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ascuito 1.pptx
- 1. Dra. Iraida Caballero Aguirrechu HHA. Oncología Clínica, Uro-oncología
- 2. Slide 24 Presented By Howard Scher at 2014 ASCO Annual Meeting
- 3. Ca Próstata Estado del Arte (2004-----2014) Docetaxel (cuando y cómo) AA (abr, enz, onz) Inmunot. TTO soporte (pred/ dex) Ac Zoled. Radium- 223
- 4. Slide 44 Terapia del Ca Próstata por etapa de la enfermedad Cuando comenzar BAT / PSA? •No existe una guía de cuando y como comenzar BAT •El momento de la introducción del BAT ante progresión ósea /PSA no se ha relacionado con tiempo SV •Evidencias en los grupos de Alto Riesgo (riesgo/beneficio)
- 5. Cáncer de próstata-tratamiento Bajo riesgo: T 1- 2a PSA ≤ 10 Gleason ≤6 Riesgo intermedio: T2b-2c PSA 10-20 ng/ml Gleason 7 Alto riesgo: T3a Gleason 8-10 PSA ≥20ng/ml Infertilidad, disfunción sexual, incontinencia urinaria, calidad de vida •Observación •Prostatectomia radical •RTP externa (conformacional) •BTR (permanente o temporal) •Terapia hormonal si prog. (No precoz) •Prostatectomia radical •RTP externa (conformacional) •BTR implante permanente •Terapia hormonal precoz + RTP (6 meses antes, durante y después) Prostatectomia/ RTP externa + BAT (I,A) Mantener por 3 años No se recomienda Bifosfonatos para prevenir metástasis óseas (I,A)
- 6. Slide 49 Presented By Mark Stein at 2014 ASCO Annual Meeting
- 7. Dónde Docetaxel? ± AA? Phase II GERICO10-GETUG P03 Trial: Docetaxel/Prednisone in Elderly mCRPC metástasis viscerales en pctes con docetaxel peor respuesta Pronostico por subgrupos debe ser considerado para futuros EC Determinación de fenotipo molecular en las metástasis hepáticas (Dr. Taplin)
- 8. Early Chemo-HT: Hypothesis Presented By Mark Stein at 2014 ASCO Annual Meeting
- 9. Slide 9 Presented By Mark Stein at 2014 ASCO Annual Meeting
- 10. Treatment Groups Were Well Balanced<br />for Baseline Patient Characteristics/Disease burden Presented By Mark Stein at 2014 ASCO Annual Meeting
- 11. PHASE iii TRIALS OF Ar targeting agents <br />PRE-ASCO 2014 Presented By Mark Stein at 2014 ASCO Annual Meeting
- 12. Slide 14 Presented By Mark Stein at 2014 ASCO Annual Meeting
- 13. <br />Most Common Adverse Events*<br /> Presented By Mark Stein at 2014 ASCO Annual Meeting •Demostrado beneficio clínico en escenario pre- docetaxel: •Retarda inicio de qtp •Reduce riesgo de muerte •Incrementa calidad de vida •Bien tolerado por largo periodo de tiempo •Seguro y combinable con otras terapias
- 14. Slide 19 Presented By Mark Stein at 2014 ASCO Annual Meeting
- 15. PHASE iii TRIALS OF Ar targeting agents <br />PRE-ASCO 2014 Presented By Mark Stein at 2014 ASCO Annual Meeting
- 16. Abiraterone plus Enzalutamide: Tissue Markers of response Presented By Mark Stein at 2014 ASCO Annual Meeting
- 17. Presented By Celestia Higano at 2014 ASCO Annual Meeting Quienes son los mejores candidatos para la inmunoterapia disponible en Ca de próstata? Bajo PSA Enfermedad poco voluminosa ECOG 0 Enfermedad indolente Sistema inmune robusto: antes de QTP, esteroides o farmacoresistencia Pacientes con enfermedad de bajo riesgo (BR) y no voluminosa Inmunoterapia
- 18. Ipilimumab: OS by Baseline Visceral Metastases Drake C, et al. ASCO GU 2014. Abstract 2. 100 80 60 40 20 0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 Mos OS (%) Group Ipi, no visceral metastases (n = 280) Pbo, no visceral metastases (n = 275) Ipi, visceral metastases (n = 114) Pbo, visceral metastases (n = 113) Median OS, Mos (95% CI) 14.4 (11.5-16.4) 10.3 (9.6-11.7) 7.4 (6.1-10.2) 5.7 (4.7-7.8)
- 19. Ca Vejiga /2014
- 20. [TITLE] Presented By Andrea Borghese Apolo, MD at 2013 ASCO Annual Meeting •15 210 muertes en 2013 en EUA •Enf. Quimiosensible pero con respuesta corta (< 6 meses) •No 2da línea •Mediana de SO en enf metastasica 12-14 meses •Pronostico pobre Ca vejiga
- 21. Learning Objectives Presented By Toni Choueiri at 2014 ASCO Annual Meeting
- 22. Slide 4 Presented By Toni Choueiri at 2014 ASCO Annual Meeting
- 23. Bladder-Preserving Therapy in Pts With MIBC and CR or Near CR: Outcomes Mitin T, et al. ASCO GU 2014. Abstract 284. Outcome at 5 Yrs, % T0 Ta/Tis P Value OS 72 61 .12 Disease-specific survival 85 67 .11 Bladder RFS 68 72 .70 • No apparent difference in rates of bladder recurrence and salvage cystectomy between groups • Authors recommend that patients with Ta or Tis disease after induction therapy continue with bladder-sparing treatment
- 24. Updated 2013 meta-analysis of adjuvant cisplatin-based chemotherapy in muscle-invasive bladder cancer Presented By Toni Choueiri at 2014 ASCO Annual Meeting
- 25. Slide 6 Presented By Toni Choueiri at 2014 ASCO Annual Meeting
- 26. MPDL3280A: Summary of Response in UBC Investigator Assessed Presented By Toni Choueiri at 2014 ASCO Annual Meeting
- 27. Conclusiones Ca Vejiga Cistectomía (I,A) Cirugía Cons. vs Cist Rad en etapas tempranas ± Linfadenectomia selectiva (III,B) Neoadyuvancia (T2, T3) [Meta-análisis Collaboration. Eur Urol 2005; 48: 189– 199; discussion 199–201] (esq. con CDDP x 2-3 ciclos) Adyuvancia según elementos dx (BSQ,G+,GIII) RTP externa dosis intermedias (45-60 Gys) según Bx y en preservación de órgano (IRMT) QTP 1ra línea (MVAC/GP) [I,A], (adyuvancia temprana) NO 2da línea (ECOG >2, Hb <10, metástasis hepáticas) (Cabozantinib/inh PD-L1)
Notas del editor
- Ipi, ipilimumab; OS, overall survival; Pbo, placebo. Nicholas J. Vogelzang, MD: The overall survival of patients with visceral metastases was very poor, as recently reported in the Journal of Clinical Oncology by Halabi and colleagues.[1] In this update of the Cancer and Leukemia Group B bevacizumab trial, visceral metastases, particularly liver metastases, were shown to be a very ominous prognostic factor. This led Dr. Drake and others to hypothesize that we need to look at the immunosuppressive effects of liver metastases. Due to the rapidly proliferative nature of visceral metastases, Dr. Drake concluded that patients with these metastases should be excluded from immunotherapy trials. Reference: 1. Halabi S, Lin CY, Kelly WK, et al. Updated prognostic model for predicting overall survival in first-line chemotherapy for patients with metastatic castration-resistant prostate cancer. J Clin Oncol. 2014;32:671-677.
- CR, complete response; MIBC, muscle-invasive bladder cancer; OS, overall survival; RFS, recurrence-free survival. Brian Rini, MD, FACP: Survival rates at 5 years were not significantly different between those patients who had either complete (T0) or near-complete (Ta/Tis) response. The overall survival rate was 72% vs 61%, respectively; the disease-specific survival rate was 85% vs 67%, respectively; and the bladder relapse–free survival rate was 68% vs 72%, respectively. In addition, there was no significant difference in the rate of salvage cystectomy between the groups. With the caveat that this is a small retrospective study, the authors recommend that patients with Ta or Tis bladder cancer after induction therapy can continue with bladder-sparing treatment, basically implying that a pathologic complete response is not required prior to salvage cystectomy. Bladder preservation is not undertaken in most US patients, but for those who do receive it, these data provide guidance on care after induction chemoradiation and appropriate next steps. Nicholas J. Vogelzang, MD: As Dr. Rini stated, the disease-free survival and bladder relapse-free survival all were excellent with T0 (no pathologic evidence of disease) or Ta or Tis disease. The bladder can likely be spared in more than 60% to 70% of patients who achieved T0, Ta, or Tis status during induction therapy.