Treating Liver Limited or Oligometastatic CRC
|
|
- Chester Robbins
- 6 years ago
- Views:
Transcription
1 ESMO Preceptorship Colorectal Cancer Nov 2016 Barcelona Treating Liver Limited or Oligometastatic CRC Claus-Henning Köhne Klinik für Onkologie und Hämatologie North West German Cancer Center (NWTZ)
2 Learning objectives All patients with liver limited or oligometastatic disease have a potential chance for cure A multidisciplinary aproach is essential The clinical presentation may be considered as Resectable, boarderline resectable, potentially resectable after chemotherapy In resectable disease surgery alone or following chemotherapy are options In boarderline and unresectable disease the most effective and still tolerable chemotherapy according to the molecular profile should be used within a multidisciplinary context Even if surgery might not be curative it extends overall survival and can be considered as a further line of chemotherapy or a form of maintenance chemotherapy
3 Guidelines CRC mut mut
4 FIRE3: Blinded review for Resektability of CRC Metastases Neumann et al, ESMO 2016
5 Liver limited disease: Patient groups Clearly resectable Borderline resectable Definitely NOT resectable
6 Resectable LLD but high risk of recurrence Fong Score Primary tumor N + DFI < 12 Monate > 1 Metastasis > 5 cm CEA > 200 ng/ml >12cm Age 51y Rectal Adeno-Ca: ct3, N+ Synchroneous LLD, ø 12 cm CEA 568 ng/ml High Fong Score Estimated 5y < 10%
7 Group 0 Resectable metastases Primary tumor N + DFI < 12 Monate > 1 Metastasis > 5 cm CEA > 200 ng/ml Fong score > 2 Disease specific survival (DSS)
8 Probability Adjuvant systemic chemotherapy of CLM: Overall survival Combined analysis FFCD / EORTC trial 5-FU/FA Overall survival FOLFIRI 1.00 Treatment HR=0.89: 95%CI [ ] year DFS: 63% vs. 77% 2-year DFS: 46% vs. 51% Months Number at risk LV5FUs LV5FUs+IRI LV5FUs adjusted Logrank p=0.43 LV5FUs+IRI Mitri et al. JCO 2008 Ychou et al. ASCO 2008
9 Neoadjuvant (perioperative) Chemotherapy in resectable CRC Liver metastases EORTC (EPOC) R FOLFOX -> OP -> FOLFOX OP RFS OS Nordlinger et al. Lancet Oncol 2013
10 Conclusions resectable & boarderline resectable disease Resectable : Perioperative Chemotherapy questionable Boarderline : no restrictions in Chemo regimens including use of EGFR
11 Case: Male 44 y, 05/06 Base line 05/06-11/06 FOLFIRI + Cetux 11/06-03/07 FOLFOX + Cetux PS 2 PS 0 liver mets operable primary tumor pcr + 5 kg mets not operable Patient died 02/15
12 Response and resection rates within trials Trials with neoadjuvant focus Trials with palliative focus CRC Give the most active (RR) regimen still tolerable by the patient Folprecht G.Köhne CH et al. Ann Oncol 2005; Jones R et al. Eur J Cancer, 2014
13 Tumor load at Baseline Morbidity ESMO acknowledges response parameters like early tumor shrinkage (ETS) or depth of response (DpR) for conversion therapy Fire-3 data Lethal tumor load OS No CT =<5 cycles 6-9 cycles =>10 cycles ETS Tumor nadir PFS Time since start of treatment Steatohepatitis Karoui Nordlinger et al, Ann.Surg Sinusoidal distention Vauthey et al. JCO 2006
14 Arguments disfavouring CapeOX over infusional Doublets (FOLFOX or FOLFIRI)
15 Randomised trials Doublets vs. Triplets and Doublets +/- VEGF 1 st line RASwt and RASmut disease CTx +/- VEGF Trial Therapy ORR DOUBLET vs. TRIPLET Trial Therapy ORR NO16966 (n=700) FOLFOX +/- Beva 38% vs. 38% n.s. GONO (n=244) FOLFIRI +/- Oxaliplatin 41% vs. 66% (n=700) ITACA (n=376) EORTC request CAPOX +/- Beva FOLFOX or FOLFIRI +/- Beva FOLFIRI +/- Bev 38% vs. 38% n.s. 48% vs. 49% n.s. not done TRIBE (n=700) Austria (n=80) AIO (n=242) FOLFIRI / BEV +/- Oxaliplatin FOLFOX / Bev +/- Irinotecan FOLFOX / Bev +/- Irinotecan 53% vs. 65% 62% vs. 81% 60% vs. 79% Saltz et al. JCO 2008, Cassidy BJC 2007, Passardi Ann Oncol 2015 Van Cutsem NEJM,
16 Randomisierte Studien mit EGFR AK 1. Linie k-ras exon 2 wt Europäische & Asiatische Erfahrungen Trial Therapy ORR CRYSTAL (n=666) FOLFIRI +/- Cetux 40% vs. 57% Chinese * (n=138) FOLFIRI or FOLFOX+/- Cetux 40% vs. 57% Infusional 5FU PRIME (n=656) OPUS (n=197) FOLFOX +/- Pani FOLFOX +/- Cetux 48% vs. 57% 34% vs. 57% Bolus 5FU Cape Tailor (n=380) VOLFI all RASwt (n=99) 2:1 COIN (n=729) NORDIC (n=194) FOLFOX +/- Cetux 34% vs. 56% FOLFOXIRI +/- Pani 61% vs. 86% XELOX/FOLFOX +/- Cetux 57% vs. 64% FLOX +/- Cetxu 47 vs. 46%
17 Chinese randomized trial in patients with non resectable k-ras exon 2 wt CRC LLD Chemotherapy +/- Cetuximab Ye et al. JCO 2013
18 CELIM: R0 Resection as a surgical maintenance therapy in the continuum of care Progression free survival Overall survival R0 resected: %CI: Not R0 res.: %CI: HR 2.10 [ ] p<0.001 R0 resected: %CI: Not R0 res.: %CI: HR 2.25 [ ], p= y-OS: 45.8% few patients without relaps Update CELIM 12/2012, ASCO 2013
19 EORTC CLOCC trial Theo Ruers et al, ASCO 2015
20 EORTC CLOCC trial N=152 Arm Resection Resection +RFA CT 12% RFA only CT+RFA 47% 6% Theo Ruers et al, ASCO 2015
21 Clearly resectable Borderline resectable Liver limited / dominant diesase S U R G E R Y Chemotherapy? adjuvant to surgery Definitely NOT resectable C H E M O Surgery! Adjuvant to chemotherapy Maintenance or an additional line of chemotherapy to chemotherapy
22 OPEN QUESTIONS Right / Left RASmut BRAFmut
23 Overall response rate left & right JY Douillard & JP Pignon ESMO 2016
24 EVALUATION OF RESPONSE SIDEDNES ORR (%) left 90,6 N=78 right N=18 OR ( ) P= OR ( ) P= ,0 60, , mfolfoxiri + panitumumab FOLFOXIRI mfolfoxiri + panitumumab FOLFOXIRI 24 Geissler et al. ESMO 2017
25 Treatment for RASmut or BRAFmut Disease? Cremolini et al. Lancet Oncol 2015
26 Welches ist die beste therapie für RASmut Erkrankung? FOLFIRI/Bev +/- Oxaliplation FP/Bev +/- Irinotecan Triplette nicht besser als Doublette Group Events/No. OS (95% CI), months Doublette nicht besser als FP+Bev RAS/BRAF WT (Arm A) 51/ ( ) RAS/BRAF WT (Arm B) 40/ ( ) RAS MT (Arm A) 68/ ( ) RAS MT (Arm B) 65/ ( ) Cremolini et al. Lancet Oncol 2015 BRAF MT (Arm A) 11/ ( ) BRAF MT (Arm B) 8/ ( ) Modest et al. ESMO 2017
27 Prognosis of BRAFmut Disease Triplett +/- Panitumumab ORR (%) super wild-type 86,0 BRAF mutation ,7 71, ,2 10 mfolfoxiri + panitumumab FOLFOXIRI mfolfoxiri + panitumumab FOLFOXIRI Jones et al. et al. JCO 2017 Geissler et al. ESMO 2017
28 CELIM 2 PI Gunnar Folprecht Dresden
29 Clearly resectable Borderline resectable Liver limited / dominant diesase S U R G E R Y Chemotherapy? adjuvant to surgery Definitely NOT resectable C H E M O Surgery! Adjuvant to chemotherapy Maintenance or an additional line of chemotherapy to chemotherapy
30 Learning objectives All patients with liver limited or oligometastatic disease have a curative chance A multidisciplinary aproach is essential Clinical presentation may be considered as Resectable, boarderline resectable, potentially resectable after chemotherapy In resectable disease surgery alone or following chemotherapy are options In boarderline and unresectable disease the most effective and still tolerable chemotherapy according to the molecular profile should be used within a multidisciplinary context Even if surgery is not curative it extends overall survival and can be considered as a line of chemotherapy or a form of maintenance chemotherapy
31 Thank you for your attention!
32 Metastatic disease including locoregional treatment
33 FOXFIRE (n=1103, 3 Studies)
34 FOXFIRE (n=1103, 3 Studies) HR: 1.04 P=0.6 Slide 12 HR: 0.90 P=0.1 Presented By Ricky Sharma at 2017 ASCO Annual Meeting
35 FOXFIRE (n=1103, 3 Studies) Best radiological response by study Presented By Ricky Sharma at 2017 ASCO Annual Meeting
36
37
38 CALGB/SWOG 80405: Baseline Characteristics Resected Patients Characteristic Kras WT codons 12/13 n=1137 Chemo + Bev n=559 Chemo + Cetux n=578 Chemo + Bev n=75 Resected Pts n=180 Chemo + Cetux n=105 Age, years Median (range) 59 (21 85) 59 (20 89) 55 (24 82) 55 (21 79) Male, % Non-Caucasian, % Achieve 14.6 NED: FOLFOX, %* /180 Prior Radiation, %* Prior Adjuvant Chemotherapy, %* Palliative intent, % Primary in place, % Liver *Stratification metastases Factor only, %
39 CALGB/SWOG 80405: Baseline Characteristics Resected Patients Characteristic Kras WT codons 12/13 n=1137 Chemo + Bev n=559 Chemo + Cetux n=578 Chemo + Bev n=75 Resected Pts n=180 Chemo + Cetux n=105 Age, years Median (range) 59 (21 85) 59 (20 89) 55 (24 82) 55 (21 79) Male, % Non-Caucasian, % FOLFOX, %* Prior Radiation, %* Prior Adjuvant Chemotherapy, %* Palliative intent, % Primary in place, % Liver *Stratification metastases Factor only, %
40 CALGB/SWOG 80405: Baseline Characteristics Resected Patients Characteristic Kras WT codons 12/13 n=1137 Chemo + Bev n=559 Chemo + Cetux n=578 Chemo + Bev n=75 Resected Pts n=180 Chemo + Cetux n=105 Palliative intent, % curative intent % 13.6% 17.5% curative intent N Resected NED (R0) N Pat Resected NED (R0) % 8.0% 11.4% 60.0% 62.8% Primary in place, % Liver metastases only, % *Stratification Factor Discrepance of numbers: Resected NED =111; Resected achieved NED=132
41 CALGB/SWOG 80405: Overall Survival (KRAS wild type, NED Post-Surgery, N=132) Arm N (Events) Median (95% CI) HR (95% CI) p Chemo + Bev 50(15) 67.4 (50.6-NA) Most pts were resectable upfront, thus surgery is the main driver or survival rather than preop chemotherapy Chemo + Cetux 82(30) 64.1 ( ) ( )
42 Resectable Colorectal Liver Metastases Presented By Jeanne Tie at 2016 ASCO Annual Meeting
43 FIRE3: Blinded review for Resektability of CRC Metastases Neumann et al, ESMO 2016
44 Patients treated with palliative Chemotherapy in a regional Center in UK Jones et al, BJS 2012
45 Guidelines CRC unresectable (LLD) mut mut
46 Case: Male 44 y, sigmoid adenocarcinoma well until 4 months ago, PS 2 weight loss ~ 5 Kg within last 3 months grossly enlarged palpable liver abdominal US: difuse hypodensic liver leasons CT scans: Synchroneous diffuse liver metastases LDH elevated, WBC /dl Bilirubin normal, LFT < 4x ULN
47 Neoadjuvant (perioperative) Chemotherapy in resectable CRC Liver metastases EORTC (EPOC) and new EPOC R FOLFOX -> OP -> FOLFOX OP RFS OS Nordlinger et al. Lancet Oncol 2013 R FOLFOX -> OP -> FOLFOX +Cet -> OP -> +Cet RFS OS Primrose et al. Lancet Oncol 2014
48 Liver limited diesase: Patient selection EPOC New EPOC Surgery Chemo Chemo Inclusion Definitely resectable Definitely and suboptimal resectable N Lesions Maximum 4 unlimited unresectable 10% 4% 12-19% Köhne JCO 2015
49 Potential disadvantage of effective neoadjuvant chemotherapy inresectable liver metastases CT/MRI prior chemo CT/MRI after chemo prior surgery Non - visible on CT/MRI, potentially visible during operation Visible on CT/MRI Köhne JCO 2015
Unresectable or boarderline resectable disease
ESMO Preceptorship Colorectal Cancer Nov 2016 Barcelona Unresectable or boarderline resectable disease Claus-Henning Köhne Klinik für Onkologie und Hämatologie North West German Cancer Center (NWTZ) Learning
More informationUnresectable or boarderline resectable (Groupp 1) chemotherpy +/- targeted agents
ESMO Preceptorship Program 27.-28. March Singapore Unresectable or boarderline resectable (Groupp 1) chemotherpy +/- targeted agents Claus-Henning Köhne Klinik für Onkologie und Hämatologie North West
More informationUnresectable or boarderline resectable disease
ESMO Preceptorship Colorecatl Cancer July 2016 Prague, Czech Republic Unresectable or boarderline resectable disease Claus-Henning Köhne Klinik für Onkologie und Hämatologie North West German Cancer Center
More informationFirst line treatment in metastatic colorectal cancer
First line treatment in metastatic colorectal cancer Claus-Henning Köhne University Clinic Onkology and Haematology North West German Cancer Center (NWTZ) A non authorised version of ESMO guidelines was
More informationKonzepte bei der Therapie des metastasierten kolorektalen Karzinoms
21. Ärzte Fortbildungskurs in Klinischer Onkologie 24.-26. Februar 2011 Kantonspital St. Gallen / Schweiz Konzepte bei der Therapie des metastasierten kolorektalen Karzinoms Claus-Henning Köhne Klinik
More informationDr. Iain Tan. Senior Consultant GI Medical Oncologist National Cancer Centre Singapore
ESMO-ASIA 2017 Preceptorship (GI cancers) Session: Metastatic colorectal cancer, liver limited metastases Topic: Unresectable or borderline resectable : chemotherapy +/- targeted agents Dr. Iain Tan Senior
More informationState of the Art: Colorectal Cancer Liver Metastasis Dr. Iain Tan
State of the Art: Colorectal Cancer Liver Metastasis Dr. Iain Tan Consultant GI Medical Oncologist National Cancer Centre Singapore Clinician Scientist, Genome Institute of Singapore OS (%) Overall survival
More informationADVANCED COLORECTAL CANCER: UNRESECTABLE OR BORDERLINE RESECTABLE (GROUP 1) CHEMOTHERAPY +/- TARGETED AGENTS. Andrés Cervantes. Professor of Medicine
ADVANCED COLORECTAL CANCER: UNRESECTABLE OR BORDERLINE RESECTABLE (GROUP 1) CHEMOTHERAPY +/- TARGETED AGENTS Andrés Cervantes Professor of Medicine 1995 One option Advances in the treatment of mcrc 2000
More informationDoes it matter which chemotherapy regimen you partner with the biologic agents?
Does it matter which chemotherapy regimen you partner with the biologic agents? Yes, it does matter! Axel Grothey Disclosures Research Funding to MAYO Clinic Genentech Bayer Eisai Pfizer Imclone Potential
More informationJY Douillard MD, PhD Professor of Medical Oncology
ESMO Preceptorship Colorectal Cancer Colorectal ESMO Cancer Preceptorship Vienna 26-27 Program October 2015 Prague May 22-23rd 2014 Review of the ESMO Consensus Conference on metastatic colo-rectal cancer
More informationChemotherapy for resectable liver mets: Options and Issues. Herbert Hurwitz Duke University Medical Center Durham, North Carolina, USA
Chemotherapy for resectable liver mets: Options and Issues Herbert Hurwitz Duke University Medical Center Durham, North Carolina, USA Chemotherapy regimens in 1 st line mcrc Standard FOLFOX-Bev FOLFIRI-Bev
More informationJY Douillard MD, PhD Professor of Medical Oncology
Colorectal Cancer ESMO Preceptorship Program Prague May 22-23rd 2014 Review of the ESMO Consensus Conference on metastatic colo-rectal cancer Basic strategy and groups (RASwt/mut, BRAF mut) JY Douillard
More informationΚίκα Πλοιαρχοπούλου. Παθολόγος Ογκολόγος Ευρωκλινική Αθηνών
Κίκα Πλοιαρχοπούλου Παθολόγος Ογκολόγος Ευρωκλινική Αθηνών Time (months) Survival outcomes in mcrc have progressively improved over the past two decades Treatment options for many patients Multidisciplinary
More informationPerioperative chemotherapy for colorectal cancer livermetastases: what is the optimal strategy?
Perioperative chemotherapy for colorectal cancer livermetastases: what is the optimal strategy? Prof Eric Van Cutsem, MD, PhD Digestive Oncology Leuven, Belgium Eric.VanCutsem@uzleuven.be A classical case
More informationColon Cancer Molecular Target Agents
Colon Cancer Molecular Target Agents Ci Caio Max SR S. Rocha Lima, M.D. MD Professor of Medicine CDi CoDiretor Cl Colorectal tlheptobiliary, Pancreatic SDG, and Phase I Unit University of Miami & Silvester
More informationIs it possible to cure patients with liver metastases? Taghizadeh Ali MD Oncologist, MUMS
Is it possible to cure patients with liver metastases? Taghizadeh Ali MD Oncologist, MUMS Survival Rates of by Stage of Adenocarcinoma of the Colon Liver Resection New Perspective Colorectal cancer liver
More informationReview of the ESMO consensus conference on metastatic colorectal cancer Basic strategies and groups. Chemotherapy and targeted agents in 1st line
ESMO Preceptorship Programme Colorectal Cancer Valencia, 18th May 2018 Review of the ESMO consensus conference on metastatic colorectal cancer Basic strategies and groups Chemotherapy and targeted agents
More informationOPTIMISING OUTCOMES FOR PATIENTS WITH ADVANCED COLORECTAL CANCER
OPTIMISING OUTCOMES FOR PATIENTS WITH ADVANCED COLORECTAL CANCER E-Learning Module Stavros Gkolfinopoulos 1, Demetris Papamichael 1, George Pentheroudakis 2 1. Cyprus Oncology Centre, Nicosia, Cyprus 2.
More informationDirk Arnold Lógica de proximidade à população
Doenca Contando metastatica já com 70 anos potencialmente de experiência no resecável: sector da saúde Tratamento igual para colon e para recto? 5 Hospitais Privados CUF 6 Clínicas de ambulatório CUF 6
More informationThe ESMO consensus conference on metastatic colorectal cancer
ESMO Preceptorship Programme Colorectal cancer Prague July, 6-7 2016 The ESMO consensus conference on metastatic colorectal cancer Andres Cervantes ESMO consensus on mcrc 2016 Chairs: Co-Chairs of working
More informationMETASTATIC COLORECTAL CANCER: TUMOR MUTATIONAL ANALYSIS AND ITS IMPACT ON CHEMOTHERAPY SUMA SATTI, MD
METASTATIC COLORECTAL CANCER: TUMOR MUTATIONAL ANALYSIS AND ITS IMPACT ON CHEMOTHERAPY SUMA SATTI, MD INTRODUCTION Second leading cause of cancer related death in the United States. 136,830 cases in 2014
More informationDevelopment of Conventional Chemotherapy in mcrc BSC vs. Chemo, Biochemical modulation, Oral fluoropyrimidines, Developmentof combination chemotherapy
ESMO Preceptorship Colorectal Cancer Colorectal ESMO Cancer Preceptorship Valencia May Program 20-21st 2016 Prague May 22-23rd 2014 Development of Conventional Chemotherapy in mcrc BSC vs. Chemo, Biochemical
More informationThe left versus right colon cancer story What is the truth?
The left versus right colon cancer story What is the truth? Prof. V. Heinemann CCC LMU, Klinikum Grosshadern Ludwig-Maximilian-University of Munich, Germany Three stages of truth (Schopenhauer) Ridicule
More informationAdjuvant therapy in older adults: controversies and challenges - Colorectal cancer -
International Society of Geriatric Oncology Lisbon October 23 rd 25t h 2014 Adjuvant therapy in older adults: controversies and challenges - Colorectal cancer - Claus-Henning Köhne Klinik für Onkologie
More informationOligometastatic CRC: What do we know about it, and how to treat it?
Oligometastatic CRC: What do we know about it, and how to treat it? Instituto CUF de Oncologia Lisboa, Portugal : Organisationsfelder Asklepios Tumorzentrum Hamburg AK Altona, Abt. Onkologie, Hämatologie
More informationCOLORECTAL CANCER. Bert H. O Neil, MD Jackie and Joseph Cusick Professor of Oncology Director, GI Malignancies and Phase I Program
COLORECTAL CANCER Bert H. O Neil, MD Jackie and Joseph Cusick Professor of Oncology Director, GI Malignancies and Phase I Program Rectal Cancer Adjuvant therapy No single study specific to rectal cancer
More informationTreatment of Colorectal Liver Metastases State of the Art
Treatment of Colorectal Liver Metastases State of the Art Eddie K. Abdalla, MD, FACS Professor and Chairman of Surgery Chief of Hepatobiliary Surgery Hilton Metropolitan Palace Hotel Beirut 16 November,
More informationAIOM GIOVANI Perugia, Luglio 2017
AIOM GIOVANI 2017 Perugia, 07-08 Luglio 2017 Scelta delle linee successive nel paziente RAS e BRAF wild-type con particolare accento su nuovi bersagli terapeutici Francesca Battaglin U.O.C. Oncologia Medica
More informationWhat s New in Colon Cancer? Therapy over the last decade
What s New in Colon Cancer? 9/19/2014 Michael McNamara, MD Therapy over the last decade Cytotoxic chemotherapy - 5FU ( Mayo, Roswell, Infusional) - Xeloda (01 ) - Oxaliplatin (02 ) - Irinotecan (96 ) Anti-
More informationAdjuvant treatment Colon Cancer
ESMO Preceptorship Colorectal Cancer, October 2016 Singapore Adjuvant treatment Colon Cancer Claus-Henning Köhne University Clinic for Onkology und Haematology Oldenburg, Germany Aim of the lecture Adjuvant
More informationMANAGEMENT OF ADVANCED COLORECTAL CANCER
MANAGEMENT OF ADVANCED COLORECTAL CANCER Alberto Sobrero IRCCS San Martino IST Genoa Italy Disclosures : Pfizer, Roche, Merck, Amgen, Celgene, Bayer, Sanofi, Nordic, Takeda,BMS, Syrtex, Servier outline
More informationMEETING SUMMARY ESMO 2018, Munich, Germany. Dr. Jenny Seligmann University of Leeds, UK HIGHLIGHTS ON COLORECTAL CANCER
MEETING SUMMARY ESMO 2018, Munich, Germany Dr. Jenny Seligmann University of Leeds, UK HIGHLIGHTS ON COLORECTAL CANCER DISCLAIMER Please note: The views expressed within this presentation are the personal
More informationValidated and promising predictive factors in mcrc: Recent updates on RAS testing Fotios Loupakis, MD PhD
Validated and promising predictive factors in mcrc: Recent updates on RAS testing Fotios Loupakis, MD PhD U.O. Oncologia 2 Universitaria Azienda Ospedaliero-Universitaria Pisana Pisa, Italy Learning Objectives
More informationNuovi dati Colon Alain Gelibter Policlinico Umberto I UOC Oncologia «B»
Nuovi dati Colon Alain Gelibter Policlinico Umberto I UOC Oncologia «B» Roma, 7 Ottobre 2017 NEOADJUVANT FOLFOX 4 VERSUS FOLFOX 4 PLUS CETUXIMAB VERSUS IMMEDIATE SURGERY FOR HIGH- RISK STAGE II AND III
More informationCetuximab with Chemotherapy as Treatment for Stage III Colon or Metastatic Colorectal Cancer
Cetuximab with Chemotherapy as Treatment for Stage III Colon or Metastatic Colorectal Cancer Cetuximab with Chemotherapy (CT) as First-Line Treatment for Metastatic Colorectal Cancer (mcrc): Analysis of
More informationTHE BEST OF ESMO 2016
THE BEST OF ESMO 2016 Colorectal cancer Pr Julien TAIEB, Sorbonne Paris Cité and Paris Descartes University Georges Pompidou European Hospital Paris, FRANCE esmo.org DISCLOSURES JT has received research
More informationTechniques to Improve Resectability of Colorectal Liver Metastases Ching-Wei D. Tzeng, M.D.
Techniques to Improve Resectability of Colorectal Liver Metastases Ching-Wei D. Tzeng, M.D. Department of Surgery Grand Rounds University of Kentucky January 15, 2014 Metastatic Colorectal Cancer (CRC)
More informationColon Cancer Liver Metastases: Liver-Directed Therapy
Colon Cancer Liver Metastases: Liver-Directed Therapy Shishir K. Maithel, MD FACS Assistant Professor of Surgery Division of Surgical Oncology Winship Cancer Institute Emory University August 10, 2014
More informationCURRENT STANDARD OF CARE OF COLORECTAL CANCER: THE EVOLUTION OF ESMO CLINICAL PRACTICE GUIDELINES
CURRENT STANDARD OF CARE OF COLORECTAL CANCER: THE EVOLUTION OF ESMO CLINICAL PRACTICE GUIDELINES Fortunato Ciardiello ESMO Past-President 2018-2019 Dipartimento di Medicina di Precisione Università degli
More informationReview of the ESMO consensus conference on metastatic CRC Basis strategies ad groups (RAS, BRAF, etc) Michel Ducreux
Review of the ESMO consensus conference on metastatic CRC Basis strategies ad groups (RAS, BRAF, etc) Michel Ducreux 2 ESMO consensus on mcrc 2016 Chairs: Co-Chairs of working groups E Van Cutsem A Sobrero
More informationManaging mcrc Across Disease Continuum: Front-Line Therapy and Treatment Beyond Progression
Managing mcrc Across Disease Continuum: Front-Line Therapy and Treatment Beyond Progression Guillermo Méndez, MD Sección Oncología Hospital de Gastroenterología Bonorino Udaondo Carlos B. Udaondo y Fundación
More informationToxicity by Age Group. Old Factor 1: Age. Disclosures. Predicting survival in metastatic colorectal cancer. Personalized Medicine - Decision Tools -
Disclosures Predicting survival in metastatic colorectal cancer Daniel Sargent, PhD Mayo Clinic Consulting activities Amgen Pfizer Roche/Genentech Sanofi-Aventis Genomic Health Personalized Medicine -
More informationResection of liver limited resectable metastases Upfront, neoadjuvant and repeat hepatectomy
Resection of liver limited resectable metastases Upfront, neoadjuvant and repeat hepatectomy Dr Chan Chung Yip MBBS, M.Med(Surgery), MD, FAMS, FRCSEd Senior Consultant and Head Department of Hepatopancreatobiliary
More informationThe role of Maintenance treatment Appropriate endpoints according to ESMO consensus
ESMO Preceptorship Programme Colorectal Cancer Singapore-October 20-22 2016 JY Douillard, MD, PhD, CMO ESMO The role of Maintenance treatment Appropriate endpoints according to ESMO consensus MAINTENANCE
More informationANTI-EGFR IN MCRC? Assoc. Prof. Gerald Prager, Medical University of Vienna, Austria
IS IT TIME TO RE-CHALLENGE ANTI-EGFR IN MCRC? Assoc. Prof. Gerald Prager, Medical University of Vienna, Austria Dr. Andrea Sartore-Bianchi, Oncologia Clinica Molecolare, Niguarda Cancer Center, Milano,
More informationColon 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 informationCASE STUDIES IN COLORECTAL CANCER: A ROUNDTABLE DISCUSSION
CASE STUDIES IN COLORECTAL CANCER: A ROUNDTABLE DISCUSSION PROVIDED AS AN EDUCATIONAL SERVICE BY THE INSTITUTE FOR CONTINUING HEALTHCARE EDUCATION SUPPORTED BY AN EDUCATIONAL GRANT FROM GENENTECH LEARNING
More informationGI SLIDE DECK. Selected abstracts from: 31 May 4 Jun 2013 Chicago, USA ASCO Annual Meeting. 27 Sep 1 Oct 2013 Amsterdam, Netherlands ESMO-ECCO
GI SLIDE DECK 31 May 4 Jun 2013 Chicago, USA ASCO Annual Meeting 2013 Selected abstracts from: 3 Jul 6 Jul 2013 Barcelona, Spain WCGIC 27 Sep 1 Oct 2013 Amsterdam, Netherlands ESMO-ECCO Supported by Eli
More informationCOME HOME Innovative Oncology Business Solutions, Inc.
COME HOME Rectal Cancer Pathway V8, April 2015 Diagnostic Workup: Bethesda Criteria: Pathology Review All patients H&P All patients Biopsy All patients Colonoscopy All patients CEA All Patients Chest/Abdominal/Pelvic
More informationREVIEW ON THE ESMO CONSENSUS CONFERENCE ON ADVANCED COLORECTAL CANCER
ESMO Preceptorship Programme Colorectal Cancer Barcelona November, 25-26, 2016 REVIEW ON THE ESMO CONSENSUS CONFERENCE ON ADVANCED COLORECTAL CANCER Andrés Cervantes Professor of Medicine Strategic changes
More informationStrategy for the treatment of metastatic CRC through the lines
Strategy for the treatment of metastatic CRC through the lines I Congresso de Oncologia D Or 2013: Satellite Symposium, ROCHE David Cosgrove, MD Johns Hopkins University Disclosures No relevant financial
More informationAshita Waterston Beatson West of Scotland Cancer Centre
Ashita Waterston Beatson West of Scotland Cancer Centre Aim of treatment Scheduling and choice of treatments are dictated by aim: Down staging for resectability: upfront intensive Prolong survival: combination
More informationMÁS ALLA DE LA PRIMERA LÍNEA: SECUENCIA DE TRATAMIENTO. Dra. Ruth Vera Complejo Hospitalario de Navarra
MÁS ALLA DE LA PRIMERA LÍNEA: SECUENCIA DE TRATAMIENTO Dra. Ruth Vera Complejo Hospitalario de Navarra GOALS Prolongation of survival Cure Improving tumour-related symptoms Stopping tumour progression
More informationClinical Spotlight in Metastatic Colorectal Cancer
2015 European Oncology Congress Clinical Spotlight in Metastatic Colorectal Cancer Featured Research: ESMO Consensus on Metastatic CRC 2015 TRIBE: Cremolini C, et al. Lancet Oncol. 2015 Aug 28. [Epub ahead
More informationTargeted Therapies in Metastatic Colorectal Cancer: An Update
Targeted Therapies in Metastatic Colorectal Cancer: An Update ASCO 2007: Targeted Therapies in Metastatic Colorectal Cancer: An Update Bevacizumab is effective in combination with XELOX or FOLFOX-4 Bevacizumab
More informationAdvances in Chemotherapy of Colorectal Cancer
Advances in Chemotherapy of Colorectal Cancer Richard M. Goldberg Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Disease Settings Adjuvant Therapy MOSAIC, FOLFOX Andre
More informationUnderstanding predictive and prognostic markers
Understanding predictive and prognostic markers Professor Aimery de Gramont Chairman of ARCAD Foundation and GERCOR, Paris FRANCE Understanding predictive and prognostic markers Aimery de Gramont Prognostic
More informationE importante t che il chirurgo conosca il profilo molecolare del carcinoma del colon?
E importante t che il chirurgo conosca il profilo molecolare del carcinoma del colon? Giuseppe Aprile Dipartimento di Oncologia Dipartimento di Oncologia Azienda Ospedaliero-Universitaria - Udine Dr. Giuseppe
More information8 Giornata Onco-ematologica Varesina
Azienda Ospedaliera Sant Antonio Abate di Gallarate 8 Giornata Onco-ematologica Varesina Le esperienze di eccellenza del DIPO di Varese Metastasi epatiche da tumore del colon-retto: terapia medica in funzione
More informationMedical Therapy of Colorectal Cancer in the Biomarker Era
Medical Therapy of Colorectal Cancer in the Biomarker Era Axel Grothey Professor of Oncology Mayo Clinic College of Medicine Rochester, Minnesota Disclosures Consulting activities (honoraria went to the
More informationIl paziente anziano con malattia oncologica avanzata: il tumore del colon-retto
Milano 05.10.2018 Il paziente anziano con malattia oncologica avanzata: il tumore del colon-retto Salvatore Corallo U.O.C. Oncologia Medica IRCCS Istituto Nazionale dei Tumori Milano CRC in elderly patients
More informationNeo- and adjuvant treatment for gastric cancer: The role of chemotherapy
Anna Dorothea Wagner, PD & MER Department of Oncology University of Lausanne Neo- and adjuvant treatment for gastric cancer: The role of chemotherapy Structure 1. Background and overview 2. Adjuvant chemotherapy:
More informationNOVITA IN TEMA DI TERAPIA DEL CARCINOMA DEL COLON-RETTO
Congresso AIOM Giovani Perugia, 9 luglio 2016 NOVITA IN TEMA DI TERAPIA DEL CARCINOMA DEL COLON-RETTO Carlotta Antoniotti Polo Oncologico Azienda Ospedaliero-Universitaria Pisana Università di Pisa What
More informationSurgical Management of Advanced Stage Colon Cancer. Nathan Huber, MD 6/11/14
Surgical Management of Advanced Stage Colon Cancer Nathan Huber, MD 6/11/14 Colon Cancer Overview Approximately 50,000 attributable deaths per year Colorectal cancer is the 3 rd most common cause of cancer-related
More informationWhat to do after 1st-line failure in mcrc?
What to do after 1st-line failure in mcrc? Werner Scheithauer Univ.Klinik für Innere Med. I & CCC, Med.Uni.Wien-AKH mcrc front-line treatment strategy today Updated results of head-to-head trials in mcrc,
More informationAnnals of Oncology Advance Access published February 27, 2014
Annals of Oncology Advance Access published February 27, 2014 1 Survival of patients with initially unresectable colorectal liver metastases treated with FOLFOX/cetuximab or FOLFIRI/cetuximab in a multidisciplinary
More informationCOLORECTAL CANCER: STATE OF THE ART
COLORECTAL CANCER: STATE OF THE ART Andrés Cervantes Professor of Medicine DECLARATION OF INTERESTS Consulting and advisory services, speaking or writing engagements, public presentations Merck Serono
More informationAdjuvant/neoadjuvant systemic treatment of colorectal cancer
5th ESO-ESMO Eastern Europe and Balkan Region Masterclass in Medical Oncology Belgrade, June 19 th 2018 Adjuvant/neoadjuvant systemic treatment of colorectal cancer Carlotta Antoniotti Polo Oncologico
More informationclinical practice guidelines
Annals of Oncology 21 (Supplement 5): v93 v97, 2010 doi:10.1093/annonc/mdq222 Advanced colorectal cancer: ESMO Clinical Practice Guidelines for treatment E. Van Cutsem 1, B. Nordlinger 2 & A. Cervantes
More informationXXV Corso Nazionale TSLB: evoluzione o ri(e)voluzione?
XXV Corso Nazionale TSLB: evoluzione o ri(e)voluzione? Marcatori predittivi di efficacia nel carcinoma del colon: DESTRO verso SINISTRO conta? Dott. Matteo Clavarezza S.C. Oncologia Medica RAS metastatic
More information(5-fluorouracil 5-FU) [ ] FOLFOXIRI FOLFOXIRI. [DOI] /j.issn
248 2016 3 1 41 3 FOLFOXIRI 21 [ ] FOLFOXIRI 21 FOLFOXIRI 150mg/m 2 d 1 85mg/m 2 d 1 200mg/m 2 d 1 5-2800mg/m 2 48h 2 1 3 4 42.9%(9/21) 8 (38.1%) 1 (4.8%)3 4.8%(1 ) 4 98.5% 93.4% 5-97.6% 14 (66.7%) 6 (28.6%)
More informationLa strategia terapeutica del carcinoma del colon metastatico
Dalla Capecitabina al TAS-102 Milano, 29 settembre 2016 La strategia terapeutica del carcinoma del colon metastatico Gianluca Masi U.O. di Oncologia Medica Universitaria Azienda Ospedaliero-Universitaria
More informationFighting a Smarter War On Colon Cancer:
Fighting a Smarter War On Colon Cancer: Value as a new endpoint? John L. Marshall, MD Tel: (202) 444-0275 Fax: (202) 444-1229 http://lombardi.georgetown.edu/gi Stakeholder Motivation Stakeholders FDA CMS/Payers
More informationAdjuvant Chemotherapy
State-of-the-art: standard of care for resectable NSCLC Adjuvant Chemotherapy JY DOUILLARD MD PhD Professor of Medical Oncology Integrated Centers of Oncology R Gauducheau University of Nantes France Adjuvant
More informationColorectal Cancer Update Dr. Barb Melosky
Colorectal Cancer Update 2017 Dr. Barb Melosky bmelosky@bccancer.bc.ca Disclosure Research Support/P.I. Honoraria/Advisory Board Bayer Roche, Amgen, Bayer, Lilly Objectives 1) Demonstrate knowledge of
More informationCost-effectiveness of Cetuximab and Panitumumab in First-line Treatment for Patients with KRAS Wild-Type Metastatic Colorectal Cancer in Ontario
Cost-effectiveness of Cetuximab and Panitumumab in First-line Treatment for Patients with KRAS Wild-Type Metastatic Colorectal Cancer in Ontario Emmanuel Ewara, Dr. Greg Zaric, Dr. Stephen Welch, Dr. Sisira
More informationBRAF Testing In The Elderly: Same As in Younger Patients?
EGFR, K-RAS, K BRAF Testing In The Elderly: Same As in Younger Patients? Nadine Jackson McCleary MD MPH Gastrointestinal Oncology Dana-Farber/Harvard Cancer Care Boston, MA, USA Outline Colorectal cancer
More informationRecent advances in treatment of metastatic colorectal cancer
Recent advances in treatment of metastatic colorectal cancer Clin. Invest. (2012) 2(11), 1109 1122 Metastatic colorectal cancer is the second leading cause of cancer-related death in the Western population.
More informationThird Line and Beyond: Management of Refractory Colorectal Cancer
Third Line and Beyond: Management of Refractory Colorectal Cancer George A. Fisher MD PhD Stanford University 1 Overview Defining the chemo refractory and intolerant Agents approved in 3 rd line setting
More information2/20/14& Medical Management of Colon and Rectal Cancer: An Overview. Outline / Learning Objectives. How common is colon cancer?
Medical Management of Colon and Rectal Cancer: An Overview Jonathan Grim, MD, PhD VA Puget Sound Health Care System Fred Hutchinson Cancer Research Center UW Medicine Outline / Learning Objectives Epidemiology
More informationADJUVANT CHEMOTHERAPY...
Colorectal Pathway Board: Non-Surgical Oncology Guidelines October 2015 Organization» Table of Contents ADJUVANT CHEMOTHERAPY... 2 DUKES C/ TNM STAGE 3... 2 DUKES B/ TNM STAGE 2... 3 LOCALLY ADVANCED
More informationTherapeutic Options for Patients with BRAF-mutant Metastatic Colorectal Cancer
Therapeutic Options for Patients with BRAF-mutant Metastatic Colorectal Cancer Axel Grothey, M.D., Professor of Oncology, Clinical and Translational Science Division of Medical Oncology Mayo Clinic, Rochester,
More informationKRAS G13D mutation testing and anti-egfr therapy
KRAS G13D mutation testing and anti-egfr therapy KRAS G13D mutation and anti-egfr therapy Current data do not support a need to specifically identify this mutation for assessing anti-egfr eligibility in
More informationIncorporating biologics in the management of older patients with metastatic colorectal cancer
Incorporating biologics in the management of older patients with metastatic colorectal cancer D Papamichael MB BS MD FRCP Cyprus Oncology Centre GSK Satellite Symposium SIOG APAC Singapore 12-13 July 2014
More informationDALLA CAPECITABINA AL TAS 102
DALLA CAPECITABINA AL TAS 102 Milano 29 settembre 2016 LE PROSPETTIVE NELLA RICERCA Armando Santoro Humanitas Cancer Center THE 1,2.AND 3 LINE CHEMOTHERAPY IN CRC M BEVACIZUMAB AFLIBERCET RAS wt RAS mu
More informationGastric and Colon Cancer. Dr. Andres Wiernik 2017
Gastric and Colon Cancer Dr. Andres Wiernik 2017 GASTRIC CANCER Gastric Cancer Classification Epidemiology General principles of Management 25% GE Junction Gastric Cancer 75% Gastric Cancer Epidemiology
More informationTargeted therapies in colorectal cancer: the dos, don ts, and future directions
Editorial Targeted therapies in colorectal cancer: the dos, don ts, and future directions Marwan Fakih City of Hope Comprehensive Cancer Center, 1500 E Duarte St, Duarte, CA 91010, USA Corresponding to:
More informationKolorektalni karcinom- novosti u liječenju. PANEL: Maja Banjin, Janja Ocvirk, Borislav Belev, Ivan Nikolić, Anes Pašić
Kolorektalni karcinom- novosti u liječenju PANEL: Maja Banjin, Janja Ocvirk, Borislav Belev, Ivan Nikolić, Anes Pašić Kolorektalni karcinomnovosti u liječenju PANEL : Maja Banjin, Janja Ocvirk, Borislav
More informationOriginal article. E. Mitry 1 *, J.-Y. Douillard 2, E. Van Cutsem 3, D. Cunningham 4, E. Magherini 5, D. Mery-Mignard 5, L. Awad 5 & P.
Original article Annals of Oncology 15: 1013 1017, 2004 DOI: 10.1093/annonc/mdh267 Predictive factors of survival in patients with advanced colorectal cancer: an individual data analysis of 602 patients
More informationEvaluation of SIRFLOX Study Results. Prof. V. Heinemann CCC LMU, Klinikum Grosshadern Ludwig-Maximilian-University of Munich, Germany
Evaluation of SIRLX Study Results Prof. V. Heinemann CCC LMU, Klinikum Grosshadern Ludwig-Maximilian-University of Munich, Germany ESM Guideline: Response is a Goal of Treatment Performance Status of the
More informationWhat s New? Dr. Barbara Melosky
Metastatic Colorectal o Carcinoma a What s New? Dr. Barbara Melosky Objectives Review any recent changes regarding treatment t t options for mcrc Discuss the common and expected toxicities of treatment
More informationRAS and BRAF in metastatic colorectal cancer management
Review Article RAS and BRAF in metastatic colorectal cancer management Jun Gong 1, May Cho 1, Marwan Fakih 2 1 Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA; 2 Medical
More informationHow to treat a patient with metastatic CRC? Towards personalized treatment strategies
How to treat a patient with metastatic CRC? Towards personalized treatment strategies Prof Eric Van Cutsem, MD, PhD Digestive Oncology Leuven, Belgium Eric.VanCutsem@uzleuven.be Progress in the treatment
More informationA Brief Overview of Screening and Management of Colorectal Cancer
A Brief Overview of Screening and Management of Colorectal Cancer Gentry King MD Assistant Professor Hematology and Medical Oncology University of Colorado Disclosures Nothing to disclose Objectives Review
More informationWhat to do after 1 st line failure?
ESMO Preceptorship Programme Colorectal Cancer Singapore 20-22 nd 2016 JY Douillard MD PhD ESMO CMO What to do after 1 st line failure? mcrc: How to maximize survival? Improving 1st line therapy efficacy
More informationDisclosure. Nothing to Disclose Will not be discussing off label use of any of the medications
Disclosure Nothing to Disclose Will not be discussing off label use of any of the medications Where s Cranbrook? Follow Up of Colorectal Cancer Stage 0 (in-situ disease) and Stage I (T1-2 N0) Follow up
More informationUniversità degli Studi di Pisa Facoltà di Medicina e Chirurgia Scuola di Specializzazione in Oncologia
Università degli Studi di Pisa Facoltà di Medicina e Chirurgia Scuola di Specializzazione in Oncologia Tesi di Specializzazione EZH2 polymorphisms and outcome of metastatic colorectal cancer patients Candidato:
More informationTreatment of the elderly metastatic colorectal cancer patient: SIOG Recommendations
Treatment of the elderly metastatic colorectal cancer patient: SIOG Recommendations D Papamichael MB BS FRCP On behalf of the SIOG CRC in the Elderly Task Force Madrid 10/11/07 8 th Meeting of the International
More informationAdjuvant Chemotherapy for Rectal Cancer: Are we making progress?
Adjuvant Chemotherapy for Rectal Cancer: Are we making progress? Hagen Kennecke, MD, MHA, FRCPC Division Of Medical Oncology British Columbia Cancer Agency October 25, 2008 Objectives Review milestones
More informationESMO 2015 Consensus on Advanced Colorectal Cancer. Eric Van Cutsem, Andres Cervantes, Dirk Arnold
ESMO 2015 Consensus on Advanced Colorectal Cancer Eric Van Cutsem, Andres Cervantes, Dirk Arnold ESMO Preceptorship Programme Colorectal Cancer Valencia 20 th May 2016 Dirk Arnold, Instituto CUF de Oncologia,
More information