PRECISION CANCER MEDICINE DR. VANESSA DICKEY TORRANCE MEMORIAL PHYSICIAN NETWORK CANCER CARE ASSOCIATES

Transcription

1 PRECISION CANCER MEDICINE DR. VANESSA DICKEY TORRANCE MEMORIAL PHYSICIAN NETWORK CANCER CARE ASSOCIATES

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6 REAL PATIENT; ANN (ALIAS) 63 year old woman who smoked for 25 years, quit 15 years ago. Complained of cough to primary care doctor for 3 months and weight loss. Lung Cancer

7 WHAT NOW? Chemotherapy was the only option for this patient, which may extend her life for a year.

8 REAL PATIENT: MIRIAM 33 YEAR OLD MOTHER. 3 MONTH OLD AT HOME PRESENTS WITH ELEVATED WBC WBC 150,000K PRIMARY CARE DOC REFERS TO CANCER CARE PATIENT HAS ENLARGED SPLEEN AND FATIGUE CHRONIC MYELOGENOUS LEUKEMIA

9 BEFORE TARGETED THERAPY

10 CINDY 46 year old woman with Triple Negative Breast Cancer treated elsewhere but seeking clinical trial expertise.

11 NURSE PRESENTS WITH JAUNDICE 54 year old nurse with Melanoma which spread to liver. Melanoma was excised 1 year ago with clear margins. What are her options now?

12 STEVE 76 year old man presents with cough. He has multiple other health issues: Coronary Artery disease, Hypertension, High Cholesterol. He wants meaningful therapy but does not want chemotherapy under any circumstances. Open to new treatments.

13 WHAT DO ALL THESE PATIENTS HAVE IN COMMON? Dismal prognosis with traditional therapies.

14 FUTURE HOLDS PROMISE Checkpoint inhibitors Targeted therapy Car T- Cells Anti-Tumor Vaccines

15 REAL PATIENT: MIRIAM 33 YEAR OLD MOTHER. 3 MONTH OLD AT HOME PRESENTS WITH ELEVATED WBC WBC 150,000K PRIMARY CARE DOC REFERS TO CANCER CARE PATIENT HAS ENLARGED SPLEEN AND FATIGUE CHRONIC MYELOGENOUS LEUKEMIA

16 VERY TARGETED THERAPY

17 GLEEVAC: TYROSINE KINASE INHIBITOR FIRST TARGETED THERAPY

18 MIRIAM- COMES IN ONCE EVERY 6 MONTHS, ON ORAL THERAPY, DAUGHTER NOW STARTING PRE-SCHOOL.

19 CINDY 46 year old woman with Triple Negative Breast Cancer treated elsewhere but seeking clinical trial expertise.

20 2 ND /3 RD LINE: SYNDAX SNDX blocks the interaction of PD-L1 with programmed cell death protein 1 (PD-1) and CD80 (B7-1). PD-L1 can be highly expressed on certain tumors, which is thought to lead to reduced activation of immune cells (cytotoxic T-cells in particular) that might otherwise recognize and attack the cancer. Inhibition of PD-L1 by atezolizumab can remove this inhibitor effect and thereby engender an anti-tumor response. It is one of several ways to block inhibitory signals related to T-cell activation, a more general strategy known as "immune checkpoint inhibition."

21 INHERITED CANCER SCREEN

22 CLINICAL TRIALS- ADVANCE THE FIELD

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24 WHILE TRADITIONAL CLINICAL TRIALS FOCUS ON A PARTICULAR CANCER TYPE, BASKET STUDIES TEST THERAPIES THAT TARGET A SPECIFIC GENETIC MUTATION FOUND IN THE TUMOR, REGARDLESS OF WHERE THE CANCER ORIGINATED. SOME PATIENTS WITH DIFFERENT CANCER TYPES WILL SHARE THE SAME MUTATION IN THEIR TUMORS BASKET STUDIES BENEFIT PATIENTS WITH RARE CANCER SUBTYPES

25 REAL PATIENT; ANN 63 year old woman who smoked for 25 years, quit 15 years ago. Complained of cough to primary care doctor for 3 months and weight loss. Lung Cancer

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27 LUNG CANCER

28 ANN ALK+ tumor and started on a pill daily Tolerating the pill well Went to Europe with her husband and living life to the fullest

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31 NURSE PRESENTS WITH JAUNDICE 54 year old nurse with Melanoma which spread to liver. Melanoma was excised 1 year ago with clear margins. What are her options now?

32 MELANOMA

33 STEVE 76 year old man presents with cough. He has multiple other health issues: Coronary Artery disease, Hypertension, High Cholesterol. He wants meaningful therapy but does not want chemotherapy under any circumstances. Open to new treatments.

34 CHECKPOINT INHIBITORS: CLOAKING

35 CHECKPOINT INHIBITORS: UNCLOAKING

36 T CELL ON THE MARCH..

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39 NEW CANCER DRUGS 2015 Oncology Alecensa (alectinib); Roche; For the treatment of ALK-positive, metastatic non-small cell lung cancer, Approved December 2015 Cotellic (cobimetinib) ; Genentech; For the treatment of BRAF V600E or V600K melanoma, Approved November 2015 Darzalex (daratumumab); Janssen Biotech; For the treatment of multiple myeloma, Approved November 2015 Empliciti (elotuzumab); Bristol-Myers Squibb; For the treatment of patients with multiple myeloma who have received prior therapies, Approved November 2015 Farydak (panobinostat); Novartis; For the treatment of multiple myeloma, Approved February 2015 Ibrance (palbociclib); Pfizer; For the treatment of ER-positive, HER2-negative breast cancer, Approved February 2015 Imlygic (talimogene laherparepvec) ; Amgen; For the treatment of unresectable recurrent melanoma, Approved October 2015 Keytruda (pembrolizumab); Merck; For the treatment of PD-L1 positive advanced non-small cell lung cancer, Approved October 2015 Lenvima (lenvatinib); Eisai; For the treatment of thyroid cancer, Approved February 2015 Lonsurf (trifluridine and tipiracil); Taiho Oncology; For the treatment of metastatic colorectal cancer, Approved September 2015 Ninlaro (ixazomib); Millennium Pharmaceuticals; For the treatment of multiple myeloma, Approved November 2015 Odomzo (sonidegib); Novartis; For the treatment of locally advanced basal cell carcinoma, July 2015 Onivyde (irinotecan liposome injection); Merrimack; For the treatment of metastatic pancreatic cancer following gemcitabine-based therapy, Approved October 2015 Opdivo (nivolumab); Bristol-Myers Squibb; For the treatment of advanced renal cell carcinoma, Approved November 2015 Opdivo (nivolumab); Bristol-Myers Squibb; For the treatment of metastatic squamous non-small cell lung cancer, Approved March 2015 Portrazza (necitumumab) ; Eli Lilly; For the treatment of metastatic squamous non-small cell lung cancer, Approved November 2015 Tagrisso (osimertinib); AstraZeneca; For the treatment of EGFR T790M mutation positive non-small cell lung cancer, Approved November 2015 Unituxin (dinutuximab); United Therapeutics; For the treatment of pediatrics with high-risk neuroblastoma, Approved March 2015 Varubi (rolapitant); Tesaro; For the prevention of delayed nausea and vomiting associated with chemotherapy, Approved September 2015 Vistogard (uridine triacetate); Wellstat Therapeutics; For the emergency treatment of patients with a fluorouracil or capecitabine overdose, Approved December 2015 Yondelis (trabectedin); Janssen; For the treatment of liposarcoma or leiomyosarcoma, Approved October 2015

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42 FINAL THOUGHTS People will live longer with cancer- chronic disease Chemotherapy still needed, unfortunately Oral Medications will be part of the defense, but will not completely replace infusions. Prevention: EVERY child should receive the HPV vaccine. Prevents Head/Neck, Cervical, Anal cancers. Only some tumors respond to immunotherapy, why? Genomics predict propensity, will people want to know? Hospice, Palliative care must be initiated early (advance dir.) Survivorship, Post therapy issues

43 NEW PATIENT BENEFITS AT TMPN VASEK POLAK BREAST CENTER NAVIGATOR FAST TRACK-> CANCER CARE GENETIC TESTING SURGEON, ONCOLOGIST, RADIATION ONCOLOGIST GENETIC COUNSELOR- COUNSYL AND TORRANCE TMPN->FAST TRACK TO SPECIALISTS Receptors on Pathology Reports- quickest turn around, discussed in tumor board setting for collaborative approach across disciplines Clinical Trial Accrual if applicable NUTRITION, LYMPHEDEMA, PHYSICAL THERAPY SUPPORT GROUPS

44 ONGOING NAVIGATOR FOLLOW UP ONCOLOGY CARE MODEL; Community-based oncology practices accepted into the OCM pilot program began their journey on July 1, 2016 towards better care, smarter spending and healthier patients. The program focuses on a comprehensive approach to patient care, including patient navigation and improved access, reduction in avoidable emergency department visits, improved advanced care planning and better psychosocial support. Only 200 practices selected. National Guidelines; NCCN, Best Practices Palliative Care Clinic, Advanced Directive Support EMR- interconnectivity with physicians and hospital Nutrition, Lymphedema, Physical Therapy SUPPORT GROUPS Support from Tertiary Center; Cedars-Sinai Hospital Survivorship

45 CEDARS-SINAI Clinical Trial Accrual; Cedars-Sinai investigators are currently conducting more than 800 clinical research projects with 230 unique Principal Investigators. Transplant Abilities Surgical Abilities and Expertise Tumor Board Conference Across sites Collaboration Nationally Academic Support The List of Benefits Goes on and on.

46 YOUR FRONT LINE OF DEFENSE TORRANCE MEMORIAL PHYSICIAN NETWORK

47 THANK YOU! THANKS for your attention.