SlideShare a Scribd company logo
CETUXIMAB IN LA
SCCHN:
HOW FAR WE GO?
MOHAMED ABDULLA M.D.
PROF. OF CLINICAL ONCOLOGY
NEMROCK
CAIRO UNIVERSITY
NEMROCK – 08/02/2015
LASCCHN: The Outcome:
Surgery
Radiation
Therapy
Key
Components
 L.R.
 Distant
Metastases
Systemic
Therapy
83%
59%
36%
0%
50%
100%
Localized Regional Metastatic
5-yearSurvival
SEER. Stat fact sheets: oral cavity and pharynx cancer. 2003-2009.
MACH-NC: 2009 Update:
93 Trials – 17346 Patients:
J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
MACH-NC: 2009 Update:
93 Trials – 17346 Patients:
J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
MACH-NC: 2009 Update:
93 Trials – 17346 Patients:
J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
MACH-NC: 2009 Update:
93 Trials – 17346 Patients:
J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
MACH-NC: 2009 Update:
93 Trials – 17346 Patients:
J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
MACH-NC: 2009 Update:
93 Trials – 17346 Patients:
J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
CISPLATIN 100 mg/m2 (D1+22+43) +
RTH
Impact of low adherence to treatment of CT on
efficacy
LA HNSCC: Theme of
Management:
 RTH  No impact.
 CRT  The most accepted standard, < 70 years.
 Cisplatin: 100 mg/m2 D1+22+43.
 IC  NPX Ca. & Organ Preservation Trial, TPF.
 Sequential:
 Healthy (PS 0 – 1).
 Young.
 N2-3 (Tany).
 T4 not destroying the organ.
 Physician – Patient preference.
www.uptodate.com 09/12/2014
J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
Can we go better?
PI3-K
STAT
AKT
Grb2
SOS RAS
RAF1
MEK
MPA
K
Gene Transcription & Cell Cycle
Progression
1. Angiogenesis
2. Survival
3. Proliferation
4. Progression
Molecular Key Players:
Carter P. Nat Rev. Cancer 2001.
Heinemann V et al. Cancer Treat Rev. 2009.
NK
CELLS
Erbitux + RT
Erbitux initial dose (400 mg/m2)
Erbitux (250 mg/m2) + RT (wks 2–8)Stage III and IV
non-metastatic
SCCHN
RT
Bonner JA, et al. N Engl J Med 2006;354:567–578
Curran D, et al. J Clin Oncol 2007;25:2191–2197
R
Primary endpoint: Duration of locoregional control
Secondary endpoints: OS, PFS, RR, QoL, and safety
Bonner Phase III study: Study
Design:
N=424
Bonner JA, et al. N Engl J Med 2006;354:567–578
Months
Locoregionalcontrol(%)
100
80
60
40
20
0
0 10 20 30 40 50 60
14.9 months
24.4 months
HR=0.68 [95% CI: 0.52–0.89]
p=0.005
3-year control rate
47%
34%
RT
Erbitux + RT
Bonner Phase III study: Local
Control:
Bonner JA, et al. Lancet Oncol 2010;11:21–28
HR=0.73 [95% CI: 0.56–0.95]
p=0.018
0 10 20 30 40 50 60 70
Overallsurvival(%)
5-year survival rate
36%
Months
46%
36%
49.0 months
29.3 months
RT
Erbitux + RT100
80
60
40
20
0
10
30
50
70
90
Bonner Phase III study: 5-Year
Survival:
Bonner et al. Lancet Oncol 2010; 11:21-28
Time (months)
Probabilityofsurvival(%)
1.00
0.80
0.60
0.40
0.20
0
0 10 20 30 40 50 60 70
0.10
0.30
0.50
0.70
0.90
Prominent rash group (n=127): Grade 2–4
Mild rash group (n=81): Grade 0/1
51% reduction in the
risk of death (p=0.002)
>68.8
months
p=0.002, HR=0.49 (0.34–0.72)
25.6
months
Cetuximab in LA SCCHN:
Bonner Phase III study: 5-Year Survival & Severity
of Rash:
Cetuximab in LA SCCHN:
Change of QoL Over Time:
Curran et al. J Clin Oncol 2007; 25:2191-2197
Globalhealthstatus/QoLscore
100
80
60
40
20
0
Visit
RT
RT + Erbitux
Baseline Week 4 Month 4 Month 8 Month 12
QoL assessment of Bonner study
QoL: Post-baseline scores for the EORTC QLQ-C30
*
Listed for its relationship to Erbitux
Bonner JA, et al. N Engl J Med 2006;354:567–578
p<0.001
p=0.01
Patients (%)
0 10 20 30 40 50 60
Mucositis
Dysphagia
Radiation dermatitis
Xerostomia
Fatigue/malaise
Acne-like rash
*Infusion reactions
RT (n=212)
Erbitux + RT (n=208)
90%
10%
COMPLIANCE
Full dose Not Full dose
Cetuximab in LA SCCHN:
Bonner Phase III study: Complications &
Compliance:
CRT: Compliance and adherence to treatment:
CRT arms of studies comparing CRT vs RT alone
Cisplatin/5-FU/FA 46%
51%
71%
0 20 40 60 80 100
Carboplatin/5-FU
Cisplatin
Patients receiving all planned doses (%)
10 705030 90
2 cycles at weeks 1 and 5
3 cycles at weeks 1, 4, and 7
3 cycles at weeks 1, 3, and 6
2nd cycle
3rd cycle
3rd cycle
1 Huguenin et al. J Clin Oncol 2004; 22:4665-4673; 2 Calais et al. J Natl Cancer Inst 1999;
91:2081-2086;
3Wendt et al. J Clin Oncol 1998; 16:1318-1324
1
2
3
CRT versus Bio-Radiotherapy:
TREMPLIN Study: Safety Data:
• RT: 70 Gy
• Erbitux: initial dose 400 mg/m2 prior to RT
then 250 mg/m2 weekly for 7 weeks
• Cisplatin: 100 mg/m2 on days 1, 22 and 43
1. Lefebvre JL et al. J Clin Oncol 2009. 2. Lefebvre JL et al. J Clin Oncol 2011.
CRT versus Bio-Radiotherapy:
Projected Efficacy:
2) Bonner J.A, et al. ASTRO 2008
1) Pignon JP, et al. Lancet 2000;355:949–955
Prominent rash group *
Most of the randomised trials have used
a dose of cisplatin of 100 mg/m2, three
times throughout the course of
radiotherapy (cumulative dose of 300
mg/m2).
CRT versus Bio-Radiotherapy:
Survival Advantages:
Huguenin, Karl 2004
two cycles of concomitant
cisplatin (20 mg/m2 on 5
days of weeks 1 and 5).
P= NS
CRT versus Bio-Chemo-
Radiotherapy:
CRT
Bio-Radiotherapy
Bio-Chemo-Radiotherapy
RTOG 0522: Progression-Free
Survival and Overall Survival
Pts at Risk, n
448 316 217 78
447 302 197 80
Pts at Risk, n
448 385 266 96
447 378 251 94
Ang KK, et al. ASCO 2011. Abstract 5500.
PFS(%)
0
25
50
75
100
Yrs After Randomization
0 1 2 3
HR: 1.05 (95% CI: 0.84-1.29;
log-rank, 1-sided P = .66)
2-Yr Rate, % (95% CI)
64.3 (59.7-68.8)Cisplatin
63.4 (58.7-68.0)Cisplatin + cet
Primary Endpoint
OS(%)
0
25
50
75
100
Yrs After Randomization
0 1 2 3
HR: 0.87 (95% CI: 0.66-1.15;
log-rank, 1-sided P = .17)
2-Yr Rate, % (95% CI)
79.7 (75.9-83.6)Cisplatin
82.6 (78.9-86.3)Cisplatin + cet
Radiation Therapy Oncology Group
RTOG-0234:
Stage III/IV
SCCHN High
Risk
Surgery
Cetuximab +
Cisplatin 30 mg/m2
+ RTH 60 Gy
Cetuximab +
Docetaxel 15
mg/m2
+ RTH 60 Gy
J Clin Oncol 32:2486-2495. © 2014 by American Society of Clinical Oncology
DFS OAS
57%
66%
69%
79%
Cetuximab in scchn  how far we go?
Cetuximab in scchn  how far we go?
This is where all footnotes and references go.
• At present, induction chemotherapy is not
considered standard treatment in advanced disease.
• ICT followed by RT-CT (so-called sequential CT-RT) is
still under evaluation.
• The overall toxicity of this approach can be
substantial thus compromising the final result.
•Radiotherapy given concomitantly with cetuximab has
demonstrated a higher response rate, longer disease-
free progression and longer overall survival versus
radiotherapy alone [II, B].
•The magnitude in effect was similar or even better than
that achieved by concomitant chemoradiation, it proved
to be less toxic
Take Home Message:
 Cetuximab is an approved key component
plus radiation therapy of LA HNSCC.
 Significant lower toxicity profile than platinum
based CRT  more adherence to treatment
schedule.
 Cisplatin + RTH: 300 mg/m2.
 Cetuximab + Docetaxel + RTH = Ideal
Partners.
 Cetuximab + RTH = Level 1 Evidence in
Guidelines.
Thank You

More Related Content

What's hot

Treatment Of Stage Iii Nsclc The Role Of Radiation Therapy
Treatment Of Stage Iii Nsclc  The Role Of Radiation TherapyTreatment Of Stage Iii Nsclc  The Role Of Radiation Therapy
Treatment Of Stage Iii Nsclc The Role Of Radiation Therapy
fondas vakalis
 
Chemoradiation vs Surgery for rectal cancer
Chemoradiation vs Surgery for rectal cancerChemoradiation vs Surgery for rectal cancer
Chemoradiation vs Surgery for rectal cancer
spa718
 
MCO 2011 - Slide 17 - J.B. Vermorken - Systemic therapy
MCO 2011 - Slide 17 - J.B. Vermorken - Systemic therapyMCO 2011 - Slide 17 - J.B. Vermorken - Systemic therapy
MCO 2011 - Slide 17 - J.B. Vermorken - Systemic therapy
European School of Oncology
 
Induction chemotherapy followed by concurrent ct rt versus ct-rt in advanced ...
Induction chemotherapy followed by concurrent ct rt versus ct-rt in advanced ...Induction chemotherapy followed by concurrent ct rt versus ct-rt in advanced ...
Induction chemotherapy followed by concurrent ct rt versus ct-rt in advanced ...
Santam Chakraborty
 
Multimodality Treatment Of Stage Iii Nsclc
Multimodality Treatment Of Stage Iii NsclcMultimodality Treatment Of Stage Iii Nsclc
Multimodality Treatment Of Stage Iii Nsclc
fondas vakalis
 
Controversies in Colorectal Cancer
Controversies in Colorectal CancerControversies in Colorectal Cancer
Controversies in Colorectal Cancer
spa718
 
Astro annual meeting 2014 highlights
Astro annual meeting 2014 highlightsAstro annual meeting 2014 highlights
Astro annual meeting 2014 highlights
Ajeet Gandhi
 
Immunotherapy maintenence for advanced urothelial cancer
Immunotherapy maintenence for advanced urothelial cancerImmunotherapy maintenence for advanced urothelial cancer
Immunotherapy maintenence for advanced urothelial cancer
Chandan K Das
 
C:\Documents And Settings\User\Desktop\Head And Neck
C:\Documents And Settings\User\Desktop\Head And NeckC:\Documents And Settings\User\Desktop\Head And Neck
C:\Documents And Settings\User\Desktop\Head And Neck
Gamal Abdul Hamid
 
INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS
INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS
INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS
Paul George
 
A. Stathis - New drugs in the treatment of lymphomas
A. Stathis - New drugs in the treatment of lymphomasA. Stathis - New drugs in the treatment of lymphomas
A. Stathis - New drugs in the treatment of lymphomas
European School of Oncology
 
Role of Chemotherapy, Targeted therapy and Immunotherapy in NSCLC Part I
Role of Chemotherapy, Targeted therapy and Immunotherapy in NSCLC Part IRole of Chemotherapy, Targeted therapy and Immunotherapy in NSCLC Part I
Role of Chemotherapy, Targeted therapy and Immunotherapy in NSCLC Part I
Mohammed Fathy
 
Cco Gi 2008 Cr Slideset
Cco Gi 2008 Cr SlidesetCco Gi 2008 Cr Slideset
Cco Gi 2008 Cr Slideset
Emad El-Nashar
 
NY Prostate Cancer Conference - B.W. Cox - Session 4: Predicting clinical and...
NY Prostate Cancer Conference - B.W. Cox - Session 4: Predicting clinical and...NY Prostate Cancer Conference - B.W. Cox - Session 4: Predicting clinical and...
NY Prostate Cancer Conference - B.W. Cox - Session 4: Predicting clinical and...
European School of Oncology
 
ImmunoOncology in Lung Cancer
ImmunoOncology in Lung CancerImmunoOncology in Lung Cancer
ImmunoOncology in Lung Cancer
spa718
 
Early Stage Nsclc The Role Of Chemotherapy
Early Stage Nsclc The Role Of ChemotherapyEarly Stage Nsclc The Role Of Chemotherapy
Early Stage Nsclc The Role Of Chemotherapy
fondas vakalis
 
Chemotherapy for CNS tumors
Chemotherapy for CNS tumorsChemotherapy for CNS tumors
Chemotherapy for CNS tumors
Chandan K Das
 
Gut talk
Gut talkGut talk
Gut talk
madurai
 
Role of induction chemotherapy in Squamous Cell Carcinoma head and Neck ...
Role of induction chemotherapy  in Squamous Cell Carcinoma     head and Neck ...Role of induction chemotherapy  in Squamous Cell Carcinoma     head and Neck ...
Role of induction chemotherapy in Squamous Cell Carcinoma head and Neck ...
Kunal Jha
 
A. Shamseddine - Prostate and renal cancer - State of the art and update on s...
A. Shamseddine - Prostate and renal cancer - State of the art and update on s...A. Shamseddine - Prostate and renal cancer - State of the art and update on s...
A. Shamseddine - Prostate and renal cancer - State of the art and update on s...
European School of Oncology
 

What's hot (20)

Treatment Of Stage Iii Nsclc The Role Of Radiation Therapy
Treatment Of Stage Iii Nsclc  The Role Of Radiation TherapyTreatment Of Stage Iii Nsclc  The Role Of Radiation Therapy
Treatment Of Stage Iii Nsclc The Role Of Radiation Therapy
 
Chemoradiation vs Surgery for rectal cancer
Chemoradiation vs Surgery for rectal cancerChemoradiation vs Surgery for rectal cancer
Chemoradiation vs Surgery for rectal cancer
 
MCO 2011 - Slide 17 - J.B. Vermorken - Systemic therapy
MCO 2011 - Slide 17 - J.B. Vermorken - Systemic therapyMCO 2011 - Slide 17 - J.B. Vermorken - Systemic therapy
MCO 2011 - Slide 17 - J.B. Vermorken - Systemic therapy
 
Induction chemotherapy followed by concurrent ct rt versus ct-rt in advanced ...
Induction chemotherapy followed by concurrent ct rt versus ct-rt in advanced ...Induction chemotherapy followed by concurrent ct rt versus ct-rt in advanced ...
Induction chemotherapy followed by concurrent ct rt versus ct-rt in advanced ...
 
Multimodality Treatment Of Stage Iii Nsclc
Multimodality Treatment Of Stage Iii NsclcMultimodality Treatment Of Stage Iii Nsclc
Multimodality Treatment Of Stage Iii Nsclc
 
Controversies in Colorectal Cancer
Controversies in Colorectal CancerControversies in Colorectal Cancer
Controversies in Colorectal Cancer
 
Astro annual meeting 2014 highlights
Astro annual meeting 2014 highlightsAstro annual meeting 2014 highlights
Astro annual meeting 2014 highlights
 
Immunotherapy maintenence for advanced urothelial cancer
Immunotherapy maintenence for advanced urothelial cancerImmunotherapy maintenence for advanced urothelial cancer
Immunotherapy maintenence for advanced urothelial cancer
 
C:\Documents And Settings\User\Desktop\Head And Neck
C:\Documents And Settings\User\Desktop\Head And NeckC:\Documents And Settings\User\Desktop\Head And Neck
C:\Documents And Settings\User\Desktop\Head And Neck
 
INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS
INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS
INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS
 
A. Stathis - New drugs in the treatment of lymphomas
A. Stathis - New drugs in the treatment of lymphomasA. Stathis - New drugs in the treatment of lymphomas
A. Stathis - New drugs in the treatment of lymphomas
 
Role of Chemotherapy, Targeted therapy and Immunotherapy in NSCLC Part I
Role of Chemotherapy, Targeted therapy and Immunotherapy in NSCLC Part IRole of Chemotherapy, Targeted therapy and Immunotherapy in NSCLC Part I
Role of Chemotherapy, Targeted therapy and Immunotherapy in NSCLC Part I
 
Cco Gi 2008 Cr Slideset
Cco Gi 2008 Cr SlidesetCco Gi 2008 Cr Slideset
Cco Gi 2008 Cr Slideset
 
NY Prostate Cancer Conference - B.W. Cox - Session 4: Predicting clinical and...
NY Prostate Cancer Conference - B.W. Cox - Session 4: Predicting clinical and...NY Prostate Cancer Conference - B.W. Cox - Session 4: Predicting clinical and...
NY Prostate Cancer Conference - B.W. Cox - Session 4: Predicting clinical and...
 
ImmunoOncology in Lung Cancer
ImmunoOncology in Lung CancerImmunoOncology in Lung Cancer
ImmunoOncology in Lung Cancer
 
Early Stage Nsclc The Role Of Chemotherapy
Early Stage Nsclc The Role Of ChemotherapyEarly Stage Nsclc The Role Of Chemotherapy
Early Stage Nsclc The Role Of Chemotherapy
 
Chemotherapy for CNS tumors
Chemotherapy for CNS tumorsChemotherapy for CNS tumors
Chemotherapy for CNS tumors
 
Gut talk
Gut talkGut talk
Gut talk
 
Role of induction chemotherapy in Squamous Cell Carcinoma head and Neck ...
Role of induction chemotherapy  in Squamous Cell Carcinoma     head and Neck ...Role of induction chemotherapy  in Squamous Cell Carcinoma     head and Neck ...
Role of induction chemotherapy in Squamous Cell Carcinoma head and Neck ...
 
A. Shamseddine - Prostate and renal cancer - State of the art and update on s...
A. Shamseddine - Prostate and renal cancer - State of the art and update on s...A. Shamseddine - Prostate and renal cancer - State of the art and update on s...
A. Shamseddine - Prostate and renal cancer - State of the art and update on s...
 

Viewers also liked

CETUXIMAB
CETUXIMABCETUXIMAB
CETUXIMAB
Vaishali Kanyal
 
Clinical studies erbitux
Clinical studies  erbituxClinical studies  erbitux
Clinical studies erbitux
eman youssif
 
Cavity of larynx
Cavity of larynxCavity of larynx
Cavity of larynx
Jinijazz93
 
Erbitux
ErbituxErbitux
Erbitux
eman youssif
 
Cancer de laringe
Cancer de laringeCancer de laringe
Cancer de laringe
Dr. Alan Burgos
 
Head And Neck Squamous Cell Carcinoma
Head And Neck Squamous Cell CarcinomaHead And Neck Squamous Cell Carcinoma
Head And Neck Squamous Cell Carcinoma
fondas vakalis
 

Viewers also liked (6)

CETUXIMAB
CETUXIMABCETUXIMAB
CETUXIMAB
 
Clinical studies erbitux
Clinical studies  erbituxClinical studies  erbitux
Clinical studies erbitux
 
Cavity of larynx
Cavity of larynxCavity of larynx
Cavity of larynx
 
Erbitux
ErbituxErbitux
Erbitux
 
Cancer de laringe
Cancer de laringeCancer de laringe
Cancer de laringe
 
Head And Neck Squamous Cell Carcinoma
Head And Neck Squamous Cell CarcinomaHead And Neck Squamous Cell Carcinoma
Head And Neck Squamous Cell Carcinoma
 

Similar to Cetuximab in scchn how far we go?

MON 2011 - Slide 14 - J.B. Vermorken - Systemic therapy
MON 2011 - Slide 14 - J.B. Vermorken - Systemic therapyMON 2011 - Slide 14 - J.B. Vermorken - Systemic therapy
MON 2011 - Slide 14 - J.B. Vermorken - Systemic therapy
European School of Oncology
 
colon cancer synopsis 2015
colon cancer synopsis 2015colon cancer synopsis 2015
colon cancer synopsis 2015
Mohamed Abdulla
 
ECCLU 2011 - N. James - Localised invasive bladder cancer - Radiotherapy
ECCLU 2011 - N. James - Localised invasive bladder cancer - RadiotherapyECCLU 2011 - N. James - Localised invasive bladder cancer - Radiotherapy
ECCLU 2011 - N. James - Localised invasive bladder cancer - Radiotherapy
European School of Oncology
 
BALKAN MCO 2011 - E. Vrdoljak - Combined chemoradiotherapy
BALKAN MCO 2011 - E. Vrdoljak - Combined chemoradiotherapyBALKAN MCO 2011 - E. Vrdoljak - Combined chemoradiotherapy
BALKAN MCO 2011 - E. Vrdoljak - Combined chemoradiotherapy
European School of Oncology
 
M crc amgen luxor 20 feb 2018
M crc amgen luxor 20 feb 2018 M crc amgen luxor 20 feb 2018
M crc amgen luxor 20 feb 2018
Mohamed Abdulla
 
Post-operative Radiotherapy for Esophageal Cancer
Post-operative Radiotherapy for Esophageal CancerPost-operative Radiotherapy for Esophageal Cancer
Post-operative Radiotherapy for Esophageal Cancer
fondas vakalis
 
Continuum of care of metastatic colorectal cancer
Continuum of care of metastatic colorectal cancerContinuum of care of metastatic colorectal cancer
Continuum of care of metastatic colorectal cancer
Mohamed Abdulla
 
Treatment of Platinum sensitive relapsed carcinoma ovary
Treatment of Platinum sensitive relapsed carcinoma ovaryTreatment of Platinum sensitive relapsed carcinoma ovary
Treatment of Platinum sensitive relapsed carcinoma ovary
Alok Gupta
 
MON 2011 - Slide 19 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MON 2011 - Slide 19 - P. Rougier - Adjuvant treatment (stage 2 and 3)MON 2011 - Slide 19 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MON 2011 - Slide 19 - P. Rougier - Adjuvant treatment (stage 2 and 3)
European School of Oncology
 
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
European School of Oncology
 
Cancer gastrico adyuvancia
Cancer gastrico adyuvanciaCancer gastrico adyuvancia
Cancer gastrico adyuvancia
Danilo Baltazar Chacon
 
Rectal cancer Preoperative Radiotherapy- Short vs long course
Rectal cancer Preoperative Radiotherapy- Short vs long courseRectal cancer Preoperative Radiotherapy- Short vs long course
Rectal cancer Preoperative Radiotherapy- Short vs long course
Gaurav Kumar
 
EBRT in breast cancer: Evolution to cutting edge
EBRT in breast cancer: Evolution to cutting edgeEBRT in breast cancer: Evolution to cutting edge
EBRT in breast cancer: Evolution to cutting edge
Pramod Tike
 
Salvage Chemotherapy for Head and Neck Cancer 2021-07 (New).ppt
Salvage Chemotherapy  for Head and Neck Cancer 2021-07 (New).pptSalvage Chemotherapy  for Head and Neck Cancer 2021-07 (New).ppt
Salvage Chemotherapy for Head and Neck Cancer 2021-07 (New).ppt
SuYuChieh1
 
Recent advances in RM Head & Neck cancer (1) (2).pptx
Recent advances in RM Head & Neck cancer (1) (2).pptxRecent advances in RM Head & Neck cancer (1) (2).pptx
Recent advances in RM Head & Neck cancer (1) (2).pptx
DrParitosh2
 
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
European School of Oncology
 
CyberKnife: A New Option In the Treatment of Lung Cancer
CyberKnife: A New Option In the Treatment of Lung CancerCyberKnife: A New Option In the Treatment of Lung Cancer
CyberKnife: A New Option In the Treatment of Lung Cancer
Kue Lee
 
G. Ceresoli - Lung cancer - State of the art
G. Ceresoli - Lung cancer - State of the artG. Ceresoli - Lung cancer - State of the art
G. Ceresoli - Lung cancer - State of the art
European School of Oncology
 
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLCBALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
European School of Oncology
 
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLCBALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
European School of Oncology
 

Similar to Cetuximab in scchn how far we go? (20)

MON 2011 - Slide 14 - J.B. Vermorken - Systemic therapy
MON 2011 - Slide 14 - J.B. Vermorken - Systemic therapyMON 2011 - Slide 14 - J.B. Vermorken - Systemic therapy
MON 2011 - Slide 14 - J.B. Vermorken - Systemic therapy
 
colon cancer synopsis 2015
colon cancer synopsis 2015colon cancer synopsis 2015
colon cancer synopsis 2015
 
ECCLU 2011 - N. James - Localised invasive bladder cancer - Radiotherapy
ECCLU 2011 - N. James - Localised invasive bladder cancer - RadiotherapyECCLU 2011 - N. James - Localised invasive bladder cancer - Radiotherapy
ECCLU 2011 - N. James - Localised invasive bladder cancer - Radiotherapy
 
BALKAN MCO 2011 - E. Vrdoljak - Combined chemoradiotherapy
BALKAN MCO 2011 - E. Vrdoljak - Combined chemoradiotherapyBALKAN MCO 2011 - E. Vrdoljak - Combined chemoradiotherapy
BALKAN MCO 2011 - E. Vrdoljak - Combined chemoradiotherapy
 
M crc amgen luxor 20 feb 2018
M crc amgen luxor 20 feb 2018 M crc amgen luxor 20 feb 2018
M crc amgen luxor 20 feb 2018
 
Post-operative Radiotherapy for Esophageal Cancer
Post-operative Radiotherapy for Esophageal CancerPost-operative Radiotherapy for Esophageal Cancer
Post-operative Radiotherapy for Esophageal Cancer
 
Continuum of care of metastatic colorectal cancer
Continuum of care of metastatic colorectal cancerContinuum of care of metastatic colorectal cancer
Continuum of care of metastatic colorectal cancer
 
Treatment of Platinum sensitive relapsed carcinoma ovary
Treatment of Platinum sensitive relapsed carcinoma ovaryTreatment of Platinum sensitive relapsed carcinoma ovary
Treatment of Platinum sensitive relapsed carcinoma ovary
 
MON 2011 - Slide 19 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MON 2011 - Slide 19 - P. Rougier - Adjuvant treatment (stage 2 and 3)MON 2011 - Slide 19 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MON 2011 - Slide 19 - P. Rougier - Adjuvant treatment (stage 2 and 3)
 
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
 
Cancer gastrico adyuvancia
Cancer gastrico adyuvanciaCancer gastrico adyuvancia
Cancer gastrico adyuvancia
 
Rectal cancer Preoperative Radiotherapy- Short vs long course
Rectal cancer Preoperative Radiotherapy- Short vs long courseRectal cancer Preoperative Radiotherapy- Short vs long course
Rectal cancer Preoperative Radiotherapy- Short vs long course
 
EBRT in breast cancer: Evolution to cutting edge
EBRT in breast cancer: Evolution to cutting edgeEBRT in breast cancer: Evolution to cutting edge
EBRT in breast cancer: Evolution to cutting edge
 
Salvage Chemotherapy for Head and Neck Cancer 2021-07 (New).ppt
Salvage Chemotherapy  for Head and Neck Cancer 2021-07 (New).pptSalvage Chemotherapy  for Head and Neck Cancer 2021-07 (New).ppt
Salvage Chemotherapy for Head and Neck Cancer 2021-07 (New).ppt
 
Recent advances in RM Head & Neck cancer (1) (2).pptx
Recent advances in RM Head & Neck cancer (1) (2).pptxRecent advances in RM Head & Neck cancer (1) (2).pptx
Recent advances in RM Head & Neck cancer (1) (2).pptx
 
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
 
CyberKnife: A New Option In the Treatment of Lung Cancer
CyberKnife: A New Option In the Treatment of Lung CancerCyberKnife: A New Option In the Treatment of Lung Cancer
CyberKnife: A New Option In the Treatment of Lung Cancer
 
G. Ceresoli - Lung cancer - State of the art
G. Ceresoli - Lung cancer - State of the artG. Ceresoli - Lung cancer - State of the art
G. Ceresoli - Lung cancer - State of the art
 
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLCBALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
 
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLCBALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
BALKAN MCO 2011 - T. Cufer - Adjuvant/neo adjuvant systemic therapy in NSCLC
 

More from Mohamed Abdulla

mHSPC Feb 2023.pptx
mHSPC Feb 2023.pptxmHSPC Feb 2023.pptx
mHSPC Feb 2023.pptx
Mohamed Abdulla
 
BTC - Durvalumab - AZ 2023.pptx
BTC - Durvalumab - AZ 2023.pptxBTC - Durvalumab - AZ 2023.pptx
BTC - Durvalumab - AZ 2023.pptx
Mohamed Abdulla
 
Ihof heterogenity &amp; personalized treatment crpc 2019
Ihof heterogenity &amp; personalized treatment crpc 2019Ihof heterogenity &amp; personalized treatment crpc 2019
Ihof heterogenity &amp; personalized treatment crpc 2019
Mohamed Abdulla
 
Triple Negative Breast Cancer
Triple Negative Breast CancerTriple Negative Breast Cancer
Triple Negative Breast Cancer
Mohamed Abdulla
 
ovarian cancer - angiogenesis
ovarian cancer - angiogenesisovarian cancer - angiogenesis
ovarian cancer - angiogenesis
Mohamed Abdulla
 
Neuroendocrine Tumors in 2019
Neuroendocrine Tumors in 2019Neuroendocrine Tumors in 2019
Neuroendocrine Tumors in 2019
Mohamed Abdulla
 
Ovarian Cancer; What is Behind the Scene
Ovarian Cancer; What is Behind the SceneOvarian Cancer; What is Behind the Scene
Ovarian Cancer; What is Behind the Scene
Mohamed Abdulla
 
metastatic colorectal cancer; a new chapter in the story
metastatic colorectal cancer; a new chapter in the storymetastatic colorectal cancer; a new chapter in the story
metastatic colorectal cancer; a new chapter in the story
Mohamed Abdulla
 
angiogenesis; a key player in all chapters of metastatic crc story2
angiogenesis; a key player in all chapters of metastatic crc story2angiogenesis; a key player in all chapters of metastatic crc story2
angiogenesis; a key player in all chapters of metastatic crc story2
Mohamed Abdulla
 
Role of Apalutamide in management of M0 CRPC
Role of Apalutamide in management of M0 CRPCRole of Apalutamide in management of M0 CRPC
Role of Apalutamide in management of M0 CRPC
Mohamed Abdulla
 
Management of metastatic colorectal cancer
Management of metastatic colorectal cancerManagement of metastatic colorectal cancer
Management of metastatic colorectal cancer
Mohamed Abdulla
 
Basic principles of cancer immunotherapy
Basic principles of cancer immunotherapyBasic principles of cancer immunotherapy
Basic principles of cancer immunotherapy
Mohamed Abdulla
 
CRPC management
CRPC managementCRPC management
CRPC management
Mohamed Abdulla
 
Astellas meeting, crpc- what we have in 2019
Astellas   meeting, crpc- what we have in 2019Astellas   meeting, crpc- what we have in 2019
Astellas meeting, crpc- what we have in 2019
Mohamed Abdulla
 
Impact of 1ry tumor location on treatment guidelines of mCRC
Impact of 1ry tumor location on treatment guidelines of mCRCImpact of 1ry tumor location on treatment guidelines of mCRC
Impact of 1ry tumor location on treatment guidelines of mCRC
Mohamed Abdulla
 
Rectal Cancer
Rectal Cancer Rectal Cancer
Rectal Cancer
Mohamed Abdulla
 
Msd msi high solid tumors
Msd msi high solid tumorsMsd msi high solid tumors
Msd msi high solid tumors
Mohamed Abdulla
 
Colon cancer sidedness 2018
Colon cancer sidedness 2018Colon cancer sidedness 2018
Colon cancer sidedness 2018
Mohamed Abdulla
 
Prostate cancer the androgenic fortified dogma
Prostate cancer  the androgenic fortified dogmaProstate cancer  the androgenic fortified dogma
Prostate cancer the androgenic fortified dogma
Mohamed Abdulla
 
Cancer immunotherapy different modes of action - astra zeneca - jordan
Cancer immunotherapy   different modes of action - astra zeneca - jordanCancer immunotherapy   different modes of action - astra zeneca - jordan
Cancer immunotherapy different modes of action - astra zeneca - jordan
Mohamed Abdulla
 

More from Mohamed Abdulla (20)

mHSPC Feb 2023.pptx
mHSPC Feb 2023.pptxmHSPC Feb 2023.pptx
mHSPC Feb 2023.pptx
 
BTC - Durvalumab - AZ 2023.pptx
BTC - Durvalumab - AZ 2023.pptxBTC - Durvalumab - AZ 2023.pptx
BTC - Durvalumab - AZ 2023.pptx
 
Ihof heterogenity &amp; personalized treatment crpc 2019
Ihof heterogenity &amp; personalized treatment crpc 2019Ihof heterogenity &amp; personalized treatment crpc 2019
Ihof heterogenity &amp; personalized treatment crpc 2019
 
Triple Negative Breast Cancer
Triple Negative Breast CancerTriple Negative Breast Cancer
Triple Negative Breast Cancer
 
ovarian cancer - angiogenesis
ovarian cancer - angiogenesisovarian cancer - angiogenesis
ovarian cancer - angiogenesis
 
Neuroendocrine Tumors in 2019
Neuroendocrine Tumors in 2019Neuroendocrine Tumors in 2019
Neuroendocrine Tumors in 2019
 
Ovarian Cancer; What is Behind the Scene
Ovarian Cancer; What is Behind the SceneOvarian Cancer; What is Behind the Scene
Ovarian Cancer; What is Behind the Scene
 
metastatic colorectal cancer; a new chapter in the story
metastatic colorectal cancer; a new chapter in the storymetastatic colorectal cancer; a new chapter in the story
metastatic colorectal cancer; a new chapter in the story
 
angiogenesis; a key player in all chapters of metastatic crc story2
angiogenesis; a key player in all chapters of metastatic crc story2angiogenesis; a key player in all chapters of metastatic crc story2
angiogenesis; a key player in all chapters of metastatic crc story2
 
Role of Apalutamide in management of M0 CRPC
Role of Apalutamide in management of M0 CRPCRole of Apalutamide in management of M0 CRPC
Role of Apalutamide in management of M0 CRPC
 
Management of metastatic colorectal cancer
Management of metastatic colorectal cancerManagement of metastatic colorectal cancer
Management of metastatic colorectal cancer
 
Basic principles of cancer immunotherapy
Basic principles of cancer immunotherapyBasic principles of cancer immunotherapy
Basic principles of cancer immunotherapy
 
CRPC management
CRPC managementCRPC management
CRPC management
 
Astellas meeting, crpc- what we have in 2019
Astellas   meeting, crpc- what we have in 2019Astellas   meeting, crpc- what we have in 2019
Astellas meeting, crpc- what we have in 2019
 
Impact of 1ry tumor location on treatment guidelines of mCRC
Impact of 1ry tumor location on treatment guidelines of mCRCImpact of 1ry tumor location on treatment guidelines of mCRC
Impact of 1ry tumor location on treatment guidelines of mCRC
 
Rectal Cancer
Rectal Cancer Rectal Cancer
Rectal Cancer
 
Msd msi high solid tumors
Msd msi high solid tumorsMsd msi high solid tumors
Msd msi high solid tumors
 
Colon cancer sidedness 2018
Colon cancer sidedness 2018Colon cancer sidedness 2018
Colon cancer sidedness 2018
 
Prostate cancer the androgenic fortified dogma
Prostate cancer  the androgenic fortified dogmaProstate cancer  the androgenic fortified dogma
Prostate cancer the androgenic fortified dogma
 
Cancer immunotherapy different modes of action - astra zeneca - jordan
Cancer immunotherapy   different modes of action - astra zeneca - jordanCancer immunotherapy   different modes of action - astra zeneca - jordan
Cancer immunotherapy different modes of action - astra zeneca - jordan
 

Recently uploaded

PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptxPICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
Aloy Okechukwu Ugwu
 
Building a Strong Partnership with Your Medical Team
Building a Strong Partnership with Your Medical TeamBuilding a Strong Partnership with Your Medical Team
Building a Strong Partnership with Your Medical Team
bkling
 
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
sonamrawat5631
 
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdfYoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Stuart McGill
 
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsxDr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi
 
Rice Bran Oil Manufacturing Process
Rice Bran Oil Manufacturing ProcessRice Bran Oil Manufacturing Process
Rice Bran Oil Manufacturing Process
nishurani4455
 
Lymphoma Made Easy , New Teaching Lectures
Lymphoma Made Easy , New Teaching LecturesLymphoma Made Easy , New Teaching Lectures
Lymphoma Made Easy , New Teaching Lectures
MiadAlsulami
 
STAPHYSAGRIA.BHMS.MATERIA MEDICA.HOMOEOPATHY
STAPHYSAGRIA.BHMS.MATERIA MEDICA.HOMOEOPATHYSTAPHYSAGRIA.BHMS.MATERIA MEDICA.HOMOEOPATHY
STAPHYSAGRIA.BHMS.MATERIA MEDICA.HOMOEOPATHY
DRPREETHIJAMESP
 
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdfHeart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
MedicoseAcademics
 
Introduction to Dental Implant for undergraduate student
Introduction to Dental Implant for undergraduate studentIntroduction to Dental Implant for undergraduate student
Introduction to Dental Implant for undergraduate student
Shamsuddin Mahmud
 
2024 07 12 Do you share my autistic traits_ - Google Sheets.pdf
2024 07 12 Do you share my autistic traits_ - Google Sheets.pdf2024 07 12 Do you share my autistic traits_ - Google Sheets.pdf
2024 07 12 Do you share my autistic traits_ - Google Sheets.pdf
CarriePoppy
 
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptxOBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
Niranjan Chavan
 
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition.docx
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition.docxTEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition.docx
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition.docx
kevinkariuki227
 
Overcoming Erectile Dysfunction Lifestyle Changes and the Role of Sildigra 25...
Overcoming Erectile Dysfunction Lifestyle Changes and the Role of Sildigra 25...Overcoming Erectile Dysfunction Lifestyle Changes and the Role of Sildigra 25...
Overcoming Erectile Dysfunction Lifestyle Changes and the Role of Sildigra 25...
ED PIllsForever
 
Prostatitis Severity- How to Determine if You Have Mild Symptoms.pptx
Prostatitis Severity- How to Determine if You Have Mild Symptoms.pptxProstatitis Severity- How to Determine if You Have Mild Symptoms.pptx
Prostatitis Severity- How to Determine if You Have Mild Symptoms.pptx
AmandaChou9
 
Article - Design and evaluation of novel inhibitors for the treatment of clea...
Article - Design and evaluation of novel inhibitors for the treatment of clea...Article - Design and evaluation of novel inhibitors for the treatment of clea...
Article - Design and evaluation of novel inhibitors for the treatment of clea...
Trustlife
 
ONYDA XR clonidine liquid preparation by Dr. Amrutha
ONYDA XR clonidine liquid preparation by Dr. AmruthaONYDA XR clonidine liquid preparation by Dr. Amrutha
ONYDA XR clonidine liquid preparation by Dr. Amrutha
Amrutha Gudimetla
 
Prevention of Cruelty to animals act 1960
Prevention of Cruelty to animals act 1960Prevention of Cruelty to animals act 1960
Prevention of Cruelty to animals act 1960
PratibhaSonawane5
 
General Endocrinology and mechanism of action of hormones
General Endocrinology and mechanism of action of hormonesGeneral Endocrinology and mechanism of action of hormones
General Endocrinology and mechanism of action of hormones
MedicoseAcademics
 
MEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate careMEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate care
Debre Berhan University
 

Recently uploaded (20)

PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptxPICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptx
 
Building a Strong Partnership with Your Medical Team
Building a Strong Partnership with Your Medical TeamBuilding a Strong Partnership with Your Medical Team
Building a Strong Partnership with Your Medical Team
 
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
High Class Girls Call Delhi 9711199171 Provide Best And Top Girl Service And ...
 
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdfYoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdf
 
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsxDr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
Dr.Tarik Enaairi - Dermatology - Mastocytosis.ppsx
 
Rice Bran Oil Manufacturing Process
Rice Bran Oil Manufacturing ProcessRice Bran Oil Manufacturing Process
Rice Bran Oil Manufacturing Process
 
Lymphoma Made Easy , New Teaching Lectures
Lymphoma Made Easy , New Teaching LecturesLymphoma Made Easy , New Teaching Lectures
Lymphoma Made Easy , New Teaching Lectures
 
STAPHYSAGRIA.BHMS.MATERIA MEDICA.HOMOEOPATHY
STAPHYSAGRIA.BHMS.MATERIA MEDICA.HOMOEOPATHYSTAPHYSAGRIA.BHMS.MATERIA MEDICA.HOMOEOPATHY
STAPHYSAGRIA.BHMS.MATERIA MEDICA.HOMOEOPATHY
 
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdfHeart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
 
Introduction to Dental Implant for undergraduate student
Introduction to Dental Implant for undergraduate studentIntroduction to Dental Implant for undergraduate student
Introduction to Dental Implant for undergraduate student
 
2024 07 12 Do you share my autistic traits_ - Google Sheets.pdf
2024 07 12 Do you share my autistic traits_ - Google Sheets.pdf2024 07 12 Do you share my autistic traits_ - Google Sheets.pdf
2024 07 12 Do you share my autistic traits_ - Google Sheets.pdf
 
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptxOBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
OBSTETRICS SEPSIS - BUNDLE APPROACH.pptx
 
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition.docx
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition.docxTEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition.docx
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition.docx
 
Overcoming Erectile Dysfunction Lifestyle Changes and the Role of Sildigra 25...
Overcoming Erectile Dysfunction Lifestyle Changes and the Role of Sildigra 25...Overcoming Erectile Dysfunction Lifestyle Changes and the Role of Sildigra 25...
Overcoming Erectile Dysfunction Lifestyle Changes and the Role of Sildigra 25...
 
Prostatitis Severity- How to Determine if You Have Mild Symptoms.pptx
Prostatitis Severity- How to Determine if You Have Mild Symptoms.pptxProstatitis Severity- How to Determine if You Have Mild Symptoms.pptx
Prostatitis Severity- How to Determine if You Have Mild Symptoms.pptx
 
Article - Design and evaluation of novel inhibitors for the treatment of clea...
Article - Design and evaluation of novel inhibitors for the treatment of clea...Article - Design and evaluation of novel inhibitors for the treatment of clea...
Article - Design and evaluation of novel inhibitors for the treatment of clea...
 
ONYDA XR clonidine liquid preparation by Dr. Amrutha
ONYDA XR clonidine liquid preparation by Dr. AmruthaONYDA XR clonidine liquid preparation by Dr. Amrutha
ONYDA XR clonidine liquid preparation by Dr. Amrutha
 
Prevention of Cruelty to animals act 1960
Prevention of Cruelty to animals act 1960Prevention of Cruelty to animals act 1960
Prevention of Cruelty to animals act 1960
 
General Endocrinology and mechanism of action of hormones
General Endocrinology and mechanism of action of hormonesGeneral Endocrinology and mechanism of action of hormones
General Endocrinology and mechanism of action of hormones
 
MEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate careMEDICAL PROFESSIONALISM Class of compassionate care
MEDICAL PROFESSIONALISM Class of compassionate care
 

Cetuximab in scchn how far we go?

  • 1. CETUXIMAB IN LA SCCHN: HOW FAR WE GO? MOHAMED ABDULLA M.D. PROF. OF CLINICAL ONCOLOGY NEMROCK CAIRO UNIVERSITY NEMROCK – 08/02/2015
  • 2. LASCCHN: The Outcome: Surgery Radiation Therapy Key Components  L.R.  Distant Metastases Systemic Therapy 83% 59% 36% 0% 50% 100% Localized Regional Metastatic 5-yearSurvival SEER. Stat fact sheets: oral cavity and pharynx cancer. 2003-2009.
  • 3. MACH-NC: 2009 Update: 93 Trials – 17346 Patients: J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
  • 4. MACH-NC: 2009 Update: 93 Trials – 17346 Patients: J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
  • 5. MACH-NC: 2009 Update: 93 Trials – 17346 Patients: J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
  • 6. MACH-NC: 2009 Update: 93 Trials – 17346 Patients: J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
  • 7. MACH-NC: 2009 Update: 93 Trials – 17346 Patients: J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14
  • 8. MACH-NC: 2009 Update: 93 Trials – 17346 Patients: J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14 CISPLATIN 100 mg/m2 (D1+22+43) + RTH
  • 9. Impact of low adherence to treatment of CT on efficacy
  • 10. LA HNSCC: Theme of Management:  RTH  No impact.  CRT  The most accepted standard, < 70 years.  Cisplatin: 100 mg/m2 D1+22+43.  IC  NPX Ca. & Organ Preservation Trial, TPF.  Sequential:  Healthy (PS 0 – 1).  Young.  N2-3 (Tany).  T4 not destroying the organ.  Physician – Patient preference. www.uptodate.com 09/12/2014 J.-P. Pignon et al. / Radiotherapy and Oncology 92 (2009) 4–14 Can we go better?
  • 11. PI3-K STAT AKT Grb2 SOS RAS RAF1 MEK MPA K Gene Transcription & Cell Cycle Progression 1. Angiogenesis 2. Survival 3. Proliferation 4. Progression Molecular Key Players: Carter P. Nat Rev. Cancer 2001. Heinemann V et al. Cancer Treat Rev. 2009. NK CELLS
  • 12. Erbitux + RT Erbitux initial dose (400 mg/m2) Erbitux (250 mg/m2) + RT (wks 2–8)Stage III and IV non-metastatic SCCHN RT Bonner JA, et al. N Engl J Med 2006;354:567–578 Curran D, et al. J Clin Oncol 2007;25:2191–2197 R Primary endpoint: Duration of locoregional control Secondary endpoints: OS, PFS, RR, QoL, and safety Bonner Phase III study: Study Design: N=424
  • 13. Bonner JA, et al. N Engl J Med 2006;354:567–578 Months Locoregionalcontrol(%) 100 80 60 40 20 0 0 10 20 30 40 50 60 14.9 months 24.4 months HR=0.68 [95% CI: 0.52–0.89] p=0.005 3-year control rate 47% 34% RT Erbitux + RT Bonner Phase III study: Local Control:
  • 14. Bonner JA, et al. Lancet Oncol 2010;11:21–28 HR=0.73 [95% CI: 0.56–0.95] p=0.018 0 10 20 30 40 50 60 70 Overallsurvival(%) 5-year survival rate 36% Months 46% 36% 49.0 months 29.3 months RT Erbitux + RT100 80 60 40 20 0 10 30 50 70 90 Bonner Phase III study: 5-Year Survival:
  • 15. Bonner et al. Lancet Oncol 2010; 11:21-28 Time (months) Probabilityofsurvival(%) 1.00 0.80 0.60 0.40 0.20 0 0 10 20 30 40 50 60 70 0.10 0.30 0.50 0.70 0.90 Prominent rash group (n=127): Grade 2–4 Mild rash group (n=81): Grade 0/1 51% reduction in the risk of death (p=0.002) >68.8 months p=0.002, HR=0.49 (0.34–0.72) 25.6 months Cetuximab in LA SCCHN: Bonner Phase III study: 5-Year Survival & Severity of Rash:
  • 16. Cetuximab in LA SCCHN: Change of QoL Over Time: Curran et al. J Clin Oncol 2007; 25:2191-2197 Globalhealthstatus/QoLscore 100 80 60 40 20 0 Visit RT RT + Erbitux Baseline Week 4 Month 4 Month 8 Month 12 QoL assessment of Bonner study QoL: Post-baseline scores for the EORTC QLQ-C30
  • 17. * Listed for its relationship to Erbitux Bonner JA, et al. N Engl J Med 2006;354:567–578 p<0.001 p=0.01 Patients (%) 0 10 20 30 40 50 60 Mucositis Dysphagia Radiation dermatitis Xerostomia Fatigue/malaise Acne-like rash *Infusion reactions RT (n=212) Erbitux + RT (n=208) 90% 10% COMPLIANCE Full dose Not Full dose Cetuximab in LA SCCHN: Bonner Phase III study: Complications & Compliance:
  • 18. CRT: Compliance and adherence to treatment: CRT arms of studies comparing CRT vs RT alone Cisplatin/5-FU/FA 46% 51% 71% 0 20 40 60 80 100 Carboplatin/5-FU Cisplatin Patients receiving all planned doses (%) 10 705030 90 2 cycles at weeks 1 and 5 3 cycles at weeks 1, 4, and 7 3 cycles at weeks 1, 3, and 6 2nd cycle 3rd cycle 3rd cycle 1 Huguenin et al. J Clin Oncol 2004; 22:4665-4673; 2 Calais et al. J Natl Cancer Inst 1999; 91:2081-2086; 3Wendt et al. J Clin Oncol 1998; 16:1318-1324 1 2 3
  • 19. CRT versus Bio-Radiotherapy: TREMPLIN Study: Safety Data: • RT: 70 Gy • Erbitux: initial dose 400 mg/m2 prior to RT then 250 mg/m2 weekly for 7 weeks • Cisplatin: 100 mg/m2 on days 1, 22 and 43 1. Lefebvre JL et al. J Clin Oncol 2009. 2. Lefebvre JL et al. J Clin Oncol 2011.
  • 20. CRT versus Bio-Radiotherapy: Projected Efficacy: 2) Bonner J.A, et al. ASTRO 2008 1) Pignon JP, et al. Lancet 2000;355:949–955 Prominent rash group * Most of the randomised trials have used a dose of cisplatin of 100 mg/m2, three times throughout the course of radiotherapy (cumulative dose of 300 mg/m2).
  • 21. CRT versus Bio-Radiotherapy: Survival Advantages: Huguenin, Karl 2004 two cycles of concomitant cisplatin (20 mg/m2 on 5 days of weeks 1 and 5). P= NS
  • 23. RTOG 0522: Progression-Free Survival and Overall Survival Pts at Risk, n 448 316 217 78 447 302 197 80 Pts at Risk, n 448 385 266 96 447 378 251 94 Ang KK, et al. ASCO 2011. Abstract 5500. PFS(%) 0 25 50 75 100 Yrs After Randomization 0 1 2 3 HR: 1.05 (95% CI: 0.84-1.29; log-rank, 1-sided P = .66) 2-Yr Rate, % (95% CI) 64.3 (59.7-68.8)Cisplatin 63.4 (58.7-68.0)Cisplatin + cet Primary Endpoint OS(%) 0 25 50 75 100 Yrs After Randomization 0 1 2 3 HR: 0.87 (95% CI: 0.66-1.15; log-rank, 1-sided P = .17) 2-Yr Rate, % (95% CI) 79.7 (75.9-83.6)Cisplatin 82.6 (78.9-86.3)Cisplatin + cet
  • 24. Radiation Therapy Oncology Group RTOG-0234: Stage III/IV SCCHN High Risk Surgery Cetuximab + Cisplatin 30 mg/m2 + RTH 60 Gy Cetuximab + Docetaxel 15 mg/m2 + RTH 60 Gy J Clin Oncol 32:2486-2495. © 2014 by American Society of Clinical Oncology DFS OAS 57% 66% 69% 79%
  • 27. This is where all footnotes and references go.
  • 28. • At present, induction chemotherapy is not considered standard treatment in advanced disease. • ICT followed by RT-CT (so-called sequential CT-RT) is still under evaluation. • The overall toxicity of this approach can be substantial thus compromising the final result. •Radiotherapy given concomitantly with cetuximab has demonstrated a higher response rate, longer disease- free progression and longer overall survival versus radiotherapy alone [II, B]. •The magnitude in effect was similar or even better than that achieved by concomitant chemoradiation, it proved to be less toxic
  • 29. Take Home Message:  Cetuximab is an approved key component plus radiation therapy of LA HNSCC.  Significant lower toxicity profile than platinum based CRT  more adherence to treatment schedule.  Cisplatin + RTH: 300 mg/m2.  Cetuximab + Docetaxel + RTH = Ideal Partners.  Cetuximab + RTH = Level 1 Evidence in Guidelines.