Lunge state of the art. Post-ASCO 2017

Transkript

1 Lunge state of the art Post-ASCO 2017 Åslaug Helland Radiumhospitalet

2 Litt strålebehandling EGFR ALK NSCLC immunterapi Mesoteliom SCLC Disposisjon

3 Salvage-behandling etter stereotaktisk strålebehandling Slide 23 Presented By Eric Brooks at 2017 ASCO Annual Meeting

4 Post-SABR isolated recurrences Presented By Suresh Senan at 2017 ASCO Annual Meeting

5 EGFR Mutasjon tilstede i ca 10% Målrettet behandling tilgjengelig Standard førstelinjes behandling ved st IV sykdom er tyrosin- kinase-hemmer Nytt medikament lovende Osimertinib effekt i CNS Gefitinib potensiale som adjuvant behandling

6 Nytt medikament utviklet, - sammenliknet med Iressa Dacomitinib versus Gefitinib for the <br />First-Line Treatment of Advanced NSCLC (ARCHER 1050): A Randomized, Open-Label, Phase 3 Trial Presented By Tony Mok at 2017 ASCO Annual Meeting

7 PFS: Blinded Independent Review <br />(ITT population) Presented By Tony Mok at 2017 ASCO Annual Meeting

8 Osimertinib EMA / FDA godkjent etter førstelinjes TKI -EGFR T790M mutasjon til stede Slide 7 Presented By Maria Garrassino at 2017 ASCO Annual Meeting

9 Slide 12 Presented By Maria Garrassino at 2017 ASCO Annual Meeting

10 EGFR adjuvant Gefitinib vs kjemoterapi som adjuvant postoperativ behandling 220 randomisert Median sykdomsfri overlevelse 28.7 (Iressa) vs 18 mnd (kjemoterapi) HR 0.6 Bedre livskvalitet Økte kostnader

11 Alectinib vs crizotinib in treatment-naïve advanced ALK+ NSCLC: primary results of the global phase III ALEX study (LBA9008) Presented By Alice Shaw at 2017 ASCO Annual Meeting

12 Ca 3% ALK-positiv lungekreft Standard behandling ALK-hemmer (Crizotinib) førstelinje Alectinib gode resultater

13 Study design Presented By Alice Shaw at 2017 ASCO Annual Meeting

14 Secondary endpoint: PFS, IRC-assessed Presented By Alice Shaw at 2017 ASCO Annual Meeting

15 PFS: analysis by subgroups* Presented By Alice Shaw at 2017 ASCO Annual Meeting

16 Immunterapi NSCLC PD1-hemmer (nivolumab og pembrolizumab) godkjent i Norge som annen-linjes behandling ved PDL1-uttrykk >1% Pembrolizumab godkjent ved >50% PDL1- uttrykk som førstelinjes-behandling God og langvarig effekt hos noen pasienter

17 Key-note 001, - pembrolizumab NSCLC 3-års data Patient Demographics/Baseline Characteristics

18 Slide 4

19 Neoadjuvant nivolumab Patients Presented By Jamie Chaft at 2017 ASCO Annual Meeting

20 Pathologic responses to neoadjuvant nivolumab Presented By Jamie Chaft at 2017 ASCO Annual Meeting

21 Atezolizumab Kontinuering av behandling etter (RECIST-) progresjon 7% ORR, 49% stabilt -> noen kan ha nytte av det

22 Mesoteliom Ca 70 får diagnosen årlig i Norge Stor sett ikke operable Kjemoterapi standard behandling 2 spennende studier: Nivo +/- ipi Kjemo +/- nintedanib

23 Slide 7 Presented By Arnaud Scherpereel at 2017 ASCO Annual Meeting

24 Slide 22 Presented By Arnaud Scherpereel at 2017 ASCO Annual Meeting

25 Study design Presented By Anna Nowak at 2017 ASCO Annual Meeting

26 OS: intention-to-treat population Presented By Anna Nowak at 2017 ASCO Annual Meeting

27 Småcellet lungekreft Få framskritt siste 10-år Aggressiv sykdom Nye resultater nivolumab +/- ipilimumab

28 CheckMate 032: Nivolumab ± Ipilimumab in Advanced SCLC <br />OS Non-Randomized Cohort Presented By Edward Garon at 2017 ASCO Annual Meeting

29 NCCN Guidelines for Nivolumab Plus Ipilimumab in SCLC Presented By Edward Garon at 2017 ASCO Annual Meeting

30 <br />CheckMate 032: Nivolumab ± Ipilimumab in Advanced SCLC <br />Phase 1/2 CheckMate 032 Study Design Randomized Cohort Presented By Edward Garon at 2017 ASCO Annual Meeting

31 CheckMate 032: Nivolumab ± Ipilimumab in Advanced SCLC<br />Summary of Response per BICR Presented By Edward Garon at 2017 ASCO Annual Meeting

32 Konklusjoner Ny RT etter stereotaksi-tilbakefall fornuftig Tagrisso god effekt intracerebralt (EGFR) Dacomotinib nytt effektivt medikament Gefitinib adjuvant ser lovende ut Alectinib god effekt! (ALK) Nivolumab neoadjuvant NSCLC spennende Pembrolizumab (NSCLC) gode 3-års-data Atezolizumab (NSCLC) - treatment beyond progression Ipi-nivo mesoteliom lovende! Mesoteliom :Nintedanib komb med kjemo lovende SCLC: Ipi-nivo - lovende