Impact of Targeted/Immunotherapy on Gamma Knife Radiosurgery

Size: px
Start display at page:

Download "Impact of Targeted/Immunotherapy on Gamma Knife Radiosurgery"

Transcription

1 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, 2017 S L I D E 0

2 Introduction Treatment of melanoma and non-small cell lung cancer has been revolutionized by immunotherapy and targeted therapies Patients living longer How does this affect radiosurgery? S L I D E 2

3 Targeted versus Immuno-therapy Targeted Therapies Melanoma BRAF: vemurafenib, dabrafenib NSCLC EGFR mutations: gefitinib, erlotinib, afatanib NSCLC ALK rearrangement: crizotinib, alectinib, ceritinib NSCLC ROS rearrangement: crizotinib Systemic Therapy RARELY curative First line therapy for NSCLC if target mutation found CNS penetration rapidly effective Efficacy might be related to drug dose (except osimertinib?) Failure by mutation e.g. T790M mutation for EGFR Immunotherapies Vaccines Anti-CTLA4: ipilimumab Anti-PD1: nivolumab, pembrolizumab Systemic Therapy CAN BE curative First line therapy for melanoma (but not NSCLC) even if target mutation found CNS penetration mechanism unclear More likely due to T-cell infiltration Response and failure dichotomous Dosing oral daily Steroids ok Dosing IV q2weeks until death or 2yrs if successful Steroids strongly discouraged S L I D E 3

4 BRAF inhibitors and Melanoma Brain Metastases 50% of melanomas have BRAF mutation: 80-90% V600E >70% of melanoma patients will develop MBM often multiple Rochet NM et al. (2011) NEJM 2011;365(25): Single case treated with SRS with progression Vemurafenib 960mg bid significant response in CNS at 1 month Dummer R et al. (2014) Eur J Cancer 2014;50(3): Prospective, vemurafenib 24 patients, unresectable, previously treated symptomatic MBM 42% partial response (>30% in 37% pts) Retrospective studies: (Dzienis 2014, Harding 2015) Asymptomatic MBM, vemurafenib 50% response in CNS Dabrafenib MBM response 78% (Azer 2014) Median PFS (intracranial and extracranial) 23.6 weeks S L I D E 4

5 BRAF inhibitors and MBMs and radiation Sambade et al. (2011) Radiother Oncol 2011;98(3): Showed a range of radiosensitivity of melanoma cells in culture Radioresistence seemed to be related to having BRAF mutation Addition BRAFi resulted in radiosensitization Confirmed by Glazer PM et al. (2013) Mechanism thought to be increase in both G1 and G2 cell cycle arrest BUT Hecht et al. (2015) Ann Oncol 2015;26(6); Normal blood cells exposed to vemurafenib Increased chromosomal aberrations ie radiosensitizes normal cells also?not associated with dabrafenib? BRAF inhibitors and WBRT Significant risk of acute dermatitis Significant radiation recall inflammatory reaction Associated with starting vemurafenib 1-42 days after radiation Less so with dabrafenib and SRS S L I D E 5

6 Clinical Experience BRAFi and GK-SRS No radiation necrosis or scalp dermatitis 53 GK treatments : 33 concurrent, 4 with drug interruption, 16 before BRAFi started Gaudy-Marqueste et al. Ann Oncol 2014;25(10): Local control 92% 6mos, 75-90% 12mos c/w 50-70% 12mos BRAF neg SRS doses 13-24Gy Distant failure rate 40-60% at median 3-6mos Ahmed et al. JNO 2015;122(1) , Ly et al. JNS 2015;123(2): , Xu et al Question of increased rate Radiation Necrosis (Xu/Sheehan 2016, Patel 2016) Concurrent and nonconcurrent If BRAF mutation present and WBRT is best RT option then Dabrafenib/Tremetinib is first line targeted therapy: If CNS disease stabilizes then usually offer SRS ECOG Recommendation: Hold BRAFi 1 day before and after GK and 3 days before and after fractionated SRS S L I D E 6

7 TKIs and Lung Cancer Brain Metastases Oncogenic mutations present in 60% adenocarcinomas EGFR/ALK-TKIs are first line treatment for mutation pos metastatic NSCLC PROs for TKI only Phase II studies of EGFR-TKI alone for brain metastases: Objective response rate 65-89% ( afatinib<gefitinib<erlotinib) Median progression-free survival months Median overall survival months No delay in initiating systemic therapy Avoid potential toxicity of local therapy CONS for TKI only Rosell et al 2009, Park et al, 2012, Iuchi et al EGFR mutants do not have increased rate of brain mets BUT brain is frequent site of disease recurrence due to low CNS penetration No additional reported toxicity with addition of RT to TKI Depending on who patient sees first, can get different first line Rx S L I D E 7

8 54yo RHWF w ALK re-arranged NSCLC NED 3 years after diagnosis, Px numbness right hand Options for Management: 5cm 1. Surgery + WBRT 2. WBRT alone 3. SBRT 4. 2-staged SRS 5. Neoadjuvant SRS then surgery 6. CNS-penetrating targeted therapy S L I D E 8

9 Example of targeted therapy response Start ceritinib f/u MRI 2 weeks S L I D E 9

10 What is the right answer for this patient? Should WBRT be used upfront? S L I D E 10

11 What is the right answer for this patient? When is the right time to use SRS? S L I D E 11

12 TKI only versus TKI-RT at first diagnosis of BrMets - Deferral of upfront RT was detrimental to overall survival - 6 centers : Yale, MSKCC, U Colorado, YCSF, CCF, Vanderbilt patients - Inclusion: new brain mets, known TKI-sensitive EGFR mutation, naïve to TKI - Exclusion: prior TKI use, TKI resistance, surgical resection, <6mos f/u S L I D E 12

13 S L I D E 13

14 Progression Free Survival RT group had more symptomatic BrMets WBRT group had larger size and number of BrMets WBRT group had worse dsgpa-based prognosis Rx TKI SRS WBRT PFS 17mos 23mos 24mos S L I D E 14

15 Rx TKI SRS WBRT OS 25mos 46mos 30mos S L I D E 15

16 Newest Addition to the TKIs - Osimertinib We Need A Randomized Trial S L I D E 16

17 Immunotherapy for untreated brain metastases NCT Non-randomized phase 2 trial using pembrolizumab Inclusion: Melanoma and Lung cancer Lung cancer patient needs PDL-1 positivity At least one untreated or progressive brain metastasis No need for steroids Preliminary results: Melanoma 18 patients 4/18 (22%) with durable CNS response Lung cancer 18 patients 6/18 (33%) with durable CNS response Neurological complications 3 patients with seizures, 1 transient cognitive dysfunction, 1 with significant edema causing herniation Lessons learned: Mechanism of action of IT can cross the blood brain barrier The majority of patients still need radiation to control CNS disease S L I D E 17

18 Lesson #1 : IT works well in some cases S L I D E 18

19 Lesson #2: Can go badly quickly in others 1 month 2 months Start trial S L I D E 19

20 Lesson #3: Adding GK to IT works great!!! surgery GK Start trial watch 6 weeks later S L I D E 20

21 Lesson #4: GK + IT can work even at lower doses (12Gy) Start trial 6 weeks S L I D E 21

22 Lesson #5 : sometimes full dose GK + IT a problem 53yo female melanoma Prior SRS x2 without event 2013 new lesion GK 2014 Pembrolizumab Oct 2014 S L I D E 22

23 Histology GK followed by Anti-PD1 agent S L I D E 23

24 Concurrent Immunotherapy in Melanoma Qian JM, Yu JB, Kluger HM, Chiang VL. Cancer Oct;122(19): Timing and type of immune checkpoint therapy affect the early radiographic response of melanoma brain metastases to stereotactic radiosurgery. S L I D E 24

25 Lesson #6: Late Effects of IT + standard dose GK 12/2015 4/2017 NED body 6/2015 1/2016 S L I D E 25

26 Delayed RN can occur years later 10/2015 1/2016 GK 12/2014 3/2017 S L I D E 26

27 Late Effect of Immunotherapy and GK 300 consecutive GK patients treated survived >6 months Mean age 59 years 55% male 39% lung cancer, 31% melanoma 39 with diagnosis of RN by imaging or histology Tumor Volumes: Mean 3.89cc (RN) versus 7.13cc (no-rn) Treatment Dose: Single fraction 18-22Gy to 45-60% isodose lines Median follow-up: 11.7mos (range 6-48 mos) S L I D E 27

28 Results: Uni-variate Analysis Systemic therapy Total (180) RN (39) % IT only TT only CT only IT+TT 4 2 IT+CT 4 0 TT+CT IT+TT+CT 2 0 None 4 1 Receiving any IT showed a trend towards increasing the risk of RN Receiving any CT significantly decreased the risk of RN Systemic Therapy OR 95%CI P-value IT TT CT S L I D E 28

29 Is it the same for lung cancer? S L I D E 29

30 64yo male EGFR WT NSCLC GK 10/2015 nivolumab 11/ HA 12/2015 S L I D E 30

31 IT and 12Gy SRS? 12Gy SRS After 6 weeks IT S L I D E 31

32 Brain metastases response to GK varies by disease S L I D E 32

33 Conclusions Brain metastasis treatment got complicated Need to be aware of patient systemic therapy plans Need to weigh efficacy and toxicity of drug only versus drug plus radiation Need to participate in clinical trials to answer the question of treatment sequence Need to understand mechanisms of interaction that result in efficacy and toxicity S L I D E 33

34 Thank You S L I D E 34

35 S L I D E 35

36 S L I D E 36

37 Comparing TKIs to chemotherapy agents Small molecule inhibitors C6H10N6O Erlotinib C22H23N3O4 TKIs - Small molecules Cross cell membranes to inhibit cytoplasmic tyrosine kinases for growth factors Pemetrexed C20H21N5O6 S L I D E 37

38 Interaction between Targeted Therapy and Radiation in the CNS Drug Gefitinib Erlotinib Crizotinib Systemic Interaction Neutropenia, mucositis, GI bleed and perforation, dermatitis, rash, pneumonitis CNS specific Interaction Few?increased ICH No data on osimertinib Herceptin (Trastuzumab)?cardiac None Vemurafenib Dabrafenib/Tremetinib?radiosensitization in tumor? Radiosensitization of healthy tissues increased RT-induced chromosomal aberrations Acute radiodermatitis, Radiation recall pneumonitis (start vem 1-42d post RT) SRS avoid skin toxicity but radionecrosis increase? 1 case radiation recall myelitis S L I D E 38

39 Having mutation and GK allows patients to get full benefit of expected survival due to improved local control Tumors with EGFR and ALK mutations are more radiosensitive The addition of radiation to TKI systemic therapy provides better LC Median OS after development of Brain Mets was 49.5mos Despite 74% presenting with BrMets No history of TKIs before development BrMets assoc with improved OS (p<0.001) S L I D E 39

40 BZ MR (excellent systemic response) 53yo right handed white male with newly diagnosed diffusely metastatic BRAF wild type melanoma. Initially presented with leg pain and now found to have pathological fracture and widespread melanoma. Was being considered for T-IL therapy at NIH but MRI brain shows 3 lesions likely consistent with brain metastases which makes him ineligible for this treatment. Patient neurologically asymptomatic and no deficits noted on exam except difficulty with use of left leg secondary to cancer involvement. MRI brain shows 5mm lesion right frontal, 3mm lesion lateral right temporal and 8mm lesion adjacent right orbital apex. 8/26 4/15 no FLAIR changes 6/3-1 bigger, 1 new?1 resolved? 7/1 all bigger 1 new 8/5 crani then GK S L I D E 40

Targeted/Immunotherapy & Molecular Profiling State-of-the-art in Cancer Care

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

More information

Alleinige Radiochirurgie und alleinige Systemtherapie zwei «extreme» Entwicklungen in der Behandlung von Hirnmetastasen?

Alleinige Radiochirurgie und alleinige Systemtherapie zwei «extreme» Entwicklungen in der Behandlung von Hirnmetastasen? Department of Radiation Oncology Chairman: Prof. Dr. Matthias Guckenberger Alleinige Radiochirurgie und alleinige Systemtherapie zwei «extreme» Entwicklungen in der Behandlung von Hirnmetastasen? Matthias

More information

Combined treatment of Brain metastases: Radiosurgery and Targeted therapy

Combined treatment of Brain metastases: Radiosurgery and Targeted therapy Combined treatment of Brain metastases: Radiosurgery and Targeted therapy Stephanie Kroeze, MD PhD OVERVIEW Introduction brain metastases Targeted therapy as monotherapy Efficacy of SRS combined with Targeted

More information

Brain metastases and meningitis carcinomatosa: Prof. Rafal Dziadziuszko Medical University of Gdańsk, Poland

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

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM BRAIN METASTASES CNS Site Group Brain Metastases Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION

More information

Radiotherapy and Brain Metastases. Dr. K Van Beek Radiation-Oncologist BSMO annual Meeting Diegem

Radiotherapy and Brain Metastases. Dr. K Van Beek Radiation-Oncologist BSMO annual Meeting Diegem Radiotherapy and Brain Metastases Dr. K Van Beek Radiation-Oncologist BSMO annual Meeting Diegem 24-02-2017 Possible strategies Watchful waiting Surgery Postop RT to resection cavity or WBRT postop SRS

More information

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? 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

More information

Society for Immunotherapy of Cancer (SITC) Immunotherapy for the Treatment of Brain Metastases

Society for Immunotherapy of Cancer (SITC) Immunotherapy for the Treatment of Brain Metastases Society for Immunotherapy of Cancer (SITC) Immunotherapy for the Treatment of Brain Metastases Geoffrey T. Gibney, MD Georgetown-Lombardi Comprehensive Cancer Center Medstar-Georgetown University Hospital

More information

Targeted therapy in NSCLC: do we progress? Prof. Dr. V. Surmont. Masterclass 27 september 2018

Targeted therapy in NSCLC: do we progress? Prof. Dr. V. Surmont. Masterclass 27 september 2018 Targeted therapy in NSCLC: do we progress? Prof. Dr. V. Surmont Masterclass 27 september 2018 Outline Introduction EGFR TKI ALK TKI TKI for uncommon driver mutations Take home messages The promise of

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

D Ross Camidge, MD, PhD

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,

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

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

WHAT S HOT IN MELANOMA CNS METASTASES?

WHAT S HOT IN MELANOMA CNS METASTASES? WHAT S HOT IN MELANOMA CNS METASTASES? GIUSEPPE MINNITI, MD, PHD Radiation Unit, UPMC, Hillman Cancer Center, San Pietro Hospital, Rome, and IRCCS Neuromed, Pozzilli (IS), Italy Marseille, September 21-22,

More information

Overview: Immunotherapy in CNS Metastases

Overview: Immunotherapy in CNS Metastases Overview: Immunotherapy in CNS Metastases Manmeet Ahluwalia, MD, FACP Miller Family Endowed Chair in Neuro-Oncology Director Brain Metastasis Research Program Cleveland Clinic Disclosures Consultant- Monteris

More information

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) 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

More information

Osimertinib Activity in Patients With Leptomeningeal Disease From Non-Small Cell Lung Cancer: Updated Results From the BLOOM Study

Osimertinib Activity in Patients With Leptomeningeal Disease From Non-Small Cell Lung Cancer: Updated Results From the BLOOM Study Osimertinib Activity in Patients With Leptomeningeal Disease From Non-Small Cell Lung Cancer: Updated Results From the BLOOM Study Abstract 9002 Yang JC, Kim DW, Kim SW, Cho BC, Lee JS, Ye X, Yin X, Yang

More information

Dr. Andres Wiernik. Lung Cancer

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

More information

The Role of Radiation Therapy in the Treatment of Brain Metastases. Matthew Cavey, M.D.

The Role of Radiation Therapy in the Treatment of Brain Metastases. Matthew Cavey, M.D. The Role of Radiation Therapy in the Treatment of Brain Metastases Matthew Cavey, M.D. Objectives Provide information about the prospective trials that are driving the treatment of patients with brain

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

Brain metastases: future developments. Emilie Le Rhun Lille, France

Brain metastases: future developments. Emilie Le Rhun Lille, France Brain metastases: future developments Emilie Le Rhun Lille, France Disclosures ELR has received research grants from Mundipharma and Amgen and honoraria for lectures or advisory board participation from

More information

Stereotactic Radiosurgery for Brain Metastasis: Changing Treatment Paradigms. Overall Clinical Significance 8/3/13

Stereotactic Radiosurgery for Brain Metastasis: Changing Treatment Paradigms. Overall Clinical Significance 8/3/13 Stereotactic Radiosurgery for Brain Metastasis: Changing Treatment Paradigms Jason Sheehan, MD, PhD Departments of Neurosurgery and Radiation Oncology University of Virginia, Charlottesville, VA USA Overall

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

OTRAS TERAPIAS BIOLÓGICAS EN CPNM: Selección y Secuencia Óptima del Tratamiento

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)

More information

Innovations in Immunotherapy - Melanoma. Systemic Therapies October 27, 2018 Charles L. Bane, MD

Innovations in Immunotherapy - Melanoma. Systemic Therapies October 27, 2018 Charles L. Bane, MD Innovations in Immunotherapy - Melanoma Systemic Therapies October 27, 2018 Charles L. Bane, MD Melanoma Prognosis Survival at 10 years Stage I: 90% Stage II: 60% Stage III: 40% Stage IV: 10% 2 Indications

More information

Melanoma: From Chemotherapy to Targeted Therapy and Immunotherapy. What every patient needs to know. James Larkin

Melanoma: From Chemotherapy to Targeted Therapy and Immunotherapy. What every patient needs to know. James Larkin Melanoma: From Chemotherapy to Targeted Therapy and Immunotherapy What every patient needs to know James Larkin Melanoma Therapy 1846-2017 Surgery 1846 Cytotoxic Chemotherapy 1946 Checkpoint Inhibitors

More information

Recent Advances in Lung Cancer: Updates from ASCO 2017

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

More information

Le#eratura ed esperienza clinica piemontese C. Mantovani (Torino)

Le#eratura ed esperienza clinica piemontese C. Mantovani (Torino) RADIOCHIRURGIA E RADIOTERAPIA STEREOTASSICA INTRACRANICA: ESPERIENZE CLINICHE E INTEGRAZIONI CON TERAPIE SISTEMICHE Le#eratura ed esperienza clinica piemontese C. Mantovani (Torino) RADIOCHIRURGIA E RADIOTERAPIA

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

A Case of Metastatic Lung Adenocarcinoma EGFR ve, ALK +

A Case of Metastatic Lung Adenocarcinoma EGFR ve, ALK + ESMO Preceptorship Programme Dr Najihah Abu Bakar University Malaya Medical Centre, Kuala Lumpur, Malaysia A Case of Metastatic Lung Adenocarcinoma EGFR ve, ALK + HISTORY Mr TT/ 65yo/ Male/ Non smoker/no

More information

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 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

More information

Lung Cancer Update 2016 BAONS Oncology Care Update

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

More information

Keytruda (pembrolizumab)

Keytruda (pembrolizumab) Keytruda (pembrolizumab) Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage Original Effective Date: 10/01/2015 Current Effective Date: 07/24/2017TBD03/01/2018 POLICY A. INDICATIONS The

More information

Treatment of Recurrent Brain Metastases

Treatment of Recurrent Brain Metastases Treatment of Recurrent Brain Metastases Penny K. Sneed, M.D. Dept. of Radiation Oncology University of California San Francisco Background Brain metastases occur in 8.5-15% of cancer pts in population-

More information

Management of Brain Metastases Sanjiv S. Agarwala, MD

Management of Brain Metastases Sanjiv S. Agarwala, MD Management of Brain Metastases Sanjiv S. Agarwala, MD Professor of Medicine Temple University School of Medicine Chief, Oncology & Hematology St. Luke s Cancer Center, Bethlehem, PA, USA Incidence (US):

More information

Immunotherapy for the Treatment of Brain Metastases

Immunotherapy for the Treatment of Brain Metastases Society for Immunotherapy of Cancer (SITC) Immunotherapy for the Treatment of Brain Metastases Lawrence G. Lum, MD, DSc Karmanos Cancer Institute and Wayne State University Advances in Cancer Immunotherapy

More information

Non-Small Cell Lung Cancer Webinar. Thursday, September 13, p.m. EDT

Non-Small Cell Lung Cancer Webinar. Thursday, September 13, p.m. EDT Non-Small Cell Lung Cancer Webinar Thursday, September 13, 2018 1 2 p.m. EDT 1 2 Webinar Faculty Julie R. Brahmer, MD Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Patrick Forde, MD Johns

More information

Efficacy of anti-pd-1 therapy in patients with melanoma brain metastases

Efficacy of anti-pd-1 therapy in patients with melanoma brain metastases Efficacy of anti-pd-1 therapy in patients with melanoma brain metastases John J. Park 1, Sagun Parakh 2,3,4, Shehara Mendis 5, Rajat Rai 6, Wen Xu 7, Serigne Lo 6, Martin Drummond 6, Catherine Rowe 7,

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

Tania Kaprealian, M.D. Assistant Professor UCLA Department of Radiation Oncology August 22, 2015

Tania Kaprealian, M.D. Assistant Professor UCLA Department of Radiation Oncology August 22, 2015 Tania Kaprealian, M.D. Assistant Professor UCLA Department of Radiation Oncology August 22, 2015 Most common brain tumor, affecting 8.5-15% of cancer patients. Treatment options: Whole brain radiation

More information

Hong Kong Hospital Authority Convention 2018

Hong Kong Hospital Authority Convention 2018 Hong Kong Hospital Authority Convention 2018 Stereotactic Radiosurgery in Brain Metastases - Development of the New Treatment Paradigm in HA, Patients Profiles and Their Clinical Outcomes 8 May 2018 Dr

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

Immunotherapy for the Treatment of Melanoma. Marlana Orloff, MD Thomas Jefferson University Hospital

Immunotherapy for the Treatment of Melanoma. Marlana Orloff, MD Thomas Jefferson University Hospital Immunotherapy for the Treatment of Melanoma Marlana Orloff, MD Thomas Jefferson University Hospital Disclosures Immunocore and Castle Biosciences, Consulting Fees I will be discussing non-fda approved

More information

Protocolos de consenso: MTS Cerebrales Resumen ASTRO. Javier Aristu y Germán Valtueña Servicio Oncología Rad. Depart.

Protocolos de consenso: MTS Cerebrales Resumen ASTRO. Javier Aristu y Germán Valtueña Servicio Oncología Rad. Depart. Protocolos de consenso: MTS Cerebrales Resumen ASTRO Javier Aristu y Germán Valtueña Servicio Oncología Rad. Depart. ASTRO 2013 Brain met SRS Abstracts 97. Comparative Effectiveness of SRS versus WBRT

More information

Targeted Drugs and Radiation: Are There Interactions? The Risk and the Reward

Targeted Drugs and Radiation: Are There Interactions? The Risk and the Reward Targeted Drugs and Radiation: Are There Interactions? The Risk and the Reward Paul W. Sperduto, MD, MPP, FASTRO May 19, 2016 Leksell Gamma Knife Society Meeting Amsterdam Conflict of Interest Grant support

More information

Recent Therapeutic Advances for Thoracic Malignancies

Recent Therapeutic Advances for Thoracic Malignancies Recent Therapeutic Advances for Thoracic Malignancies Developed in collaboration Learning Objectives Upon completion, participants should be able to: Interpret new developments in the use of radiation

More information

Sergio Bracarda MD. Head, Medical Oncology Department of Oncology AUSL-8 Istituto Toscano Tumori (ITT) San Donato Hospital Arezzo, Italy

Sergio Bracarda MD. Head, Medical Oncology Department of Oncology AUSL-8 Istituto Toscano Tumori (ITT) San Donato Hospital Arezzo, Italy Sergio Bracarda MD Head, Medical Oncology Department of Oncology AUSL-8 Istituto Toscano Tumori (ITT) San Donato Hospital Arezzo, Italy Ninth European International Kidney Cancer Symposium Dublin 25-26

More information

Outline. WBRT field. Brain Metastases. Whole Brain RT Prophylactic WBRT Stereotactic radiosurgery (SRS) 1 fraction Stereotactic frame

Outline. WBRT field. Brain Metastases. Whole Brain RT Prophylactic WBRT Stereotactic radiosurgery (SRS) 1 fraction Stereotactic frame Radiation Therapy for Advanced NSC Lung Ca Alexander Gottschalk, M.D., Ph.D. Associate Professor Director of CyberKnife Radiosurgery Department of Radiation Oncology University of California San Francisco

More information

Case Studies. Ravi Salgia, MD, PhD

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

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

A Population-Based Study on the Uptake and Utilization of Stereotactic Radiosurgery (SRS) for Brain Metastasis in Nova Scotia

A Population-Based Study on the Uptake and Utilization of Stereotactic Radiosurgery (SRS) for Brain Metastasis in Nova Scotia A Population-Based Study on the Uptake and Utilization of Stereotactic Radiosurgery (SRS) for Brain Metastasis in Nova Scotia Gaurav Bahl, Karl Tennessen, Ashraf Mahmoud-Ahmed, Dorianne Rheaume, Ian Fleetwood,

More information

Melanoma: Therapeutic Progress and the Improvements Continue

Melanoma: Therapeutic Progress and the Improvements Continue Melanoma: Therapeutic Progress and the Improvements Continue David W. Ollila, MD Professor of Surgery Jesse and James Millis Professor of Melanoma Research May 20, 2016 Disclosures: NONE Outline 2016 Therapeutic

More information

Brain mets under I.O.

Brain mets under I.O. Brain mets under I.O. Bernard Escudier Gustave Roussy, Villejuif, France Disclosure Honorarium received from BMS, Novartis, Pfizer, Bayer, Roche, Exelixis, Ipsen, Eisai, Calithera Travel Grant from BMS,

More information

Targeted Therapies in Lung Cancer Patient Forum

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.

More information

Personalized Treatment Approaches for Lung Cancer

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

More information

Targeted Therapy for NSCLC: EGFR and ALK Fadlo R. Khuri, MD

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

More information

3/13/2018. Case 1. Multidisciplinary Management of Cancers Thoracic Oncology Tumor Board

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

More information

Radiation Therapy and Immunotherapy: New Frontiers

Radiation Therapy and Immunotherapy: New Frontiers Radiation Therapy and Immunotherapy: New Frontiers Nevada Oncology Society Fall Meeting November 16 th, 2017 Anshu K. Jain, MD Radiation Oncologist, Ashland Bellefonte Cancer Center Assistant Clinical

More information

Immunotherapy in Unresectable or Metastatic Melanoma: Where Do We Stand? Sanjiv S. Agarwala, MD St. Luke s Cancer Center Bethlehem, Pennsylvania

Immunotherapy in Unresectable or Metastatic Melanoma: Where Do We Stand? Sanjiv S. Agarwala, MD St. Luke s Cancer Center Bethlehem, Pennsylvania Immunotherapy in Unresectable or Metastatic Melanoma: Where Do We Stand? Sanjiv S. Agarwala, MD St. Luke s Cancer Center Bethlehem, Pennsylvania Overview Background Immunotherapy clinical decision questions

More information

Minesh Mehta, Northwestern University. Chicago, IL

Minesh Mehta, Northwestern University. Chicago, IL * Minesh Mehta, Northwestern University Chicago, IL Consultant: Adnexus, Bayer, Merck, Tomotherapy Stock Options: Colby, Pharmacyclics, Procertus, Stemina, Tomotherapy Board of Directors: Pharmacyclics

More information

Targeted Therapies in the Management of Non-Small Cell Lung Cancer. A Multi-Disciplinary Approach

Targeted Therapies in the Management of Non-Small Cell Lung Cancer. A Multi-Disciplinary Approach Targeted Therapies in the Management of Non-Small Cell Lung Cancer A Multi-Disciplinary Approach Course Faculty Medical Oncologists: Dr. Barb Melosky British Columbia Cancer Agency, Vancouver, BC Dr. Jeff

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

CNS SESSION 3/8/ th Multidisciplinary Management of Cancers: A Case based Approach

CNS SESSION 3/8/ th Multidisciplinary Management of Cancers: A Case based Approach CNS SESSION Chair: Ruben Fragoso, MD/PhD UC Davis Fellow: Michael Cardenas, MD UC Davis Panel: Gordon Li, MD Stanford Seema Nagpal, MD Stanford Jennie Taylor, MD UCSF HPI: 46 yo right handed woman who

More information

Special Situation: Brain metastases

Special Situation: Brain metastases ESMO Advanced Course on Unsolved Questions in Immuno-Oncology February 16-17 2018, Amsterdam, Netherlands Special Situation: Brain metastases Matthias Preusser, MD Associate Professor of Medicine Department

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

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 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

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

Medical Treatment of Advanced Lung Cancer

Medical Treatment of Advanced Lung Cancer Medical Treatment of Advanced Lung Cancer Oncology for Scientists April 26, 2018 Edwin Yau, MD., Ph.D. Assistant Professor of Oncology Department of Medicine Department of Cancer Genetics and Genomics

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

Optimal Management of Isolated HER2+ve Brain Metastases

Optimal Management of Isolated HER2+ve Brain Metastases Optimal Management of Isolated HER2+ve Brain Metastases Eliot Sims November 2013 Background Her2+ve patients 15% of all breast cancer Even with adjuvant trastuzumab 10-15% relapse Trastuzumab does not

More information

Treating Multiple. Brain Metastases (BM)

Treating Multiple. Brain Metastases (BM) ESTRO 36 5-9 May 2017, Vienna Austria, Accuray Symposium Treating Multiple Brain Metastases (BM) with CyberKnife System Frederic Dhermain MD PhD, Radiation Oncologist Gustave Roussy University Hospital,

More information

Opzioni terapeutiche nel paziente ALK-traslocato

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

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

The Rapidly Changing World of EGFR Mutation-Positive Acquired Resistance

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

More information

Precision medicine for gliomas

Precision medicine for gliomas Precision medicine for YAZMIN ODIA, MD MS LEAD PHYSICIAN OF MEDICAL NEURO-ONCOLOGY DISCLOSURES Novocure: Advisory Board for Optune in No other financial conflicts of interest Glioma OVERVIEW INFILTRATIVE,

More information

Selecting the Optimal Treatment for Brain Metastases

Selecting the Optimal Treatment for Brain Metastases Selecting the Optimal Treatment for Brain Metastases Clinical Practice Today CME Co-provided by Learning Objectives Upon completion, participants should be able to: Understand the benefits, limitations,

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

pan-canadian Oncology Drug Review Final Clinical Guidance Report Dabrafenib (Tafinlar) and Trametinib (Mekinist) for Non-Small Cell Lung Cancer

pan-canadian Oncology Drug Review Final Clinical Guidance Report Dabrafenib (Tafinlar) and Trametinib (Mekinist) for Non-Small Cell Lung Cancer pan-canadian Oncology Drug Review Final Clinical Guidance Report Dabrafenib (Tafinlar) and Trametinib (Mekinist) for Non-Small Cell Lung Cancer November 2, 2017 DISCLAIMER Not a Substitute for Professional

More information

Management Strategies for Lung Cancer Sensitive or Resistant to EGRF Inhibitors

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

More information

REPORT ASCO 2018 CHICAGO: RESPIRATORY ONCOLOGY Johan Vansteenkiste / Christophe Dooms, Univ. Hospital KU Leuven and Leuven Lung Cancer Group

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

More information

Overcoming Toxicities Associated with Novel Checkpoint Inhibitor Immunotherapy. Tara C. Gangadhar, MD Assistant Professor of Medicine ICI Boston 2016

Overcoming Toxicities Associated with Novel Checkpoint Inhibitor Immunotherapy. Tara C. Gangadhar, MD Assistant Professor of Medicine ICI Boston 2016 Overcoming Toxicities Associated with Novel Checkpoint Inhibitor Immunotherapy Tara C. Gangadhar, MD Assistant Professor of Medicine ICI Boston 2016 Overcoming toxicity A new context for evaluating toxicity

More information

Oligometastatic Disease

Oligometastatic Disease Oligometastatic Disease Fact or Fantasy? Jennifer R Bellon MD, FASTRO Dana-Farber Cancer Institute Harvard Medical School Alexander V Louie MD PhD, FRCPC London Health Sciences Center Western University

More information

Recent Advances in Lung Cancer: Updates from ASCO Updates from ESMO, AACR and ASCO

Recent Advances in Lung Cancer: Updates from ASCO Updates from ESMO, AACR and ASCO Recent Advances in Lung Cancer: Updates from ASCO 2018 Updates from ESMO, AACR and ASCO Charu Aggarwal, MD, MPH Assistant Professor of Medicine Division of Hematology-Oncology Abramson Cancer Center University

More information

NCCN Non-Small Cell Lung Cancer V Meeting June 15, 2018

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

More information

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 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

More information

Surgery for recurrent brain metastases

Surgery for recurrent brain metastases Surgery for recurrent brain metastases Pr Philippe METELLUS Neurosurgeon, Clairval Hospital Center, Marseille 8th Annual Brain Metastases Research and Emerging Therapy Conference September 21st, 2018 Conflict

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Proteomic Testing for Targeted Therapy in Non-Small Cell Lung File Name: Origination: Last CAP Review: Next CAP Review: Last Review: proteomic_testing_for_targeted_therapy_in_non_small_cell_lung_cancer

More information

The incidence of brain metastasis (BM) in adult patients

The incidence of brain metastasis (BM) in adult patients clinical article J Neurosurg 125:17 23, 2016 Does immunotherapy increase the rate of radiation necrosis after radiosurgical treatment of brain metastases? *Rovel J. Colaco, MD, FRCR, 1 Pierre Martin, BSc,

More information

II sessione. Immunoterapia oltre la prima linea. Alessandro Tuzi ASST Sette Laghi, Varese

II sessione. Immunoterapia oltre la prima linea. Alessandro Tuzi ASST Sette Laghi, Varese II sessione Immunoterapia oltre la prima linea Alessandro Tuzi ASST Sette Laghi, Varese AGENDA Immunotherapy post-chemo ( true 2/3L ) Immunotherapy in oncogene addicted NSCLC (yes/no? when?) Immunotherapy

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Mezquita L, Auclin E, Ferrara R, et al. Association of the Lung Immune Prognostic Index with immune checkpoint inhibitor outcomes in patients with advanced non small cell lung

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

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Proteomic Testing for Systemic Therapy in Non-Small-Cell Lung Cancer Page 1 of 41 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Proteomic Testing for Systemic

More information

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 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

More information

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 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,

More information

Medical Policy. MP Proteomic Testing for Targeted Systemic in Non-Small-Cell Lung Cancer

Medical Policy. MP Proteomic Testing for Targeted Systemic in Non-Small-Cell Lung Cancer Medical Policy MP 2.04.125 Proteomic Testing for Targeted Systemic in Non-Small-Cell Lung Cancer BCBSA Ref. Policy: 2.04.125 Last Review: 11/15/2018 Effective Date: 11/15/2018 Section: Medicine Related

More information

NCCN Guidelines for Central Nervous System Cancers V Follow-Up on 02/23/18

NCCN Guidelines for Central Nervous System Cancers V Follow-Up on 02/23/18 GLIO-3 and GLIO-4 Submission from Novocure Inc. (12/19/17 and 9/7/17) Please consider adding tumor treating fields in combination with temozolomide for the treatment of adult patients with newly diagnosed,

More information

New paradigms for treating metastatic melanoma

New paradigms for treating metastatic melanoma New paradigms for treating metastatic melanoma Paul B. Chapman, MD Melanoma Clinical Director Melanoma and Immunotherapeutics Service Memorial Sloan Kettering Cancer Center, New York 20 th Century Overall

More information

Alimta (pemetrexed) Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage

Alimta (pemetrexed) Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage Alimta (pemetrexed) Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage Original Effective Date: 09/01/2007 Current Effective Date: TBD003/01/201703/01/2018 POLICY A. INDICATIONS The indications

More information

Colon cancer: Highlights. Filippo Pietrantonio Istituto Nazionale dei Tumori di Milano

Colon cancer: Highlights. Filippo Pietrantonio Istituto Nazionale dei Tumori di Milano Colon cancer: Highlights Filippo Pietrantonio Istituto Nazionale dei Tumori di Milano Agenda 1) Metastatic colorectal cancer First-line treatment molecularly unselected: FOLFOXIRI-bev (CHARTA trial) Later-line

More information

Where are we with radiotherapy for biliary tract cancers?

Where are we with radiotherapy for biliary tract cancers? Where are we with radiotherapy for biliary tract cancers? Professor Maria A. Hawkins Associate Professor in Clinical Oncology MRC Group Leader/Honorary Consultant Clinical Oncologist CRUK MRC Oxford Institute

More information