GemCap ny standard for adjuvant behandling pancreas cancer ...
Transcript of GemCap ny standard for adjuvant behandling pancreas cancer ...
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Halfdan Sørbye, prof
Haukeland Univ Sykehus
GemCap ny standard for adjuvant behandling pancreas cancer.
PRRT behandling ved NET veldokumentert og må snarest
etableres i Norge.
Immunterapi ved metastatisk MSI-H kolorektal cancer gir
langtidsoverlevere.
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Slide 7
Presented By John Neoptolemos at 2016 ASCO Annual Meeting
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Survival by Treatment
Presented By John Neoptolemos at 2016 ASCO Annual Meeting
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Treatment Effect by R-Status
Presented By John Neoptolemos at 2016 ASCO Annual Meeting
Er nå ny standard.Innsendt NEJMFormell beslutning fra NGICG gjøres etter publikasjonen.
I mellomtiden……..
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● Kan gi problemer i tolkningen av 2 andre
pågående adjuvante studier:
● Gem/nab-paclitaxel vs gemcitabine alene
(ferdig inkl)
● FOLFOXIRI vs gemcitabine
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Background (2)
Presented By Marcel Verheij at 2016 ASCO Annual Meeting
Behandling ved operable ventrikkel cancer
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Trial design
Presented By Marcel Verheij at 2016 ASCO Annual Meeting
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Results: Study Profile
Presented By Marcel Verheij at 2016 ASCO Annual Meeting
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Results: Overall Survival
Presented By Marcel Verheij at 2016 ASCO Annual Meeting
Ingen hensikt å bytte til postopr
kjemoradioterapi
Adjuvante studier: behandling gis pre-
operativt
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Nevroendocrine tumores (NET)
Nordiske 2014
Guidelines:
Metastaser fra
NET i tynntarm.
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SA Chelator Radioisotope+ + =
SSR
NET cell
90Y-DOTATOC
177Lu-DOTATOC
Peptid Reseptor Radionukleotide Therapy = PRRT
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Slide 4
Presented By Jonathan Strosberg at 2016 ASCO Annual Meeting
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Progression-Free Survival
Presented By Jonathan Strosberg at 2016 ASCO Annual Meeting
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Overall Survival (interim analysis)
Presented By Jonathan Strosberg at 2016 ASCO Annual Meeting
MVi MÅ nå få denne behandling etablert i Norge.
Per i dag mye for pengene: 32 m for 350 000kr
50 pasienter sendes årlig til 200 behandlinger i utlandet (for
få..)
OUS søkt HSØ - tidligst 2018 + midler overføres fra
utenlandsbudsjettet
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Slide 4
Presented By Dung Le at 2016 ASCO Annual Meeting
5%
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Slide 6
Presented By Dung Le at 2016 ASCO Annual Meeting
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Slide 14
Presented By Dung Le at 2016 ASCO Annual Meeting
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Slide 13
Presented By Dung Le at 2016 ASCO Annual Meeting
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Slide 17
Presented By Dung Le at 2016 ASCO Annual Meeting
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Slide 18
Presented By Dung Le at 2016 ASCO Annual Meeting
Hva sier vi til våre pasienter ??
Teste for MSI før oppstart 1-
linje sammen med RAS/BRAF
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HER2 testing ved mCRC?
● 5% HER2 amplifisert ved mCRC
● 2 studie kohorter viser HER2 amplikasjon
negative prediktiv markør for effekt av
EGFR-hemmer behandling (like mye som
RAS mutasjon).
● Relevant for 1 av 8 pasienter som får
EGFR-hemmer i dag……
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Nivolumab ± Ipilimumab in Treatment of Patients With Metastatic Colorectal Cancer With and Without High Microsatellite Instability: <br />CheckMate 142 Interim Results
Presented By Michael Overman at 2016 ASCO Annual Meeting
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Slide 8
Presented By Neil Segal at 2016 ASCO Annual Meeting
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Investigator-Assessed Best Overall Response in <br />Patients With MSI-H Receiving Nivolumab + Ipilimumab
Presented By Michael Overman at 2016 ASCO Annual Meeting
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Clinical activity and safety of cobimetinib and atezolizumab in colorectal cancer
Presented By Johanna Bendell at 2016 ASCO Annual Meeting
MSS
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PD-L1 and MEK Inhibition: A Rational Combination
Presented By Johanna Bendell at 2016 ASCO Annual Meeting
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Slide 17
Presented By Neil Segal at 2016 ASCO Annual Meeting
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Medikamentell behandling ved metastatisk colorektalcancer
Palliativ intensjon
1. linje
3. linje
2. linje
FOLFIRI
(FLIRI)
+ EGFR-hemmer
FLIRI/
FOLFIRI
Flv/Capecitabine/
S-1 (Nordic9)
±bevacizumab
FOLFIRI
(FLIRI) +
bevacizumab
FLIRI
FOLFIRIFLOX/CAPOX
FOLFOX
FLIRI
FLOX/CAPOX
Irinotecan
Cetuximab/panitumumab ± irinotecan
FLOX/CAPOX
FOLFOXFOLFOX (FLOX/CAPOX)
± bevacizumab
FOLFOXIRI±bev
mut BRAF
WT-RAS
WT-RAS
Intensified treatmentSequencial treatment
(elderly/fragile)
Studie:
BRAF +
MEK
hemmer
3/4 .linje Regorafenib
Studie?MSI-H
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FIRE-3: Sidedness is prognostic…
Presented By Kimmie Ng at 2016 ASCO Annual Meeting
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CALGB/SWOG 80405
Presented By Alan Venook at 2016 ASCO Annual Meeting
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Venook et al: Major findings
Presented By Kimmie Ng at 2016 ASCO Annual Meeting
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Overall Survival by Sidedness and Biologic
Presented By Alan Venook at 2016 ASCO Annual Meeting
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Lee et al: Major findings
Presented By Kimmie Ng at 2016 ASCO Annual Meeting
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Should EGFR antibodies be withheld in the first-line setting from patients with right-sided primaries?
Presented By Kimmie Ng at 2016 ASCO Annual Meeting
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Slide 4
Presented By Jeanne Tie at 2016 ASCO Annual Meeting
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Circulating Tumor DNA (ctDNA)
Presented By Jeanne Tie at 2016 ASCO Annual Meeting
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The Potential of Circulating Tumor DNA (ctDNA) to Reshape The Design of Clinical Trials Testing Adjuvant Therapy in Patients with Early Stage Cancers
Presented By Jeanne Tie at 2016 ASCO Annual Meeting
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● Methods: 231 pts with Stage II colon cancer
● Plasma samples collected starting 4-10
weeks after surgery.
● Somatic mutations in pts' tumors were
identified via sequencing, then designed
personalized assays to quantify ctDNA in
plasma samples.
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Recurrence-Free Survival<br />(Patients not treated with chemotherapy)
Presented By Jeanne Tie at 2016 ASCO Annual Meeting
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Slide 11
Presented By Jeanne Tie at 2016 ASCO Annual Meeting
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Slide 15
Presented By Jeanne Tie at 2016 ASCO Annual Meeting