New Options for Achieving Individualized Approaches to Non-Small Cell Lung Cancer (NSCLC) Management

Size: px
Start display at page:

Download "New Options for Achieving Individualized Approaches to Non-Small Cell Lung Cancer (NSCLC) Management"

Transcription

1 New Options for Achieving Individualized Approaches to Non-Small Cell Lung Cancer (NSCLC) Management Ramaswamy Govindan, MD Director Professor of Medicine Director, Thoracic Oncology Program Department of Internal Medicine, Division of Oncology Washington University School of Medicine St. Louis, Missouri

2 Faculty Disclosure It is the policy of The France Foundation to ensure balance, independence, objectivity, and scientific rigor in all its sponsored educational activities. All faculty, activity planners, content reviewers, and staff participating in this activity will disclose to the participants any significant financial interest or other relationship with manufacturer(s) of any commercial product(s)/device(s) and/or provider(s) of commercial services included in this educational activity. The intent of this disclosure is not to prevent a person with a relevant financial or other relationship from participating in the activity, but rather to provide participants with information on which they can base their own judgments. The France Foundation has identified and resolved any and all conflicts of interest prior to the release of this activity. Dr. Govindan has received grants/research support from Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, Lilly Oncology, and Pfizer.

3 Educational Activity Learning Objectives List barriers that hinder optimal care for NSCLC patients and establish methods to achieve improved outcomes Define strategies to better include patients and their families in a shared decision making process for the management of their NSCLC Assess the latest data from newer oncologic therapies to determine future strategies for improving the significant failure rate seen among current approaches for NSCLC management Determine individualized NSCLC patient scenarios where novel targeted therapies may apply and assess how these options may integrate into existing regimens, taking into account potential safety issues Examine the potential role of biomarkers in the individualized management of NSCLC patients and identify new knowledge and skill sets required for their incorporation into clinical practice

4 Estimated New Cancer Cases United States, 2009 Males Females Jemal A, et al. CA Cancer J Clin. 2009;59(4):

5 Estimated Cancer Deaths United States, 2009 Males Females Jemal A, et al. CA Cancer J Clin. 2009;59(4):

6 Non-small Cell Lung Cancer (NSCLC) NSCLC accounts for ~135,000 cases of lung cancer annually Approximately 30 40% of these patients will have metastatic disease Untreated patients have a median survival of ~4 5 months

7 > 85% of Lung Cancer Is Caused by Cigarette Smoking Decrease in risk seen 5 years after stopping, never reaches baseline Cessation after diagnosis improves treatment tolerance and outcome Videtic GM, et al. J Clin Oncol. 2003;21(8): Fox JL, et al. Lung Cancer. 2004;44(3):

8 Survival by Clinical and Pathologic Stage Proposed IASLC Stage Groupings IASLC = International Association for the Study of Lung Cancer Detterbeck FC, et al. Chest. 2009;136: Goldstraw P, et al. J Thorac Oncol. 2007;2:

9 Lung Cancer: Symptoms Related to Primary Lesion Cough, often dry Shortness of breath Hemoptysis Wheezing Related to Spread within Chest Shortness of breath Hoarseness Superior vena cava syndrome Horner s syndrome Related to Distant Metastasis Brain Bone Liver Adrenal glands

10 Lung Cancer Assessment History and Physical Exam Assess weight loss Performance status Labs: CBC, comprehensive metabolic panel Smoking cessation counseling CXR CT Chest with IV contrast (includes liver and adrenal glands) Biopsy Bronchoscopy CT guided Mediastinoscopy Endoscopic ultrasonography Thoracentesis +/- FDG-PET scan +/- MRI Brain/Spine

11 Overview of NSCLC Treatment Stage I Stage II Stage III Stage IV or Recurrent Disease Surgery (Radiation if inoperable) Surgery With Adjuvant Chemotherapy Surgery or Radiation With Chemotherapy Chemotherapy Targeted Therapy

12 Non-Small Cell Lung Cancer: Stage IV Disease General Principles Baseline factors predict survival Weight loss Gender Performance status Age does not predict worse outcome Elderly patients with a good performance status should be offered systemic treatment Older patients are more susceptible to toxic side effects of chemotherapy

13 Survival with Cytotoxic Chemotherapies Delbaldo C, et al. JAMA. 2004;292: drugs are better than 1

14 Survival with Cytotoxic Chemotherapies Delbaldo C, et al. JAMA. 2004;292: cytotoxic drugs are not better than 2

15 Cis/Gem vs Cis/Pemetrexed Randomization Factors Stage Performance status Gender Histologic vs cytologic diagnosis History of brain metastases R A N D O M I Z A T I O N Vitamin B 12, folate, and dexamethasone given in both arms Cisplatin 75 mg/m 2 day 1 + Gemcitabine 1250 mg/m 2 days 1,8 (n = 863) Each cycle repeated q 3 wk up to 6 cycles Cisplatin 75 mg/m 2 day 1 + Pemetrexed 500 mg/m 2 day 1 (n = 862) Primary Endpoint Overall Survival Scagliotti GV, et al. J Clin Oncol. 2008;26(21):

16 Survival Probability Cis/Gem vs Cis/Pemetrexed: Survival Median (95% CI) Cisplatin/pemetrexed 10.3 ( ) Cisplatin/gemcitabine 10.3 ( ) CP vs CG Adjusted HR (95% CI) Survival Time, mo 0.94 ( ) Scagliotti GV, et al. J Clin Oncol. 2008;26(21):

17 Survival Probability Cis/Gem vs Cis/Pemetrexed: Survival in Nonsquamous Carcinoma Median (95% CI) Cisplatin/pemetrexed 11.8 (10.4, 13.2) Cisplatin/gemcitabine 10.4 (9.6, 11.2) CP vs CG Adjusted HR (95% CI) 0.81 ( ) Survival Time in Patients With Nonsquamous Histology, mo Scagliotti GV, et al. J Clin Oncol. 2008;26(21):

18 Pre-specified Histology Analysis Histology Subgroup Median Overall Survival in Months (95% CI) Unadjusted Hazard Ratio Cisplatin/ Pemetrexed Cisplatin/ Gemcitabine (HR) a,b (95% CI) Adjusted Hazard Ratio (HR) a,b,c (95% CI) Nonsquamous NSCLC d (N = 1252) Adenocarcinoma (N = 847) 11.0 ( ) 12.6 ( ) N = 618 N = ( ) 10.9 ( ) N = 634 N = ( ) 0.84 ( ) 0.84 ( ) 0.84 ( ) Large Cell (N = 153) 10.4 ( ) N = ( ) N = ( ) 0.67 ( ) Other e (N = 252) 8.6 ( ) N = ( ) N = ( ) 1.08 ( ) Squamous Cell NSCLC (N = 473) 9.4 ( ) N = ( ) N = ( ) 1.23 ( ) a An HR that is less than 1.0 indicates that survival is better in the AC arm than in the GC arm. Alternatively, an HR that is greater than 1.0 indicates survival is better in the GC arm than in the AC arm. b Unadjusted for multiple comparisons c HRs adjusted for ECOG PS, gender, disease stage, and basis for pathological diagnosis (histopathological/cytopathological) d Included adenocarcinoma, large cell, and other histologies except those with squamous cell type e The subgroup of other represents patients with primary diagnosis of NSCLC whose disease did not clearly qualify as adenocarcinoma, squamous cell carcinoma, or large cell carcinoma. Scagliotti GV, et al. J Clin Oncol. 2008;26(21):

19 Maintenance Pemetrexed vs Placebo Pemetrexed + BSC (N = 441)* Stage IIIB/IV NSCLC ECOG PS prior cycles of gem, doce, or tax + cis or carbo, with CR, PR, or SD 2:1 Randomization Primary Endpoint = PFS Placebo (d1, q21d) + BSC (N = 222)* Ciuleanu T, et al. Lancet. 2009;374(9699):

20 PFS Probability Progression-free Survival HR = 0.60 (95% CI: ) P < Pemetrexed 4.0 mos Placebo 2.0 mos Time (months) Ciuleanu T, et al. Lancet. 2009;374(9699):

21 Survival Probability Overall Survival (ITT) 1.0 HR = 0.79 (95% CI: ) P = Pemetrexed 13.4 mos Placebo 10.6 mos Time (months) Ciuleanu T, et al. Lancet. 2009;374(9699):

22 Survival Probability Overall Survival Adenocarcinoma Adenocarcinoma (n = 481) 1.0 HR = 0.70 (95% CI: ) P = Pemetrexed 15.5 mos Placebo 10.3 mos Time (months) Ciuleanu T, et al. Lancet. 2009;374(9699):

23 Targeted Therapy in Oncology Target Present in tumor tissue Critical for tumor growth/progression Druggable Dispensable or absent in normal cells Drug Discovery and Development Agent Targets tumor cells Spares normal cells Decreased toxicity

24 Agents Targeting the VEGF Pathway Anti-VEGF antibodies (bevacizumab) VEGF Soluble VEGFRs (VEGF-Trap) P P P P VEGFR-1 P P P P VEGFR-2 Anti-VEGFR antibodies (IMC-1121b) Podar K, Anderson K. Blood. 2005;105(4): Endothelial cell Small-molecule VEGFR inhibitors Vatalanib (PTK 787) Sunitinib (SU11248) Sorafenib (Bay ) ZD6474

25 Phase III Trial of Bevacizumab in Non-Squamous NSCLC: ECOG 4599 N = 855 (eligible) Eligibility: Non-squamous NSCLC No Hx of hemoptysis No CNS metastases Stratification Variables: RT vs no RT Stage IIIB or IV vs recurrent Wt loss < 5% vs 5% Measurable vs non-measurable Sandler A, et al. New Engl J Med. 2006;355(24): (PC) Paclitaxel 200 mg/m 2 Carboplatin AUC = 6 (q 3 weeks) x 6 cycles (PCB) PC x 6 cycles + Bevacizumab (15 mg/kg q 3 wks) to PD No crossover to bevacizumab permitted

26 Patients With PFS (%) Patients Surviving (%) Carboplatin/Paclitaxel +/- Bevacizumab: Key Clinical Outcomes Progression-Free Survival Carboplatin/paclitaxel Carboplatin/paclitaxel + bevacizumab P < 0.001; HR = 0.66 Median PFS: 6.2 months vs 4.5 months 6-Month PFS: 55% vs 33% 1-Year PFS: 15% vs 6% Overall Survival Carboplatin/paclitaxel Carboplatin/paclitaxel + bevacizumab P = 0.003; HR = 0.79 Median OS: 12.3 months vs 10.3 months 1-Year OS: 51% vs 44% 2-Year OS: 23% vs 15% Months Months HR = hazard ratio; OS = overall survival; PFS = progression-free survival Response rate = carboplatin/paclitaxel 15%; carboplatin/paclitaxel + bevacizumab 35%; P < Sandler A, et al. N Engl J Med. 2006;355(24): Sandler A, et al. J Clin Oncol. 2005;23(16S):4.

27 Grade 3 5 Non-Hematologic Toxicity CP (N = 441) BvCP (N = 427) P Value Hemorrhage Hemoptysis 0.5% 2.1% CNS 0.2% 0.7% GI 0.5% 1.2% Other 0.2% 1.2% Hypertension 0.7% 7.7% < Proteinuria % < Venous thromb 3.2% 5.6% Arterial thromb 1.6% 2.8% Sandler A, et al. New Engl J Med. 2006;355(24):

28 AVAiL Trial Study Design Previously untreated, stage IIIb, IV or recurrent non-squamous NSCLC R A N D O M I Z E Bevacizumab 7.5 mg/kg + CG Placebo CG Placebo 15 + CG Bevacizumab 15 mg/kg + CG Bevacizumab Bevacizumab PD PD PD Stratification factors: disease stage, ECOG, PS, region, gender Reck M, et al. J Clin Oncol. 2009;27(8): CG: cisplatin-gemcitabine

29 AVAiL Primary Endpoint: PFS Bevacizumab 7.5 mg Group Bevacizumab 15 mg Group Toxicity was similar to that of E4599 Reck M, et al. J Clin Oncol. 2009;27(8): CG: cisplatin-gemcitabine

30 Probability of OS AVAiL: Overall Survival (secondary endpoint) HR (95% CI) Placebo + CG Bev 7.5 mg/kg + CG 0.93 ( ) Bev 15 mg/kg + CG 1.03 ( ) P value Median OS (months) No. at risk Placebo + CG Bev 7.5 mg/kg + CG Bev 15 mg/kg + CG Time (months) Reck M, et al. Ann Oncol Feb 11. [Epub ahead of print] ITT (intent-to-treat) population CG: cisplatin-gemcitabine

31 Oral VEGF-TKIs Agent Target/MOA Company ZD6474 VEGFR-2, EGFR AstraZeneca Sunitinib VEGFR-1/2, PDGFR, Kit, FLT-3 Sugen/Pfizer Inc Sorafenib VEGFR-2/3, FLT-3, Kit Onyx/Bayer Vatalanib VEGFR-1/2/3, PDGFR, Kit Novartis AG VEGFR-1/2, PDGFR, Kit Pfizer Inc AMG 706 VEGFR, PDGFR, Kit, Ret Amgen AEE-788 VEGFR, EGFR, erb Novartis

32 Adenocarcinoma Molecular Subtypes Pending

33 Adenocarcinoma Molecular Subtypes KRAS Pending EGFR BRAF PIK3CA MEK FGFR4 EML4-ALK HER2

34 EGFR Signaling gefitinib erlotinib Adapted from Ciardiello F, Tortora G. N Engl J Med. 2008;358:

35 EGFR Mutations Found in 350 of 2105 patients with advanced NSCLC(16.6%) Mutation distribution Women > men (70% vs 30%) Never smokers > smoking history (67% vs 33%) Those with adenocarcinomas (80.9%) (P < for all comparisons) Deletions in exon 19 (62.2%) and L858R (37.8%) Adverse events Mild rashes Diarrhea Grade 3 cutaneous toxic effects in 16 patients (7.4%) Grade 3 diarrhea in 8 patients (3.7%) Rosell R, et al; Spanish Lung Cancer Group. N Engl J Med. 2009;361(10):

36 EGFR Mutations Rosell R, et al; Spanish Lung Cancer Group. N Engl J Med. 2009;361(10):

37 IPASS Study Design Patients Chemonaïve Age 18 years Adenocarcinoma histology Never or light exsmokers Life expectancy 12 weeks PS 0-2 Measurable stage IIIB/ IV disease Gefitinib (250 mg/day) 1:1 randomization Carboplatin (AUC 5 or 6) / paclitaxel (200 mg/m 2 ) 3 weekly Endpoints Primary Progression-free survival (non-inferiority) Secondary Objective response rate Overall survival Exploratory EGFR mutation Mok TS, et al. N Engl J Med. 2009;361(10):

38 Mok TS, et al. N Engl J Med. 2009;361(10): First-line Gefitinib vs Carboplatin-Paclitaxel

39 Mok TS, et al. N Engl J Med. 2009;361(10): First-line Gefitinib vs Carboplatin-Paclitaxel

40 Mechanisms of TKI Resistance TKI Sensitive Acquired Resistance 50% 20% Poor Initial Response Gazdar AF. Cancer Metastasis Rev. 2010;29(1):37-48.

41 Irreversible EGFR Inhibitors EGFR HER2 HER4 Clinical IC 50, nm IC 50, nm IC 50, nm Phase BIBW PF HKI Doebele RC, et al. Lung Cancer Jan 19. [Epub ahead of print]

42 Management of Cutaneous Toxicities Associated With EGFR Inhibitors Employ a proactive approach in managing skin reactions Suggest that patients use a thick, alcohol-free emollient cream Suggest that patients use a sunscreen of SPF 15 or higher, preferably containing zinc oxide or titanium dioxide If patient presents with rash, verify appropriate administration of drug* and proceed with the following therapy algorithm *Patient should be taking the drug on an empty stomach at the same time each day Lynch TJ, et al. Oncologist. 2007;12(5):

43 Proposed Therapy Algorithm for the Management of Cutaneous Toxicities Associated With EGFR Inhibitors The use of topical steroids should be employed in a pulse manner based on your institution s guidelines Lynch TJ, et al. Oncologist. 2007;12(5):

44 EML4-ALK Fusion Product in NSCLC A receptor tyrosine kinase (anaplastic lymphoma kinase [ALK] fuses to the echinoderm microtubule-associated protein-like 4 (EML-4) Multiple variants of the translocation have been identified Oncogenic (transforms cell lines and transgenic mice develop lung cancer) EML4-ALK fusion transcript was detected in 6.7% (5 out of 75) of NSCLC patients examined Soda M, et al. Nature. 2007;448(7153):

45 Frequency of EML4/ALK Translocations Author Total Number Pos % Notes Shaw ASCO 2009 Inamura, JTO 2008 Takeuchi, CCR 2008 Koivuner, CCR 2008 Wong, Cancer 2009 Takahashi, ASO % More likely in adenocarcinoma, light or never smokers, didn t overlap with EGFR or KRAS, younger patients % No overlap with EGFR or KRAS % % More common in never or light smokers % Mostly adenocarcinoma, never smokers, younger % Only looked at surgical cases. No overlap with EGFR, KRAS, HER2, 4 never smokers, 1 < 1py smoker, all adenocarcinomas.

46 Is the EML4-ALK Transcript Specific for NSCLC? PCR in 120 NSCLC specimens 1 Controls: Non-neoplastic lung tissues ALK protein levels assayed from 662 NSCLC specimens Results EML4-ALK transcripts (variants 1 and 3) detected in 9/120 NSCLC samples Also found in noncancerous lung tissues No transcripts were detected in matching tumor samples from these patients Analysis of EML4-ALK+ cases Only a minority of cells harbored the EML4-ALK gene (FISH) None of these cases was found to express the EML4-ALK protein Conclusion: EML4-ALK transcript cannot be regarded as a specific diagnostic tool for NSCLC Findings challenged by Mano et al 2 Martelli MP, et al. Am J Pathol. 2009;174: Mano H, Takeuchi K. Am J Pathol Jan 14. [Epub ahead of print]

47 Tumor Responses to PF for NSCLC Evaluable Patients With ALK Fusions Tumor Size Change Duration of Response (Weeks) Kwak EL, et al. ASCO

48 Molecular Analysis and NSCLC ERCC1 (excision repair cross complementation) Expression prognostic for improved survival Expression predictive of reduced response to platinum-based therapy RRM1 (regulatory subunit of ribonucleotide reductase) Expression prognostic for improved survival Expression predictive of reduced response to gemcitabine therapy BRCA1 (breast cancer 1) Low level of expression prognostic for long survival Low level of expression may be predictive of good platinum efficacy and poor taxane efficacy EGFR (epidermal growth factor receptor) EGFR mutations and gene copy number prognostic of survival Predictive for EGFR tyrosine kinase inhibitor efficacy Oligonucleotide-based Gene Expression Profiles Promising strategy for risk assessment and prediction of therapeutic efficacy Bepler G, et al. Cancer Control. 2008;15(2):

49 NSCLC Management Guidelines 1 Recommendations for the treatment of patients with stage IV NSCLC, based on 162 publications Chemotherapy and biologicals Strategies that improve overall survival First-line therapy Patients with performance status of 0 or 1 Platinum-based two-drug combination of cytotoxic drugs is recommended Nonplatinum cytotoxic doublets are acceptable for patients with contraindications For patients with performance status of 2, single cytotoxic drug is sufficient Azzoli CG, et al. J Clin Oncol. 2009;27(36):

50 NSCLC Management Guidelines 2 Stop first-line cytotoxic chemotherapy at disease progression or after 4 cycles in patients who are not responding to treatment Stop two-drug cytotoxic chemotherapy at 6 cycles in all patients EGFR mutations First-line gefitinib may be recommended for patients with known mutation Otherwise, cytotoxic chemotherapy is preferred Cetuximab is recommended with cisplatin-vinorelbine for patients with EGFR-positive tumors by immunohistochemistry Bevacizumab is generally recommended with carboplatin-paclitaxel Second-line therapy Docetaxel Erlotinib Gefitinib or Pemetrexed Third-line therapy Erlotinib for erlotinib or gefitinib naive patients Data are insufficient to recommend the routine third-line use of cytotoxic drugs Data are insufficient to recommend routine use of molecular markers to select chemotherapy Azzoli CG, et al. J Clin Oncol. 2009;27(36):

51 Nursing Considerations Assessment Geriatric Patient Planning Histology, Stage, Intervention Patient Education Knowledge base Caregiver Support Resources

52 Multidisciplinary Patient Management Oncologists Nurses Thoracic surgeons Pulmonologists Pathologists Pharmacists Medical directors Case managers

53 Communication With Patients Goals Compliance (especially with po medications) Smoking cessation Patient self evaluation and reporting Manage disease symptoms, disease burden, and treatment side effects Offer Web resources

54 Case Scenario 1 55-year-old person with Stage IV NSCLC Adenocarcinoma histology Good performance status Hemoptysis on 3 occasions, total ~15 cc blood What is the most appropriate chemotherapy? A. Cisplatin and gemcitabine B. Cisplatin and pemetrexed C. Carboplatin, paclitaxel, bevacizumab D. Carboplatin and paclitaxel E. Cisplatin, vinorelbine, cetuximab

55 Case Scenario 1 55-year-old person with Stage IV NSCLC Adenocarcinoma histology Good performance status Hemoptysis on 3 occasions, total ~15 cc blood What is the most appropriate chemotherapy? Cisplatin and gemcitabine Cisplatin and pemetrexed B. Carboplatin, paclitaxel, bevacizumab Carboplatin and paclitaxel Cisplatin, vinorelbine, cetuximab

56 Case Scenario 2 55-year-old woman with Stage IV NSCLC Adenocarcinoma Good performance status EGFR exon 19 deletion What is the optimal chemotherapy? A. Carboplatin, paclitaxel, bevacizumab B. Carboplatin, paclitaxel C. Cisplatin, pemetrexed, bevacizumab D. Erlotinib

57 Case Scenario 2 55-year-old woman with Stage IV NSCLC Adenocarcinoma Good performance status EGFR exon 19 deletion What is the optimal chemotherapy? A. Carboplatin, paclitaxel, bevacizumab B. Carboplatin, paclitaxel C. Cisplatin, pemetrexed, bevacizumab Erlotinib

58 Case Scenario 3 55-year-old woman with Stage IV adenocarcinoma of the lung, completes 6 cycles of cisplatin, pemetrexed, and bevacizumab with stable disease, grade 1 neuropathy, and continues to work full time What is the most appropriate next step? A. Continue cisplatin, pemetrexed, and bevacizumab until progression B. Continue pemetrexed and bevacizumab until progression C. Continue bevacizumab until progression D. Continue pemetrexed until progression E. Discontinue therapy and monitor until progressive disease

59 Case Scenario 3 55-year-old woman with Stage IV adenocarcinoma of the lung, completes 6 cycles of cisplatin, pemetrexed, and bevacizumab with stable disease, grade 1 neuropathy, and continues to work full time What is the most appropriate next step? Continue cisplatin, pemetrexed, and bevacizumab until progression Continue pemetrexed and bevacizumab until progression Continue bevacizumab until progression Continue pemetrexed until progression Discontinue therapy and monitor until progressive disease

60 Case Scenario 4 55-year-old man with Stage IV squamous cell carcinoma completes 6 cycles of cisplatin and vinorelbine with stable disease, grade 1 neuropathy, and continues to work full time What is the most appropriate next step? Continue cisplatin and vinorelbine until progression Start erlotinib and continue until progression Start docetaxel and continue until progression Continue gemcitabine until progression Discontinue therapy and monitor until progressive disease

61 Case Scenario 4 55-year-old man with Stage IV squamous cell carcinoma completes 6 cycles of cisplatin and vinorelbine with stable disease, grade 1 neuropathy, and continues to work full time What is the most appropriate next step? Continue cisplatin and vinorelbine until progression Start erlotinib and continue until progression Start docetaxel and continue until progression Continue gemcitabine until progression Discontinue therapy and monitor until progressive disease

62 Summary Chemotherapy Two agents > one Three agents can be better than two Role for maintenance therapy? Still under evaluation Targeted Therapy Agents targeting the EGFR and VEGF pathways have proved successful Further study will include Earlier stage NSCLC Promising therapies are in development

63 Molecular targeting of cancer:

64

65 Lung Cancer: Conclusions Smoking remains primary cause of lung cancer Screening remains controversial Staging helps determine treatment Clinical trial participation may be attractive Multiple options in non-small cell lung cancer The Future: treat lung cancer based on molecular characteristics of tumors

SURGICAL GRAND ROUNDS

SURGICAL GRAND ROUNDS SURGICAL GRAND ROUNDS David H. Harpole, Jr., M.D. New Options for Achieving Individualized Approaches to Non-small Cell Lung Cancer Management Dr. Harpole has financial relationships with the following

More information

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 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

More information

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? 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

More information

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 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

More information

1st line chemotherapy and contribution of targeted agents

1st line chemotherapy and contribution of targeted agents ESMO PRECEPTORSHIP PROGRAMME NON-SM ALL-CELL LUNG CANCER 1st line chemotherapy and contribution of targeted agents Yi-Long Wu Guangdong Lung Cancer Institute Guangdong General Hospital Guangdong Academy

More information

Choosing Optimal Therapy for Advanced Non-Squamous (NS) Non-Small Cell Lung Cancer

Choosing Optimal Therapy for Advanced Non-Squamous (NS) Non-Small Cell Lung Cancer Choosing Optimal Therapy for Advanced Non-Squamous (NS) Non-Small Cell Lung Cancer Jyoti D. Patel, MD Associate Professor Feinberg School of Medicine Robert H Lurie Comprehensive Cancer Center Northwestern

More information

11/21/2009. Erlotinib in KRAS Mt patients. Bevacizumab in Squamous patients

11/21/2009. Erlotinib in KRAS Mt patients. Bevacizumab in Squamous patients Decision-Making in Non-Small Cell Lung Cancer (NSCLC): Moving from Empiric to Personalized & Molecular-based Therapy David R. Gandara, MD University of California Davis Cancer Center Disclosures Research

More information

EGFR inhibitors in NSCLC

EGFR inhibitors in NSCLC Suresh S. Ramalingam, MD Associate Professor Director of Medical Oncology Emory University i Winship Cancer Institute EGFR inhibitors in NSCLC Role in 2nd/3 rd line setting Role in first-line and maintenance

More information

Molecular Targets in Lung Cancer

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

More information

Targeted Agents as Maintenance Therapy. Karen Kelly, MD Professor of Medicine UC Davis Cancer Center

Targeted Agents as Maintenance Therapy. Karen Kelly, MD Professor of Medicine UC Davis Cancer Center Targeted Agents as Maintenance Therapy Karen Kelly, MD Professor of Medicine UC Davis Cancer Center Disclosures Genentech Advisory Board Maintenance Therapy Defined Treatment Non-Progressing Patients Drug

More information

1 st line chemotherapy and contribution of targeted agents in non-driver addicted NSCLC

1 st line chemotherapy and contribution of targeted agents in non-driver addicted NSCLC 1 st line chemotherapy and contribution of targeted agents in non-driver addicted NSCLC Dr Ross Soo, FRACP National University Cancer Institute, Singapore National University Health System Cancer Science

More information

Plotting the course: optimizing treatment strategies in patients with advanced adenocarcinoma

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

More information

Maintenance paradigm in non-squamous NSCLC

Maintenance paradigm in non-squamous NSCLC Maintenance paradigm in non-squamous NSCLC L. Paz-Ares Hospital Universitario Virgen del Rocío Sevilla Agenda Theoretical basis The data The comparisons Agenda Theoretical basis The data The comparisons

More information

Antiangiogenic Agents in NSCLC Where are we? Which biomarkers? VEGF Is the Only Angiogenic Factor Present Throughout the Tumor Life Cycle

Antiangiogenic Agents in NSCLC Where are we? Which biomarkers? VEGF Is the Only Angiogenic Factor Present Throughout the Tumor Life Cycle Antiangiogenic Agents in NSCLC Where are we? Which biomarkers? Martin Reck Department e t of Thoracic c Oncology ogy Hospital Grosshansdorf Germany VEGF Is the Only Angiogenic Factor Present Throughout

More information

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 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

More information

Histology: Its Influence on Therapeutic Decision Making

Histology: Its Influence on Therapeutic Decision Making Histology: Its Influence on Therapeutic Decision Making Mark A. Socinski, MD Professor of Medicine and Thoracic Surgery Director, Lung Cancer Section, Division of Hematology/Oncology Co-Director, UPMC

More information

Slide 1. Slide 2 Maintenance Therapy Options. Slide 3. Maintenance Therapy in the Management of Non-Small Cell Lung Cancer. Maintenance Chemotherapy

Slide 1. Slide 2 Maintenance Therapy Options. Slide 3. Maintenance Therapy in the Management of Non-Small Cell Lung Cancer. Maintenance Chemotherapy Slide 1 Maintenance Therapy in the Management of Non-Small Cell Lung Cancer Frances A Shepherd, MD FRCPC Scott Taylor Chair in Lung Cancer Research Princess Margaret Hospital, Professor of Medicine, University

More information

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 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

More information

Maintenance Therapy for Advanced NSCLC: Which Patients, Which Approach?

Maintenance Therapy for Advanced NSCLC: Which Patients, Which Approach? Maintenance Therapy for Advanced NSCLC: Which Patients, Which Approach? Mark A. Socinski, MD Visiting Professor of Medicine and Thoracic Surgery Director, Lung Cancer Section, Division of Hematology/Oncology

More information

Angiogenesis and tumor growth

Angiogenesis and tumor growth Anti-angiogenic agents: where we are? Martin Reck Department of Thoracic Oncology Hospital Grosshansdorf Germany Angiogenesis and tumor growth Journal of experimental Medicine 1972; 133: 275-88 1 Angiogenesis

More information

Exploring Personalized Therapy for First Line Treatment of Advanced Non-Small Cell Lung Cancer (NSCLC)

Exploring Personalized Therapy for First Line Treatment of Advanced Non-Small Cell Lung Cancer (NSCLC) Exploring Personalized Therapy for First Line Treatment of Advanced Non-Small Cell Lung Cancer (NSCLC) Suresh S. Ramalingam, MD Director of Thoracic Oncology Associate Professor Emory University Atlanta,

More information

Changing demographics of smoking and its effects during therapy

Changing demographics of smoking and its effects during therapy Changing demographics of smoking and its effects during therapy Egbert F. Smit MD PhD. Dept. Pulmonary Diseases, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands Smoking prevalence adults

More information

EGFR MUTATIONS: EGFR PATHWAY AND SELECTION OF FIRST-LINE THERAPY WITH TYROSINE KINASE INHIBITORS

EGFR MUTATIONS: EGFR PATHWAY AND SELECTION OF FIRST-LINE THERAPY WITH TYROSINE KINASE INHIBITORS EGFR MUTATIONS: EGFR PATHWAY AND SELECTION OF FIRST-LINE THERAPY WITH TYROSINE KINASE INHIBITORS Federico Cappuzzo Istituto Clinico Humanitas IRCCS Rozzano-Italy The EGFR/HER Family Ligand binding domain

More information

Metastatic NSCLC: Expanding Role of Immunotherapy. Evan W. Alley, MD, PhD Abramson Cancer Center at Penn Presbyterian

Metastatic NSCLC: Expanding Role of Immunotherapy. Evan W. Alley, MD, PhD Abramson Cancer Center at Penn Presbyterian Metastatic NSCLC: Expanding Role of Immunotherapy Evan W. Alley, MD, PhD Abramson Cancer Center at Penn Presbyterian Disclosures: No relevant disclosures Please note that some of the studies reported in

More information

MAINTENANCE TREATMENT CHEMO MAINTENANCE OR TARGETED OF BOTH? Martin Reck Department of Thoracic Oncology LungenClinic Grosshansdorf

MAINTENANCE TREATMENT CHEMO MAINTENANCE OR TARGETED OF BOTH? Martin Reck Department of Thoracic Oncology LungenClinic Grosshansdorf MAINTENANCE TREATMENT CHEMO MAINTENANCE OR TARGETED OF BOTH? Martin Reck Department of Thoracic Oncology LungenClinic Grosshansdorf OUTLINE Background and Concept Switch Maintenance Continuation Maintenance

More information

1st-line Chemotherapy for Advanced disease

1st-line Chemotherapy for Advanced disease SESSION 3: ADVANCED NSCLC 1st-line Chemotherapy for Advanced disease JY DOUILLARD MD PhD Professor Emeritus in Medical Oncology Chief Medical Officer (CMO) ESMO Lugano CH Percent Survival HISTORICAL BASIS

More information

PROGNOSTIC AND PREDICTIVE BIOMARKERS IN NSCLC. Federico Cappuzzo Istituto Toscano Tumori Ospedale Civile-Livorno Italy

PROGNOSTIC AND PREDICTIVE BIOMARKERS IN NSCLC. Federico Cappuzzo Istituto Toscano Tumori Ospedale Civile-Livorno Italy PROGNOSTIC AND PREDICTIVE BIOMARKERS IN NSCLC Federico Cappuzzo Istituto Toscano Tumori Ospedale Civile-Livorno Italy Prognostic versus predictive Prognostic: In presence of the biomarker patient outcome

More information

NCCN Non Small Cell Lung Cancer V Meeting July 8, 2016

NCCN Non Small Cell Lung Cancer V Meeting July 8, 2016 NSCL 3 Submission from Myriad requesting the following statement to be listed as an additional high risk factor in footnote p : For lung ADC, a highrisk 46 gene molecular prognostic score determined by

More information

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. 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

More information

Targeted therapy in lung cancer : experience of NIO-RABAT

Targeted therapy in lung cancer : experience of NIO-RABAT Targeted therapy in lung cancer : experience of NIO-RABAT I.ELGHISSASSI, H.ERRIHANI Medical oncology department, NIO- RABAT 02-05- 2012, FEZ In Morocco, lung cancer is the most common tumor among men At

More information

VEGF-Inhibitors in NSCLC. Martin Reck Department of Thoracic Oncology Hospital Grosshansdorf Germany

VEGF-Inhibitors in NSCLC. Martin Reck Department of Thoracic Oncology Hospital Grosshansdorf Germany VEGF-Inhibitors in NSCLC Martin Reck Department of Thoracic Oncology Hospital Grosshansdorf Germany Conflicts of interest Advisory Board: AstraZeneca Bristol-Myers Squibb Daiichi Sankyo Eli Lilly Merck

More information

Biomarkers of Response to EGFR-TKIs EORTC-NCI-ASCO Meeting on Molecular Markers in Cancer November 17, 2007

Biomarkers of Response to EGFR-TKIs EORTC-NCI-ASCO Meeting on Molecular Markers in Cancer November 17, 2007 Biomarkers of Response to EGFR-TKIs EORTC-NCI-ASCO Meeting on Molecular Markers in Cancer November 17, 2007 Bruce E. Johnson, MD Dana-Farber Cancer Institute, Brigham and Women s Hospital, and Harvard

More information

Treatment of EGFR mutant advanced NSCLC

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

More information

ESMO THE CHRISTIE PRECEPTORSHIP PROGRAMME. 1 st line chemotherapy for advanced NSCLC. Benjamin BESSE, MD, PhD Head Dpt of Cancer Medicine

ESMO THE CHRISTIE PRECEPTORSHIP PROGRAMME. 1 st line chemotherapy for advanced NSCLC. Benjamin BESSE, MD, PhD Head Dpt of Cancer Medicine ESMO THE CHRISTIE PRECEPTORSHIP PROGRAMME 1 st line chemotherapy for advanced NSCLC Benjamin BESSE, MD, PhD Head Dpt of Cancer Medicine 2017 PD-L1 50% Pembrolizuma b [I,A] Courtesy of J.Remon Adapted from

More information

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. 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

More information

LONDON CANCER NEW DRUGS GROUP RAPID REVIEW. Erlotinib for the third or fourth-line treatment of NSCLC January 2012

LONDON CANCER NEW DRUGS GROUP RAPID REVIEW. Erlotinib for the third or fourth-line treatment of NSCLC January 2012 Disease background LONDON CANCER NEW DRUGS GROUP RAPID REVIEW Erlotinib for the third or fourth-line treatment of NSCLC January 2012 Lung cancer is the second most common cancer in the UK (after breast),

More information

Systemic therapy in early stage NSCLC. Disclosures

Systemic therapy in early stage NSCLC. Disclosures Systemic therapy in early stage NSCLC Christian Manegold, MD Professor of Medicine, Heidelberg University Interdisciplinary Thoracic Oncology Department of Surgery University Medical Center Mannheim, Germany

More information

The Evolving Role of Molecular Markers in Managing Non-Small Cell Lung Cancer

The Evolving Role of Molecular Markers in Managing Non-Small Cell Lung Cancer The Evolving Role of Molecular Markers in Managing Non-Small Cell Lung Cancer Nathan A. Pennell, M.D., Ph.D. Assistant Professor Solid Tumor Oncology Cleveland Clinic Taussig Cancer Institute www.cancergrace.org

More information

Monoclonal Antibodies in the Management of Non-Small Cell Lung Cancer (NSCLC): 2016 Update Angioinhibitors and EGFR MAbs

Monoclonal Antibodies in the Management of Non-Small Cell Lung Cancer (NSCLC): 2016 Update Angioinhibitors and EGFR MAbs Monoclonal Antibodies in the Management of Non-Small Cell Lung Cancer (NSCLC): 2016 Update Angioinhibitors and EGFR MAbs Corey J Langer, MD, FACP Director Thoracic Oncology Abramson Cancer Center Professor

More information

Heather Wakelee, M.D.

Heather Wakelee, M.D. Heather Wakelee, M.D. Assistant Professor of Medicine, Oncology Stanford University Sponsored by Educational Grant Support from Adjuvant (Post-Operative) Lung Cancer Chemotherapy Heather Wakelee, M.D.

More information

Antiangiogenici in combinazione a chemioterapia in prima linea: bevacizumab

Antiangiogenici in combinazione a chemioterapia in prima linea: bevacizumab Micro-ambiente tumorale. Antiangiogenici e immunoterapia: miti e realtà Milano, 11 Ottobre 2016 Antiangiogenici in combinazione a chemioterapia in prima linea: bevacizumab Francesco Grossi U.O.S. Tumori

More information

Improving outcomes for NSCLC patients with brain metastases

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

More information

Treatment of EGFR mutant advanced NSCLC

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

More information

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 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

More information

LUNG CANCER TREATMENT: AN OVERVIEW

LUNG CANCER TREATMENT: AN OVERVIEW LUNG CANCER TREATMENT: AN OVERVIEW KONSTANTINOS N. SYRIGOS, M.D., Ph.D. Αναπλ. Καθηγητής Παθολογίας-Ογκολογίας, Ιατρικής Σχολής Αθηνών. Διευθυντής Ογκολογικής Μονάδας, Νοσ. «Η Σωτηρία». Visiting Professor

More information

Targeted Therapies for Advanced NSCLC

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

More information

Strategies in the therapy of advanced NSCLC SAMO Winter-Conference 2008 on Chest tumors

Strategies in the therapy of advanced NSCLC SAMO Winter-Conference 2008 on Chest tumors Strategies in the therapy of advanced NSCLC SAMO Winter-Conference 2008 on Chest tumors Miklos Pless Medical Oncology Kantonsspital Winterthur 2 Setting the stage. 1995: Chemotherapy works! Meta-Analysis

More information

Ludger Sellmann 1, Klaus Fenchel 2, Wolfram C. M. Dempke 3,4. Editorial

Ludger Sellmann 1, Klaus Fenchel 2, Wolfram C. M. Dempke 3,4. Editorial Editorial Improved overall survival following tyrosine kinase inhibitor treatment in advanced or metastatic non-small-cell lung cancer the Holy Grail in cancer treatment? Ludger Sellmann 1, Klaus Fenchel

More information

Understanding Options: When Should TKIs be Considered?

Understanding Options: When Should TKIs be Considered? Advanced Stage Squamous NSCLC: Evolution and Increasing Complexity of the Therapeutic Landscape Understanding Options: When Should TKIs be Considered? David R. Gandara, MD University of California Davis

More information

IRESSA (Gefitinib) The Journey. Anne De Bock Portfolio Leader, Oncology/Infection European Regulatory Affairs AstraZeneca

IRESSA (Gefitinib) The Journey. Anne De Bock Portfolio Leader, Oncology/Infection European Regulatory Affairs AstraZeneca IRESSA (Gefitinib) The Journey Anne De Bock Portfolio Leader, Oncology/Infection European Regulatory Affairs AstraZeneca Overview The Drug The Biomarker and Clinical Trials Sampling Lessons Learned The

More information

Nivolumab: esperienze italiane nel carcinoma polmonare avanzato

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

More information

Tumor Board Discussions: Case 1

Tumor Board Discussions: Case 1 Tumor Board Discussions: Case 1 David S. Ettinger, MD The Alex Grass Professor of Oncology Johns Hopkins University School of Medicine Baltimore, Maryland Case #1 50-year-old Asian female, never smoker

More information

K-Ras signalling in NSCLC

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

More information

Thoracic and head/neck oncology new developments

Thoracic and head/neck oncology new developments Thoracic and head/neck oncology new developments Goh Boon Cher Department of Hematology-Oncology National University Cancer Institute of Singapore Research Clinical Care Education Scope Lung cancer Screening

More information

Maintenance Treatment for Advanced NSCLC. Yvonne Summers PhD, FRCP ESMO Preceptorship Programme March 2017

Maintenance Treatment for Advanced NSCLC. Yvonne Summers PhD, FRCP ESMO Preceptorship Programme March 2017 Maintenance Treatment for Advanced NSCLC Yvonne Summers PhD, FRCP ESMO Preceptorship Programme March 2017 Milestones in the Palliative Systemic Treatment of NSCLC 1990 2000 2010 2015 Platinum based Chemotherapy

More information

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 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

More information

7/6/2015. Cancer Related Deaths: United States. Management of NSCLC TODAY. Emerging mutations as predictive biomarkers in lung cancer: Overview

7/6/2015. Cancer Related Deaths: United States. Management of NSCLC TODAY. Emerging mutations as predictive biomarkers in lung cancer: Overview Emerging mutations as predictive biomarkers in lung cancer: Overview Kirtee Raparia, MD Assistant Professor of Pathology Cancer Related Deaths: United States Men Lung and bronchus 28% Prostate 10% Colon

More information

Squamous Cell Carcinoma Standard and Novel Targets.

Squamous Cell Carcinoma Standard and Novel Targets. Squamous Cell Carcinoma Standard and Novel Targets. Mohamed K. Mohamed, MD, PhD Director of Thoracic Oncology Cone Health Cancer Center Greensboro, NC 1 Mohamed Mohamed, MD, PhD Squamous Cell Carcinoma:

More information

Slide 1. Slide 2. Slide 3. Individualized Therapy in Lung Cancer : Where are we in 2011? Notable Advances in Cancer Research in the last 2 years

Slide 1. Slide 2. Slide 3. Individualized Therapy in Lung Cancer : Where are we in 2011? Notable Advances in Cancer Research in the last 2 years Slide 1 Individualized Therapy in Lung Cancer : Where are we in 2011? Giorgio V. Scagliotti University of Torino Department of Clinical & Biological Sciences giorgio.scagliotti@unito.it Slide 2 Notable

More information

The road less travelled: what options are available for patients with advanced squamous cell carcinoma?

The road less travelled: what options are available for patients with advanced squamous cell carcinoma? Robert Pirker Medical University of Vienna Vienna, Austria The road less travelled: what options are available for patients with advanced squamous cell carcinoma? Disclosures Honoraria for advisory board/consulting

More information

Incorporating Immunotherapy into the treatment of NSCLC

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

More information

NSCLC with squamous histology: Current treatment and new options on horizon

NSCLC with squamous histology: Current treatment and new options on horizon NSCLC with squamous histology: Current treatment and new options on horizon Prof. Yasser A.Kader Professor of Oncology Faculty of Medicine, Cairo University 2015 Lung Cancer: Incidence and Mortality New

More information

Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010

Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 LSU HEALTH SCIENCES CENTER NSCLC Guidelines Feist-Weiller Cancer Center Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 Initial Evaluation/Intervention: 1. Pathology Review 2. History and Physical

More information

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 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,

More information

Practice changing studies in lung cancer 2017

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

More information

Systemic Treatment for Patients with Advanced Non-Small Cell Lung Cancer P.M. Ellis, E.T. Vella, Y.C. Ung and the Lung Cancer Disease Site Group

Systemic Treatment for Patients with Advanced Non-Small Cell Lung Cancer P.M. Ellis, E.T. Vella, Y.C. Ung and the Lung Cancer Disease Site Group A Quality Initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) Systemic Treatment for Patients with Advanced Non-Small Cell Lung Cancer P.M. Ellis, E.T. Vella, Y.C. Ung and

More information

Comparison of Gefitinib versus Docetaxel in Patients with Pre-Treated Non-Small Cell Lung Cancer (NSCLC)

Comparison of Gefitinib versus Docetaxel in Patients with Pre-Treated Non-Small Cell Lung Cancer (NSCLC) J Lung Cancer 2009;8(2):61-66 Comparison of Gefitinib versus Docetaxel in Patients with Pre-Treated Non-Small Cell Lung Cancer (NSCLC) More effective treatments in first, second, and third-line of metastatic

More information

Non-Small Cell Lung Cancer:

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

More information

Non-small Cell Lung Cancer: Multidisciplinary Role: Role of Medical Oncologist

Non-small Cell Lung Cancer: Multidisciplinary Role: Role of Medical Oncologist Non-small Cell Lung Cancer: Multidisciplinary Role: Role of Medical Oncologist Vichien Srimuninnimit, MD. Medical Oncology Division Faculty of Medicine, Siriraj Hospital Outline Resectable NSCLC stage

More information

Combined Modality Therapy State of the Art. Everett E. Vokes The University of Chicago

Combined Modality Therapy State of the Art. Everett E. Vokes The University of Chicago Combined Modality Therapy State of the Art Everett E. Vokes The University of Chicago What we Know Some patients are cured (20%) Induction and concurrent chemoradiotherapy are each superior to radiotherapy

More information

HOW TO GET THE MOST INFORMATION FROM A TUMOR BIOPSY

HOW TO GET THE MOST INFORMATION FROM A TUMOR BIOPSY HOW TO GET THE MOST INFORMATION FROM A TUMOR BIOPSY 7 TH Annual New York Lung Cancer Symposium Saturday, November 10, 2012 William D. Travis, M.D. Attending Thoracic Pathologist Memorial Sloan Kettering

More information

Quale sequenza terapeutica nella malattia EGFR+

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

More information

PRACTICE GUIDELINE SERIES

PRACTICE GUIDELINE SERIES ELLIS et al. PRACTICE GUIDELINE SERIES The role of the epidermal growth factor receptor tyrosine kinase inhibitors as therapy for advanced, metastatic, and recurrent nonsmall-cell lung cancer: a Canadian

More information

Frequency of Epidermal Growth Factor Mutation Status and Its Effect on Outcome of Patients with Adenocarcinoma of the Lung

Frequency of Epidermal Growth Factor Mutation Status and Its Effect on Outcome of Patients with Adenocarcinoma of the Lung Journal of Cancer Therapy, 2014, 5, 1012-1020 Published Online September 2014 in SciRes. http://www.scirp.org/journal/jct http://dx.doi.org/10.4236/jct.2014.511106 Frequency of Epidermal Growth Factor

More information

Chemotherapy and Immunotherapy in Combination Non-Small Cell Lung Cancer (NSCLC)

Chemotherapy and Immunotherapy in Combination Non-Small Cell Lung Cancer (NSCLC) Chemotherapy and Immunotherapy in Combination Non-Small Cell Lung Cancer (NSCLC) Jeffrey Crawford, MD George Barth Geller Professor for Research in Cancer Co-Program Leader, Solid Tumor Therapeutics Program

More information

in combination with cisplatin as first-line doublet 3 as maintenance agent following non-pemetrexed platinum doublet 4

in combination with cisplatin as first-line doublet 3 as maintenance agent following non-pemetrexed platinum doublet 4 Overall survival (OS) results from PARAMOUNT study of maintenance plus best supportive care (BSC) versus plus BSC, immediately after induction with - Cisplatin, in patients with advanced Nonsquamous Non-small

More information

Treatment of EGFR-Mutation+ NSCLC in 1st- and 2nd-Line

Treatment of EGFR-Mutation+ NSCLC in 1st- and 2nd-Line Treatment of EGFR-Mutation+ NSCLC in 1st- and 2nd-Line Martin Reck David F. Heigener Department of Thoracic Oncology Hospital Grosshansdorf Germany Identification of driver mutation in tumor specimens

More information

PF , HKI 272 XL647, BIBW

PF , HKI 272 XL647, BIBW Targeted Therapy for Lung Cancer? Emerging Novel targets for NSCLC 11 th UCSF/UCD Thoracic Oncology Conference 11/21/29 Sarita Dubey, M.D., Medical Oncology University of California, San Francisco Cytotoxic

More information

continuing education Non-small cell lung cancer: Molecular targets and emerging options for care Daniel Morgensztern, MD

continuing education Non-small cell lung cancer: Molecular targets and emerging options for care Daniel Morgensztern, MD continuing education educational objectives After participating in this activity, clinicians should be better able to Perform diagnostic/molecular testing (EGFR, KRAS, EML4-ALK) for NSCLC according to

More information

Immune Checkpoint Inhibitors for Lung Cancer William N. William Jr.

Immune Checkpoint Inhibitors for Lung Cancer William N. William Jr. Immune Checkpoint Inhibitors for Lung Cancer William N. William Jr. Diretor de Onco-Hematologia Hospital BP, A Beneficência Portuguesa Non-Small Cell Lung Cancer PD-1/PD-L1 Inhibitors in second-line therapy

More information

Management of advanced non small cell lung cancer

Management of advanced non small cell lung cancer Management of advanced non small cell lung cancer Jean-Paul Sculier Intensive Care & Thoracic Oncology Institut Jules Bordet Université Libre de Bruxelles (ULB) www.pneumocancero.com Declaration No conflict

More information

Personalized maintenance therapy in advanced non-small cell lung cancer

Personalized maintenance therapy in advanced non-small cell lung cancer China Lung Cancer Research Highlight Personalized maintenance therapy in advanced non-small cell lung cancer Kazuhiro Asami, Kyoichi Okishio, Tomoya Kawaguchi, Shinji Atagi Department of Clinical Oncology,

More information

Stage III NSCLC: Overview

Stage III NSCLC: Overview Locally Advanced NSCLC: New Concepts in Combined Modality Therapy NSCLC: Stage Distribution Randeep Sangha, MD Visiting Assistant Professor UC Davis Cancer Center Sacramento, CA Stage III NSCLC: Overview

More information

Prognostic and predictive biomarkers in

Prognostic and predictive biomarkers in OLOGICAL SCIENCES O DEPT. OF CLINICAL & BIO UNIVERSITY UNIVERSTY OF TORINO Prognostic and predictive biomarkers in early stage NSCLC Giorgio V. Scagliotti University of Torino Department of Clinical &

More information

Personalized Medicine for Advanced NSCLC in East Asia

Personalized Medicine for Advanced NSCLC in East Asia Personalized Medicine for Advanced NSCLC in East Asia - Update treatment strategy for NSCLC based on Japanese clinical practice guideline - Masahiro Tsuboi, M.D., Ph.D. Associate-professor, School of Medicine,

More information

Chemo-radiotherapy in non-small cell lung cancer. HARMESH R NAIK, MD. September 25, 2002

Chemo-radiotherapy in non-small cell lung cancer. HARMESH R NAIK, MD. September 25, 2002 Chemo-radiotherapy in non-small cell lung cancer HARMESH R NAIK, MD. September 25, 2002 Epidemiology Estimated 170000 new cases Estimated 157,000 deaths Second commonest cancer diagnosis in men and women

More information

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) 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

More information

LUNG CANCER. Agnieszka Słowik, MD. Department of Oncology, University Hospital in Cracow Jagiellonian University

LUNG CANCER. Agnieszka Słowik, MD. Department of Oncology, University Hospital in Cracow Jagiellonian University LUNG CANCER Agnieszka Słowik, MD Department of Oncology, University Hospital in Cracow Jagiellonian University Epidemiology Most common malignancy worldwide Place of lung cancer among other malignancies

More information

Personalized Medicine: Lung Biopsy and Tumor

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

More information

Outline. The Lung Cancer Patient in 2011 Not the Marlboro Man. Lung Cancer

Outline. The Lung Cancer Patient in 2011 Not the Marlboro Man. Lung Cancer Outline The Lung Cancer Patient in 2011 Not the Marlboro Man Jeanne Griffin Vaughn, APN-BC, AOCN Epidemiology Staging and Patterns of Spread Clinical Presentation Treatments March 26, 2011 Lung Cancer

More information

Additional clinical features of this patient include:

Additional clinical features of this patient include: *Not an actual patient. Challenge your knowledge of biomarker testing in advanced NSCLC. Consider this case study of disease progression following chemotherapy, with insightful commentary from Dr Edward

More information

Sequencing in EGFR-Mutated NSCLC: Does Order Matter?

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,

More information

Reflex Testing Guidelines for Immunotherapy in Non-Small Cell Lung Cancer

Reflex Testing Guidelines for Immunotherapy in Non-Small Cell Lung Cancer Reflex Testing Guidelines for Immunotherapy in Non-Small Cell Lung Cancer Jimmy Ruiz, MD Assistant Professor Thoracic Oncology Program Wake Forest Comprehensive Cancer Center Disclosures I have no actual

More information

Individualized therapy in lung cancer Where are we in 2012?

Individualized therapy in lung cancer Where are we in 2012? UNIVERSITY OF OF TORINO DEPARTMENT OF ONCOLOGY Individualized therapy in lung cancer Where are we in 2012? Giorgio V. Scagliotti University of Torino Professor of Medical Oncology Department of Oncology

More information

Cancer Cell Research 14 (2017)

Cancer Cell Research 14 (2017) Available at http:// www.cancercellresearch.org ISSN 2161-2609 Efficacy and safety of bevacizumab for patients with advanced non-small cell lung cancer Ping Xu, Hongmei Li*, Xiaoyan Zhang Department of

More information

ASCO Highlights Lung Cancer

ASCO Highlights Lung Cancer ASCO Highlights Lung Cancer Anne S. Tsao, M.D. Director, Mesothelioma Program Assistant Professor July 11, 2009 The University of Texas MD ANDERSON CANCER CENTER Department of Thoracic/Head & Neck Medical

More information

Systemic therapy for Non-Small Cell Lung Cancer in 2013 (What you should know)

Systemic therapy for Non-Small Cell Lung Cancer in 2013 (What you should know) Systemic therapy for Non-Small Cell Lung Cancer in 2013 (What you should know) นายแพทย ช ยย ทธ ย ทธ เจร ญธรรม หน วยมะเร งว ทยา ภาคว ชาอาย ร อาย รศาสตร Inter-hospitol Conference, 16 th March 2013 Systemic

More information

ALK Fusion Oncogenes in Lung Adenocarcinoma

ALK Fusion Oncogenes in Lung Adenocarcinoma ALK Fusion Oncogenes in Lung Adenocarcinoma Vincent A Miller, MD Associate Attending Physician, Thoracic Oncology Service Memorial Sloan-Kettering Cancer Center New York, New York The identification of

More information

2012 Chicago Multidisciplinary Symposium in Thoracic Oncology September 6-8, 2012 Friday, September 7, News Briefing 7:15 a.m.

2012 Chicago Multidisciplinary Symposium in Thoracic Oncology September 6-8, 2012 Friday, September 7, News Briefing 7:15 a.m. 2012 Chicago Multidisciplinary Symposium in Thoracic Oncology September 6-8, 2012 Friday, September 7, News Briefing 7:15 a.m. Central time Moderated by Heather Wakelee, MD Stanford University Stanford,

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