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.
Halfdan Sørbye, prof
Haukeland Univ Sykehus
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
Er nå ny standard.
Innsendt NEJM
Formell beslutning fra NGICG gjøres etter publikasjonen.
I mellomtiden……..
Presented By John Neoptolemos at 2016 ASCO Annual Meeting
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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
Behandling ved operable ventrikkel cancer
Background (2)
Presented By Marcel Verheij at 2016 ASCO Annual Meeting
Trial design
Presented By Marcel Verheij at 2016 ASCO Annual Meeting
Results: Study Profile
Presented By Marcel Verheij at 2016 ASCO Annual Meeting
Ingen hensikt å bytte til postopr
kjemoradioterapi
Results: Overall Survival
Adjuvante studier: behandling gis preoperativt
Presented By Marcel Verheij at 2016 ASCO Annual Meeting
Nevroendocrine tumores (NET)
Nordiske 2014
Guidelines:
Metastaser fra
NET i tynntarm.
Peptid Reseptor Radionukleotide Therapy = PRRT
SA + Chelator + Radioisotope =
90Y-DOTATOC
177Lu-DOTATOC
SSR
NET cell
Slide 4
Presented By Jonathan Strosberg at 2016 ASCO Annual Meeting
Progression-Free Survival
Presented By Jonathan Strosberg at 2016 ASCO Annual Meeting
MVi MÅ nå få denne behandling etablert i Norge.
Overall Survival (interim analysis)
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
Presented By Jonathan Strosberg at 2016 ASCO Annual Meeting
Slide 4
5%
Presented By Dung Le at 2016 ASCO Annual Meeting
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
Hva sier vi til våre pasienter ??
Teste for MSI før oppstart 1linje sammen med RAS/BRAF
Presented By Dung Le at 2016 ASCO Annual Meeting
HER2 testing ved mCRC?
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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
MSS
Clinical activity and safety of cobimetinib and atezolizumab in colorectal cancer
Presented By Johanna Bendell at 2016 ASCO Annual Meeting
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
Studie:
BRAF +
MEK
hemmer
1. linje
2. linje
mut BRAF
FOLFOXIRI±bev
FOLFIRI
(FLIRI)
+ EGFR-hemmer
FLIRI
FOLFIRI
FOLFOX (FLOX/CAPOX)
± bevacizumab
FOLFIRI
(FLIRI) +
bevacizumab
FLOX/CAPOX
FOLFOX
Regorafenib
Studie?
Sequencial treatment
(elderly/fragile)
FLOX/CAPOX
FOLFOX
Flv/Capecitabine/
S-1 (Nordic9)
±bevacizumab
FLIRI
FLOX/CAPOX
Irinotecan
FLIRI/
FOLFIRI
Cetuximab/panitumumab ± irinotecan
3. linje
3/4 .linje
Intensified treatment
WT-RAS
MSI-H
Palliativ intensjon
WT-RAS
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
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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.
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