Some observations 2 full days 80 posters 23 free papers Clinical Trials Update Sarcoma Service Updates SACT Proton NHS E Unusual cases Epithelioid Clear Cell PEComa Case based discussions ID: 1042881
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1. Notes from BSG 2019LondonSome observations
2. 2 full days, 80 posters, 23 free papersClinical Trials UpdateSarcoma Service Updates (SACT, Proton, NHS E)Unusual cases(Epithelioid, Clear Cell, PEComa)Case based discussionsGuest Lectures – Immunotherapy overview, Retroperitoneal surgery, Best practice in rehab. Topics; Spinal sarcomas, MDT improvements, Adj chemo, Fibromatosis, GIST.
3. OlaratumabNoticable by its absence!PDGFRa inhibitor, monoclonal antibodyInitial randomised phase 2 trial had stunning survival advantage.133 patientsOS at 12 months: 14.7 months v 26.5 monthsPFS median: 4 months v 6 months
4. OlaratumabPhase 3 trial ANNOUNCEReported Jan 2019No difference in Overall SurvivalNo safety concernsNo benefit to patients continuingNo Results expected for a year
5. Consider:PS 0-1Under 65 yrs (45 yrs)20 cm thigh tumourGrade 3MFH/UPSWide resection, clear marginsAlso getting Radiotherapy
6. Predicted outcome - Sarculator If aged 4510 yr OS = 51% (30% Persarc)10yr DM = 58%
7. Italian papers3 v 5 courses (Ifos 9, Epi 120)EORTC 62931 Lancet Oncology 2012, 13, (10) 1045-54Adj chemo (Ifos/Adria) v nilCompletely resected limb/trunk high risk STSNo difference between 2 groups
8. Italian group – different chemo for different pathology, nothing beats Ifos/AnthracyclinePasquali EJC 2019, 109, 51-60Based on re analysis of EORTC 62931 Used Sarculator to assign into: Poor 10 year OS (<51%)Medium and Good 10 yr OSCompared effect of chemo or no chemo
9. Pasquali EJC 2019, 109, 51-60For the poor risk group chemo halved the risk of recurrence or deathSuggested - increase OS by 21% at 8 yrsNeed to treat 5 to benefit 1Those at greatest risk benefit most
10. Concerns:What is the cost and morbidity/mortalityIn-patient chemo, central access, longer until return to workRisk of serious events (death) – in EORTC study – same, except more infection in control group.40% grade 3 + 4 haematological event
11. Chemotherapy dosesIfos 5/Adriamycin 75 (used in EORTC study, Ifos dose criticised)Italian (Ifos 9 / Epirubicin 120)Should it be Ifos 9 plus Adriamycin 50-75??
12. Will need to have SSN view on thisPropose to discuss this in September meetingTo agree who should be offered thisHow we will deliverDoses, drugs and number of coursesSequencing with surgery and RT
13. Measurable Outcomes(Like our QPI)From the MDT meeting or recordHave they seen a CNSHas PS been documented? TNMHave they had written and verbal infoHNA in line with recovery package
14. Key worker / CNSNot part of ‘QPI’, if it was – how would it be ‘measured’Can we demo that each region has good coverage – geographical and tumour typeNot all (eg) breast cancer pts now have a CNS
15. Managing ExpectationsFor outcomesFunctionSurvivalFor access toDrugs (chemo, immuno, cannabis)Investigations / New technologies Personalised medicine / drugable targets
16. Genomic SequencingWhat is it going to beWhat consent is requiredWhat samples are neededHow long to get a reportWhat difference will a report make Need for ‘genomic ‘MDTs’GeCIP (Genomics England Clinical Interpretation Partnership)
17. GIST – S BauerHeat maps, molecular analysis, surgical optionsNecrosis is bad Intermediate risk with necrosis as bad as a high riskHigh risk with necrosis worse againAblative RT for rectal GIST to avoid surgeryLarge gastric GIST may benefit from 9-12 mo pre op imatinib
18. FibromatosisDesmoid Global Consensus? Publication this yearMutational analysis on all specimensCTNNB1 mutations and APC mutations are mutually exclusive
19. FibromatosisAll patients should have ‘active surveillance’ initiallyUnless life threatening or critical anatomical siteMove to therapy should be: After at least 2 further assessmentsAt least a year from diagnosisProgression of tumour and / or increasing symptoms
20. FibromatosisAbdominal Wall Surgery 1st optionExtremity, Chest wall, GirdlesOnly surgery if very low morbidityOtherwise Medical therapyIntrabdominal, Retroperitoneal, PelvicConsider systemic therapy as first option
21. FibromatosisFAP associated Desmoid tends to be more aggressive and multifocal
22. FibromatosisDrugs / combinations may not have evidence of a good levelTamoxifen, Calyx, DTICOnly randomised data exists forSorefanib, pazopanib and MTX/VBLPhase II dataImatinibSuggest start with least toxic, and work up
23. Random observationsSunitinib for Solitary Fibrous TumourTKI in osteosarocma – possibly with conventional chemo BrachyuriNYES01 in Synovial sarcoma and Myxoid sarcoma – may be a target / immuno optionRMH immunocore phase 1 study
24. Random observationsChondrosarcomaDe differentiated, may be an immunological mechLeiomyosarcomaGem or Gem/DTICOften first choice
25. High dose in EwingsIn relapse / refractory diseaseSelected casesBest if just localised disease +/- lungMore aggressive trt at relapseSuggested median efs 84 mo v 10 mo
26. There were many other interesting posters and talksTry to come get involved in and attend BSG 2020Glasgow 26th and 27th February 2020