terapia medica gist€¦ · rare adult solid cancers are grouped in 10 domains corresponding to the...
TRANSCRIPT
DISCLOSURESHonoraria received for speaker, consultancy or advisory role from Pharma:Bayer, Deciphera, Eisai, Eli Lilly, Nektar Therapeutics, Pfizer
Honoraria received for speaker role from commercial Educational Providers:Accademia Nazionale Medicina, AIOM Servizi, Doctaforum, Dueci Promotion, Giava, Humanitas Mirasole, IMS Health, Micon, Peperosso, Realtime Meeting, SAMO, START Promotion, Unitelma
Institutional financial support to clinical studies from Pharma to my Unit at Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy:Advenchen Laboratories, Amgen Dompé, AROG Pharmaceuticals, Bayer, Blueprint Medicines, Daiichi Sankyo, Deciphera, Eisai, Eli Lilly, Epizyme Inc, Glaxo, Karyopharm Pharmaceuticals, Novartis, Pfizer, PharmaMar
GIST – localizedoperablelocalized
mutationalanalysis
surgery
Imatinibx 3 yrs
insensitive
sensitive
risksignificantlow
follow-up
GIST: prognostic factors
mitoses size site
[genotype]
Lancet 2009;373:1097
J Clin Oncol 2015;33:4276
OS TTF
RFS
J Clin Oncol 2016;34:244
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6
GIST - Adjuvant
3 yrs
01 yr 2 yrs
?
OSRFS
R OSrelapse
RFS
OSImatinib
Imatinib
R Rrelapse
Rrelapse
Imatinib
Imatinib
Imatinib
R Rrelapse
Rrelapse
Imatinib
Imatinib
Imatinib
R Rrelapse
Rrelapse
Imatinib
Imatinib
Imatinib
R Rrelapse
Rrelapse
Imatinib
Imatinib
Imatinib
JAMA Oncol 2018:e184060 [Epub ahead of print]
Cytoreductive therapy
KITex 11 mutated 60%ex 9 mutated 10%other mutations 10%
PDGFRA 10%ex 18 D842V mutatedother mutations
WT 10%SDH neg
SDH non-mutated SDHA/B/C/D mutated
SDH pos in NF1BRAF mutated…….
KITex 11 mutated 60%ex 9 mutated 10%other mutations 10%
PDGFRA 10%ex 18 D842V mutatedother mutations
WT 10%SDH neg
SDH non-mutatedSDHA/B/C/D mutated
SDH pos in NF1BRAF mutated…….
Imatinib sensitivity
Lasota J et al, Histopathology 2008;53:245
exon 9 (~10%) exon 11 (~70%) exon 13 (~5%)
exon 17 (~5 %)
PDGFRA (~10%) KIT(~80%) WT (~10%)
Corless CL et al. J Clin Oncol 2005;23:5357
PDGFRA
Clin Cancer Res 2012;18:4375
Heinrich M et al, CTOS 2018
PNAS 2011;108:314
Mussi C, Clin Cancer Res 2008;14:4550
Neurofibromatosis, type 1
GIST – metastatic disease
metastatic,sensitive mutation
progression
Imatinib
progression
Sunitinib
Regorafenib
generalized
surgery
focal
Imatinib surgery
Imatinib
chemotherapy
OS
months
J Clin Oncol 2017;35:1713
post-Imatinib
pre-Imatinib
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
post-Imatinib
pre-Imatinib
Lancet Oncol 2010;11:942
Secondary resistance
Lancet 2006;368:1329
R
placebo
Sunitinib
Second line – Phase 3
progression2
1
R
placebo
Regorafenib
Third line – Phase 3
progression2
1
Lancet 2013;381:295
Liegl B, J Pathol, 2008;216:64
Secondary resistance: molecular heterogeneity
Serrano-García C et al, ASCO 2013
Serrano-García C et al, ASCO 2013
Clin Cancer Res 2019;25:609
Heinrich M et al, CTOS 2018
George S et al, ESMO 2018
Lancet Oncol 2013;14:1175
Focal progression
Surgeryof progressing disease
Raut CP, J Clin Oncol 2006;24:2325
Surgeryof limited progression
Surgeryof responding residual disease
COUNTRIES/Towns
BELGIUM (Antwerp, Brussels, Leuven, Liège)
CZECH REPUBLIC (Brno, Prague)
DENMARK (Aarhus)
GERMANY (Berlin, Essen, Mannheim, Hamburg-Eppendorf, Marburg, Würzburg)
FINLAND (Turku)
FRANCE (Lyon, Paris, Villejuif)
HUNGARY (Budapest)
ITALY (Aviano, Bologna, Candiolo, Firenze, Genoa, Meldola, Milan, Naples, Rome, Siena, Torino, Treviso)
LITHUANIA (Kaunas)
NETHERLANDS (Amsterdam, Leiden, Maastricht, Njimegen, Rotterdam, Gronigen)
NORWAY (Oslo)
POLAND (Warsaw)
PORTUGAL (Coimbra, Lisboa, Porto)
SPAIN (Sevilla, Barcelona)
SWEDEN (Karolinska, Uppsala)
SLOVENIA (Ljubljana)
UNITED KINGDOM (Coventry, London, Oxford, Sheffield)
Rare adult solid cancers are grouped in 10 domains corresponding to the RARECARE classification and the ICD10.
These domains are also based on pre-existing successful collaborations, in particular for clinical research and expert networks active in the last 10-20 years
www.jointactionrarecancers.eu
