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