logging in or signing up Colorectal cancer hassan ebrahim amusegy Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 153 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: January 29, 2012 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Updates on Colorectal Cancer Treatment: Hassan M Ebrahim , MD, MB CHB American Board Certified Doctors for Egypt Ahmed Maher Hospital – May 21, 2011 Updates on Colorectal Cancer TreatmentIntroduction : More in middle-aged group > 50 year-old Left-side dominant Change of stool character Early detection Right-side disease Young-aged group, familial Advanced disease IntroductionManagement of Early Stages: Stage I, II, III Colon cancer Low anterior resection (LAR) Rectal cancer Abdominal perineal resection (APR) permanent colostomy Anal preserve induction CCRT surgery Management of Early StagesHigh-risk of recurrence: Stage IIB (T4), III(N+) Adjuvant chemotherapy Attempt to eradicate micrometastasis Adjuvant CCRT – for rectal cancer To improve local control High-risk of recurrenceAdjuvant chemotherapy: Adjuvant chemotherapy No adjuvant C/T Adjuvant C/T DFS: 30% DFS: 50% 30% alive 50% alive 50% dead 70% dead Benefit 20% ptsAdjuvant chemotherapy: Bolus 5FU/LV as a standard 6 months duration 5-year OS 66% Oxaliplatin / Irinotecan era doublet chemotherapy as the standard for metastatic disease how about doublet in adjuvant setting ? Adjuvant chemotherapyPowerPoint Presentation: New England Journal of Medicine 2004 FOLFOX vs. infusional 5FU/LVPowerPoint Presentation: Oxaliplatin + bolus 5FU/LV vs. 5FU/LV Journal of clinical oncology 2007PowerPoint Presentation: IFL, 6m 5FU/LV, 6m JCO 2004; 22: 245s CALGB Stage III OP Too toxic, mortality Early closure!! FOLFIRI, 6m LV5FU, 6m Stage III OP No difference !! JCO 2005; 23: 246s ACCORD 2 Irinotecan + 5FU/LVAdjuvant chemotherapy: Oxaliplatin + 5FU/LV could be a new standard Not yet Adjuvant chemotherapyAdjuvant chemotherapy in Stage II Disease: Benefits remain Controversial. Not routinely recommended. Adjuvant chemotherapy for medically fit, high risk stage II disease. MMR testing is favored than Oncotype DX Adjuvant chemotherapy in Stage II DiseaseMetastatic Disease: Essentially incurable Resection of metastasis could prolong survival liver lung “Continuum of care” rather than “Lines” of therapy. Metastatic DiseaseActive agents : 5-FU leucovorin Oxaliplatin Irinotecan Monoclonal antibodies Cetuximab (Erbitux) Bevacizumab (Avastin) Panitumumab (Vecitibix) Active agents5-FU: Leucovorin enhances 5FU binding Infusional better than bolus Capecitabine may substitute HDFL 5-FUOxaliplatin: Derivative from Cisplatin Accumulative toxicity Neuropathy OxaliplatinIrinotecan : Plant alkaloid unpredictable acute toxicity Diarrhea Gene polymorphism – UGT1A1 Impaired bile metabolism No accumulated toxicity IrinotecanDoublet is mainstay: Oxaliplatin + 5FU/LV FOLFOX Irinotecan + 5FU/LV FOLFIRI Doublet is mainstayPowerPoint Presentation: Journal of Clinical Oncology 2004 FOLFIRI FOLFOX FOLFIRI FOLFOX RR: 4% RR: 15% RR: 56% RR: 54% 220 pts Overall Survival : 21.5m vs. 20.6mThree drug combination: FOLFOXIRI vs. FOLFIRI Improved outcome RR: 66%, 41%, p=0.0002 PFS: 9.8m, 6.9m, p=0.0006 OS: 22.6m, 16.7m, p=0.032 Three drug combination Journal of Clinical Oncology 2007Bevacizumab (Avastin®): Anti-VEGF Ab (vascular endothelial growth factor) Avascular tumour Angiogenic switch Vascularised tumour Tumour cell intravasation Seeding in distant organs Secondary angiogenesis Premalignant stage Malignant tumour Tumour growth Vascular invasion Dormant micrometastasis Overt metastasis Bevacizumab ( Avastin ® )PowerPoint Presentation: Kaplan-Meier Estimates of Survival Hurwitz, H. et al. N Engl J Med 2004;350:2335-234 Bevacizumab (Avastin®): Side effects & contraindications Is it a standard first line? Not yet Continuation beyond progression? A trend but contravrsial Bevacizumab ( Avastin ® ) Cetuximab (Erbitux): Anti-EGFR Ab (Epidermal growth factor receptor) Monotherapy vs. combined with chemotherapy K-ras wild type First line (+ Irinotcan), second line or refractory Cetuximab ( Erbitux )PowerPoint Presentation: Cetuximab Montherapy vs. Cetuximab plus Irinotecan Cunningham, D. et al. N Engl J Med 2004;351:337-345PowerPoint Presentation: . Tabernero J et al. JCO2007;25:5225-5232 ©2007 by American Society of Clinical Oncology Cetuximab, Oxaliplatin,vs. Cetuximab plus Oxaliplatin Panitumumab (Vectibix): Anti-EGFR Ab K-ras wild type First line, second line or refractory Less hypersensitivity reactions Are EGFR MoAbs interchangeable? Panitumumab ( Vectibix )PowerPoint Presentation: . Van Cutsem E et al. JCO 2007;25:1658-1664 ©2007 by American Society of Clinical Oncology Panitumumab vs. Best Supportive CarePowerPoint Presentation: K K K K signal transduction Migration Proliferation Adhesion Differentiation K K K 1 1 1 1 1 2 2 EGFR MoAbs K 1 K 1 K 1 K 1Monoclonal Antibodies: Plus 5FU-based doublet is the mainstay mAbs optimal combination and sequence to be defined Monoclonal Antibodies You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Colorectal cancer hassan ebrahim amusegy Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 153 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: January 29, 2012 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Updates on Colorectal Cancer Treatment: Hassan M Ebrahim , MD, MB CHB American Board Certified Doctors for Egypt Ahmed Maher Hospital – May 21, 2011 Updates on Colorectal Cancer TreatmentIntroduction : More in middle-aged group > 50 year-old Left-side dominant Change of stool character Early detection Right-side disease Young-aged group, familial Advanced disease IntroductionManagement of Early Stages: Stage I, II, III Colon cancer Low anterior resection (LAR) Rectal cancer Abdominal perineal resection (APR) permanent colostomy Anal preserve induction CCRT surgery Management of Early StagesHigh-risk of recurrence: Stage IIB (T4), III(N+) Adjuvant chemotherapy Attempt to eradicate micrometastasis Adjuvant CCRT – for rectal cancer To improve local control High-risk of recurrenceAdjuvant chemotherapy: Adjuvant chemotherapy No adjuvant C/T Adjuvant C/T DFS: 30% DFS: 50% 30% alive 50% alive 50% dead 70% dead Benefit 20% ptsAdjuvant chemotherapy: Bolus 5FU/LV as a standard 6 months duration 5-year OS 66% Oxaliplatin / Irinotecan era doublet chemotherapy as the standard for metastatic disease how about doublet in adjuvant setting ? Adjuvant chemotherapyPowerPoint Presentation: New England Journal of Medicine 2004 FOLFOX vs. infusional 5FU/LVPowerPoint Presentation: Oxaliplatin + bolus 5FU/LV vs. 5FU/LV Journal of clinical oncology 2007PowerPoint Presentation: IFL, 6m 5FU/LV, 6m JCO 2004; 22: 245s CALGB Stage III OP Too toxic, mortality Early closure!! FOLFIRI, 6m LV5FU, 6m Stage III OP No difference !! JCO 2005; 23: 246s ACCORD 2 Irinotecan + 5FU/LVAdjuvant chemotherapy: Oxaliplatin + 5FU/LV could be a new standard Not yet Adjuvant chemotherapyAdjuvant chemotherapy in Stage II Disease: Benefits remain Controversial. Not routinely recommended. Adjuvant chemotherapy for medically fit, high risk stage II disease. MMR testing is favored than Oncotype DX Adjuvant chemotherapy in Stage II DiseaseMetastatic Disease: Essentially incurable Resection of metastasis could prolong survival liver lung “Continuum of care” rather than “Lines” of therapy. Metastatic DiseaseActive agents : 5-FU leucovorin Oxaliplatin Irinotecan Monoclonal antibodies Cetuximab (Erbitux) Bevacizumab (Avastin) Panitumumab (Vecitibix) Active agents5-FU: Leucovorin enhances 5FU binding Infusional better than bolus Capecitabine may substitute HDFL 5-FUOxaliplatin: Derivative from Cisplatin Accumulative toxicity Neuropathy OxaliplatinIrinotecan : Plant alkaloid unpredictable acute toxicity Diarrhea Gene polymorphism – UGT1A1 Impaired bile metabolism No accumulated toxicity IrinotecanDoublet is mainstay: Oxaliplatin + 5FU/LV FOLFOX Irinotecan + 5FU/LV FOLFIRI Doublet is mainstayPowerPoint Presentation: Journal of Clinical Oncology 2004 FOLFIRI FOLFOX FOLFIRI FOLFOX RR: 4% RR: 15% RR: 56% RR: 54% 220 pts Overall Survival : 21.5m vs. 20.6mThree drug combination: FOLFOXIRI vs. FOLFIRI Improved outcome RR: 66%, 41%, p=0.0002 PFS: 9.8m, 6.9m, p=0.0006 OS: 22.6m, 16.7m, p=0.032 Three drug combination Journal of Clinical Oncology 2007Bevacizumab (Avastin®): Anti-VEGF Ab (vascular endothelial growth factor) Avascular tumour Angiogenic switch Vascularised tumour Tumour cell intravasation Seeding in distant organs Secondary angiogenesis Premalignant stage Malignant tumour Tumour growth Vascular invasion Dormant micrometastasis Overt metastasis Bevacizumab ( Avastin ® )PowerPoint Presentation: Kaplan-Meier Estimates of Survival Hurwitz, H. et al. N Engl J Med 2004;350:2335-234 Bevacizumab (Avastin®): Side effects & contraindications Is it a standard first line? Not yet Continuation beyond progression? A trend but contravrsial Bevacizumab ( Avastin ® ) Cetuximab (Erbitux): Anti-EGFR Ab (Epidermal growth factor receptor) Monotherapy vs. combined with chemotherapy K-ras wild type First line (+ Irinotcan), second line or refractory Cetuximab ( Erbitux )PowerPoint Presentation: Cetuximab Montherapy vs. Cetuximab plus Irinotecan Cunningham, D. et al. N Engl J Med 2004;351:337-345PowerPoint Presentation: . Tabernero J et al. JCO2007;25:5225-5232 ©2007 by American Society of Clinical Oncology Cetuximab, Oxaliplatin,vs. Cetuximab plus Oxaliplatin Panitumumab (Vectibix): Anti-EGFR Ab K-ras wild type First line, second line or refractory Less hypersensitivity reactions Are EGFR MoAbs interchangeable? Panitumumab ( Vectibix )PowerPoint Presentation: . Van Cutsem E et al. JCO 2007;25:1658-1664 ©2007 by American Society of Clinical Oncology Panitumumab vs. Best Supportive CarePowerPoint Presentation: K K K K signal transduction Migration Proliferation Adhesion Differentiation K K K 1 1 1 1 1 2 2 EGFR MoAbs K 1 K 1 K 1 K 1Monoclonal Antibodies: Plus 5FU-based doublet is the mainstay mAbs optimal combination and sequence to be defined Monoclonal Antibodies