Ulrik Lassen MD, PH.D Phase 1 Unit

Slides:



Advertisements
Similar presentations
Inhibition of Poly (ADP-Ribose) Polymerase (PARP) by ABT-888 in Patients With Advanced Malignancies: Results of a Phase 0 Trial Shivaani Kummar, MD National.
Advertisements

1Kitasato-Harvard Symposium 10/03/2002 New Monoclonal Antibody Approved for Advanced Breast Cancer Shin-ichi Nihira, Ph.D. Dept. Clinical Research 3 Chugai.
Zeroing in on Non-Small Cell Lung Cancer: Integrating Targeted Therapies into Practice.
Clinical Implementation of Genomic Cancer Medicine
Wilson WH et al. Proc ASH 2012;Abstract 686.
A trial for women with –‘Triple negative’ breast cancer (TNBC) –Localised to breast +/- lymph nodes –Recommended standard treatment involves NEPTUNE Taxane.
Yan Guo Assistant Professor Department of Cancer Biology Vanderbilt University USA.
Gene 210 Cancer Genomics April 29, Key events in investigating the cancer genome M R Stratton Science 2011;331:
Gene 210 Cancer Genomics May 5, Key events in investigating the cancer genome M R Stratton Science 2011;331:
Molecular Testing of lung cancer in routine practice
© NuAge Vision Webwww.nuage-vision.com Tel:+44 (0) (0) Developing.
Re-Examination of the Design of Early Clinical Trials for Molecularly Targeted Drugs Richard Simon, D.Sc. National Cancer Institute linus.nci.nih.gov/brb.
Precision Medicine: From stratified therapies to personalized therapies Fabrice ANDRE Institut Gustave Roussy Villejuif, France.
Comprehensive Gene Expression Analysis of Prostate Cancer Reveals Distinct Transcriptional Programs Associated With Metastatic Disease Kevin Paiz-Ramirez.
Metastatic Breast Cancer: One Size Does Not Fit All Clifford Hudis, M.D. Chief, Breast Cancer Medicine Service MSKCC.
About these slides SPEC – Short Presentation in Emerging Concepts Provided by the CAP as an aid to pathologists to facilitate discussion on the topic.
New Developments in Cancer Treatment Dulcinea Quintana, MD.
Challenges in Incorporating Integral NGS into Early Clinical Trials
Stem Cells In Clinical Practice: STELLA Experience Manolo D’Arcangelo Department of Oncology Ospedale Civile di Livorno.
Oncology Update Louis Lao. Objective How to cure cancer in the Asian population (20min)
Prognose mittels Genexpression Prof. Martin H. Brutsche Kantonsspital St. Gallen-CH.
Michael Birrer Ian McNeish New Developments in Biology and Targets of Epithelial Ovarian Cancer.
The Value of Tissue Banks to Drug and Dx Developers Barbara L. Handelin, Ph.D. Conflicts of Interest, Privacy/Confidentiality, and Tissue Repositories:
Computational biology of cancer cell pathways Modelling of cancer cell function and response to therapy.
Phase I Study of PLX4032: Proof of Concept for V600E BRAF Mutation as a Therapeutic Target in Human Cancer Flaherty K et al. American Society of Clinical.
Developing medicines for the future and why it is challenging Angela Milne.
Activity and Tolerability of Afatinib (BIBW 2992) and Cetuximab in NSCLC Patients with Acquired Resistance to Erlotinib or Gefitinib Janjigian YY et al.
Overall survival in NSCLC
Full Proposal for the German Cancer Aid Priority Program 'Translational Oncology' (2st call) 2015 Lead Applicants: Prof. Dr. med. Magnus von Knebel Doeberitz.
INTERPRETING GENETIC MUTATIONAL DATA FOR CLINICAL ONCOLOGY Ben Ho Park, M.D., Ph.D. Associate Professor of Oncology Johns Hopkins University May 2014.
Clinicopathologic Features of EML4-ALK Mutant Lung Cancer Shaw AT et al. ASCO 2009; Abstract (Poster)
Personalized medicine in lung cancer R4 김승민. Personalized Medicine in Lung Cancer patients with specific types and stages of cancer should be treated.
1 Trends in drug development programs in the era of Personalized Medicine Gunnar Saeter, M.D., Ph.D. Head, Institute for Cancer Research Oslo University.
Genomic Medicine Rebecca Tay Oncology Registrar. What is Genomic Medicine? personalised, precision or stratified medicine.
CtDNA NGS testing identified a high-level MET amplification (copy number of 53.6 in circulation) (Figure 1A). The test was repeated on a second tube of.
Anna Buder Institute of Cancer Research Department of Medicine I Medical University of Vienna Liquid Biopsies Analysis of circulating cell-free tumor-DNA.
The Center for Personalized Diagnostics: Past, Present, and FUTURE
San Antonio Breast Cancer Symposium – December 6-10, 2016
Emerging Genomic Technologies: Extending the Application of Genomics to Prediction, Diagnosis, Monitoring, and Early Detection Luis A. Diaz, M.D. Johns.
 Adaptive Enrichment Designs for Confirmatory Clinical Trials Specifying the Intended Use Population and Estimating the Treatment Effect Richard Simon,
Session 2: Regulation of Genetic Testing- view from FDA OHOP
Phase I/II Study of Lorlatinib in Advanced ALK+ or ROS1+ NSCLC
Acquired Resistance to Crizotinib from a Mutation in CD74-ROS1 Mark M
Gene expression.
Christopher S. Lathan, M. D. , M. S. , M. P. H
Dose-escalation patient response.
Unità Clinica di Diagnostica Istopatologica e Molecolare
The New Taxonomy of Metastatic NSCLC and Physician Treatment Based on Pathologic and Molecular Characteristics The New Taxonomy of Metastatic Non-Small.
Tania Tillett Royal United Hospital
Monitoring EGFR mutation status in Non-small cell lung cancer (NSCLC) patients using circulating Tumour DNA (ctDNA). Matthew Smith Molecular Pathology.
Beatriz Pérez González 2017/18 Genomics
Gideon Blumenthal, MD Office of Hematology Oncology Products
WES detects a limited number of clinically targetable alterations in patients with advanced cancer. WES detects a limited number of clinically targetable.
Adam L. Cohen, MD, MS Assistant Professor Division of Oncology
DKTK MASTER is an example of whole-exome and transcriptome sequencing-based precision oncology programme. DKTK MASTER is an example of whole-exome and.
RESEARCH IN MOLECULAR THERAPI
Defining Patient-Centered Care: Spotlight on Advanced Non-Small Cell Lung Cancer.
Waterfall plot of the best per cent change from baseline in SLD of target lesions in 33 patients. Waterfall plot of the best per cent change from baseline.
A Novel Approach to Detect Programed Death Ligand 1 (PD-L1) Status and Multiple Tumor Mutations Using a Single Non–Small-Cell Lung Cancer (NSCLC) Bronchoscopy.
Clinical courses of patients.
MX39795 Study Design Category 1 R 3:1 Category 2 Inclusion criteria
XL647—A Multitargeted Tyrosine Kinase Inhibitor: Results of a Phase II Study in Subjects with Non-small Cell Lung Cancer Who Have Progressed after Responding.
Loyola Marymount University
High-level clonal amplification of FGFR2 predicts for sensitivity to FGFR inhibitor. High-level clonal amplification of FGFR2 predicts for sensitivity.
Loyola Marymount University
Esteller, New England Journal of Medicine, 2008
Loyola Marymount University
Loyola Marymount University
Tyrosine kinase inhibitors
Updates in Best Practices in Non-Small Cell Lung Cancer
Presentation transcript:

Ulrik Lassen MD, PH.D Phase 1 Unit Personalised Cancer Medicine in Phase 1 Cancer Research at Rigshospitalet Ulrik Lassen MD, PH.D Phase 1 Unit

Background New targeted therapy is selected according to specific molecular alterations in the tumors Determination of HER2-gene expression in breast cancer is a routine due to treatment with trastuzumab (Herceptin). Analysis af K-ras mutation status is a routine in order to select patients with colorectal cancer for anti-EGFR therapy Also EGFR and ALK mutations in lung cancer

There may be an advantage by selecting patients Tumor regression was seen in 30% of patients with mutations, compared to 10% of patients without mutations. There may be an advantage by selecting patients Titel/beskrivelse (Sidehoved/fod)

Non-small cell lung cancer - subtyping Erlotinib, gefitinib crizotinib

ALK-inhibition in NSCLC 31 heavily pre-treated patients with NSCLC and ALK re-arrangement tested in a Phase 1 trial. 20/31 had regression, (including 1 CR; and long-term regression - median 24 weeks) The fusion gene was first identified in NSCLC in 2007, clinical activity seen in 2009 – and crizotinib was FDA-approved in 2011 Kwak EL et al, N Engl J Med 2010 Mab og TKI UL/2012

Phase 1 trial: Partial remission in 81% of patients with Braf-V600E+ melanoma (960 mg BID) Enlarge and brighten title and authors of phase ! expansion Investigator assessments Includes confirmed & unconfirmed responses 6

New track for early clinical trials

Schedule of assessments: Differential timing of dosing, PD biopsy, and imaging Schedule A: QW End of Cycle 2 Scans FDG PET Tumor Bx RG7212 dosing … Cycle 1 Scr D1 D2 D3 D4 D8 D15 D17 Cycle 2 D1 D2 D4 D8 D15 RG7212 dosing Tumor Bx FDG PET End of Cycle 2 Scans Schedule B: Q3W Both schedules: blood samples taken at multiple time points for PK and PD assessments

Titel/beskrivelse (Sidehoved/fod) Navn (Sidehoved/fod)

The most important finding at the moment is the feasibility of performing complex molecular characterization in daily clinical practice. A hundred patients were enrolled in seven months. For some patients, the results of the analyses changes the phase 1 trials and treatments for which they were being considered Titel/beskrivelse (Sidehoved/fod) Navn (Sidehoved/fod)

Also in Denmark? Patients with good performance status and tumor lesions assessable for biopsy are included in a study of genomic characterization A collaboration between the Phase 1 Unit, Pathology, Genomic Medicine, Clinical Genetics, Diagnostic Radiology and Bioinformatics Important for drug development, attracting new studies and allocating patients for studies We are part of an European network and hope to be able to distribute patients for enrichment of studies in the future

Complete genomic profile of phase 1 population Up to 200 patients are referred to the Phase 1 Unit every year. Every patient will be asked for a signed informed Eligible patients are required to fulfill normal criteria for entering early phase studies, including normal organ function and adequate performance status, as well as measurable disease. Most patient fulfill these criteria, and it is anticipated that 500 patients will be eligible during the project period (5 years). Patients will be referred for ultrasound-guided tumor biopsies with 18 Gauge needle. Biopsies snap-frozen/RNA-later and paraffin-embedded as well as verified for their representativeness, tumor cell content, and suitability for molecular analysis at the Department of Pathology

Genome-wide technologies and identification of tumor specific genetic changes The Center for Genomic Medicine functions as core facility for array and NGS technologies and covers all necessary high-throughput analyses from microarray-based transcriptome profiling to analysis of SNP arrays (Affymetrix) as well as NGS (Illumina and Roche platforms). The pipeline from biopsy to isolation of DNA and RNA is firmly established as part of our front-line work-up of carcinoma of unknown origin and childhood solid tumours, which are subject to array analysis and exome sequencing, respectively. All samples are handled according to standard operation procedures and quality control parameters according to MIAME and Tumor Analysis Best Practices Working Group www.rhmicroarray.com

List of first line therapeutic targets Whole exome ~23,000 genes (research)) First line gene targets are sequenced to a coverage above 500 - 1000x (labelled in RED (n=48)). Second line genes labelled in BLACK (n=117) and whole exome (n=23.000) are sequenced to an average coverage of 50-100x.

Status 1 breast cancer patient with ROS1 mutation: - offered crizotinib Several patients with either BRCA-mut, low p53 or ATM – allocated to PARP-inhibitors Several patients with FGF-ligand overexpression - allocated for studies with FGFR-modifying agents No specific pattern – allocated to other Phase 1 studies

The perspectives of gene profiling Enrichment of population for phase 1 studies Attracting more studies and offering personalized therapy for the patients Recruiting patients Referring patients for appropriate studies locally and globally Offering treatment with selected marketed targeted agents