GemCap ny standard for adjuvant behandling pancreas cancer

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.

Slide 7

Presented By John Neoptolemos at 2016 ASCO Annual Meeting

Survival by Treatment

Presented By John Neoptolemos at 2016 ASCO Annual Meeting

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……..

● Kan gi problemer i tolkningen av 2 andre

pågående adjuvante studier:

● Gem/nab-paclitaxel vs gemcitabine alene

(ferdig inkl)

● FOLFOXIRI vs gemcitabine

Background (2)

Presented By Marcel Verheij at 2016 ASCO Annual Meeting

Behandling ved operable ventrikkel cancer

Trial design

Presented By Marcel Verheij at 2016 ASCO Annual Meeting

Results: Study Profile

Presented By Marcel Verheij at 2016 ASCO Annual Meeting

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

Nevroendocrine tumores (NET)

Nordiske 2014

Guidelines:

Metastaser fra

NET i tynntarm.

SA Chelator Radioisotope+ + =

SSR

NET cell

90Y-DOTATOC

177Lu-DOTATOC

Peptid Reseptor Radionukleotide Therapy = PRRT

Slide 4

Presented By Jonathan Strosberg at 2016 ASCO Annual Meeting

Progression-Free Survival

Presented By Jonathan Strosberg at 2016 ASCO Annual Meeting

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

Slide 4

Presented By Dung Le at 2016 ASCO Annual Meeting

5%

Slide 6

Presented By Dung Le at 2016 ASCO Annual Meeting

Slide 14

Presented By Dung Le at 2016 ASCO Annual Meeting

Slide 13

Presented By Dung Le at 2016 ASCO Annual Meeting

Slide 17

Presented By Dung Le at 2016 ASCO Annual Meeting

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

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……

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

Slide 8

Presented By Neil Segal at 2016 ASCO Annual Meeting

Investigator-Assessed Best Overall Response in <br />Patients With MSI-H Receiving Nivolumab + Ipilimumab

Presented By Michael Overman at 2016 ASCO Annual Meeting

Clinical activity and safety of cobimetinib and atezolizumab in colorectal cancer

Presented By Johanna Bendell at 2016 ASCO Annual Meeting

MSS

PD-L1 and MEK Inhibition: A Rational Combination

Presented By Johanna Bendell at 2016 ASCO Annual Meeting

Slide 17

Presented By Neil Segal at 2016 ASCO Annual Meeting

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

FIRE-3: Sidedness is prognostic…

Presented By Kimmie Ng at 2016 ASCO Annual Meeting

CALGB/SWOG 80405

Presented By Alan Venook at 2016 ASCO Annual Meeting

Venook et al: Major findings

Presented By Kimmie Ng at 2016 ASCO Annual Meeting

Overall Survival by Sidedness and Biologic

Presented By Alan Venook at 2016 ASCO Annual Meeting

Lee et al: Major findings

Presented By Kimmie Ng at 2016 ASCO Annual Meeting

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

Slide 4

Presented By Jeanne Tie at 2016 ASCO Annual Meeting

Circulating Tumor DNA (ctDNA)

Presented By Jeanne Tie at 2016 ASCO Annual Meeting

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

● 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.

Recurrence-Free Survival<br />(Patients not treated with chemotherapy)

Presented By Jeanne Tie at 2016 ASCO Annual Meeting

Slide 11

Presented By Jeanne Tie at 2016 ASCO Annual Meeting

Slide 15

Presented By Jeanne Tie at 2016 ASCO Annual Meeting