Transcript ONS Highlights - ANCO On-Line

Carol S. Viele RN MS OCN
Clinical Nurse Specialist
Hematology-Oncology-Bone Marrow Transplant
UCSF
Associate Clinical; Professor
Department of Physiological Nursing
UCSF School of Nursing
Overview
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Held in Boston, Massachusetts
April 29-May 1, 2011
55 sessions over 3.5 days of the meeting
Session topics included:
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Infection, Sepsis Update
Clinical Trials/ Protocol Issues
International Oncology
Ethics
Preparing for the future of Oncology Nursing
BMT Toxicities
Safe Handling Issues
Genotype directed therapy
Genetics
Highlights in Crash Course in BMT
 Presenters from Johns Hopkins, Seattle Cancer Care Alliance and
Stanford University
 Topics: Pulmonary Issues, Hepatic Toxicity and Hepatic GVHD and
Skin Toxicity
 Pulmonary Issues
 Incidence 30-60%
 Cause of death 60%
 Diagnosis
 Bronchoscopy
 Lung biopsy
 Risk Factors/Etiology
 Aspergillus
 CMV
 Pneumocystis jiroveci
 Bronchiolitis Obliterans
 BOOP
 DAH
Highlights in Crash Course in BMT
 Interventions
 Antibiotics
 Antifungals
 Antivirals
 Steroids
 Anxiolytics
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Benzodiazepines
 Dypsnea management
Highlights in Crash Course in BMT
 Hepatic Complications
 Sinusoidal obstruction syndrome
 Graft versus host disease
 Drug induced lung injury
 Infections
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Bacterial
Fungal
Viral
 Cholecystitis
Highlights in Crash Course in BMT
 Diagnostic tests
 Laboratory data
 Imaging
 Liver biopsy
 Prevention
 Ursodiol
 Antifungals
 Antivirals
 Conditioning regimens
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Decreased intensity regimens
No cytoxan
Highlights in Crash Course in BMT
 Treatments
 Low dose tissue plasminogen activator
20% response
 Antithrombin III
 Defibrotide
 > 36 % response rate
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Highlights in Crash Course BMT
 Hepatic Graft versus Host disease
 Onset 2-4 weeks post BMT
 Jaundice and increased LFT’s
 Staging directly related to level of bilirubin
 Prevention and Treatment
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Calcineurin inhibitors
Mycophenolate mofetil
Methotrexate
Ursodiol
Steroids
ATG
Sirolimus
Rapamycin
Monoclonal antibodies
Highlights Genotype Directed
Therapy Lung Cancer
 By Lecia Sequist MD, MPH
 NSCL Cancer therapy
 Chemotherapy- modestly successful
 Molecular targeting
 Key pieces to understand the cell biology of each
individual’s tumor
 Treatment effective against the particular biology of
tumor
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EGFR dysregulation
 Tyrosine kinase inhibitors in lung
 Gefitinib- Iressa
 Erlotinib- Tarceva
Highlights Gene Directed Therapy Lung
Cancer
 Treatment:
 Find EGFR mutations in patients
 10% of lung cancer patient have EGFR mutations
 Response rates as high as 70% in this group of patients 1
 Based on the Mok trial US is looking at need for molecular
testing of tumors
 More common in:
 Women
 Never smokers
 Little smoking history
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Mok 2009 NEJM
Highlights Gene Directed Therapy
Lung Cancer
 Targeted therapy eventually develops resistance
 Mass General is doing repeat biopsies to track
resistance development in tumors
 Initial response is usually 12 months
 Looking at another pathway the MET inhibitor
 Adding a MET inhibitor with Erlotinib
 Another pathway is ALK translocation
 First described in 2007
 Can be responsible for lung cancer progression
Highlights Gene Directed Therapy
Lung Cancer
 Crizotinib – a new agent being trialed and the target
is ALK
 Phase I study
 150 Patients
 Dramatic responses
 ? FDA approval in 2011
Highlights Gene Directed Therapy
Lung Cancer
 Future genotype directed therapy in lung cancer
 KRAS
 ALK
 BRAF
 MET
 PDGFR
 EGFR
Highlights Biology of Pediatric and
Adult Cancers
 John Maris MD Children’s Hospital Philadelphia
 Belinda Mandrell PhD RN PNP
 The future in cancer treatment is a “ personal
approach”
 Need to understand hereditary cancers
 Genomic profiling
 Practical and ethical implications
Highlights Biology of Pediatric and
Adult Cancers
 Childhood cancers
 Continue to cause significant morbidity and mortality
 Cure rates are stagnant
 Late effects are significant
 Childhood cancers represent a microcosm of cancers
in general
 Cancer is the leading cause of death in children
except for accidents
 2/3 of children who survive have life long disabilities
 1/4 of the children who survive have significant life
long disabilities such as CHF and hearing loss
Highlights Biology of Pediatric and
Adult Cancers
 Molecularly targeted agents
 Increase the cure rates
 Decrease the toxicity rates
Highlights Biology of Pediatric and
Adult Cancers
 Neuroblastoma
 Median age at diagnosis 17 months
 15% of childhood mortality
 Induces significant morbidity
 30% of cases spontaneously resolve
 50% of cases are high risk disease
 Need to define the molecular targets
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Genetic basis of disease
Define the oncogenic drivers of this disease
Highlights Biology of Pediatric and
adult Cancers
 Genomic profiling
 ALK (Anaplastic lymphoma kinase) gene is
the major familial neuroblastoma gene and is
located on chromosome 2
 Occurs in 80% of familial disease
 PHOX 2B occurs in 10% of Familial
neuroblastoma
Highlights Biology of Pediatric and
adult Cancers
 Genomic Profiling includes:
 DNA copy numbers- Single Nucleotide
Polymorphism arrays
 RNA copy numbers – Expression arrays
 Mutations- Sequencing analysis
Vision for all patients they will all have DNA
sequencing done at diagnosis. As we treat
patients mutations will occur and moving
forward we can profile the DNA and RNA
alterations
Highlights Biology of Pediatric and
Adult Cancers
 Genetic Profiling Considerations
 Family history may suggest a genetic cancer
syndrome
 Tests need to be adequately interpreted
 Consent for testing must occur
 Pre and Post counseling needs to occur
 Patients need to know the results may affect
their ability to obtain life insurance not health
insurance
Highlights Biology of Pediatric and
Adult Cancers
 Informed Consent Issues:
 Clinical Implications
 Importance for children
 Accuracy of testing
 Fees
 Psychological issues
 Confidentiality issues
 Insurance issues