Hear about the latest breaking colorectal cancer research! Fight CRC will be joined by Dr. Axel Grothey who will spend the hour detailing the research presented at the 2020 Gastrointestinal (GI) Cancers Symposium hosted by the American Society of Clinical Oncology.
Understand the concept of Colorectal Cancer clinical trials and the differences across the phases. Presented by Dr. Sam J. Lubner MD, FACP University of Wisconsin Carbone Cancer Center
Take a deeper dive into the topic of Precision Medicine and what this means for colorectal cancer. This webinar is brought to you by Fight CRC’s Research Advocacy Training and Support (RATS) program.
This months @FightCRC #CRCWebinar will focus on the recap of the annual 2018 ASCO conference. We are lucky to have Medical Advisory Board member Dr. Goldberg, to discuss the colorectal cancer highlights from the conference, which was held this year on June 1-5, 2018 in Chicago.
Dr. Richard M Goldberg, MD, is West Virginia University Cancer Institute’s (WVUCI) Director, and Director of the WVU Cancer Signature Program. He serves as a member of WVU health sciences Vice President and Executive Dean, Clay Marsh’s leadership team.As WVUCI’s Director, he oversees the clinical, research, and teaching missions of the cancer institute and its component organizations that include satellite clinical and clinical research locations that are dispersed throughout West Virginia.
Tailoring Colorectal Cancer Treatment: Sidedness, Biomarkers - August 2018 CR...Fight Colorectal Cancer
This month’s FightCRC webinar, Dr. Kanwal Raghav will spend the hour diving into the research behind two biomarkers related to colorectal cancer: HER2 and sidedness. This informative session will talk about the biomarkers that researchers are studying, as they may affect your treatment plan. Knowing your biomarkers will allow you to be your own best advocate.
To share the knowledge from 2015 GI ASCO, Dr. Al Benson, one of FightCRC Medical Advisory Board members, and Andi Dwyer discuss key highlights as they pertain to colorectal cancer from the symposium and what they mean for patients.
On September 3, 2015, Ovarian cancer survivors and FDA Patient Representatives Peg Ford, Susan Leighton and Annie Ellis were invited to provide the patient perspective at the recent Ovarian Cancer Endpoints Workshop hosted by the Food and Drug Administration (FDA). This meeting was co-sponsored by the Society of Gynecologic Oncology (SGO), the American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO). Many important topics to the ovarian cancer community were discussed, including novel clinical trial designs, biomarkers, and new classes of agents such as immunotherapies.
Understand the concept of Colorectal Cancer clinical trials and the differences across the phases. Presented by Dr. Sam J. Lubner MD, FACP University of Wisconsin Carbone Cancer Center
Take a deeper dive into the topic of Precision Medicine and what this means for colorectal cancer. This webinar is brought to you by Fight CRC’s Research Advocacy Training and Support (RATS) program.
This months @FightCRC #CRCWebinar will focus on the recap of the annual 2018 ASCO conference. We are lucky to have Medical Advisory Board member Dr. Goldberg, to discuss the colorectal cancer highlights from the conference, which was held this year on June 1-5, 2018 in Chicago.
Dr. Richard M Goldberg, MD, is West Virginia University Cancer Institute’s (WVUCI) Director, and Director of the WVU Cancer Signature Program. He serves as a member of WVU health sciences Vice President and Executive Dean, Clay Marsh’s leadership team.As WVUCI’s Director, he oversees the clinical, research, and teaching missions of the cancer institute and its component organizations that include satellite clinical and clinical research locations that are dispersed throughout West Virginia.
Tailoring Colorectal Cancer Treatment: Sidedness, Biomarkers - August 2018 CR...Fight Colorectal Cancer
This month’s FightCRC webinar, Dr. Kanwal Raghav will spend the hour diving into the research behind two biomarkers related to colorectal cancer: HER2 and sidedness. This informative session will talk about the biomarkers that researchers are studying, as they may affect your treatment plan. Knowing your biomarkers will allow you to be your own best advocate.
To share the knowledge from 2015 GI ASCO, Dr. Al Benson, one of FightCRC Medical Advisory Board members, and Andi Dwyer discuss key highlights as they pertain to colorectal cancer from the symposium and what they mean for patients.
On September 3, 2015, Ovarian cancer survivors and FDA Patient Representatives Peg Ford, Susan Leighton and Annie Ellis were invited to provide the patient perspective at the recent Ovarian Cancer Endpoints Workshop hosted by the Food and Drug Administration (FDA). This meeting was co-sponsored by the Society of Gynecologic Oncology (SGO), the American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO). Many important topics to the ovarian cancer community were discussed, including novel clinical trial designs, biomarkers, and new classes of agents such as immunotherapies.
Dr. Stephanie Blank and Dr. Melissa Frey update us on the latest developments in ovarian cancer research and treatment from the annual conference of the Society of Gynecologic Oncology. Dr. Blank is a gynecologic oncologist at Perlmutter Cancer Center at NYU Langone Medical Center and an associate professor at NYU School of Medicine. Dr. Frey is a Gynecological Oncology Fellow at NYU Langone Medical Center.
Clinical Trials for Ovarian Cancer: Fact vs. Fictionbkling
Courtney Hudson, CEO & Co-Founder of EmergingMed, explains the basics of clinical trials and the process of developing new treatments in the emerging age of personalized medicine and immunotherapy. Lean how to identify appropriate clinical trials, find strategies to determine your best options, and figure out which questions to ask when making your decisions. Watch the accompanying webinar: https://vimeo.com/203510985
A diagnosis of DCIS often brings mixed messages. Is this a real breast cancer? What is the meaning of Stage 0? If this is not life threatening, why are the treatments similar to those recommended for an invasive cancer? Deborah Collyar, founder of Patient Advocates in Research, helps us interpret the new findings that will aid you in navigating this diagnosis.
Nov. Webinar - Research Update: advanced adenomas among first degree relative...Fight Colorectal Cancer
Fight CRC has funded Dr. Christine Molmenti from Northwell Health and Dr. Heather Hampel from The Ohio State University Comprehensive Cancer Center to research the feasibility of determining advanced adenoma(s) history among first degree relatives of early onset colorectal cancer patients. In this month's webinar, Dr. Molmenti and Andrea (Andi) Dwyer from Fight CRC and University of Colorado, will explain why the research is important, how Fight CRC is involved, and how the results could have clinical implications.
Dr. Maurie Markman, President of Science and Medicine at Cancer Treatment Centers of America, shares his expertise on the latest developments in immunotherapy for ovarian cancer.
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
Robert P. Edwards, MD, Chair of OB/GYN/RS, Co-Director of Women's Cancer Program at University of Pittsburgh, offers information about the current state of immunotherapy for recurrent ovarian cancer patients.
SHARE Presentation: New Developments in the Medical Treatment of Breast Cance...bkling
Dr. Cliff Hudis on the latest information on new breast cancer treatments. Dr. Hudis is Chief of Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center.
DCIS Topic-Driven Round Table: Decision-Making and Treatment Choicesbkling
Facilitator Deb Hackenberry is joined by Cecilia Hammond, Senior Medical Science Liaison at Genomic Health, to discuss better decision-making and your treatment choices with DCIS.
New post-chemotherapy maintenance treatment options for ovarian cancer have emerged in recent years. Dr. Maurie Markman explains and takes questions on maintenance therapies for ovarian cancer in our 4th annual Joan Sommer Educational Program.
Tonight’s speakers: Dr. Dan Sargent and Kim Ryan
Disclaimer: “This Report is not an official event of the 2012 Gastrointestinal Cancers Symposium. Not sponsored or endorsed by any of the cosponsoring organizations of the 2012 Gastrointestinal Cancers Symposium.”
Strategies for Long-term Management of Recurrent Ovarian Cancerbkling
A panel of doctors and patients will discuss decision-making in the recurrent setting of ovarian cancer, including how to understand and consider options like chemotherapy, surgery, and clinical trials. Panelists include Dr. Jason Wright and Dr. June Hou from Columbia University College of Physicians and Surgeons, survivor/research advocate Annie Ellis, and others living with recurrence.
2017 ASCO RECAP: The Latest in Colorectal Cancer Research #CRCWebinarFight Colorectal Cancer
Don’t miss our recap webinar from the American Society of Clinical Oncology Annual Conference (ASCO) where we discuss the latest research and treatments for colorectal cancer patients presented during the conference.
Dr. Dustin Deming, a medical oncologist and Fight CRC Medical Advisory Board Member will guide us through his findings. Dr. Deming brings a unique perspective as a researcher, oncologist and colorectal cancer survivor. In this webinar we will dive into the research and explain what it means for those living with colorectal cancer.
Dr. Stephanie Blank and Dr. Melissa Frey update us on the latest developments in ovarian cancer research and treatment from the annual conference of the Society of Gynecologic Oncology. Dr. Blank is a gynecologic oncologist at Perlmutter Cancer Center at NYU Langone Medical Center and an associate professor at NYU School of Medicine. Dr. Frey is a Gynecological Oncology Fellow at NYU Langone Medical Center.
Clinical Trials for Ovarian Cancer: Fact vs. Fictionbkling
Courtney Hudson, CEO & Co-Founder of EmergingMed, explains the basics of clinical trials and the process of developing new treatments in the emerging age of personalized medicine and immunotherapy. Lean how to identify appropriate clinical trials, find strategies to determine your best options, and figure out which questions to ask when making your decisions. Watch the accompanying webinar: https://vimeo.com/203510985
A diagnosis of DCIS often brings mixed messages. Is this a real breast cancer? What is the meaning of Stage 0? If this is not life threatening, why are the treatments similar to those recommended for an invasive cancer? Deborah Collyar, founder of Patient Advocates in Research, helps us interpret the new findings that will aid you in navigating this diagnosis.
Nov. Webinar - Research Update: advanced adenomas among first degree relative...Fight Colorectal Cancer
Fight CRC has funded Dr. Christine Molmenti from Northwell Health and Dr. Heather Hampel from The Ohio State University Comprehensive Cancer Center to research the feasibility of determining advanced adenoma(s) history among first degree relatives of early onset colorectal cancer patients. In this month's webinar, Dr. Molmenti and Andrea (Andi) Dwyer from Fight CRC and University of Colorado, will explain why the research is important, how Fight CRC is involved, and how the results could have clinical implications.
Dr. Maurie Markman, President of Science and Medicine at Cancer Treatment Centers of America, shares his expertise on the latest developments in immunotherapy for ovarian cancer.
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
Robert P. Edwards, MD, Chair of OB/GYN/RS, Co-Director of Women's Cancer Program at University of Pittsburgh, offers information about the current state of immunotherapy for recurrent ovarian cancer patients.
SHARE Presentation: New Developments in the Medical Treatment of Breast Cance...bkling
Dr. Cliff Hudis on the latest information on new breast cancer treatments. Dr. Hudis is Chief of Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center.
DCIS Topic-Driven Round Table: Decision-Making and Treatment Choicesbkling
Facilitator Deb Hackenberry is joined by Cecilia Hammond, Senior Medical Science Liaison at Genomic Health, to discuss better decision-making and your treatment choices with DCIS.
New post-chemotherapy maintenance treatment options for ovarian cancer have emerged in recent years. Dr. Maurie Markman explains and takes questions on maintenance therapies for ovarian cancer in our 4th annual Joan Sommer Educational Program.
Tonight’s speakers: Dr. Dan Sargent and Kim Ryan
Disclaimer: “This Report is not an official event of the 2012 Gastrointestinal Cancers Symposium. Not sponsored or endorsed by any of the cosponsoring organizations of the 2012 Gastrointestinal Cancers Symposium.”
Strategies for Long-term Management of Recurrent Ovarian Cancerbkling
A panel of doctors and patients will discuss decision-making in the recurrent setting of ovarian cancer, including how to understand and consider options like chemotherapy, surgery, and clinical trials. Panelists include Dr. Jason Wright and Dr. June Hou from Columbia University College of Physicians and Surgeons, survivor/research advocate Annie Ellis, and others living with recurrence.
2017 ASCO RECAP: The Latest in Colorectal Cancer Research #CRCWebinarFight Colorectal Cancer
Don’t miss our recap webinar from the American Society of Clinical Oncology Annual Conference (ASCO) where we discuss the latest research and treatments for colorectal cancer patients presented during the conference.
Dr. Dustin Deming, a medical oncologist and Fight CRC Medical Advisory Board Member will guide us through his findings. Dr. Deming brings a unique perspective as a researcher, oncologist and colorectal cancer survivor. In this webinar we will dive into the research and explain what it means for those living with colorectal cancer.
Dr. Michael Morse from Duke University and Fight CRC’s Andi Dwyer discuss the state of the science and clinical care of Immunotherapy (IO); giving a glimpse of the contributions of the Fight CRC IO Workgroup.
Join Fight CRC and Dr. Scott Kopetz to learn about the latest breaking colorectal cancer research from the American Society of Clinical Oncology 2019 Annual Conference.
Fight Colorectal Cancer’s Medical Advisory Board Member, Axel Grothey, MD, focused this webinar to stage III colon cancer patients. Dr. Grothey, medical oncologist at Mayo Clinic, will spend the hour discussing current treatment options and exciting new research that pertains to stage III colon cancer patients.
Dr. Dustin Deming led us through a discussion on the latest research and treatments for colorectal cancer patients presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.
A few of the topics covered include research on immunotherapy and trials studying:
– MSI-H (review of the Anti-PD-1 trial)
– HER2 amplification
– BRAF mutations
For more updates on colorectal cancer research, visit our blog: http://fightcolorectalcancer.org/category/research-treatment/
In this webinar, Dr. Azad discusses colorectal cancer recurrence. She addresses things to do to help reduce the risk of recurrence, in addition to what steps should be taken if colon or rectal cancer returns.
Gastric cancer
Second most common cancer-related death.
4th most common cancer
Korea, Japan, China, Taiwan high rates.
with 875,000 injured annually person in the world.
Palliative chemotherapy with:
Irinotecan and cisplatin.
Folic acid, 5-FU, and irinotecan (FOLFIRI).
Leucovorin, 5-FU, and oxaliplatin (FOLFOX).
Phase II studies evaluating irinotecan-based or oxaliplatin-based regimens demonstrate similar response rates
Dr. Murphy presents slides discussing general screening trends in the US, including how the US compares to other countries, different screening modalities, and differences in screening by:
-Age
-Gender
-Geography
-Race/Ethnicity
Looking to kick start your physical activity? Hoping to learn about how body movement can be a huge benefit for CRC patients and survivors? Curious about Climb for a Cure? Join this interactive webinar featuring Karia Coleman, MSK, personal trainer and athletic strength coach, and Fight CRC advocates as they discuss the importance, challenges, and joys of physical activity.
From bowel frequency, pain, and more, many colorectal cancer treatments lead to digestive side effects. Join this webinar with Dr. Cathy Eng to learn all about the digestive system, the side effects that are common due to CRC treatment, and how to manage those side effects.
Maine recently passed major colorectal cancer (CRC) policy at the state level. Join us to listen to their story and learn what worked well for CRC state advocacy!
Indiana just passed major colorectal cancer (CRC) policy this year. Join us to listen to their story and learn what worked well for CRC advocacy in Indiana!
Kentucky was one of the first states in the US to pass major colorectal cancer (CRC) policy. Join us to listen to their story and learn what worked well for CRC state advocacy!
Join Fight CRC in a webinar about biomarkers. In this session, Dr. Chris Lieu will focus the discussion on the NTRK biomarker, in addition to ctDNA, and Next-Generation Sequencing.
Join us as Eden Stotsky-Himelfarb, BSN, RN from Johns Hopkins Medicine discusses how to manage after a colorectal cancer diagnosis. In this session, she will cover understanding diagnoses, shared decision making, managing mental health, talking to family and colleagues, and more.
Some colorectal cancer treatments lead to side effects of the skin. In this webinar, Dr. Nicole LeBoeuf will discuss these specific side effects. She will talk about why they occur, how to prepare for them, and how to manage them.
Anticipating the end of life and making decisions about medical care at this time can be difficult and distressing for people with cancer and their loved ones. However, it is incredibly important to plan for the transition to end-of-life care.
In this webinar, we will discuss questions to ask when considering an end to curative treatment, what to expect with hospice and end-of-life care, a new medical care team, advance directives and healthcare proxies, options for pain, the role of caregivers and loved ones, and more.
In this webinar, Dr. Angela Nicholas, Dr. Chris Heery, and Wenora Johnson discuss all things clinical trials. Dr. Nicholas, a family practitioner and caregiver to her late husband, John MacCleod will dive into her experience searching for clinical trials along with advice to those currently searching, or planning on searching in the future. Dr. Heery, Chief Medical Officer for Precision Biosciences will spend time dispelling myths around clinical trials and challenges to enrollment, and Wenora Johnson, a stage III colon cancer survivor will describe the process and her point of view curating trials in the Fight CRC trial finder.
In this webinar, Dr. Popp will discuss everything you need to know about palliative care! This is an important webinar for colorectal cancer patients and their loved ones.
eeling worn out and exhausted all the time? You may be experiencing cancer-related fatigue. Tune in to this webinar to learn what cancer-related fatigue is, how to spot it, and how to manage it.
May 2019 – What You Need to Know About Chemotherapy Induced Neuropathy WebinarFight Colorectal Cancer
Neuropathy is a common side effect for colorectal cancer patients. It is a side effect that can be incredibly challenging to manage, and can affect daily living. Join this informative webinar to learn all about neuropathy—why it happens, how to prepare for it, and methods to try and reduce its effects. This is an important webinar for all survivors and patients! Dana will speak from both the medical professional and patient angle, as she is a colon cancer survivor herself!
A cancer diagnosis and cancer treatment can be traumatic. An experience with cancer can lead to serious psychological distress that should be addressed. In this webinar, Schuyler Cunningham, Clinical Social Worker, talks about what trauma is, how to identify it, and what steps to take next.
There are countless questions when it comes to medical cannabis and colorectal cancer: How can it help? How do you get it? Are there drug interactions with chemo? What are the side effects? Is it legal where I live?
There are countless questions when it comes to medical cannabis and colorectal cancer: How can it help? How do you get it? Are there drug interactions with chemo? What are the side effects? Is it legal where I live?
March 2019 - Polyps and Prevention: The Importance of Screening for Colorecta...Fight Colorectal Cancer
Did you know that colon polyps can lead to cancer? Did you know that colorectal cancer can be prevented through regular screening? It is important to stay up to date on CRC screening and guidelines, and it is also important to know about polyps and the role that they play in the development of colorectal cancer.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
3. TODAY’S
WEBINAR
01 Ask a question in the panel on the right side of
your screen
QUESTIONS
02 Watch a recording of this webinar on the Fight
CRC website. Visit FightCRC.org
WEBINAR ARCHIVE
03 Follow along on Twitter. Use the hashtag
#CRCWebinar
TWEET ALONG!
4. Resources
Fight CRC offers a wide
variety of resources for
those touched by colorectal
cancer. Visit FightCRC.org
to view, download, and
order the latest resources.
5. The information and services provided by Fight Colorectal Cancer are for general informational
purposes only. The information and services are not intended to be substitutes for professional
medical advice, diagnoses or treatment.
If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the
nearest emergency room.
Fight Colorectal Cancer never recommends or endorses any specific physicians, products or
treatments for any condition.
6. TODAY’S
PRESENTER
Dr. Axel Grothey
Axel Grothey, MD, is a consultant at the West Cancer Center, University of Tennessee, in Memphis, TN.
Dr. Grothey received his medical degree at Ruhr-Universität Bochum, Germany, and completed
residencies at West German Tumor Center and the Institute of Pathology at the University of Essen and a
residency and fellowship at the University of Bochum. He also completed a research fellowship at MD
Anderson Cancer Center at the University of Texas. He joined Mayo Clinic as a consultant in 2005 and was
appointed as Professor of Oncology in 2007. He left Mayo Clinic in 2018 to join West Cancer Center.
Dr. Grothey’s clinical interests focus on gastrointestinal cancers, in particular, colorectal cancer,
antiangiogenesis, signal transduction inhibitors, and clinical trial design and statistics. As a consultant and
investigator, his research has been funded by the National Cancer Institute (NCI) and the National
Institutes of Health, among other organizations.
He currently co-chairs the NCI Gastrointestinal Cancer Steering Committee after having served as chair of
the Colon Cancer Task Force for 6 years. He currently holds professional positions in multiple associations
and societies. He is a member of the NCCN Guidelines Committee for Colon, Rectal, and Anal Cancer and
also a member of the European Society of Medical Oncology (ESMO) guidelines committee for colorectal
cancer. Dr. Grothey performs journal review and editorial activities for numerous medical journals and is
the editor for Clinical Colorectal Cancer, Emerging Cancer Therapeutics, Practice Updates, and
Therapeutic Advances in Medical Oncology. He is a member of the editorial board of the Journal of
Clinical Oncology and Journal of the National Cancer Institute.
In educational activities, he is a five-time recipient of Teacher of the Year recognition at Mayo Clinic. Dr.
Grothey has given numerous international, national, and regional presentations, as well as invited and
visiting professor presentations. He has co-authored more than 500 articles, books, book chapters,
editorials, abstracts, and letters.
7. Updates on Colorectal Cancer
Axel Grothey, MD
Director, GI Oncology Research
West Cancer Center and Research Institute
8. Goal of medical therapy in GI Cancers
Finding the right treatment
for the right patient
at the right time
Individualized therapy
did not start with
molecular profiling
9. New IDEAs in the Adjuvant Setting
• Immunotherapy
• In MSI-H / MMR-D cancers: US ATOMIC trial (FOLFOX +/- Atezolizumab)
ongoing
• ctDNA
• As marker of minimal residual disease to select patients for therapy in stage II
(various trials ongoing or planned around the world)
– superiority question
• Select patients who do not need adjuvant therapy in stage III
– non-inferiority question
• Stem cell inhibitors?
• BRAF targeted agents and combinations (Adjuvant BEACON?)
11. Circulating Tumor DNA (ctDNA)
• Tumors release small cell-free DNA fragments
• ctDNA ≠ CTC (circulating tumor cells)
• Identify point mutations (or other genetic changes) in
tumor examine blood for matching mutation
Biology of ctDNA
ctDNA in Solid Tumors
• Frequently detected in metastatic solid malignancies1
• ? Useful marker of minimal residual disease after early-
stage cancer surgery (lung2, breast3, pancreas4) 1. Bettegowda et al. Sci Transl Med. 2014;6(224):224ra24.
2. Newman et al. Nat Med. 2014 May; 20(5): 548–554
3. Garcia-Murillas et al. Sci Transl Med. 2015;7(302):302ra133
4. Sausen et al. Nat Commun. 2015 Jul 7;6:7686
12. ctDNA as Marker for MRD (molecular residual disease)
• Two main types of tests:
• Tumor-agnostic
• NGS or PCR panel of common mutations in CRC
• E.g. LUNAR-1 (Guardant)
• Methylation markers
• E.g. Colvera (Quest)
Pro: easy logistics; Con: lower sensitivity
• Tumor-informed
• NGS or PCR panel of mutations detected in patient’s primary tumor
• E.g. Signatera (Natera)
Pro: high sensitivity; Con: logistics more complicated
13. 0 12 24 36 48 60
0
20
40
60
80
100
Time from Surgery (months)
PercentageRecurrence-Free
Stage II Recurrence-Free Survival
(Patients not treated with chemotherapy)
n Events 3-yr RFS
ctDNA Negative 164 16 90%
ctDNA Positive 14 11 0%
HR: 18 (95% CI: 7.9–40), p < 0.001
Tie et al. Sci Transl Med 2016
14. Clinical Low-Risk
(dMMR or pMMR + no poor prognostic features)
Clinical High-Risk
(pMMR + at least one poor prognostic features)
HR: 28 (95% CI: 8.3–93)
p < 0.001
HR: 7.5 (95% CI: 2.6–22)
p < 0.001
Recurrence-Free Survival
Tie et al. Sci Transl Med 2016
15. PPV = 100%
Post-op ctDNA
Positive
8%
Yes
0%
ctDNA and 3-year Recurrence Prediction Accuracy
= Recurrence = No Recurrence
92%
No
NPV = 91%
9%
Tie et al. Sci Transl Med 2016
16. ctDNA and Outcome in Stage III Colon Cancer
Tie et al., JAMA Oncol 2019N=96, all received adjuvant Tx
HR 3.8 HR 6.8
17. ctDNA and Outcome in Stage III Colon Cancer
Tie et al., JAMA Oncol 2019
HR 3.7 HR 6.5
18. NRG GI005 (COBRA): ctDNA as a predictive marker for response
to adjuvant chemotherapy in stage II colon cancer
PI V. Morris
Endpoints:
Phase II: Clearing rate of ctDNA
Phase III: DFS
N=1408
Activated Dec 2019
19. Potential Applications
Opportunity
Monitor
adjuvant
therapy effect
Opportunity
Recurrence
surveillance
SurveillanceDiagnosis Assessment Surgery Assessment
Lower Risk Observation
Higher Risk Chemotherapy
Opportunity
High-risk
screening or
equivocal finding
adjudication
Opportunit
ctDNA detecti
/ clearance as
surrogate
endpoint
Opportunity
Molecular staging
using ctDNA to
determine whether to
give neoadjuvant
therapy
Opportunity
Molecular staging
using ctDNA to
determine whether
to give adjuvant
therapy
Planned “IDEA-2”: Non-inferiority study for ctDNA-neg low-risk
stage III CC --- one of several potential designs
ctDNA test
(week 4-5)
BRAF testing*
MSI testing*
Stratified by:
Age (<70/≥70)
Particip. Group
Primary endpoint: DFS
Study design: Non-inferiority
Non-inferiority margin: TBD
International collaboration
Low-risk Stage III
colon cancer
after curative surgery
RctDNA negative
3 months CAPOX
Observation only
ctDNA analysis every 3 months
until 2 years after surgery
*Results of BRAF and MSI testing will be used
in pre-specified subgroup analysis
20. BRAF Mutations in CRC
•BRAF is primary effector of KRAS
signaling
•BRAF mutations:
•Occur most frequently in exon 15
(V600E)
•Found in 4%-14% of patients with CRC
•Mutually exclusive with KRAS
mutations
•Associated with poor prognosis
Raf
MEK
Erk
P
P P
P
Tumor cell
proliferation
and survival
EGF
Tumor Cell
Ras
Yarden. Nat Rev Mol Cell Biol. 2001; Di Nicolantonio. J Clin Oncol. 2008;
Artale. J Clin Oncol. 2008.
21. Rationale for combined BRAF and EGFR blockade
BRAFmut
RAS
MEK
EGFR
ERK
EGFR
1Hong et al Cancer Disc ‘16
22. Encorafenib plus Cetuximab With or Without
Binimetinib for BRAF V600E–Mutant Metastatic
Colorectal Cancer:
Quality of Life Results from a Randomized, 3-Arm,
Phase 3 Study vs. the Choice of Either Irinotecan or
FOLFIRI plus Cetuximab (BEACON CRC)
Scott Kopetz, Axel Grothey, Eric Van Cutsem, Rona Yaeger, Harpreet Wasan,
Takayuki Yoshino, Jayesh Desai, Fortunato Ciardiello, Fotios Loupakis, Yong Sang Hong,
Neeltje Steeghs, Tormod Kyrre Guren, Hendrik-Tobias Arkenau, Pilar Garcia-Alfonso,
Ashwin Gollerkeri, Kati Maharry, Janna Christy-Bittel, Christopher Keir, Michael Pickard,
and Josep Tabernero
Scott Kopetz, MD
BEACON CRC: Binimetinib, Encorafenib, And Cetuximab COmbiNed to Treat BRAF-mutant ColoRectal Cancer
23. Triplet therapy
ENCORAFENIB + BINIMETINIB + CETUXIMAB
n = 205
Doublet therapy
ENCORAFENIB + CETUXIMAB
n = 205
Control arm
FOLFIRI + CETUXIMAB, or
irinotecan + CETUXIMAB
n = 205
R
1:1:1
Phase 3
Study Design
Primary
Endpoints:
OS
(All randomized Pts)
Randomization was stratified by ECOG PS (0 vs. 1), prior use of irinotecan (yes vs. no), and cetuximab source (US-licensed vs. EU-approved)
Triplet vs Control
Secondary Endpoints: Doublet vs Control and Triplet vs Doublet - OS & ORR, PFS, Safety
ORR –
Blinded Central
Review
(1st 331 randomized Pts)
Safety Lead-in
QOL Assessments: EORTC QOL Questionnaire (QLQ C30), Functional Assessment of Cancer Therapy Colon Cancer, EuroQol 5D5L, and
Patient Global Impression of Change).
ENCORAFENIB +
BINIMETINIB +
CETUXIMAB
N = 30
Encorafenib 300 mg PO daily
Binimetinib 45 mg PO bid
Cetuximab standard weekly
dosing
Patients with BRAFV600E mCRC with disease progression after 1 or 2 prior regimens; ECOG PS of 0 or 1;
and no prior treatment with any RAF inhibitor, MEK inhibitor, or EGFR inhibitor
24. Randomized
(N=665)
Control
(N=221)
Doublet
(N=220)
Triplet
(N=224)
Received allocated
treatment
99%
Did not receive
treatment
1%
Median follow-up time for OS for all patients was 7.8 months
Subject Disposition
*As of the data cutoff date of February 11, 2019. NOTE: Discontinued/Ongoing percentages may not add to 100 because denominator includes patients who did not receive treatment.
Discontinued treatment 64%
Treatment ongoing* 35%
Received allocated
treatment
87%
Did not receive
treatment
13%
Discontinued treatment 71%
Treatment ongoing* 17%
Received allocated
treatment
98%
Did not receive
treatment
2%
Discontinued treatment 63%
Treatment ongoing* 35%
Kopetz et al. N Engl J Med 2019; 381:1632-1643
25. Baseline Patient Characteristics
25
CHARACTERISTICPGICPGIC
Triplet
N=224
Doublet
N=220
Control
N=221
Female 53% 48% 57%
Age, median (range), years 62 (26, 85) 61 (30, 91) 60 (27, 91)
ECOG PS 0 52% 51% 49%
Location of primary tumor*
Left colon (includes rectum) 35% 38% 31%
Right colon 56% 50% 54%
≥3 organs involved 49% 47% 44%
Presence of liver metastases 64% 61% 58%
Prior lines of therapy
1 65% 66% 66%
>1 35% 34% 34%
MSI-H† 10% 9% 5%
CEA Baseline Value > 5 ug/L 80% 70% 81%
CRP Baseline Value > 10mg/L 42% 36% 41%
CA 19.9 Baseline Value > 35 U/mL 71% 68% 71%
FACT-C Total Score, median (range) 97 (36, 134) 96 (27, 135) 98 (29, 134)
EORTC QLQ-C30 Global Health Status, median (range) 67 (0, 100) 67 (0, 100) 67 (0, 100)
PGIC, median (range) 4 (1, 7) 4 (1, 7) 4 (1, 7)
Abbreviations: CEA, carcinoembryonic antigen; CRP, c-reactive protein; ECOG PS, Eastern Cooperative Oncology Group Performance Status; MSI-H, microsatellite instability high (abnormal high); FACT-C, Functional Assessment of Cancer
Therapy – Colorectal (version 4); EORTC QLQ-C30, European Organization for Research and Treatment of Cancer core quality-of-life Questionnaire (version 3.0); PGIC, Patient Global Impression of Change.
Baseline characteristics are summarized for all 665 randomized patients. †Based on assessment by polymerase chain reaction. MSI status is missing in 23% of patients. *Remaining patients had primary tumor in both left and right sides of
colon and those with unknown location of primary tumor.
Kopetz et al. N Engl J Med 2019; 381:1632-1643
26. Overall Survival and Objective Response Rate
Objective Response Rate (First 331 Randomized Patients)
Confirmed Response
by blinded central review
Triplet
N=111
Doublet
N=113
Control
N=107
Objective Response Rate 26% 20% 2%
95% (CI) (18%, 35%) (13%, 29%) (<1%, 7%)
p-value vs. Control <0.0001 <0.0001
Triplet vs Control* Doublet vs Control*
Kopetz et al. N Engl J Med 2019; 381:1632-1643*Overall survival analysis conducted in all randomized patients.
27. Maintenance of Quality of Life: EORTC QLQ-C30
27
Time to Definitive Deterioration in EORTC QLQ-C30 Global Health Status*
* The time to definitive deterioration is defined as the time from the date of randomization to the date of event, which is defined as at least 10% worsening relative to Baseline of the corresponding scale
score with no later improvement above this threshold observed during the course of the study or death due to any cause.
28. Maintenance of Quality of Life: FACT-C
28
Time to Definitive Deterioration in FACT-C Colorectal Cancer Subscale*
Results for EuroQol 5D5L
were similar as other QOL assessments.
* The time to definitive deterioration is defined as the time from the date of randomization to the date of event, which is defined as at least 10% worsening relative
to Baseline of the corresponding scale score with no later improvement above this threshold observed during the course of the study or death due to any cause.
29. BEACON CRC: Updated Analysis
• In this updated analysis of BEACON CRC
(which includes ORR for all randomized patients
(additional 364 patients) and 6 months additional
follow-up):
• The triplet and doublet demonstrated
improved OS and ORR in patients with BRAF
V600E-mutant mCRC when compared with
current standard of care chemotherapy
• The safety profile was consistent with the known
safety profile of each agent and consistent with the
primary analysis.
The full updated BEACON results with
subgroup analysis will be presented at a
future congress
Triplet vs Doublet
Objective Response Rate
Confirmed Response
by blinded central review
Triplet
N=224
Doublet
N=220
Control
N=221
Objective Response Rate 27% 20% 2%
95% (CI) (21%, 33%) (15%, 25%) (<1%, 5%)
p-value vs. Control <0.0001 <0.0001
Median OS Follow up:
12.8 months*
30. Efficacy Subgroup Analyses
Exploratory subgroup analyses suggest pts in some poorer prognostic categories may benefit
more from triplet than doublet therapy
32. CheckMate-142 Study Design
• CheckMate-142 is an ongoing, multi-cohort, nonrandomized phase 2 study evaluating the efficacy and
safety of nivolumab-based therapies in patients with mCRC (NCT02060188)
• Median follow-up for the 1L nivolumab plus low-dose ipilimumab cohort was 13.8 months (range, 9–19)c
aUntil disease progression or discontinuation in patients receiving study therapy beyond progression, discontinuation due to toxicity, withdrawal of consent, or the study end; bPatients with a CR, PR, or SD for ≥12
weeks divided by the number of treated patients; cTime from first dose to data cutoff
BICR = blinded independent central review
• Histologically
confirmed
metastatic or
recurrent CRC
• MSI-H/dMMR per
local laboratory 1L
Nivolumab 3 mg/kg Q2Wa
Previously treated
Previously treated
Nivolumab 3 mg/kg +
ipilimumab 1 mg/kg Q3W
(4 doses and then
nivolumab 3 mg/kg Q2W)a
Nivolumab 3 mg/kg Q2W +
ipilimumab 1 mg/kg Q6Wa
Primary endpoint:
• ORR per investigator
assessment (RECIST v1.1)
Other key endpoints:
• ORR per BICR, DCRb,
DOR, PFS, OS, and safety
N=45
Lenz et al., ESMO 2018, ASCO GI 2020
33. Best Reduction in Target Lesions
*Confirmed response per investigator assessment
aEvaluable patients per investigator assessment
• 84% of patients had a reduction in tumor burden from baseline
Lenz et al., ASCO GI 2020
Who are these patients? Hyperprogression?
34. Progression-Free and Overall Survival
Lenz et al., ASCO GI 2020
Median follow-up: 20 months
PFS
OS
We do not see this with chemotherapy!
36. Evaluation of First-Line IO in MSI-H mCRC is Ongoing
MMR-D mCRC
Strat: BRAF mut,
site of met, prior
adj Tx
mFOLFOX6 + BEV
Atezolizumab
mFOLFOX6 + BEV +
Atezolizumab
R
COMMIT Trial
NRG-GI004/
SWOG 1610
N=51/347
(since 11/17)
Primary EP: PFS
PIs: James Lee, Mike Overman
KEYNOTE-177 has finished accrual
Results TBD
To be redesigned,
Atezo alone arm dropped
37. Clinicaltrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT03406871 (Accessed April 15, 2019); Fukuoka S, et al. ASCO 2018:Poster TPS3124; Fukuoka S, et al. ASCO 2019:Poster 2522.
REGONIVO: A phase 1/2 study of regorafenib plus nivolumab in
advanced gastric cancer and CRC (EPOC1603/NCT03406871)
Dose escalation cohort: “3+3” design Expansion cohort
Regorafenib
Level 3: 160 mg/day
3 weeks on/1 week off
+
Nivolumab 3 mg/kg
q2w
N=3
Colorectal cancer
Gastric cancer
N=36
Regorafenib
Level 1: 80 mg/day
3 weeks on/1 week off
+
Nivolumab 3 mg/kg
q2w
N=4
Regorafenib
Level 2: 120 mg/day
3 weeks on/1 week off
+
Nivolumab 3 mg/kg
q2w
N=7
• Patients with
histologically or
cytologically confirmed
advanced or metastatic
solid tumors (selected
solid tumors in the
expansion cohort)
N=50
Translational research:
• T-cell phenotype assays including Treg analysis using
both flow cytometry and CyTOF
• In vitro functional assays
• HLA typing
• Immunohistochemistry (e.g., PD-L1, FoxP3, CD68,
CD163)
• Mutational analyses (whole exome sequencing)
• RNA sequencing
• 16S sequencing
Primary endpoints:
• Dose escalation: MTD/RD and
safety of combination treatment
• Dose expansion: Safety and efficacy of the combination
treatment at the regorafenib MTD/RD
Secondary endpoints:
• ORR (RECIST v1.1 and irRECIST)
• PFS
• OS
• DCR
• Incidence of TEAEs
Key inclusion criteria:
• Patients with unresectable, recurrent solid tumors
who are refractory or intolerant to standard
chemotherapy
• ECOG PS 0 or 1
Key exclusion criteria:
• Prior regorafenib treatment; prior immune
checkpoint blockade was permitted
38. Fukuoka S, et al. ASCO 2019:Poster 2522. Update: Shitara et al, ASCO GI 2020
REGONIVO: The ORR was 36% in CRC and 44% in gastric cancerChangefrombaseline(%)
PD SD PR CR
New lesion
Anti-PD-1/PDL-1 refractory
MSI-H (all other patients were MSS)
Colorectal cancer Gastric cancer
ORR 36%
(MSS 33%)
ORR 44%
(all responders were MSS)
39. Fukuoka S, et al. ASCO 2019:Poster 2522. Update: Shitara et al, ASCO GI 2020
REGONIVO: The ORR was 36% in CRC and 44% in gastric cancerChangefrombaseline(%)
PD SD PR CR
New lesion
Anti-PD-1/PDL-1 refractory
MSI-H (all other patients were MSS)
Colorectal cancer Gastric cancer
ORR 36%
(MSS 33%)
ORR 44%
(all responders were MSS)
40. Abstract 7: A randomized phase III trial
comparing primary tumor resection plus
chemotherapy with chemotherapy alone in
incurable stage IV colorectal cancer: JCOG1007
study (iPACS)
Yukihide Kanemitsu, MD et al
41.
42.
43.
44.
45.
46. Conclusions
• Advances in molecular profiling have identified multiple colorectal
cancer subtypes which warrant specific interventions
• Tissue/ organ independent drug approvals based on molecular
signature are emerging
• Who to test, when and how….?
• Even common organ cancers are turned into a collection of rare
diseases
• Challenges for clinical trial design to provide proof of efficacy of
novel therapy
• Augmented immunotherapy can be real !
• ctDNA will change the way we diagnose and treat cancer patients
48. Fight Colorectal Cancer Mission
We FIGHT to cure colorectal cancer and serve as relentless champions of
hope for all affected by this disease through informed patient support,
impactful policy change, and breakthrough research endeavors.