14 Conclusiones: De Sidney a Denver

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Autor/a Dra. Josefa Terrasa
V Jornada de Revisión del Congreso Mundial de Cáncer de Pulmón.
ARCO MEDITERRANEO. Valencia 8-Nov-2013

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14 Conclusiones: De Sidney a Denver

  1. 1. Conclusiones: de Sydney a Denver Sefa Terrasa Pons Oncología Médica Hospital Universitario Son Espases Palma de Mallorca
  2. 2. Conclusiones • Las aportadas por cada uno de los ponentes en cada uno de los temas. De Sydney a Denver • Del 2013 al 2015, futuro a corto plazo • Presidente del IASLC del 2013 al 2015: Toni Mok
  3. 3. Crizotinib vs Chemotherapy in ALK + NSCLC Probability of survival without progression (%) 100 Crizotinib (n=173) (n=174) 100 (58) 127 (73) 7.7 Events, n (%) 80 Chemotherapy 3.0 Median, mo 0.49 (0.37 to 0.64) HR (95% CI) <0.0001 P 60 40 20 0 0 5 10 15 20 25 2 1 0 0 Time (months) No. at risk Crizotinib Chemotherapy 173 174 93 49 38 15 11 4 Shaw et al., NEJM 2012
  4. 4. Estrategia global: • Aunar esfuerzos de todos los profesionales implicados ( investigadores básicos, clínicos, estadistas, informáticos…), de la industria farmacéutica, de las instituciones, delas asociaciones (IASLC) …
  5. 5. Magnitude of Genomic Derangement is greatest in Lung Cancer n=109 81 64 38 316 100 17 82 28 119 Mutations Per Mb DNA 40 Carcinogeninduced Cancers 100 / Mb Ovarian, Breast, Prostate Cancers 1 / Mb 0.1 / Mb ?? From The Cancer Genome Atlas Project: Govindan R. J Clin Oncol. 2012 (Proc ASCO Annual Meeting);30 (suppl): abstr 7006. Squamous Hematologic & Childhood Cancers Adenoca 10 / Mb 21 20
  6. 6. Drugable targets in smokers and never smokers Govindan et al, 2012 Cell 150: 1121
  7. 7. Low Frequency Drivers: Challenges • A separate trial for each drug or genotype population ? • How relevant is prior treatment with chemo?  Chemonaive vs pretreated • Do we always need a chemo (or placebo) comparator?  Which threshold of activity (RR, PFS) make this unnecessary • Are historical comparisons approppiate ?  Prospective phase II-III trials
  8. 8. MASTER PROTOCOL (FOCR): Squamous Lung Cancer- 2nd Line Therapy CT* Biomarker Profiling (NGS/CLIA) Biomarker Non-Match NonMatch Drug Multiple Phase II- III Arms with “rolling Opening & Closure Biomarker A TT A CT* Endpoint (Interim PFS) OS Biomarker Β TT B CT* Endpoint (Interim PFS) OS Biomarker C TT C+CT CT* Endpoint (Interim PFS) OS Biomarker D TT D+E E* Endpoint (Interim PFS) OS TT=Targeted therapy, CT=chemotherapy (docetaxel or gemcitabine), E=erlotinib PI: V. Papadimitrakopoulou (SWOG)
  9. 9. De Sydney a Denver • • • • • ¿Podremos retrasar o prevenir la resistencia a las terapias dirigidas? Nuevas dianas tratables: ROS 1, KRAS,BRAF, HER2,PIK3CA, MET Posibles dianas en ca. Escamoso: FGFR1, PIK3CA Que papel tendrá la inmunoterapia ¿Combinaciones de tratamientos diana con inmunoterapia?
  10. 10. Gracias josefa.terrasa@ssib.es

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