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Advances in Diagnosis & Imaging
of Cancer- Impacting Treatment
Dr.Harsha Doddihal
Associate Medical Director-Quintiles,
Clinical Oncologist-My Health World,Indiranagar
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?
Management Of Cancer
Treatment, Diagnosis

CANCER

Surgery

PATHOLOGY &
IMAGING

Radiotherapy

Chemotherapy

Personalized/Molec
ular/Targeted
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
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
Advances In Diagnosis
Tumor definition by PET

Vander wel et al. Int J Radiat
Oncol Biol Phys. 2005; 61: 649-55.
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)
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
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
Cancer genomics: from discovery science to
personalized medicine Nature
Medicine 17, 297–303 (2011)
Targeted Therapy Definition
 Drugs targeted at pathways, processes and physiology

which are uniquely disrupted in cancer cells:
 Receptors
 Genes
 Angiogenesis
 Tumor pH
Hormonal Therapy-Breast Cancer

Anastrozole,
Letrozole
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
Bevacizumab
HER 2

http://www.gene.com/media/product-information/kadcyla-moa
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
Thank you
Questions???
Dr.Harsha Doddihal,

Curate’s Egg!

Associate Medical Director, Quintiles,
Consultant Oncologist- My Health World,
Indiranagar

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