Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
Teràpies diana: fer un bon ús dels biomarcadors i del seu
valor predictiu
Joan Albanell
Hospital del Mar, PSM
Universitat Pompeu Fabra
A virtuous circle?
Challenges
1. Only a fraction of targeted drugs have a biomarker
2. When a biomarker is available, not all tests/labs provide reliable results
3. Reimbursement and accreditation strategies of biomarkers
unclear/ongoing
Nov 2005
Erlotinib
(pancreas)
Dec 2005
Sorafenib
(RCC)
Jan 2006
Sunitinib
(GIST)
Jan 2006
Sunitinib
(RCC)
Jun 2006
Cetuximab
(SCCHN)
Sep 2006
Panitunumab
(colon)
Oct 2006
Bevacizumab
(NSCLC & Colon)
Nov 2006
Trastuzumab
(adjuvant BC)
Apr 2007
Lapatinib
(BC)
May 2007
Temsirolimus
(RCC)
2005 2006 2010
Oct 2009
Pazopanib
(RCC)
July 2009
Bevacizumab
(RCC)
March2009
Everolimus
(RCC)
Nov 2010
Trastuzumab
(gastric cancer)
Targeted therapies approved by the US Food and Drug
Administration for the treatment of solid tumours since 2005-2010
November 2007
Sorafenib
(HCC)
February 2008
Bevacizumab
(Breast)
May 2009
Bevacizumab
(Gliobastoma)
2007 2008 2009
June 2005
Gefitinib
(NSCLC)
Molecularly Targeted Anti-Cancer Agents that Need a Target/Biomarker for
Prescription and Are EMA Approved
Drug
Trastuzumab
Lapatinib
Pertuzumab
T-DM1
Cetuximab
Panitumumab
Gefitinib
Erlotinib
Crizotinib
Vemurafenib
Imatinib
Biomarker
HER2 ampl/overexpr
HER2 ampl/overexpr
HER2 ampl/overexpr
HER2 ampl/overexpr
K-Ras, N-Ras wt
K-Ras, N-Ras wt
EGFR mutation
EGFR mutation
Alk translocation
B-Raf mutation
C-kit positive
Tumor type (% with target)
Breast (early and advanced), Gastric (15-20%)
Advanced breast (15-20%)
Advanced breast (15-20%)
Advanced breast (15-20%)
Advanced colorectal (40%), head and neck
Advanced colorectal (40%)
Advanced lung cancer (NSCLC) (10%)
Advanced lung cancer (NSCLC) (10%)
Advanced lung cancer (NSCLC) (2-4%)
Advanced Melanoma (50%)
Advanced GIST (95%)
Challenge 1. Only a subset of targeted drugs have a
validated biomarker
Targeting Treatment to a Specific Variant in the Melanoma Gene
McDermott U et al. N Engl J Med 2011;364:340-350.
NRAS
KRAS
EXON 2 EXON 3 EXON 4 EXON 1
12 13 61 117 146
EXON 2 EXON 3 EXON 4 EXON 1
12 13 61 117 146
40% 4% 6%
3% 4% 1%
59
59
12 13 61 117 146 59
12 13 61 117 146 59
RAS mutations in colorectal cancer detected in
daily clinical practice
RAS detection Platform – Hospital del Mar
SAMPLES RECIEVED 392
Not evaluable 1
Analyzed 358
Mutated 157
KRAS 12-13 114
KRAS A59 1
KRAS Q61 7
KRAS EXON 4 10
NRAS 12-13 15
NRAS Q61 10
Not Mutated 201
114; 32%
1; 0%
7; 2%
10; 3%
15; 4%
10; 3%
201; 56%
KRAS 12-13
KRAS 59
KRAS 61
KRAS EXON 4 NRAS 12-13
NRAS 61
NO MUTADAS
HER2+++
Courtesy JM. Corominas (quality control SEAP)
Challenge 2. A good therapy starts with a good diagnosis
HER2 FALSE NEGATIVE
HER2+++
Courtesy JM. Corominas (quality control SEAP)
Challenge 2. A good therapy starts with a good diagnosis
- Identification of labs that do not provide
adequate results
- Acreditation process ongoing (SEAP)
Challenge 2. A good therapy starts with a good diagnosis
EGFR results from the EMQN quality control - 2011
Courtesy of Bea Bellosillo (Hospital del Mar)
Challenge 2. A good therapy starts with a good diagnosis
PR PD
CE
A
(ng/m
L)
Liv
er
targ
et le
sio
n
(mm
)
CEA Liver target lesion
PR PD
Cetuximab based therapy Panitumumab therapy
Time (weeks)
EGFR S492R (% of detected alleles)
KRAS Q61H (% of detected alleles)
Muta
tio
ns
(% o
f de
tecte
d a
llele
s) EGFR gene amplification
1
2
Gene
co
py n
um
be
r
(ratio E
GF
R/C
EP
7)
25%
44%
0% 0% 0%
Time (weeks)
On (un)natural selection (Bellosillo…Montagut, in preparation)
Treatment Recommendation Shifted in a
Third of the Patients After Oncotype DX Testing
11.2% HT alone to CHT
20.6% CT to HT alone
Global
Therapy
Subset
Therapy
Personalized
Therapy
Challenge 3. Reimbursement and accreditation strategies
of biomarkers unclear/ongoing
Plataforma de biomarcadores SEOM SEAP
Selección de centros
Gestión de recursos (Industria)
Comisiones: evaluación de centros, técnica, ética