What s New? Dr. Barbara Melosky
|
|
- Joshua McCormick
- 5 years ago
- Views:
Transcription
1 Metastatic Colorectal o Carcinoma a What s New? Dr. Barbara Melosky
2 Objectives Review any recent changes regarding treatment t t options for mcrc Discuss the common and expected toxicities of treatment Discuss new targeted therapies that will be seen in the clinic in the future
3 Conflict of Interest I have received honorariums from Roche Sanofi-Aventis Amgen
4 Metastatic Colorectal Cancer Completely Unresectable Resectable Potentially Resectable
5 mcrc Resectable 15% Unresectable 85% Preoperative Therapy Resectable First-Line 2-3 months 15-30% Chemotherapy 2-3 months Hepatectomy (One-stage or Two-stage) ± PVE* CONVERSION Second-Line Chemotherapy Postoperative Therapy 3-4 months Third-Line Chemotherapy Kopetz S and Vauthey JN Lancet 2008
6 Metastatic Colorectal Cancer Completely Unresectable
7 mcrc Resectable 15% Unresectable 85% Preoperative Therapy Resectable First-Line 2-3 months 15-30% Chemotherapy 2-3 months Hepatectomy (One-stage or Two-stage) ± PVE* CONVERSION Second-Line Chemotherapy Postoperative Therapy 3-4 months Third-Line Chemotherapy Kopetz S and Vauthey JN Lancet 2008
8 Lines of Therapy Today First Line FOLFIRI + Bevacizumab FOLFOX + Bevacizumab Optimox or Drug Holidays Capecitabine Second Line FOLFOX or FOLFIRI No Bevacizumab is allowed Third Line Kras WT: Panitumumab or Cetuximab
9 Treatment Options in mcrc Monotherapy RR 15-30% MS months Combination therapy RR 30-50% MS months Sequential therapy incorporating different combination therapy and single agents MS months
10 5FU the Drug of Choice for over 30 Years! Nature, March 30, 1957
11 First Line FOLFOX or FOLFIRI?
12
13
14
15
16 Why the bevacizumab?
17 VEGF Angiogenesis
18
19 IFL and Avastin: OS HR=0.66 (95% CI: ) 1.0 p< Estimated probabil lity IFL + Avastin IFL + placebo Months ITT population Hurwitz et al. NEJM 2004
20
21 Safety of bevacizumab
22 Bevacizumab Safety profile Most common Hypertension, proteinuria, fatigue, Most Serious GI perforation, bleeding, ATE Special Interest Wound-healing, epistaxis, VTE, fistula
23 Overview of grade 3 adverse events of special interest in randomised trials in mcrc AVF2107g E NO Patients (% %) Hurwitz NEJM 2004; 2. Giantonio JCO 2007; 3. Saltz JCO 2008
24 Treatment to Progression?
25 Optimox 1
26 OPTIMOX Continous vs Stop and Go FOLFOX OPTIMOX 600+ patients FOLFOX x6 cycles 5FU/LV x 12 cycles FOLFOX Andre T et al. Proc ASCO. 2003;23 (abstr 1016).
27 OPTIMOX R 620 pts FOLFOX 6x FOLFOX- 12x slv5fu2-6x FOLFOX (%) Continuous Stop and Go RR PFS DDC OS G3/4 NTox Primary endpoint Tournigand et al, JCO 2006
28 OPTIMOX 1: neurotoxicity 25 Grade 3 neurotoxicity Continous Stop and Go Cycles Tournigand et al, JCO 2006
29 Acute Neuropathy Hg 2+ + TTX oxaliplatin EXTRA Membrane Na + INTRA ATP ATP oxalate Ca 2+ Dach-Pt
30 Acute Neuropathy Transient Cold-triggered paresthesia/dysesthesia Frequent (85-95%) Not dose-limiting Treatment: Prolong the infusion
31 Oxaliplatin Neurotoxicity
32 Chronic Neuropathy Cumulative dose Frequency of grade 3: 15-20% Dose-limiting toxicity of Oxaliplatin Treatment: Dose reduction
33 What about prevention of the neuropathy? The Calcium and Magnesium Story
34 Concept
35
36
37
38 However. Independent Radiological Review e
39
40
41 Elderly/ PS poor Single Agent Capecitabine
42 Fluoropyrimidines in Metastatic Disease Median survival: ~ 12 months Infusional 5FU better than bolus Capecitabine oral 5FU Regimen Response, % Bolus 5-FU 7-15 Infusional 5-FU FU/LV Mayo, Roswell schedules de Gramont (LV5-FU2) AIO (once weekly, 24-hour infusion) M R ll h d l Capecitabine 20-25
43 Enzymatic activation of Xeloda Intestine Liver Xeloda Xeloda CE Tumour 5 -DFCR CyD 5 -DFCR CyD 5 -DFUR 5 -DFCR = 5 -deoxy-5-fluorocytidine; 5 -DFUR = 5 -deoxy-5-5 -DFCR = 5 -deoxy-5-fluorocytidine; 5 -DFUR = 5 -deoxy-5- fluorouridine; CyD = cytidine deaminase; CE = carboxylesterase 5 -DFUR Thymidine phosphorylase (TP) 5-FU
44 Xeloda: Phase III-results in metastatic CRC Pooled Data Arms: no. % RR TTP/m Med. Surv/ m Xeloda: * FU/LV:
45
46
47
48 Second Line? What ever you didn t use first line
49 Concept of All-3-Drugs 11 Phase III Trials, 5768 Patients (mo) Me edian OS First-Line Therapy Infusional 5-FU/LV + irinotecan Infusional 5-FU/LV + oxaliplatin Bolus 5-FU/LV + ii irinotecan Irinotecan + oxaliplatin Bolus 5-FU/LV LV5FU FOLFOXIRI Patients with 3 drugs (%) CAIRO 2007 Grothey & Sargent, JCO 2005
50 What s New? Continuous Inhibition of VEGF
51 ASCO 2012 TML Study Bevacizumab beyond progression R A Standard N second-line D chemotherapy Standard O M first-line Progression I chemotherapy S + bevacizumab A Standard T second-line I chemotherapy O N + bevacizumab First-line (n=820) Primary endpoint = OS Second-line
52 OS 1.0 CT (n=410) BEV + CT (n=409) OS estima ate HR: 0.81 (95% CI: ) p= (log-rank test) mo 11.2 mo Time (months)
53 Aflibercept Aflibercept Blocks all human VEGF-A isoforms, VEGF-B and placental growth factor (PlGF)²
54 VELOUR mcrc Previously Treated FOLFOX +/- Bevacizumab R A N D O M I Z E Aflibercept 4 mg/kg IV, day 1 + FOLFIRI q2 weeks Placebo IV, day 1 + FOLFIRI q2 weeks Tabernero et al. Eur J Cancer. 2011;47(2): Abstract 6LBA
55 Overall Survival, ITT Population Tabernero et al. Eur J Cancer. 2011;47(2): Abstract 6LBA
56 Overall Survival Placebo/ FOLFIRI Median (mos) N = 614 Aflibercept/FOLFIRI Median (mos) N = 612 P-value for interaction All Patients All Patients Prior BEV No Yes Tabernero et al. Eur J Cancer. 2011;47(2): Abstract 6LBA
57 Third LIne Kras Wild Type: EGFR Inhibitors Kras Mutation: Clinical Trial
58 mcrc EGFR (Epidermal Growth Factor Receptor) Cell Membrane TK P TK P STATs PI3 kinase Ras/Raf Akt P PTEN MAPK/ERK Angiogenesis Apoptosis Proliferation Invasion & metastasis
59 Panitumumab Cetuximab EGFR (Epidermal Growth Factor Receptor) Cell Membrane TK P TK P STATs PI3 kinase Ras/Raf Akt P PTEN MAPK/ERK Angiogenesis Apoptosis Proliferation Invasion & metastasis
60 Panitumumab Cetuximab EGFR (Epidermal Growth Factor Receptor) Cell Membrane TK P TK P STATs PI3 kinase Ras/Raf Akt P PTEN MAPK/ERK Angiogenesis Apoptosis Proliferation Invasion & metastasis
61 Nomenclature No mutation in Kras= Wild type Kras= Treatment with EGFR MOA
62
63
64 NCIC CTG CO.17 Failed all recommended therapies R E G I S T E R R A N D O M I Z E Cetuximab* + BSC BSC alone Disease Progression or Unacceptable Toxicity
65 NCIC CTG C0.17: Overall survival in K-Ras Wild-Type patients 1 Study arm MS (months) 95% CI roportion Aliv ve P Cetuximab + BSC BSC alone HR % CI (0.41,0.74) Stratified Log rank p-value: < Cetuximab BSC Time from Randomisation (Months) Cetuximab BSC
66
67
68 Mild Grade 1 may not need treatment Topical clindamycin 2%, with hydrocortisone 1% in lotion base applied twice daily
69 Moderate Minocycline 100 mg bid for 4 weeks Topical clindamycin 2% with hydrocortisone 1% in lotion base bid Scalp lesions: Clindamycin 2%, Triamcinolone acetonide 0.1% in equal parts of propylene glycol and water
70 Grade 3 Stop drug therapy for 1 week and restart at lower dose Minocycline 100 mg bid for 4 weeks Topical clindamycin 2% with hydrocortisone 1% in lotion base bid Scalp lesions: Clindamycin 2%, Triamcinolone acetonide 0.1% in equal parts of propylene glycol and water
71 What about Preventing the Rash? Prophylactic Minocycline
72
73 Patient Assignments: Treatment Arm and Randomization 2 nd nd LINE TREATMENT FOLFIRI Q2W + IRINOTECAN Q3W + PANITUMUMAB THERAPY* PANITUMUMAB THERAPY n = 48 n = 47 RANDOMIZATION PRE-EMPTIVE EMPTIVE SKIN TREATMENT REACTIVE SKIN TREATMENT Doxycycline 100 mg BID
74
75 STEPP Subsets: Summary of Efficacy By Central Review ITT WT KRAS Mutant KRAS Pre-emptive Reactive Pre-emptive Reactive Pre-emptive Reactive n ORR (%) Median PFS (months) Do Not Copy or Distribute Amgen Canada 2008
76 Overall Survival for Panitumumab Patients by Grade of Skin Toxicity it
77 Overall Survival by Worst Grade of Rash NCIC CTG CO Grade HR 95%CI p-value 2+ vs (0.22, 0.50) < ive Prop portion Al vs (0.40, 0.93) vs (0.41, 0.72) < Grade n Median Survival mo mo mo Survival (months) Grade 0 Grade 1 Grade 2+ Jonker DJ et al. N Engl J Med 2007;357:
78 What is new? Regorafinib
79 Mode of action of regorafenib (BAY ) Regorafenib inhibits multiple cell-signaling kinases: Angiogenic VEGFR1 3, TIE2 Stromal PDGFR-β, FGFR Oncogenic KIT, PDGFR, RET T 1/2 in man: approx hrs Two major metabolites (M2, M5) are pharmacologically active Wilhelm SM et al. Int J Cancer 2011
80 CORRECT mcrc after standard therapy R A N D O M I Z AT T I O N Z AT 2 : 1 Regorafenib + BSC 160 mg orally once daily 3 weeks on, 1 week off Placebo + BSC 3 weeks on, 1 week off Primary Endpoint: OS
81 Overall response and disease control rates Best response, % Regorafenib N=505 Placebo N=255 Complete response 0 0 Partial response Stable disease Progressive disease Disease control rate,,%* *DCR = PR + SD; p<
82 Progression-free survival Su urvival dis stribution fu unction Regorafenib Placebo Median 1.9 mos 1.7 mos 95% CI Hazard ratio: 0.49 (95% CI: ) 1-sided p-value: < Placebo N=255 Regorafenib N= Days from randomization
83 Overall survival Survival distributio on function n Placebo N=255 Regorafenib N=505 Regorafenib Placebo Median 6.4 mos 5.0 mos 95% CI Hazard ratio: 0.77 (95% CI: ) 1-sided p-value: Days from randomization
84 O 2012
85 Lines of Therapy Today (Yesterday) First Line FOLFIRI + Bevacizumab FOLFOX + Bevacizumab Optimox or Drug Holidays Capecitabine Second Line FOLFOX or FOLFIRI No Bevacizumab is allowed Third Line Kras WT: Panitumumab or Cetuximab
86 Lines of Therapy Tomorrow First Line FOLFIRI + Bevacizumab FOLFOX + Bevacizumab Optimox or Drug Holidays Capecitabine Second Line FOLFOX or FOLFIRI + Bevacizumab is allowed + Aflibercept (with FOLFIRI) Third Line Kras WT: Panitumumab or Cetuximab End of Line Regorafinib
87 Each month, the Canadian Oncology Societies es produces live, interactive e educational webinars aimed at oncology professionals. Programs are archived on the COS website ca Your input and suggestions would be welcome. For information: info@cos.ca or
88 Thank you
Does 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 informationConflicts of Interest GI Malignancies: An Update on Current Treatment Options
Conflicts of Interest GI Malignancies: An Update on Current Treatment Options Nothing to disclose Trevor McKibbin, PharmD, MS, BCOP Clinical Specialist, Hematology/Oncology Winship Cancer Institute of
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 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 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 informationAntiangiogenic therapy in GI cancer: current status and future directions
Riccardo Giampieri, MD, PhD Università Politecnica delle Marche Ospedali Riuniti diancona Antiangiogenic therapy in GI cancer: current status and future directions Before starting Summary - Antiangiogenesis
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 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 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 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 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 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 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 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 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 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 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 informationNuevos Agentes en el Manejo de Cáncer Colorectal: Dónde Incorporalos?
Nuevos Agentes en el Manejo de Cáncer Colorectal: Dónde Incorporalos? Prof. Dr. Paulo M. Hoff Instituto do Câncer do Estado de São Paulo - ICESP Faculdade de Medicina Universidade de São Paulo (USP) Conflicts
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 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 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 informationTargeted and Chemotherapeutic Approaches to Management of Metastatic Colorectal Cancer. Nicole M. Ross, MSN, CRNP, AOCNP Fox Chase Cancer Center
Targeted and Chemotherapeutic Approaches to Management of Metastatic Colorectal Cancer Nicole M. Ross, MSN, CRNP, AOCNP Fox Chase Cancer Center Learning Objectives Critically evaluate current clinical
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 informationMetastatic Colorectal Cancer. Update 2015
Metastatic Colorectal Cancer Update 2015 A/Prof Jeremy Shapiro GI Medical Oncologist Cabrini Hospital, Melbourne 1 Not all pts with metastatic CRC are equal 1 st consideration can patient be cured by resection
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 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 information1 st LINE ANTI-VEGF TREATMENT OF METASTATIC COLORECTAL CANCER (CRC)
1 st LINE ANTI-VEGF TREATMENT OF METASTATIC COLORECTAL CANCER (CRC) Role of the VEGF Pathway in Oncogenesis The Role of Angiogenesis in Cancer Somatic mutation Small avascular tumor Tumor secretion of
More informationPanitumumab: The KRAS Story. Chrissie Fletcher, MSc. BSc. CStat. CSci. Director Biostatistics, Amgen Ltd
Panitumumab: The KRAS Story Chrissie Fletcher, MSc. BSc. CStat. CSci. Director Biostatistics, Amgen Ltd Clinical Background: panitumumab in mcrc Panitumumab is a fully human IgG2 monoclonal antibody directed
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 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 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 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 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 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 informationBevacizumab is currently licensed for the following indication relevant for this NICE review:
Roche Executive Summary Context Bevacizumab (Avastin) is a humanized (93% human) murine monoclonal antibody which binds to and neutralizes VEGF, a powerful pro-angiogenic glycoprotein produced by both
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 informationTargeting EGFR in Advanced Colorectal Cancer. Eric - Chen, MD, PhD
Targeting EGFR in Advanced Colorectal Cancer Eric - Chen, MD, PhD Outline Review of clinical data Kras and beyond Management of common side effects Alternative dosing regimens Treatment of 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 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 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 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 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 informationRECONSIDERING THE BENEFIT OF INTERMITTENT VERSUS CONTINUOUS TREATMENT IN THE MAINTENANCE TREATMENT SETTING OF METASTATIC COLORECTAL CANCER
RECONSIDERING THE BENEFIT OF INTERMITTENT VERSUS CONTINUOUS TREATMENT IN THE MAINTENANCE TREATMENT SETTING OF METASTATIC COLORECTAL CANCER SUNAKAWA, Y, 1 BEKAIISAAB, T, 2 AND STINTZING, S. 3 SELECTED HIGHLIGHTS
More informationChemotherapy options and outcomes in older adult patients with colorectal cancer
Critical Reviews in Oncology/Hematology 72 (2009) 155 169 Chemotherapy options and outcomes in older adult patients with colorectal cancer Muhammad W. Saif a,, Stuart M. Lichtman b a Yale University School
More informationADVANCES IN COLON CANCER
ADVANCES IN COLON CANCER Peter T. Silberstein, M.D., FACP Professor, Creighton University Chief Hematology/Oncology UNIVERSAL SCREENING FOR LYNCH SYNDROME OF ALL PATIENTS WITH COLON CANCER ADOPTED BY CHI
More informationOptimizing Sequencing Beyond Disease Progression After Second-Line Therapy in Metastatic Colorectal Cancer
Optimizing Sequencing Beyond Disease Progression After Second-Line Therapy in Metastatic Colorectal Cancer Kabir Mody, MD, and Tanios Bekaii-Saab, MD Abstract Colorectal cancer (CRC) remains a significant
More informationChemotherapy of colon cancers
Chemotherapy of colon cancers Stage distribution Stage I : 15% T 1,2 NO Stage IV: 20 25% M+ Stage II : 20 30% T3,4 NO Stage III N+: 30 40% clinical stages I, II, or III colon cancer are at risk for having
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 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 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 informationJonathan Dickinson, LCL Xeloda
Xeloda A blockbuster in the making Jonathan Dickinson, LCL Xeloda Xeloda unique tumor-activated mechanism Delivering more cancer-killing agent straight into cancer Highly effective comparable efficacy
More informationTHE ROLE OF PREDICTIVE AND PROGNOSTIC MARKERS IN COLORECTAL CANCER
THE ROLE OF PREDICTIVE AND PROGNOSTIC MARKERS IN COLORECTAL CANCER Cathy Eng, M.D., F.A.C.P. Associate Professor Associate Medical Director, Colorectal Center Dept of GI Medical Oncology November 5, 2010
More information2 nd line Therapy and Beyond NSCLC. Alan Sandler, M.D. Oregon Health & Science University
2 nd line Therapy and Beyond NSCLC Alan Sandler, M.D. Oregon Health & Science University Treatment options for advanced or metastatic (stage IIIb/IV) NSCLC Suitable for chemotherapy Diagnosis Unsuitable/unwilling
More informationAntiangiogenic Agents in NSCLC Where are we? Which biomarkers? VEGF Is the Only Angiogenic Factor Present Throughout the Tumor Life Cycle
Antiangiogenic Agents in NSCLC Where are we? Which biomarkers? Martin Reck Department e t of Thoracic c Oncology ogy Hospital Grosshansdorf Germany VEGF Is the Only Angiogenic Factor Present Throughout
More 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 informationEVIDENCE IN BRIEF OVERALL CLINICAL BENEFIT
of the clinical trial data for this outcome. Therefore, perc considered that the cost-effectiveness of cetuximab plus FOLFIRI would be at the higher end of the EGP s range of best estimates. Therefore,
More informationAdvances in the Management of Colorectal Cancer
Advances in the Management of Colorectal Cancer Dr Ashraf Wadee Medical Oncologist Charlotte Maxeke Johannesburg Academic Hospital and Wits Donald Gordon Medical Colorectal Cancer: Background 3 rd most
More informationMetastatic Colorectal Cancer : The role of Personalised Medicine, Biomarkers and Early tumour shrinkage. Dr Lee-Ann Jones
Metastatic Colorectal Cancer : The role of Personalised Medicine, Biomarkers and Early tumour shrinkage Dr Lee-Ann Jones Aim Metastatic Colorectal Cancer: Past: 5FU, oxaliplatin, irinotecan..blanket treatment
More informationNew Options in Metastatic Colorectal Cancer. Jeffrey A. Bubis, DO, FACOI, FACP Fleming Island Baptist South Palatka
New Options in Metastatic Colorectal Cancer Jeffrey A. Bubis, DO, FACOI, FACP Fleming Island Baptist South Palatka 4 th most frequently diagnosed CA in the US 2 nd leading cause of CA death in the US Incidence
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 informationDisclosures. Clinical and molecular features to guide adjuvant therapy. Personalized Medicine - Decision Tools -
Disclosures Clinical and molecular features to guide adjuvant therapy Daniel Sargent Professor of Biostatistics & Oncology Mayo Clinic Consulting activities Amgen Pfizer Roche/Genentech Sanofi-Aventis
More informationVectibix. Vectibix (panitumumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.21.85 Subject: Vectibix Page: 1 of 5 Last Review Date: December 2, 2016 Vectibix Description Vectibix
More informationOVERALL CLINICAL BENEFIT
cetuximab plus FOLFIRI to convert unresectable liver metastatses to resectable, perc confirmed that neither the FIRE-3 study nor the CRYSTAL study were designed to assess resectability and, in the absence
More informationThe following slides are provided as presented by the author during the live educa7onal ac7vity and are intended for reference purposes only.
The following slides are provided as presented by the author during the live educa7onal ac7vity and are intended for reference purposes only. If you have any ques7ons, please contact Imedex via email at:
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 informationCetuximab plus 5-FU/FA/oxaliplatin (FOLFOX-4) in the first-line treatment of metastatic colorectal cancer: a large-scale Phase II study (OPUS)
Cetuximab plus 5-FU/FA/oxaliplatin (FOLFOX-4) in the first-line treatment of metastatic colorectal cancer: a large-scale Phase II study (OPUS) C Bokemeyer, E Staroslawska, A Makhson, I Bondarenko, JT Hartmann,
More informationDisclosures. Colorectal Cancer Update GAFP November Risk Assessment. Colon and Rectal Cancer The Challenge. Issues in Colon and Rectal Cancer
Disclosures Colorectal Cancer Update GAFP November 2006 Robert C. Hermann, MD Georgia Center for Oncology Research and Education Northwest Georgia Oncology Centers, PC WellStar Health System Marietta,
More information/m 2 Oxaliplatin 85 1 Q2W 1-3 Leucovorin Q2W 5-FU Q2W 5-FU Q2W
癌症診療指引33 Adjuvant therapy of colon cancer mfolfox6 Oxaliplatin 85 1 Q2W 1-3 FOLFOX4 Oxaliplatin 85 1 Q2W 9 Leucovorin 200 1-2 Q2W 5-FU 400 1-2 Q2W 5-FU 600 1-2 Q2W FLOX Oxaliplatin 85 1,15,29 Q8W 4 Leucovorin
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 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 informationAdjuvant therapies for large bowel cancer Wasantha Rathnayake, MD
LEADING ARTICLE Adjuvant therapies for large bowel cancer Wasantha Rathnayake, MD Consultant Clinical Oncologist, National Cancer Institute, Maharagama, Sri Lanka. Key words: Large bowel; Cancer; Adjuvant
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 informationWhere Are Anti-Angiogenic Agents Positioned Within Cancer Care Guidelines?
Introduction Additionally, other anti-angiogenic drugs, including sorafenib, sunitinib, axitinib, pazopanib, vandetanib, The development and subsequent use of drugs for treating cancer cabozantinib, and
More informationColorectal Cancer Therapy and Associated Toxicity
Colorectal Cancer Therapy and Associated Toxicity Mountain States Cancer Conference November 6, 2010 Colin D. Weekes, M.D., Ph.D Assistant Professor University of Colorado GI Cancers Are Common 2009 Estimated
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 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 informationtrial update clinical
clinical trial update by John W. Mucenski, BS, PharmD, Director of Pharmacy Operations, UMPC Cancer Centers In order to provide the most up-to-date and efficacious care to their patients, oncologists must
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 informationOncologist. The. Gastrointestinal Cancer
The Oncologist Gastrointestinal Cancer The Clinical Benefit of Bevacizumab in Metastatic Colorectal Cancer Is Independent of K-ras Mutation Status: Analysis of a Phase III Study of Bevacizumab with Chemotherapy
More informationTobias Engel Ayer Botrel 1,2*, Luciana Gontijo de Oliveira Clark 1, Luciano Paladini 1 and Otávio Augusto C. Clark 1
Botrel et al. BMC Cancer (2016) 16:677 DOI 10.1186/s12885-016-2734-y RESEARCH ARTICLE Open Access Efficacy and safety of bevacizumab plus chemotherapy compared to chemotherapy alone in previously untreated
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 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 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 informationTraitement de 2ème ligne du cancer colorectal métastatique : nouvelles données cliniques en 2018
GR DIG 2017 Traitement de 2ème ligne du cancer colorectal métastatique : nouvelles données cliniques en 2018 9 décembre 2017 Benoist Chibaudel Oncologie Médicale Institut Hospitalier Franco-Britannique,
More informationManagement of Advanced Colorectal Cancer in Older Patients
Review Article [1] April 15, 2005 By Stuart M. Lichtman, MD, FACP [2] Many elderly individuals have substantial life expectancy, even in the setting of significant illness. There is evidence to indicate
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 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 information療指引 34 Adjuvant Therapy of Colon Cancer
療指引 34 Adjuvant Therapy of Colon Cancer mfolfox6 Oxaliplatin 85 1 Q2W 1~3, 10 FLOX Oxaliplatin 85 1,15,29 Q8W 4 Leucovorin 500 1,8,15,22,29,35 Q8W 5-FU 500 1,8,15,22,29,35 Q8W Capecitabine Capecitabine
More informationOpinion 17 October 2012
The legally binding text is the original French version TRANSPARENCY COMMITTEE Opinion 17 October 2012 VECTIBIX 20 mg/ml, concentrate for solution for infusion B/1 vial of 5 ml (CIP code: 3400957181857)
More informationManagement of Patients with Colorectal Cancer
Management of Patients with Colorectal Cancer Elsevier Office of Continuing Medical Education Independent Conference Highlights of the ASCO-GI 2018 Symposium Disclaimer The views expressed in the following
More informationTumors in the Randomized German AIO study KRK-0306
FOLFIRI plus Cetuximab versus FOLFIRI plus Bevacizumab as First- Line Treatment for Patients with Metastatic Colorectal Cancer (mcrc): Analysis of Patients with KRAS-Mutated Tumors in the Randomized German
More informationTherapy for Metastatic Colorectal Cancer
Therapy for Metastatic Colorectal Cancer Richard M. Goldberg Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Learning Objectives Key
More informationMEET ROY*: A PATIENT WITH LIVER-LIMITED mcrc
MEET ROY*: A PATIENT WITH LIVER-LIMITED mcrc * A hypothetical case study of a patient eligible for first-line mcrc therapy. mcrc = metastatic colorectal cancer. WHAT CLINICAL CHARACTERISTICS AFFECT YOUR
More informationReview Article Advances of Targeted Therapy in Treatment of Unresectable Metastatic Colorectal Cancer
BioMed Research International Volume 2016, Article ID 7590245, 14 pages http://dx.doi.org/10.1155/2016/7590245 Review Article Advances of Targeted Therapy in Treatment of Unresectable Metastatic Colorectal
More informationPanel Two: Evidence for Use of Maintenance Therapy
Panel Two: Evidence for Use of Maintenance Therapy Evidence for Use of Maintenance Therapy Richard L. Schilsky University of Chicago Comprehensive Cancer Center What is maintenance therapy? The continued
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 informationThe treatment of metastatic colorectal cancer in 2007
The treatment of metastatic colorectal cancer in 2007 Prof Eric Van Cutsem, MD, PhD Gastrointestinal Oncology Unit University Hospital Gasthuisberg Leuven - Belgium CRC is a major health concern Life-time
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 informationCHEMOTHERAPY FOR COLON CANCER OUTLINE OF TODAY S TALK. Colon Cancer Epidemiology 11/6/2012 GATRA/GCCR FALL CONFERENCE NOVEMBER 14 16, 2012
CHEMOTHERAPY FOR COLON CANCER JONATHAN C. BENDER,MD MEDICAL DIRECTOR OF PIEDMONT FAYETTE CANCER CENTER OUTLINE OF TODAY S TALK 1. Overview of Colon Cancer in the US 2. Colon Cancer staging and risks of
More information