Senior Member Emeritus Moffitt Cancer Center Tampa FL General strategies of Cancer Treatment and evaluation of Response Clinical case 83 year old man with cough CT chest reveals a 3 cm mass Left Lowe Lobe ID: 935347
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Lodovico Balducci M.D.Senior Member EmeritusMoffitt Cancer CenterTampa, FL
General strategies of Cancer Treatment and evaluation of Response
Slide2Clinical case
83 year old man with cough
CT chest reveals a 3 cm mass Left Lowe Lobe
Biopsy reveals an adenocarcinoma primary lung
PS 1; Lives alone, Independent ADL IADL
Slide3Clinical case
ROS: osteoarthritis, type II DM
PMH: MI age 65: CABPG; quit smoking
Colon cancer stage II age 71; surgery
Fracture right tibia age 19
Appendectomy age 41
Slide4Clinical case
HB 13.8; Ca 10.1
Physical exam:
Lung moving 3 cm bilaterally
Deformity Left knee
Overweight
Slide5Strategy of cancer treatment
CLINICAL DECISIONS
Patient
Life expectancy
Treatment tolerance
Goals
Cancer
Stage
Aggressiveness
Treatment Sensitivity
Tumor sanctuary
Treatment
Effectiveness
Toxicity
Slide6What do we want to know
Stage: PET scan; CT scan, MRI
Sensitivity to treatment:
EGFR mutation
Ros
Mutation
ALK mutation
PDL1?
Slide7What will we do
with the information
Local disease: surgery; radiosurgery, ablation
Metastatic disease: systemic treatment according to sensitivity
Loco-regional disease: combination of local and systemic treatment
Brain metastases: may add radiation
Slide8Forms of cancer treatment
Loco regional treatment
Systemic treatment
Surgery
Radiation Therapy
Loco-regional infusions
Local ablation
Hormonal therapy
Cytotoxic chemotherapy
Targeted therapy
Immune check-point inhibitors
Vaccines
Radio-isotopes
Slide9Examples of tumor markers
Lung:
Ras
,
Ros
, EGFR,
ALK
Breast: hormone receptors, HER,
Brca
Colorectal:
Ras
,
MSI
All MSI
?
Slide10Adjuvant and neoadjuvant treatment
65 year old woman with a 2 cm tumor of the left
breast
Has breast sparing surgery. LNs are
negative
Tumor is positive for ER and PR and negative for HER
55 year old woman with a reddened mass of the left breast, adherent to the chest wall and edematous left upper
extremity
No distant metastases; ER-PR-
Slide11Clinical case
79
year old man with colon cancer metastatic to the liver . Previously controlled with chemotherapy but now disease is
progressing
MSI
negative
Wants to live 6 more months to the wedding of his granddaughter
Slide12Evaluation of response
Metastatic disease:
Measurable
Size
Vitality
Time to progression
Survival
New
lesions
Non measurable
Disappearance
New lesions
Time to progression
survival
Slide13Evaluation of response
Neo-adjuvant treatment: size
Adjuvant treatment:
Disease free survival
Overall survival
Slide14Conclusions
Treatment related decisions include assessment of patient’s condition and goals, stage of diseases, sensitivity to treatment and treatment
toxicity
Assessment of response in the presence of measurable disease involves: size, tumor vitality, time to progression and
survival
Assessment of response in the adjuvant setting includes disease free survival and overall survival