Opening remarks Welcome to CUP 2019: Cancer of Unknown Primary in the Era of Precision Medicine Focus: Contemporary Clinical Management and International.

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Presentation transcript:

Opening remarks Welcome to CUP 2019: Cancer of Unknown Primary in the Era of Precision Medicine Focus: Contemporary Clinical Management and International CUP Research

Opening remarks… continued Objectives: Current Optimal Tissue Diagnostics Clinical and Translational Trials Optimal Clinical Management and Focus on the Future Debate Controversies Regarding Biology, Diagnosis and Treatment

Many Different cancers present as cup The CUP Syndrome is unique and appears to be a small subset of many specific cancer types with very small anatomical primary sites, but with ability to metastasize The explanation of why the small invasive primary does not grow large and why metastasis develop and grow remains unknown, but likely a genetic/epigenetic mechanism.

Management of patients with metastatic cancer

A New initiative: precision medicine defined The Prevention and Treatment of Patients Based on Individual Variability Collins and Varmus, NEJM 2015

Precision oncology: Not So new after all but expanding rapidly Breast Cancer Hormone Receptor, HER2, BRCA Status GEJ Cancer HER2 Status CRC KRAS Status HN Cancer HPV Status Guides Treatment Ovarian Cancer BRCA Status Guides Treatment CML BCR-ABL Status Guides Treatment AML Cytogenetics Guide Treatment NHL FISH Status Guides Treatment Lung Cancer EGFR, ALK/ROS 1 Guides Treatment

A Case for rapid change: Lung cancer care EGFR 2004 Erlotinib 2015 Osimertinib Histology 2006 Bevacizumab 2007 Pemetrexed ALK 2011 Crizotinib 2014 Ceritinib Alectinib 2017 Brigatinib 2018 Lorlatinib ROS 2016 PDL1, BRAF, MSI, HER2, RET, NTRK, TMB? Pembrolizumab (PD-L1+) Dabrafenib, Tramectinib Pembrolizumab (MSI, +chemo) Larotrectinib

Precision medicine DATA the right drug at the right dose to the right patient

MAJOR QUESTIONS Is CUP a Single Entity With a Unique Biology? Does the Diagnosis of the Tissue of Origin and Site-Specific Therapy Improve Patient Outcomes? Does Comprehensive Molecular Profiling (NGS) of the Biopsy Specimen Provide Information for Precision Therapy? Does Empiric Chemotherapy (one therapy for CUP patients) Still Have a Role? Yes and No!