Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Caris Centers of Excellence Virtual Molecular Tumor Board - June 29, 2015

4,498 views

Published on

Slide deck from Caris Life Sciences' Virtual Molecular Tumor Board hosted by the COE Network.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Caris Centers of Excellence Virtual Molecular Tumor Board - June 29, 2015

  1. 1. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Patient 1
  2. 2. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Clinical History • male, early 50's, metastatic CRC • 2 years ago, presented with near obstructing sigmoid cancer, large volume liver mets, increased LFTs • KRAS/extended RAS WT from SC node biopsy • Treated with XELOX + Bev- strong PR • Cardiac event- changed to bolus 5FU/bev maintenance • PD 12 months ago- changed to IRI + Panitumumab– PR, rash • CEA increased- increased bowel symptoms- • CT showed only PD in colon primary- partial obstruction • Surgical resection of primary • KRAS mutation on CARIS profile • PD while off chemo during surgery, retreated with IRI + Panitumumab, responding again
  3. 3. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile Test One: at diagnosis
  4. 4. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile Test One: at diagnosis pan-RAS testing: QNS, thus no cetuximab treatment association
  5. 5. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Relevant Stains • specimen 1 (2014) specimen 2 (2015)
  6. 6. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile Test Two: 2 months later
  7. 7. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile Test Two: 2 months later
  8. 8. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile Test Two: 2 months later
  9. 9. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Molecular Tumor Summary • KRAS • previous LN KRAS WT • First Caris specimen QNS • Repeat Caris test: K-RAS exon2 G12V mutation • BRCA1 and BRCA2 VUS • Not clinically actionable • Predicted beneficial cytotoxics: • 5-FU / Capecitabine • Irinotecan • Taxanes
  10. 10. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Discussion Points •KRAS mutated primary, mets WT •What next? •BRCA mutations?
  11. 11. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Patient 2
  12. 12. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Treatment Summary • male, early 50's, met CRC – Refractory to Oxali, irinotecan • KRAS mut • Enrolled on regorafanib trial – Biopsy at baseline and on treatment for biomarker discovery – Currently responding
  13. 13. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris report • QNS – Discuss tissue sample needs for analysis and trials
  14. 14. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile Initial testing at diagnosis
  15. 15. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile Repeat testing
  16. 16. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Relevant Stains • first specimen (2014) second specimen (2015)
  17. 17. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Relevant Stains • 2014: TOPO1 2+/15%, patchy 2015: TOPO1 2+/100% limited sample size and bias
  18. 18. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Molecular Tumor Summary • Initial testing: • KRAS mutation G12D, exon 2 • PD-1 positive IHC, PD-L1 negative • APC mutation S1362fs • CMET mutation T1010I • Subsequent testing (IHC only): • TOPO1 positive / irinotecan beneficial • TS positive / 5-FU & Cape non-beneficial
  19. 19. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Patient 3
  20. 20. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Clinical History • female, early 40's, previously healthy • Developed fatigue and iron deficiency • Back pain • CT abdomen revealed: – Acending colon lesion 3.6 cm – Liver radiodensities up to 3.2 x 2.6cm
  21. 21. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Pathology • Metastatic colorectal adenocarcinoma • KRAS codon 12 mutation in exon 2 detected
  22. 22. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Clinical Course • Started on XELOX + Bevacizumab • Required dose reduction in Xeloda and Oxaliplatin due to severe fatigue • Achieved stable disease • Followed by maintenance Xeloda + Bevacizumab • Developed abdominal pain 5 months after initial diagnosis • CT revealed free air, suspicious for perforation • CEA elevation to 369 • Resumed XELOX • Developed oxaliplatin allergy • Changed to Xeloda single agent • Non-obstructive hyperbilirubinemia (direct bili. 6.5) • No irinotecan
  23. 23. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile
  24. 24. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris IHC Findings
  25. 25. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Relevant Stains • H & E MSH2
  26. 26. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Relevant Stains • TOPO1 TS
  27. 27. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Relevant Stains • PD-1 PD-L1
  28. 28. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile
  29. 29. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Tumor Profile Summary • KRAS exon 2 mutation G13D (no anti-EGFR) • cMET mutation T1010I (clinical trial options) • PD-1 expression (clinical trial options) • Low TS expression (capecitabine benefit) • TOPO1 overexpression (irinotecan benefit) • MSI-normal, normal MLH1/MSH2
  30. 30. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Patient 4
  31. 31. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Clinical History • Demographics: male, mid-30's Relevant medical history: • Non-corrected undescended testes • Initial diagnosis – RP mass – Mixed germ cell tumor • Recurrent disease- at 6 months, one year, four years, seven years, and nine years • Most recent recurrence- HTN, decreased renal function due to renal artery compression by tumor. Renal artery stent with improvement in kidney function • Symptoms / physical findings: – abdominal pain, weight loss, HTN
  32. 32. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Prior Treatment Initial diagnosis: PEB X 4 followed by incomplete resection of retroperitoneal disease At 6 months: TIP X 2 followed by triple tandem PSCT At 1 year: Resection of residual mass-teratoma At 4 years: Recurrent abdominal disease resected/ nephrectomy- teratoma At 7 years: Mass in pancreas resected, splenectomy- GCT At 9 years: Recurrent intra abdominal disease- GCT EP X 4 followed by resection followed by EP X2
  33. 33. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Radiology • Most recent recurrence: • CT scan abdomen – increased nodularity in the mesentery, • PET scan – 2 areas of increased uptake retroperitoneum • Renal artery compression by tumor
  34. 34. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Pathology • Initial diagnosis: RP mass- embryonal, choriocarcinoma, yolk sac, mature teratoma • At one year: Teratoma • At four years: Teratoma • At 7 years: Embryonal, yolk sac, teratoma • At 9 years: Metastatic carcinoma c/w GCT showing features of embryonal carcinoma
  35. 35. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile
  36. 36. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Caris Molecular Intelligence Profile
  37. 37. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Relevant Stains • H&E: Yolk sac component EGFR (L718R 97%): 1+/70% total EGFR expression (IHC)
  38. 38. The information contained in these slides is provided for educational purposes only and has been permanently de-identified Molecular Tumor Summary • Standard first-line BEP treatment has no established biomarker specific for germ cell tumor lineage • Second-line therapies with biomarkers include taxanes and gemcitabine • Molecular profiling favors taxanes over gemcitabine • Off-label considerations of potential benefit include anthracyclines and temozolomide

×