor of Oncology The Sidney Kimmel Comprehensive
LUNG CANCER IN FOCUS. ALK Inhibitors in Non Small Cell Lung Cancer: How Many Are Needed and How Should They Be Sequenced?
LUNG CANCER IN FOCUS Current Developments in the Management of Section Editor: Mark A. Socinski, MD ALK Inhibitors in Non Small Cell : How Many Are Needed and How Should They Be Sequenced? Alice T. Shaw,
BRAIN METS IN 2018: ANY CLOSER TO THE END OF A LONG AND WINDING ROAD?
BRAIN METS IN 2018: ANY CLOSER TO THE END OF A LONG AND WINDING ROAD? M.J. van den Bent The Brain Tumor Center at Erasmus MC Cancer Center Rotterdam, the Netherlands Molecular targets in primary cancers
Sequencing in EGFR-Mutated NSCLC: Does Order Matter?
Sequencing in EGFR-Mutated NSCLC: Does Order Matter? Maximilian J. Hochmair, MD Otto Wagner Hospital Vienna, Austria Disclosures Honoraria: AstraZeneca, AbbVie, Pfizer, Boehringer Ingelheim, Roche, MSD,
Management Strategies for Lung Cancer Sensitive or Resistant to EGRF Inhibitors
Management Strategies for Lung Cancer Sensitive or Resistant to EGRF Inhibitors Conor E. Steuer, MD Assistant Professor The Winship Cancer Institute of Emory University July 27, 2017 1 Lung Cancer One
Recent Advances in Lung Cancer: Updates from ASCO 2016
Recent Advances in Lung Cancer: Updates from ASCO 2016 Charu Aggarwal, MD, MPH Assistant Professor of Medicine Division of Hematology-Oncology Abramson Cancer Center University of Pennsylvania 6/23/2016
Treatment of EGFR mutant advanced NSCLC
Treatment of EGFR mutant advanced NSCLC Raffaele Califano Department of Medical Oncology The Christie and Manchester University Hospital Manchester, UK Outline Data on first-line Overcoming T790M mutation
La sequenza terapeutica nel paziente con NSCLC avanzato in base all istologia e alla caratterizzazione molecolare: Impatto sulla pratica clinica?
La sequenza terapeutica nel paziente con NSCLC avanzato in base all istologia e alla caratterizzazione molecolare: Impatto sulla pratica clinica? GRUPPO A Luca Toschi (former Vanesa Gregorc) Who are oncogene
Monthly Oncology Tumor Boards: A Multidisciplinary Approach to Individualized Patient Care Lung Cancer: Advanced Disease March 8, 2016
Monthly Oncology Tumor Boards: A Multidisciplinary Approach to Individualized Patient Care Lung Cancer: Advanced Disease March 8, 2016 Jae Kim, MD City of Hope Comprehensive Cancer Center Karen Reckamp,
The Rapidly Changing World of EGFR Mutation-Positive Acquired Resistance
The Rapidly Changing World of EGFR Mutation-Positive Acquired Resistance H. Jack West, MD Swedish Cancer Institute Seattle, WA GRACE Targeted Therapies Forum September 16, 2017 Cleveland, OH EGFR Mutation-Positive
Inhibidores de EGFR Noemi Reguart, MD, PhD Hospital Clínic Barcelona IDIPAPS
Inhibidores de EGFR Noemi Reguart, MD, PhD Hospital Clínic Barcelona IDIPAPS Driver Mutations to Classify Lung Cancer Unknown 36% KRAS 25% EGFR 15% ALK 4% HER2 2% Double Mut 2% BRAF 2% PIK3CA
Treatment of EGFR mutant advanced NSCLC
Treatment of EGFR mutant advanced NSCLC Raffaele Califano Department of Medical Oncology The Christie and University Hospital of South Manchester, Manchester, UK Outline Data on first-line Overcoming T790M
Tissue or Liquid Biopsy? ~For Diagnosis, Monitoring and Early detection of Resistance~
16 th Dec. 2016. ESMO Preceptorship Program Non-Small-Cell Lung Cancer @Singapore Tissue or Liquid Biopsy? ~For Diagnosis, Monitoring and Early detection of Resistance~ Research Institute for Disease of
The Evolution of Frontline Therapy in ALK-Positive Advanced NSCLC: Which ALK TKI to Use Upfront?
The Evolution of Frontline Therapy in ALK-Positive Advanced NSCLC: Which ALK TKI to Use Upfront? Jeffrey Zweig, MD, and Heather Wakelee, MD Abstract Therapeutic options for advanced anaplastic lymphoma
NSCLC: immunotherapy as a first-line treatment. Paolo Bironzo Oncologia Polmonare AOU S. Luigi Gonzaga Orbassano (To)
NSCLC: immunotherapy as a first-line treatment Paolo Bironzo Oncologia Polmonare AOU S. Luigi Gonzaga Orbassano (To) The 800-pound gorilla Platinum-based chemotherapy is the SOC for 1st-line therapy in
Lung Cancer Genetics: Common Mutations and How to Treat Them David J. Kwiatkowski, MD, PhD. Mount Carrigain 2/4/17
Lung Cancer Genetics: Common Mutations and How to Treat Them David J. Kwiatkowski, MD, PhD Mount Carrigain 2/4/17 Histology Adenocarcinoma: Mixed subtype, acinar, papillary, solid, micropapillary, lepidic
MANEJO ACTUAL DEL PACIENTE CON CPNM CON REORDENACIONES ALK/ROS O MUTACIONES EN EGFR Rosario García Campelo Complejo Hospitalario Universitario A
MANEJO ACTUAL DEL PACIENTE CON CPNM CON REORDENACIONES ALK/ROS O MUTACIONES EN EGFR Rosario García Campelo Complejo Hospitalario Universitario A Coruña The seventies IMAGINE The eighties The Ninety 2000
NSCLC: Terapia medica nella fase avanzata. Paolo Bidoli S.C. Oncologia Medica H S. Gerardo Monza
NSCLC: Terapia medica nella fase avanzata Paolo Bidoli S.C. Oncologia Medica H S. Gerardo Monza First-line Second-line Third-line Not approved CT AND SILENT APPROVAL Docetaxel 1999 Paclitaxel Gemcitabine
Quale sequenza terapeutica nella malattia EGFR+
Trattamento della malattia avanzata oncogene-addicted Quale sequenza terapeutica nella malattia EGFR+ Chiara Bennati AUSL della Romagna Ravenna, Italy A matter of fact Outline Can we improve PFS/OS with
Non-Small Cell Lung Cancer:
Non-Small Cell Lung Cancer: Where We Are Today Sila Shalhoub, PharmD PGY2 Oncology Pharmacy Resident Shalhoub.Sila@mayo.edu Pharmacy Grand Rounds September 26, 2017 2017 MFMER slide-1 Objectives Identify
3/13/2018. Case 1. Multidisciplinary Management of Cancers Thoracic Oncology Tumor Board
Multidisciplinary Management of Cancers Thoracic Oncology Tumor Board Matthew Gubens, MD MS, UC San Francisco, Chair Julia Rotow, MD, UC San Francisco, Fellow Colin Blakely, MD PhD, UC San Francisco GigI
14,30 18,20. II Sessione. Moderatori: Giovanni Apolone, Roberto Labianca
14,30 18,20 II Sessione Moderatori: Giovanni Apolone, Roberto Labianca 15,10 15,30 Ca polmonare (never smokers): attualità e prospettive di ricerca Giulio Metro Ca polmonare (never smokers): attualità
Do You Think Like the Experts? Refining the Management of Advanced NSCLC With ALK Rearrangement. Reference Slides Introduction
Do You Think Like the Experts? Refining the Management of Advanced NSCLC With ALK Rearrangement Reference Slides Introduction EML4-ALK Fusion Oncogene Key Driver in 3% to 7% NSCLC Inversion or Translocation
Molecular Testing in Lung Cancer
Molecular Testing in Lung Cancer Pimpin Incharoen, M.D. Assistant Professor, Thoracic Pathology Department of Pathology, Ramathibodi Hospital Genetic alterations in lung cancer Source: Khono et al, Trans
Beyond ALK and EGFR: Novel molecularly driven targeted therapies in NSCLC Federico Cappuzzo AUSL della Romagna, Ravenna, Italy
Beyond ALK and EGFR: Novel molecularly driven targeted therapies in NSCLC Federico Cappuzzo AUSL della Romagna, Ravenna, Italy Oncogenic drivers in NSCLC Certain tumours arise as a result of aberrant activation
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
IMPORTANT PATHWAYS TO TARGET IN (ADVANCED) NSCLC:
IMPORTANT PATHWAYS TO TARGET IN (ADVANCED) NSCLC: A focus on EGFR-inhibition and implications for clinical practice Floriana Morgillo, MD PhD and Morena Fasano, MD PhD Faculty of Medicine, Università degli
EGFR Mutation-Positive Acquired Resistance: Dominance of T790M
Treatment of EGFR Mutation-Positive Acquired Resistance: T790M+ or T790M- H. Jack West, MD Swedish Cancer Institute, Seattle, WA EGFR Mutation-Positive Acquired Resistance: Dominance of T790M Yu, Clin
PROGRESSION AFTER THIRD GENERATION TKI
PROGRESSION AFTER THIRD GENERATION TKI What next? National Cancer Center Hospital Yuichiro Ohe, MD Name of lead presenter Yuichiro Ohe employee of company and/or profit-making organization adviser of company
ALK positive Lung Cancer. Shirish M. Gadgeel, MD. Director of the Thoracic Oncology program University of Michigan
ALK positive Lung Cancer Shirish M. Gadgeel, MD. Director of the Thoracic Oncology program University of Michigan Objectives What is ALK translocation? What drugs are used in what sequence? How many times
For analyst certification and disclosures please see page 5
Conference Update June 7, 2017 ASCO 2017 Detailed Presentation Notes Day 5 As part of our ongoing coverage of the 2017 American Society of Clinical Oncology (ASCO) conference, we attended multiple oral
The oncologist s point of view: the promise and challenges of increasing options for targeted therapies in NSCLC
The oncologist s point of view: the promise and challenges of increasing options for targeted therapies in NSCLC Egbert F. Smit Department of Thoracic Oncology, Netherlands Cancer Institute, and Department
K-Ras signalling in NSCLC
Targeting the Ras-Raf-Mek-Erk pathway Egbert F. Smit MD PhD Dept. Pulmonary Diseases Vrije Universiteit VU Medical Centre Amsterdam, The Netherlands K-Ras signalling in NSCLC Sun et al. Nature Rev. Cancer
ASCEND-2: a canary in a coal mine for descending to second-line treatment for ALK-rearranged non-small cell lung cancer
Editorial ASCEND-2: a canary in a coal mine for descending to second-line treatment for ALK-rearranged non-small cell lung cancer Viola W. Zhu 1,2, Sai-Hong Ignatius Ou 1 1 Division of Hematology/Oncology,
Case Studies. Ravi Salgia, MD, PhD
Case Studies Ravi Salgia, MD, PhD Professor and Arthur & Rosalie Kaplan Chair Medical Oncology and Therapeutics Research Associate Director for Clinical Sciences Research City of Hope 04-21-2018 Objectives
Impact of Targeted/Immunotherapy on Gamma Knife Radiosurgery
Impact of Targeted/Immunotherapy on Gamma Knife Radiosurgery Veronica Chiang, MD Yale University Department of Neurosurgery IGKRF Scientific Session University of Pennsylvania, Philadelphia June 23-24,
Targeted Therapies in Lung Cancer Patient Forum
Targeted Therapies in Lung Cancer Patient Forum Welcome! What to expect today Experts in EGFR, ALK, ROS1, BRAF, MET, and RET+ lung cancers will be presenting and interacting with patients and caregivers.
Personalized Genetics
Personalized Genetics Understanding Your Genetic Test Results Tracey Evans, MD September 29, 2017 Genetics 101 Punnett Square Genetic Pedigree 2 Genetics 101 Punnett Square Genetic Pedigree 3 It s not
New options for old and new targets in NSCLC Rosario García Campelo Medical Oncology Unit University Hospital A Coruña
New options for old and new targets in NSCLC Rosario García Campelo Medical Oncology Unit University Hospital A Coruña Phase II GOAL TRIAL DESIGN Key inclusion criteria Patients with locally advanced or
ALK +ive Lung Cancer: First line and Resistance Disease
ALK +ive Lung Cancer: First line and Resistance Disease Professor Tony Mok Li Shu Fan Medical Foundation Professor of Clinical Oncology Dept of Clinical Oncology The Chinese University of Hong Kong Disclosures
Is advanced lung cancer becoming a chronic disease?
Is advanced lung cancer becoming a chronic disease? James Chung-Man HO ( 何重文 ) M.D. FRCP Associate Professor, The University of Hong Kong Honorary Consultant, Department of Medicine Specialist in Respiratory
Hacia una mayor individualización clínica en el CPNM. J.M. Sánchez Torres H.U. Princesa, Madrid
Hacia una mayor individualización clínica en el CPNM J.M. Sánchez Torres H.U. Princesa, Madrid Lung cancer histologic subtypes NSCLC (80-85%) SCLC (15-20%) Squamous carcinoma (25 30%) Non-squamous carcinoma
ARIAD Pharmaceuticals, Inc.
ARIAD Pharmaceuticals, Inc. June 8, 2016 David Sachs Non-small cell lung cancer 1 ARIAD clinical trial patient Some of the statements in this presentation constitute forward looking statements under the
Making the first decision: EGFR mutation-positive NSCLC in the advanced setting
ELCC May 217, Switzerland Making the first decision: EGFR mutation-positive NSCLC in the advanced setting Noemí Reguart, MD, PhD Hospital Clínic de Barcelona, Spain Disclosures Consultant or Advisory Role
Prioritizing molecular markers to test for in the initial workup of advanced non-small cell lung cancer: wants versus needs
Review Article Page 1 of 9 Prioritizing molecular markers to test for in the initial workup of advanced non-small cell lung cancer: wants versus needs Howard West Medical Oncology, Swedish Cancer Institute,
EGFR TKI sequencing: does order matter?
EGFR TKI sequencing: does order matter? Nicolas Girard Thorax Institut Curie-Montsouris, Paris, France In Switzerland, afatinib is approved as monotherapy for patients with non-small cell lung cancer (Stage
Maintenance therapy in advanced non-small cell lung cancer. Egbert F. Smit MD PhD Dept Thoracic Oncology Netherlands Cancer Institute
Maintenance therapy in advanced non-small cell lung cancer. Egbert F. Smit MD PhD Dept Thoracic Oncology Netherlands Cancer Institute e.smit@nki.nl Evolution of front line therapy in NSCLC unselected pts
The evolving treatment of NSCLC
The evolving treatment of NSCLC Maya Gottfried Head of Oncology Institute Meir Medical Center Dr.Natalie.M.R. Lung cancer: most common malignancy and leading cause of cancer-related mortality GLOBOCAN
NCCN Non-Small Cell Lung Cancer V Meeting June 15, 2018
Guideline Page and Request Illumina Inc. requesting to replace Testing should be conducted as part of broad molecular profiling with Consider NGS-based assays that include EGFR, ALK, ROS1, and BRAF as
Dr. Andres Wiernik. Lung Cancer
Dr. Andres Wiernik Lung Cancer Lung Cancer Facts - Demographics World Incidence: 1 8 million / year World Mortality: 1 6 million / year 5-year survival rates vary from 4 17% depending on stage and regional
Intracranial efficacy of crizotinib versus chemotherapy in PROFILE 1014: shining a light on central nervous system endpoints in clinical trials
Perspective Intracranial efficacy of crizotinib versus chemotherapy in PROFILE 1014: shining a light on central nervous system endpoints in clinical trials Terry L. Ng, D. Ross Camidge Division of Medical
Plotting the course: optimizing treatment strategies in patients with advanced adenocarcinoma
Pieter E. Postmus University of Liverpool Liverpool, UK Plotting the course: optimizing treatment strategies in patients with advanced adenocarcinoma Disclosures Advisor Bristol-Myers Squibb AstraZeneca
Nivolumab: esperienze italiane nel carcinoma polmonare avanzato
NSCLC avanzato: quali novità nel 2018? Negrar, 30 Ottobre 2018 Nivolumab: esperienze italiane nel carcinoma polmonare avanzato Francesco Grossi UOC Oncologia Medica Fondazione IRCCS Ca Granda Ospedale
Target therapy nel NSCLC con EGFR M+ Cesare Gridelli Division of Medical Oncology S.G. Moscati Hospital Avellino (Italy)
Target therapy nel NSCLC con EGFR M+ Cesare Gridelli Division of Medical Oncology S.G. Moscati Hospital Avellino (Italy) cgridelli@libero.it First-Line Treatment of Advanced NSCLC EGFR-mutation analysis
ADVANCES IN LUNG CANCER TREATMENTS
ADVANCES IN LUNG CANCER TREATMENTS Joan H. Schiller, MD Deputy Director of Clinical Research; Chief of Hematology/Oncology Inova Schar Cancer Institute; Fairfax, VA Chair of the Scientific Steering Committee,
Nouvelles stratégies Prise en charge en cas d altération oncogénique
Nouvelles stratégies Prise en charge en cas d altération oncogénique David Planchard (MD, PhD) Department of Cancer Medicine Thoracic Unit Gustave Roussy Villejuif (France) Disclosure Slide Consultancy
Best of ASCO 2014 Lung
Best of ASCO 214 Lung Heather Wakelee, MD Associate Professor of Medicine, Oncology Stanford Cancer Institute Stanford, California USA Outline ALK: 82: 1st line crizotinib Profile 114 83: ASCEND ceritinib
Afatinib in patients with EGFR mutation-positive NSCLC harboring uncommon mutations: overview of clinical data
Afatinib in patients with EGFR mutation-positive NSCLC harboring uncommon mutations: overview of clinical data Oscar Arrieta, 1 Pedro De Marchi, 2 Nobuyuki Yamamoto, 3 Chong-Jen Yu, 4 Sai-Hong I Ou, 5
2 nd line Therapy and Beyond NSCLC. Alan Sandler, M.D. Oregon Health & Science University
2 nd line Therapy and Beyond NSCLC Alan Sandler, M.D. Oregon Health & Science University Treatment options for advanced or metastatic (stage IIIb/IV) NSCLC Suitable for chemotherapy Diagnosis Unsuitable/unwilling
Updates in Lung Cancer
Updates in Lung Cancer J. Tanner Ringley, PharmD, BCOP, CPP Levine Cancer Institute Learning Objectives: Discuss incorporation of liquid biopsies into practice and interpretation of immunotherapy biomarker
Benefit Risk Analysis Of Decision-Making: Oncology
Benefit Risk Analysis Of Decision-Making: Oncology G.K. Raju, Ph.D. December 13 th 2016 Outline Background Approach Application to Oncology Non-Small Cell Lung Cancer Learnings & Ongoing Work Acknowledgements
Stratégies thérapeutiques optimales en cas de positivité HER2, BRAF, ALK
Stratégies thérapeutiques optimales en cas de positivité HER2, BRAF, ALK David Planchard (MD, PhD) Department of Cancer Medicine Thoracic Unit Gustave Roussy Villejuif (France) Disclosure Slide AstraZeneca,
Supplementary Online Content
Supplementary Online Content Kris MG, Johnson BE, Berry LD, et al. Using Multiplexed Assays of Oncogenic Drivers in Lung Cancers to Select Targeted Drugs. JAMA. doi:10.1001/jama.2014.3741 etable 1. Trials
Next Generation EGFR Inhibitors
Next Generation EGFR Inhibitors Tony Mok MD Li Shu Fan Medical Foundation Professor of Clinical Oncology Dept. of Clinical Oncology The Chinese University of Hong Kong EGFR TKIs First Generation -Gefitinib
Slide 1. Slide 2. Slide 3. Disclosures. Personalized Medicine for Advanced NSCLC in East Asia. No conflicts related to this presentation
Slide 1 12 th International Lung Cancer Conference Personalized Medicine for Advanced NSCLC in East Asia Masahiro Tsuboi, M.D., Ph.D. Group Chair, Lung Cancer Surgical Study Group in Japan Clinical Oncology
Lung Cancer. Karen Reckamp, MD Medical Director, Clinical Research. Click to edit Master Presentation Date
Advances in Targeted Therapy for Lung Cancer Karen Reckamp, MD Medical Director, Clinical Research City of Hope Comprehensive Cancer Center Click to edit Master Presentation Date Disclosures Consultant
Lihong Ma 1 *, Zhengbo Song 2 *, Yong Song 1, Yiping Zhang 2. Original Article
Original Article MET overexpression coexisting with epidermal growth factor receptor mutation influence clinical efficacy of EGFR-tyrosine kinase inhibitors in lung adenocarcinoma patients Lihong Ma 1
Brain metastases and meningitis carcinomatosa: Prof. Rafal Dziadziuszko Medical University of Gdańsk, Poland
Brain metastases and meningitis carcinomatosa: a palliative situation? Prof. Rafal Dziadziuszko Medical University of Gdańsk, Poland SAMO, Lucerne, February 1-2, 2013 Treatment options for NSCLC patients
REPORT ASCO 2018 CHICAGO: RESPIRATORY ONCOLOGY Johan Vansteenkiste / Christophe Dooms, Univ. Hospital KU Leuven and Leuven Lung Cancer Group
1 REPORT ASCO 2018 CHICAGO: RESPIRATORY ONCOLOGY Johan Vansteenkiste / Christophe Dooms, Univ. Hospital KU Leuven and Leuven Lung Cancer Group OUR 10 MESSAGE HIGHLIGHTS 1/ Advanced NSCLC 1 st line: IO
Personalized Medicine: Lung Biopsy and Tumor
Personalized Medicine: Lung Biopsy and Tumor Mutation Testing Elizabeth H. Moore, MD Personalized Medicine: Lung Biopsy and Tumor Mutation Testing Genomic testing has resulted in a paradigm shift in the
Nuevos fármacos anti ALK. Javier de Castro
Nuevos fármacos anti ALK Javier de Castro Cáncer de Pulmón ALK + Incidencia 2-7% 5-6ª dec, No fumador De Castro J, Clin and Trasl 2013 Fusión de NPM-ALK descubierta LACG* Fusión de EML4- ALK descubierta
Maintenance Therapy for Advanced NSCLC: When, What, Why & What s Left After Post-Maintenance Relapse?
Maintenance Therapy for Advanced NSCLC: When, What, Why & What s Left After Post-Maintenance Relapse? Mark A. Socinski, MD Professor of Medicine Multidisciplinary Thoracic Oncology Program Lineberger Comprehensive
Updates in Lung Cancer. J. Tanner Ringley, PharmD, BCOP, CPP Levine Cancer Institute
Updates in Lung Cancer J. Tanner Ringley, PharmD, BCOP, CPP Levine Cancer Institute Learning Objectives: Discuss incorporation of liquid biopsies into practice and interpretation of immunotherapy biomarker
Targeting Acquired Resistance to EGFR Kinase Inhibitors: Beyond T790M Mutation
Targeting Acquired Resistance to EGFR Kinase Inhibitors: Beyond T790M Mutation James Chih-Hsin Yang, MD, PhD National Taiwan University Hospital National Taiwan University Cancer Center Taipei, Taiwan
Emerging Algorithm for Optimal Sequencing of EGFR TKIs in EGFR Mutation Positive NSCLC
Emerging Algorithm for Optimal Sequencing of EGFR TKIs in EGFR Mutation Positive NSCLC Keunchil Park, MD, PhD Samsung Medical Center, Sungkyunkwan University School of Medicine Faculty Disclosure Consulting
Hidetoshi Hayashi, Kazuhiko Nakagawa
Editorial Current evidence in support of the second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor alectinib for the treatment of non-small cell lung cancer positive for ALK translocation