Introducción. Enric Carcereny ICO Badalona-Hospital Germans Trias i Pujol
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1 Introducción Enric Carcereny ICO Badalona-Hospital Germans Trias i Pujol
2
![0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11[Internet].](/docs-images/96/126831537/images/3-4.jpg "Lyon, France: International Agency for Research on Cancer; 2013.")
3 Introducción Cáncer de pulmón: la neoplasia más frecuente y la principal causa de muerte relacionada con el cáncer. GLOBOCAN 2012 ( mundial, ambos sexos) millones 1 de nuevos casos a nivel mundial 1.59 millones 1 (1 de cada 5) muertes estimadas en el mundo Mueren más personas de cáncer de pulmón que de mama, colon y próstata juntos 1 En Europa, ~1,000 personas mueren de cáncer de pulmón cada día 1,2 1. Ferlay J, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11[Internet]. Lyon, France: International Agency for Research on Cancer; Available from: Accessed September 2014; 2. Ferlay J, et al. Eur J Cancer. 2013;49:
4 Biomarcadores pronósticos Evolución de la clasificación del cáncer de pulmon M Reck, DF Heigener, T Mok, JC Soria, KF Rabe, 2013
5 Biomarcadores pronósticos PD-L1>1% 66% PD-L1 >50% 28% Aggarwal C; Rodríguez Abreu D. Abstract 2989; Ann Oncol-2016
6 Estadíos iniciales y enfermedad localmente avanzada LACE (Lung Adjuvant Cisplatin Evaluation) Pignon JCO 08
7 Estadíos iniciales y enfermedad localmente avanzada PACIFIC TRIAL Paz-Ares et al ESMO 2017
8 Estadíos iniciales y enfermedad localmente avanzada PACIFIC TRIAL PROGRESION FREE SURVIVAL Paz-Ares et al ESMO 2017
9 Estadíos iniciales y enfermedad localmente avanzada PACIFIC TRIAL Time to distant metastasis or death Paz-Ares et al ESMO 2017
10 Enfermedad avanzada Evolución de los factores para la elección del tratamiento en pacientes con CPNM avanzado Evidence From Literature Evidence From Literature Molecular Factors Physician Experience Patient Preference Empiric Approach to the Selection of Therapy for NSCLC 1 Physician Experience Histologic Factors Integrated Approach to the Selection of Therapy for NSCLC 1 Patient Preference Individual Patient Characteristics (Age, PS, Sex, Smoking Status) Clinical Factors Individual Patient Characteristics (Age, PS, Sex, Smoking Status) 1. Gandara DR, et al. Clin Lung Cancer. 2009;10:
11 Enfermedad avanzada Bhramer J el al ACCR 2017
12 Enfermedad avanzada NSCLC: OS improvements 2015 Pembrolizumab: PD-L Nivolumab: NSQ Pretreated Median OS, months ~ Docetaxel 2004 Pemetrexed: NSQ 2004 Erlotinib ~ Nintedanib + docetaxel: NSQ a 2014 Ramucirumab + docetaxel 2015 Nivolumab: SQ ~ ~12+ 1 st -line 1994 Vinorelbine ~ Platinum-based doublet ~8 10 Median OS, months 2008 Pemetrexed + chemotherapy: NSQ a 2006 Bevacizumab + chemotherapy: NSQ 2001 Docetaxel + chemotherapy ~ Nab-paclitaxel + chemotherapy ~12+ Median OS >20 months with targeted therapies for patients with EGFR mutations or ALK translocation a Adenocarcinoma only. ALK=anaplastic lymphoma kinase; EGFR=epidermal growth factor receptor; NSCLC=non-small cell lung cancer; NSQ=non-squamous; OS=overall survival; SQ=squamous. Stinchcombe TE, F1000Prime Rep. 2014;6:117; Giotrif US Prescribing Information; Alimta US Prescribing Information; Avastin US Prescribing Information; Taxotere US Prescribing Information; Tarveva US Prescribing Information; Socinski MA, et al. J Clin Oncol. 2012;30: ; Opdivo US Prescribing Information; Cyramza US Prescribing Information; Vargatef SmPC; Paz-Ares L, et al. Presented at ASCO 2015, Abstract LBA109; Schiller J, et al. New Engl J Med. 2002;346:92 98.
13 Enfermedad avanzada Keynote 024, Pembrolizumab in PD-L1 positive patients PFS 10.3 vs 6m HR months OS 80% vs 72.4% HR 0.6 Reck M, et al. NEJM 2016
14 Enfermedad avanzada Knowledge of non-small cell lung adenocarcinoma has evolved in recent decades Ashley J. Vargas, Nature Reviews 2016
15 Enfermedad avanzada New EGFR inhibitors.
16 Enfermedad avanzada AURA 3 Mok et al. NEJM 2016
17 Enfermedad avanzada FLAURA trial Primary Endpoint: PROGRESSION FREE SURVIVAL Ramalingam et al. ESMO 2017
18 Enfermedad avanzada FLAURA trial Secondary Endpoint: OVERALL SURVIVAL
19 Enfermedad avanzada
![survival [2] : <5% Most patients relapse within a year of starting treatment, even if responsive to therapy [2,3] 5-year survival [2] : 10](/docs-images/96/126831537/images/20-4.jpg "13% Year 4 Year 5 5-year survival [2] : 1-2% Low overall survival Untreated, SCLC is rapidly fatal within 2-3 months of diagnosis [3] *Rates")
20 Disease Burden and unmet needs of SCLC LD-SCLC: Cáncer de pulmón no microcítico y otros tumores ED-SCLC: 10% brain metastasis at diagnose Diagnosis ~30% [1] ~70% [1] Most patients diagnosed at highly aggressive stage [1] 2-year survival [2] : 20 40% Year 1 Year 2 Year 3 2-year survival [2] : <5% Most patients relapse within a year of starting treatment, even if responsive to therapy [2,3] 5-year survival [2] : 10 13% Year 4 Year 5 5-year survival [2] : 1-2% Low overall survival Untreated, SCLC is rapidly fatal within 2-3 months of diagnosis [3] *Rates in the US
21 Cáncer de pulmón no microcítico y otros tumores Systemic treatments in first line ED/LD Cisplatin/Carboplatin-Based Regimens EC is recommended by NCCN and ESMO as first-line therapy in pts with ED/LD, and has been found to be comparable to EP [1,2] EP [3] EC [3] Number, n mos 9.64 mo 9.41 mo 1-yr OS 36.2% 35.0% mpfs 5.46 mo 5.33 mo ORR 67.1% 66.0% 1. NCCN Guidelines. SCLC. V ; 2. Früh M et al. Ann Oncol. 2013;3. Rossi A et al. J Clin Oncol. 2012
22
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