Panaroma da Medicina e Oncologia. Stephen Stefani, MD

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1 Panaroma da Medicina e Oncologia Stephen Stefani, MD

3 Cancer é um problema global 1 em 6 mortes é decorrente de câncer Cancer é a segunda causa de morte Re responsável por 8.8 milhões de mortes por ano World Health Organisation. Cancer Fact Sheet. Updated February

4 Incidência América Latina: Europa: EUA: Mortalidade América Latina: Europa: EUA: 163 casos para cada pessoas 264 casos para cada pessoas 300 casos para cada pessoas 13 mortes para cada 22 casos de câncer 13 mortes para cada 30 casos de câncer 13 mortes para cada 37 casos de câncer Stephen Stefani

6 Monthly and Median Costs of Cancer Drugs at the Time of FDA Approval Monthly Cost of Treatment (2014 Dollars, log scale) $ $10000 $1000 $100 $10 $ Year of FDA Approval Individual Drugs Median Monthly Price (per 5 year period) Source: Peter B. Bach, MD, Memorial Sloan-Kettering Cancer Center

8 Can Society Afford State-of-the-Art Cancer Treatment? Neal J. Meropol, Susan Desmond-Hellmann, Sean Tunis, Kevin A. Schulman

10 Stephen Stefani

11 BMJ 2004;329: (24 July), doi: /bmj

332 HISTORY Further responses to Nature s editorial on statues p.

12 PRASHANTH VISHWANATHAN/ BLOOMBERG/ GETTY Cenário merece reflexão! TECHNOLOGY How flexible electronics are set to merge with our bodies p.328 COMMENT PHYSICS A thrilling guide up the steep slopes of physics p.331 FICTION Happy 130th to Sherlock Holmes, science enthusiast p.332 HISTORY Further responses to Nature s editorial on statues p estudos clínicos em câncer de I Look beyond technology in cancer care A patient awaiting treatment for cancer in an Indian hospital. Treating cancer with the latest drugs and techniques is costly and w ill not improve survival globally, warn Richard Sullivan, C. S. Pramesh and Christopher M. Booth. n Nigeria, Malaysia, India and many other low- and middle-income countries, it is common to see hundreds of people queueing in the street to see a cancer doctor. It s also common in those regions to see people with curable cancer having chemotherapy, but not radiotherapy or surgery. In fact, 90% of people in low-income countries lack access to basic radiotherapy. In wealthy countries, the push to develop new drugs, surgery and radiation techniques to treat cancer is at best unsustainable. Of 277 cancer-drug therapies for which clinical trials were published in , only 15% identified treatments that led to meaningful improvements in patient survival or quality of life 1. Indeed, studies reveal that the more expensive the drug, the less clinical benefit it seems to give 2 (see A world of difference, panel a). In middle- and low-income countries the technology-centric approach to cancer threatens to do more harm than good. For the past 15 years, we have worked as clinical researchers in some 40 countries and conducted more than a dozen studies on national cancer-control planning. Our experiences along with epidemiological and other data collected over 20 years indicate that the countries that rate relatively poorly on measures of cancer survival and mortality do so largely because of deficits at the political, economic and social level. To improve the survival and well-being of the roughly 16 million people who have cancer worldwide, researchers, physicians, policymakers and patient organizations must focus on education, stigma, training and staffing to ensure that the right care Somente 15% dos estudos mostraram ganhos que levaram pacientes a viver mais e melhor! 2 1 S E P T E M B E R V O L N A T U R E 3 2 5

13 Stephen Stefani

14 I-O (IMUNO-ONCOLOGIA)

15 I-O (IMUNO-ONCOLOGIA) I-O + Chemotherapy I-O + Radiotherapy I-O + targeted therapies Ipilimumab + etoposide/platinum (SCLC) Ipilimumab + paclitaxel/carboplatin (lung cancer and melanoma) Ipilimumab + fotemustine (melanoma) Ipilimumab + temozolomide (melanoma) Nivolumab + chemotherapy (NSCLC) IMP321 (LAG-3) + paclitaxel (breast cancer) Pembrolizumab + paclitaxel or carboplatin (NSCLC) Ipilimumab + radiotherapy (melanoma, NHL, colon, rectal) Poxviral vaccine + radiotherapy (prostate cancer) LC9018 (vaccine) + radiotherapy (carcinoma of the uterine cervix) Adoptive dendritic cell immunotherapy + radiotherapy (heptoma) CpG + radiotherapy (B-cell lymphoma) Sipuleucel-T + radiation therapy (CRPC) accessed 26 March 2014;; Formennti et al, J Natl Cancer Inst 2013; 105(4): 256; Ferrara et al, Curr Opin Mol Ther 2009; 11: 37 Ipilimumab + trametinib + dabrafenib (melanoma) Ipilimumab + rituximab (B-cell lymphoma) Ipilimumab then vemurafenib (melanoma) Ipilimumab + dasatinib (GIST) Ipilimumab + bevacizumab (melanoma) Nivolumab + everolimus (RCC) Nivolumab + erlotinib (NSCLC) Nivolumab + Ipilimumab or bevacizumab (NSCLC) Nivolumab + sunitinib, or pazopanib (RCC) Pidilizumab + rituximab (follicular lymphoma) Urelumab + rituximab (B-cell NHL or CLL) Pembrolizumab + bevacizumab or pemetrexed or ipilimumab or erlotinib or gefitinib (NSCLC) Tremelimumab plus MEDI4763 (advanced solid tumors) MPDL3280A + avastin (RCC) 15

17 Big Data The Transformation of Cancer Care through Health Information Technology

19 Resources From Cost to Value in Cancer Care

20 Cancer Panomics Precision Medicine Realized

21 MEDICINA DE PRECISÃO Sem benefício + Toxicidade Pacientes com O mesmo diagnóstico + Benefício + Toxicidade Sem Benefiício Sem Toxicidade + Benefício Sem Toxicidade

29 /StephenStefani

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION SUPPLEMENTARY NFORMATON n format provided by Melero et al. (AUGUST 2015) Supplementary nformation S3 Combinations including two or more immunotherapy agents based on PD-1/PD-L1 blockade. (Source: https://clinicaltrials.gov/