11

News from American News from American Society of Clinical Oncology Society of Clinical Oncology

Meeting June 2011Meeting June 2011(Lung and Skin)(Lung and Skin)

Paul DonnellanPaul DonnellanConsultant Medical OncologistConsultant Medical Oncologist

Galway University HospitalsGalway University Hospitals

Common causes of cancer death in the United States, 2008

Rudin C M et al. Clin Cancer Res 2009;15:5622-5625

©2009 by American Association for Cancer Research

44

Melanoma: MortalityMelanoma: Mortality

Tsao, H. et al. N Engl J Med 2004;351:998-1012

Clinical Images of Pigmented Lesions

77

Metastatic MelanomaMetastatic MelanomaYoung age at onsetYoung age at onsetDismal prognosisDismal prognosis– 1yr survival 25%; 1yr survival 25%; – 2yr survival 10% (Korn et al JCO 2008)2yr survival 10% (Korn et al JCO 2008)

Chemotherapy ineffectiveChemotherapy ineffective– Dacarbazine (DTIC) Dacarbazine (DTIC)

response rates 10%response rates 10%median survival < 8 monthsmedian survival < 8 monthsNever shown to improve survivalNever shown to improve survival

High Dose Interleukin-2High Dose Interleukin-2

• 16% respond (6% completely and for 16% respond (6% completely and for median duration 10 yrs)median duration 10 yrs)

Immune ERU…Immune ERU…

.

Kirkwood J M et al. JCO 2008;26:3445-3455

Kaplan–Meier Curves for Overall Survival and Progression-free Survival in the Intention-to-Treat Population

Hodi FS et al. N Engl J Med 2010;363:711-723

Intracellular Signaling Pathways in Melanoma Known to Be Important in the Response and Resistance to Targeted Therapy.

Smalley KS, Sondak VK. N Engl J Med 2010;363:876-878.

Targeting Treatment to a Specific Variant in the Melanoma Gene.

McDermott U et al. N Engl J Med 2011;364:340-350.

Best Tumor Response for Each Patient.

Chapman PB et al. N Engl J Med 2011. DOI: 10.1056/NEJMoa1103782

Chapman PB et al. N Engl J Med 2011. DOI: 10.1056/NEJMoa1103782

McMullan, D. M. et al. N Engl J Med 2006;354:397

A 72-year-old man presented for evaluation of progressive dyspnea and cough

Smoking image Smoking image

Lung CancerLung Cancer

Tarceva• Tablet once a day

• Few side effects

• If have the target mutation, the response to treatment is 5 times higher than with chemotherapy!

• 55% vs 11%

Crizotinib• Tablet once a day

• Targets EML4-ALK (5% on NSCLC)

• Few side effects

• Dramatic response in patients who have failed chemotherapy

• 90% patients respond

• Randomised Clinical Trial UCHG