The Best of GI Oncology 2009 / 2010

Esta es la información recibida acerca del próximo simposio a realizarse:

A través de la presente, nos es grato comunicar a usted, la realización del II Simposio “The Best of G.I. Oncology“, que se llevará a cabo el día 8 de abril en el Hotel El Director de 15 a 19 hrs.
(Iba a realizarse el 25 de marzo, pero por los últimos acontecimientos, ocurridos en nuestro país, lo hemos cambiado de fecha)

Durante este Simposio se realizará una puesta al día acerca de los últimos avances expuestos a la comunidad oncológica internacional durante el año 2009 e incluyendo ASCO G.I. que se realizó en la ciudad de Orlando, USA los días 22 al 24 de enero de este año.
Esta actividad congregará a Cirujanos, Oncólogos, Patólogos, Radioterapeutas, Enfermeras y Químicos Farmacéuticos especialistas, y como expositores contaremos con la asistencia de los distinguidos profesionales especialistas de nuestro país.
Esta actividad no tiene costo de inscripción para los participantes, sólo rogamos enviar ficha de inscripción que se adjunta, a la brevedad al mail: secretaria@cancerchile.cl

O a los teléfonos: 3434531 - 3434490

Atentamente
Comisión Organizadora

FICHA DE INSCRIPCIÓN


NOMBRE………………………………………………………………………………

PROFESIÓN: ………………………………………………………………………….

LUGAR DE TRABAJO………………………………………………………………..

TELÉFONO DE CONTACTO………………………………………………………...

MAIL……………………………………………………………………………………



Rosario Guzmán Del Rio
Fundación Oncológica Cancer Chile

El programa del simposio es el siguiente:

The Best of GI Oncology Meetings
2009-2010
Programa
14:30-14:45 INSCRIPCIONES
14:45-15:00 BIENVENIDA

MODULO I : CÁNCER GÁSTRICO, PÁNCREAS, VÍAS BILIAR E HÍGADO
PRESIDE : Dr. Jorge Gallardo
Dra. Paulina Veglia


Horário Tema Expositor


15:00 - 15:15
Estudio TOGA: Herceptina en cáncer de estómago
Dr.Christian Caglevic

15:15 - 15:30
Avastin en cáncer gástrico
Dr.Eric Orellana

15:30 - 15:45
S-1 en cáncer gástrico: Estudio Fase II, S-1 mas paclitaxel en cáncer gástrico avanzado, 1ª línea
Dra. Pamela Salman

15:45 - 16:00
Estudio: Presencia de células cancerosas en peritoneo, en pacientes con cáncer gástrico, predice una pobre sobrevida específica de la enfermedad. La QT puede ser un beneficio
Dr. Juan Carlos Díaz

16:00 - 16:15
Análisis y discusión

16:15 - 16:30
SPAC III: Adyvancia en cáncer de páncreas
Dra. Mónica Ahumada

16:30 - 16:45
Estudio CONKO IV: Tratamiento anticoagulante en cáncer de páncreas
Dr. Claudio Salas

16:45 – 17:00
Gemcitabina-cisplatino en tumores de vía biliar
Dr. Conrado Vogel

17:00
PAUSA



MODULO II: NUEVOS TEMAS EN CÁNCER COLORECTAL Y RESECCIÓN DE
METÁSTASIS
PRESIDE : Dr. Pablo González
Dr. Christian Caglevic

17:15 - 18:00
Estudio LAR en carcinoides
Dr. Luis Villanueva

18:00 - 18:15
Terapia con radiopéptidos en tumores neuroendocrinos
Dr. Horacio Amaral

18:15 - 18:30
Predicción de riesgo en recurrencia en Cáncer de colon
Dr. Hernán de la Fuente

18:30 - 18:45
Xeloda en adyuvancia cáncer de colon. Etapa III
Dr. Fernando Chuecas

18:45 - 19:00
Ensayo: Quimioradiación utilizando mitomicina o cisplatino, con o sin mantenimiento con cisplatino / 5 FU en carcinoma de células escamosas del ano
Dr. Felipe Rey

19:00 - 19:15
Cetuximab más FOLFIRI en tratamiento de cáncer colorectal metastático: influencia de biomarcadores KRAS y BRAF (datos actualizados estudio CRYSTAL)
Dr. Alejandro Acevedo

19:15 - 19:30
Análisis y discusión temas de cáncer colorrectal
Dr. Francisco Orlandi

19:30
Cóctel de clausura

New-Generation Platinum Agents for Solid Tumors

Cisplatin was one of the first chemotherapeutic agents to exhibit broad efficacy in solid tumors and it remains among the most widely used agents in the treatment of cancer. Its introduction inspired great efforts to design similarly effective platinum agents that overcome the three main limitations of cisplatin: toxicity, tumor resistance and poor oral bioavailability. However, 40 years after the initial discovery of cisplatin, only two platinum agents have garnered US FDA approval: carboplatin and oxaliplatin. Although hundreds of promising agents were tested in clinical trials during the 1990s, only oxaliplatin made it past clinical development. For a brief period, the economic cost of these unsuccessful efforts retarded further efforts to develop new agents. However, two exciting platinum agents have been brought to Phase III trials: satraplatin in hormone-refractory prostate cancer and picoplatin in small-cell lung cancer. If successful, they may inspire a new effort to bring better-designed platinum agents to market. This article reviews the clinical development of platinum agents to date and speculates on the role of platinum agents in the near future.

Más información en http://www.medscape.com/viewarticle/589012

ESAs Increase Mortality in Cancer Patients, Meta-Analysis Confirms

ESAs Increase Mortality in Cancer Patients, Meta-Analysis Confirms CME/CE

News Author: Zosia Chustecka
CME Author: Charles Vega, MD, FAAFP

Authors and Disclosures

CME/CE Released: 05/04/2009; Valid for credit through 05/04/2010

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May 4, 2009 — The huge meta-analysis of individual patient data that confirmed an increased mortality in cancer patients treated with erythropoiesis-stimulating agents (ESAs) has been published in the May 2 issue of theLancet.

The researchers analyzed individual data for 13,933 cancer patients participating in 53 trials, and found that ESAs increased the relative risk for mortality by 17%. When they considered only cancer patients who were undergoing chemotherapy (10,441 patients in 38 trials), they found that ESAs increased the relative risk by 10%.

These results were first presented at the 2008 annual meeting of the American Society of Hematology (ASCO), and were reported by Medscape Oncology at the time.

"The increase in mortality is very worrisome," J. Evan Sadler, MD, PhD, from Washington University in St. Louis, Missouri, commented at the time, noting that these products should be used with "appropriate caution."

These new data will reignite concerns over the use of ESAs in cancer patients, Dr. Sadler said. But another expert, Samuel Silver, MD, PhD, FACP, from the University of Michigan in Ann Arbor, suggested that there was "no new cause for concern."

The safety of these drugs in cancer patients has already been extensively discussed by regulatory authorities in both the United States and Europe, and both have restricted their use in this patient population. In the United States, these products also carry a black-box warning stating that they can increase the risk for death in cancer patients. The restrictions are already in line with these new data, Dr. Silver said, adding that he does not anticipate any further regulatory moves in the near future.

New Data Back Regulatory Moves

Lead author of the meta-analysis, Julia Bohlius, MD, from the Institute of Social and Preventive Medicine at the University of Bern in Switzerland, said that the US Food and Drug Administration was right in restricting the use of these products in cancer patients, and that her team's results — which were not available at the time the regulatory moves were made — "back this decision." The individual patient data meta-analysis provides a clearer picture of the risk for mortality with these agents, showing a larger treatment effect and greater statistical significance than had been reported previously in literature-based meta-analyses, she said. In addition, the team was able, for the first time, to separate on-study mortality from overall survival. "I am more convinced now that the adverse effect is real," she said.

"The increased risk of death associated with treatment with these drugs should be balanced against their benefits," Dr. Bohlius and colleagues conclude in their paper.

On the benefits of ESAs, which are used to treat anemia in cancer patients, Dr. Bohlius told Medscape Oncologythat she is convinced by the evidence from the literature that these products reduce the need for blood transfusions. However, she is less convinced by the evidence that they improve quality of life and reduce fatigue, because some studies are positive and others are less so, and there might be a publication bias here.

"In clinical practice, the increased risk of death and thromboembolic events should be balanced against the benefits of treatment with ESAs, taking into account each patient's clinical circumstances and preferences," the researchers write.

No Way of Identifying Patients

From a physician's point of view, one of the most perplexing issues with the use of these agents is that there is no way of identifying which cancer patients are most likely to benefit — only about 50% to 60% respond to treatment with ESAs with an increase in red blood cell count, Dr. Bohlius noted.

There is also no way to identify those in whom the risk for death is increased with the use of ESAs, she added. None of the factors that the team analyzed were predictive — not hemoglobin levels at baseline, target hemoglobin levels, or the planned doses of ESA. "But there may be something else, something that wasn't measured, or something that we don't know about yet," she added.

"The patients who respond to ESA treatment are the ones who show better survival," she said, but this might not be related to the treatment. It might be that these are the "healthier" cancer patients; the ones with the most severe anemia are likely the ones who have the most aggressive cancers and are the ones who are the most likely to die.

When asked about the mechanism by which ESAs raise the risk for mortality, senior author Andreas Engert, MD, from the Cochrane Haematological Malignancies Group at the University of Cologne in Germany, said he felt the most likely explanation was an increase in thromboembolic events.

"Increasing evidence suggests that ESAs might cause thromboembolic and cardiovascular events, independent of hemoglobin concentrations," the researchers write in the article. In their analysis, patients with previous thromboembolic events seemed to be protected, and they speculate that this might be because they had received prophylactic anticoagulation treatment.

There are several other hypotheses explaining how ESAs increase the risk for mortality in cancer patients. One focuses on erythropoietin receptors on tumors, hypothesizing that ESAs act on these receptors and stimulate tumor growth, as previously reported by Medscape Oncology. Some studies have shown such receptors, whereas others have not, Dr. Bohlius said.

Further study is needed to elucidate how ESAs exert this adverse effect, and to find some clinical or molecular factor that identifies patients who are most likely to be harmed and those who are most likely to benefit from these agents, she said.

Dr. Bohlius reported receiving honoraria and travel grants from Amgen, and some of her coauthors declare relationships with pharmaceutical companies, as detailed in the article.

Lancet. 2009;373:1532-1542.

Clinical Context

Many patients with cancer go on to have anemia, which can be the result of effects of the cancer itself or cancer treatment. Bohlius and colleagues performed a meta-analysis of ESAs to find the balance between potential harms and benefits of these medications in cancer patients. Their results, which were published in the May 17, 2006, issue of the Journal of the National Cancer Institute, found that ESAs did improve hemoglobin concentrations and reduced the need for transfusion. However, these medications were also associated with a 67% increase in the risk for thromboembolism. Finally, the risk for mortality was slightly higher in patients receiving ESAs, although this result failed to reach statistical significance.

The current meta-analysis uses individual cancer patient data to examine the issue of ESAs and mortality more closely.

Study Highlights

• Researchers examined studies published between 1985 and 2008, which compared epoetin or darbepoetin vs control treatment in patients with cancer. Trials involving patients with myelodysplastic syndromes and acute leukemia were excluded.
• The primary outcome was mortality, both during the active trial period and after (overall survival duration).
• Researchers attempted to account for individual patient differences that could affect the primary outcome, including age, sex, the type of tumor and its treatment, hemoglobin concentrations, a history of thromboembolism, and the dose of ESAs.
• 53 studies involving a total of 13,933 patients were included in the meta-analysis. Nearly two thirds of the meta-analysis cohort consisted of women, and the mean age of the patients was 60 years.
• 72% of the trials focused on patients receiving chemotherapy, and another 9% of research included patients receiving radiochemotherapy.
• Mortality was a primary endpoint in only 9% of included research, and it was a secondary endpoint in 28% of the studies. In the other research, mortality was included as a safety outcome.
• The duration of treatment with ESAs ranged between 8 and 52 weeks. There was evidence that these medications were not used in compliance with current indications for cancer patients.
• The median follow-up period for mortality during the active study period was nearly 4 months. The median follow-up duration for overall survival was 6.2 months.
• 1530 patients died during the active study period, and 4993 patients died overall. The hazard ratio for mortality associated with the use of ESAs vs control treatment during active treatment was 1.17, and the hazard ratio for overall survival was 1.06. Both of these results were statistically significant.
• There was limited heterogeneity between trials in the primary outcome.
• Among the subgroup of patients treated with chemotherapy, ESAs were associated with a nonsignificant trend toward a higher risk for mortality during the active study period and for overall survival duration as well.
• The particular cancer treatment that patients received did not significantly alter the study's main finding.
• Higher-quality trials tended to find a greater risk for mortality associated with ESAs vs lower-quality trials.
• Patients with a low baseline hematocrit level of less than 23.5% experienced a higher risk for mortality associated with the use of ESAs, as did patients who did not have a history of thromboembolism. This latter phenomenon may have been the result of wider use of antithrombotic therapy in patients with previous thromboembolic events.

Clinical Implications

• In a previous meta-analysis, ESAs were demonstrated to improve hemoglobin concentrations and reduce the need for blood transfusions in patients with cancer. However, they were also associated with a higher risk for thromboembolism. ESAs did not have a significant effect on the risk for mortality in this study.
• The current meta-analysis suggests that the use of ESAs may increase the risk for mortality in patients with cancer.

Tarceva (erlotinib):Dear HCP letter issued to warn about GI perforation, exfoliative skin conditions and corneal perforation/ulceration

Tarceva (erlotinib)

Audience: Oncological, dermatological and ophthalmological healthcare professionals 
OSI, Genentech and FDA notified healthcare professionals of new safety information added to the WARNINGS AND PRECAUTIONS sections of the prescribing information for Tarceva. Gastrointestinal perforation (including fatalities), bullous, blistering and exfoliative skin conditions including cases suggestive of Stevens-Johnson syndrome/toxic epidermal necrolysis, in some cases fatal, and ocular disorders, including corneal perforation or ulceration have been reported during use of Tarceva. The new safety information comes from routine pharmacovigilance activities of clinical study and postmarketing reports. Tarceva monotherapy is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of at least one prior chemotherapy regimen. In combination with gemcitabine, Tarceva is also indicated for the first-line treatment of patients with locally advanced, unresectable, or metastatic pancreatic cancer.

Read the complete MedWatch 2009 Safety summary, including a link to the OSI Dear Healthcare Professional Letter, at:

http://www.fda.gov/medwatch/safety/2009/safety09.htm#Tarceva 

Colegas

En relación al congreso reciente en el que hemos participado, quise desarrollar esta pequeña web para mejorar la comunicación entre los colegas a lo largo de Chile. Quien quiera publicar acá sólo debe enviarme un correo a alerodria@gmail.com y yo me encargaré de subirlo a la página. De este modo estaremos conectados.
Se reciben notificaciones, alertas, informaciones de congresos, simposios, reuniones, datos freaks, etc.

Realmente espero que esto no sirva como herramienta de comunicación y estrategia.

Q.F. Alejandra Rodríguez Acuña