Advances in Diagnosis & Imaging Impacting Cancer Treatment


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"Personalized Medicine" is making its way into health care. Oncology is a prime example. This is helped by advancements in imaging and molecular pathology. PET-CT, cancer pathways define how a cancer patient will be treated. Drugs approved by FDA last year gives a glimpse into the progress happening.

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Advances in Diagnosis & Imaging Impacting Cancer Treatment

  1. 1. Advances in Diagnosis & Imaging of Cancer- Impacting Treatment Dr.Harsha Doddihal Associate Medical Director-Quintiles, Clinical Oncologist-My Health World,Indiranagar
  2. 2. Learning Objectives  Treatment pillars of cancer  Basics  Advances in diagnosis  Shifting paradigm  New molecules approved and their rationale •How does chemotherapy act? Name a tumor suppressor gene? •When is surgery alone sufficient? •What are the pathways mutated in a cancer cell? •Knowing that it is a Non Small Cell Lung Cancer adenocarcinoma sufficient? •When is PET scan useful? •How is new drug development and approval being shaped by molecular advancements?
  3. 3. Management Of Cancer Treatment, Diagnosis CANCER Surgery PATHOLOGY & IMAGING Radiotherapy Chemotherapy Personalized/Molec ular/Targeted
  4. 4. Cancer-MalignancyNeoplasm Resisting Cell Death Sustaining Proliferative Signaling Evading growth suppressors Activating Invasion and metastasis Enabling replicative immortality Inducing Angiogenesis Hallmarks of Cancer-D Hanahan 2011
  5. 5. Shifting Paradigm-Pathology  Cytology        FNAC Incisional Biopsy Excisional Biospy Trucut Biposy Surgical Specimen Frozen Sample Paraffin Block CTC, CDNA Exception: Brain and Bone HPR IHC FISH Oncotype DX 70, 21 Gene Assay EGFR & ALK CD 20 Kras BCR-ABL, Philadelphia Chromosome ER/PgR HER 2 BRAF PSA CA125 CA19 9 AFP βHCG
  6. 6. Advances In Diagnosis
  7. 7. Tumor definition by PET Vander wel et al. Int J Radiat Oncol Biol Phys. 2005; 61: 649-55.
  8. 8. Response to Hormonal Therapy Post-Rx Pre-Rx Example 1 • Recurrent sternal lesion • ER+ primary • Recurrent Dz strongly FES+ Example 2 FES FDG FDG • Newly Dx’d met breast CA • ER+ primary • FES-negative bone mets University of Washington (Linden, J Clin Onc, 2006)
  9. 9. Key advances in the history of cancer chemotherapy. DeVita V T , and Chu E Cancer Res 2008;68:8643-8653 ©2008 by American Association for Cancer Research
  10. 10. Key advances in the history of cancer chemotherapy. DeVita V T , and Chu E Cancer Res 2008;68:8643-8653 ©2008 by American Association for Cancer Research
  11. 11. Cancer genomics: from discovery science to personalized medicine Nature Medicine 17, 297–303 (2011)
  12. 12. Targeted Therapy Definition  Drugs targeted at pathways, processes and physiology which are uniquely disrupted in cancer cells:  Receptors  Genes  Angiogenesis  Tumor pH
  13. 13. Hormonal Therapy-Breast Cancer Anastrozole, Letrozole
  14. 14. CML Mechanism of action of imatinib Bcr-Abl P P P Bcr-Abl Substrate Substrate Y ATP Imatinib P Y= Tyrosine P= Phosphat e Nilotinib Dasatinib Ponatinib
  15. 15. Bevacizumab
  16. 16. HER 2
  17. 17. Molecule Compan y Target Indication Other Indication s Gazyva (obinutuzumab) Genentec h CD 20 Untreated CLL Gilotrif (afatinib) BI ErbB1, ErbB2, ErbB4 mNSCLC Imbruvica (ibrutinib) Pharmacy Bruton’s tyrosine clics kinase BTK Mantle cell Lymphoma Kadcyla (adotrastuzumab emtansine) Genentec h Her-2 MBC Mekinist (trametinib) GSK MEK 1 & 2 M Melanoma BRAF V600E/K Pomalyst (pomalidomide) Celgene Immunomodulatory RRMM Revlimid (lenalidomide) Celgene Immunomodulatory Mantle Cell MM, MDS Stivarga (regorafenib) Bayer VEGF, Multikinase Inhibitor Advanced GIST mCRC, AMD Tafinlar (dabrafenib) GSK BRAF kinases M Melanoma
  18. 18. Thank you Questions??? Dr.Harsha Doddihal, Curate’s Egg! Associate Medical Director, Quintiles, Consultant Oncologist- My Health World, Indiranagar