Ο ρόλος των μη χειρουργικών θεραπειών στο μη μεταστατικό μυοδιηθητικό καρκίνο ουροδόχου κύστεως Γεώργιος Δ. Λύπας Παθολόγος Ογκολόγος Α’ Ογκολογική Κλινική.

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Presentation transcript:

Ο ρόλος των μη χειρουργικών θεραπειών στο μη μεταστατικό μυοδιηθητικό καρκίνο ουροδόχου κύστεως Γεώργιος Δ. Λύπας Παθολόγος Ογκολόγος Α’ Ογκολογική Κλινική & Μονάδα Γενετικής Ογκολογίας ΔΘΚΑ ΥΓΕΙΑ

Clinical States Model: Bladder Cancer

Treatment options? Presented By Matt Galsky at 2014 ASCO Annual Meeting

Cystectomy is potentially curative Presented By Matt Galsky at 2014 ASCO Annual Meeting

Bladder cancer is a disease of the elderly Presented By Matt Galsky at 2014 ASCO Annual Meeting

Radical cystectomy is performed less frequently in the elderly Presented By Matt Galsky at 2014 ASCO Annual Meeting

Bladder Cancer: A disease of the elderly

What else do we need to know? Presented By Matt Galsky at 2014 ASCO Annual Meeting

Geriatric Assessment Presented By Matt Galsky at 2014 ASCO Annual Meeting

Overview Presented By Nicholas James at 2013 ASCO Annual Meeting

Background

Bladder cancer is a systemic disease

Neoadjuvant chemotherapy and survival

Neoadjuvant chemotherapy

MRC/EORTC Trial - Loco-regional and metastatic control

Is survival better after surgery? Presented By Nicholas James at 2013 ASCO Annual Meeting

Survival from UK Registry data

Survival is better after surgery?

Survival surgery vs radiotherapy

Age at diagnosis

Choice of treatment

Chemoradiation vs radiotherapy alone

Synchronous Chemo-radiotherapy

Cisplatinum and RT +/- surgery

BCON: Aim and endpoints

BCON Results

BC2001: Trial design

Chemotherapy regimen

Patient demographics

Acute toxicity

RTOG 6 month toxicity outcomes

Loco-regional disease free survival in chemotherapy randomisation

Slide 29

Patterns of recurrence after chemoRT

Markers for outcome

Baseline indicators of poor outcome with (chemo)RT

Can we select good responders?

Trimodality therapy

Results – Boston approach

MRE11 hypothesis

Slide 37

Cisplatin Toxicities

Impact of Renal Impairment on Eligibility for Adjuvant Cisplatin-Based Chemotherapy

Unfit for Cisplatin

Concurrent RT with non-platinum chemotherapy ● Gemcitabine 200mg/m2: twice a week (from d1) ● n=34 (elderly pts) ● T2-T4, N any ● 6 wks – CR:13/34 ● 1y. survival 81% ● Gr3-4 toxicity: 5/34 (feb. neutropenia or dehydration) J Clin Oncol 27, 2009 (suppl; abstr e16135)

Outline

Optimization of Chemotherapy: Avoid in those unlikely to respond

Alterations in ATM, RB1 or FANCC predict pathologic complete response (pT0) (Plimack et al. Abstract 4538)

Association of ERCC2 mutations with cisplatin sensitivity in MIBC (Rosenberg et al. Abstract 4510)

Outline

Optimization of Chemotherapy: Avoid in those likely to experience toxicity

Induction of p16LUC Correlates with Age

Expression of p16 INK4a by age and prior chemotherapy exposure

Outline

Slide 29

Slide 30

Slide 2

Slide 3

Slide 12

Response according to PD-L1 status (on tumor cells) by IHC

Slide 13

Conclusions