molecular & genomic pathology in the management of cancer: teaching...who, when, what and how
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Molecular & Genomic Pathology in the Management of Cancer: Teaching...Who, When, What and How. Antonia R. Sepulveda MD., PhD Columbia University, NY, NY. Notice of Faculty Disclosure. - PowerPoint PPT PresentationTRANSCRIPT
Molecular & Genomic Pathology in the Management of Cancer:
Teaching...Who, When, What and How
Antonia R. Sepulveda MD., PhDColumbia University, NY, NY
Notice of Faculty Disclosure
In accordance with ACCME guidelines, any individual in a position to influence and/or control the content of this ASCP CME activity has disclosed all relevant financial relationships within the past 12 months with commercial interests that provide products and/or services related to the content of this CME activity.
The individual below has responded that he/she has no relevant financial relationship(s) with commercial interest(s) to disclose:
Antonia R. Sepulveda MD., PhD.
HeItadline
Molecular mechanisms underlying cell function - Physiology - Pathology
Colorectal Cancer Molecular Mechanisms & Pathways
Molecular Testing: It Used to be “Simple”• One order – One test
– One result– One interpretation– One clinical application
Molecular Pathology: Solid Tumors Personalized Diagnostics for Targeted Therapies
Colon CancerLung Cancer Melanoma
KRAS mtBRAF mtMSIMLH1………
EGFR mtKRAS mtBRAF mtEML4Alk………
BRAF mtKIT mt………
Esophageal-Gastric Breast
Her2 neuIHC / FISH
GISTs
KITPDGFRA
GISTs
KITPDGFRA
BRAF V600E
BRAF V600EA: 30% T: 70%
A T
Colorectal Cancer: MSI-HSporadic? HNPCC/LS?
MLH1 Loss
PMS2 Loss
Then came Gene Panels and
Exome and Genome…
Molecular Genomic Pathology Heat Map: NGS-Tumors
Courtesy of Helen Fernandes PhD
What is the role of Pathologists and
Pathologists in Training in the Genomic Era?
Molecular Rotation: Residents
• Molecular Pathology (4 weeks)• Cytogenetics - tumor (4 weeks)• Cytogenetics - constitutional (2-4 weeks)• Immunogenetics (2 weeks)• Lectures• Journal Club
Molecular Genetic Pathology Fellowship• Knowledge of the principles of Molecular
Genetic Pathology:– Basic molecular biology, genetics, testing
methodologies, laboratory management
• Clinical application in:– Inherited disorders, oncology and gene targeted
therapies, infectious disease, hematology, immunogenetics and pharmacogenetics
Molecular & Genomic Pathology in the Management of Cancer:
Teaching...Who?
Trainees:ResidentsFellows:
Molecular Genetic PathologyAnatomic Pathology Subspecialties
Practicing Pathologists
Molecular & Genomic Pathology in the Management of Cancer:
Teaching… When and How?
-Lectures:
General: technical considerations
Integrated in subspecialty Anatomic Pathology
-Journal Club
-Tumor Boards and Multidisciplinary subspecialty
conferences
-CME conferences
Molecular & Genomic Pathology in the Management of Cancer:
Teaching… When and How?
Practice, Practice, Practice
-Rotations through dedicated service (PGM)
-Integration in Surgical and Cytopathology reports
-Molecular Oncology Case review conferences
Molecular & Genomic Pathology in the Management of Cancer:
Teaching...What? - Molecular mechanisms of disease-Technical approaches-Result interpretation-Correlation with surgical/cytopathology diagnosis-Integration with clinical setting
-Indications for targeted therapy-Indications as predictors of disease
development or recurrence
Molecular & Genomic Pathology in the Management of Cancer:
Teaching...What?
Identifying a Curriculum-Local Institution-Societies:
AMP Training & Education Committee Curriculum development task forces:
• Molecular Pathology Residency Training• MGP Fellow Training and Curriculum in
Genomics
Molecular & Genomic Pathology in the Management of Cancer: Sailing ahead!