GRACE :: Lung Cancer

acquired resistance

Denise Brock

Lung Cancer Video Library – Spanish Language: Video #36 Treatment Options for Acquired Resistance to EGFR TKIs: T790M-Negative Disease

Share
 
GRACE Cancer Video Library - Lung

 

We continue to provide informational videos for our Spanish speaking community and welcome Dr. Luis Raez, MD FACP FCCP, Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University.  Dr. Raez joined GRACE to discuss the basics of lung cancer.  In this 36th video for the Spanish lung cancer video library, Dr. Raez discusses treatment options for acquired resistance to EGFR TKIs: T790M-negative disease.


 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
download transcripts
 

Opciones de tratamiento para la resistencia adquirida a los inhibidores de tirosinas cinasa del receptor del factor de crecimiento epidérmico (EGFR): enfermedad T790M negativo.

Treatment options for acquired resistance to tyrosine kinase inhibitor in the epidermal growth factor receptor (EGFR): T790 negative disease

 Dr. Luis Raez, MD FACP FCCP

Chief of Hematology/Oncology and Medical Director, Memorial Cancer Institute,
Clinical Associate Professor of Medicine, Florida International University

 

Spanish TRANSCRIPT

También cuando hablamos de resistencia a inhibidores de la tirosina cinasa, ya hablamos que para los pacientes con 790 hay un nuevo fármaco que se llama osimertinib. El problema es ¿qué hacemos con el resto de los pacientes? Como les decía 60% de los pacientes que están en inhibidores de la tirosina cinasa, van a tener la mutación 790, que, si ustedes saben la pueden encontrar en la sangre, la orina o en una nueva biopsia, y ahí vamos a poder usar el fármaco nuevo.

Pero, ¿qué hacemos con el 40% de pacientes que no podemos documentar la mutación?

Hay esperanza para estos pacientes porque sabemos hoy en día que para muchos de estos pacientes que no tienen esta mutación, el mecanismo de resistencia está a través de la vía MET. Entonces tenemos en investigación inhibidores de MET y de su vía, que podría ser una solución para salvar a estos pacientes. La otra opción es que algunos de estos pacientes, en un grupo pequeño como del 10% hacen carcinoma de pulmón de células pequeñas. En otras palabras, el tumor original que era carcinoma de células granes se transforma en carcinoma de células pequeñas, entonces estos pacientes no van a responder a ninguna terapia blanco existente porque no tenemos terapia blanco para carcinoma de células pequeñas y entonces hay que ponerlo en quimioterapia.

Por eso es tan importante hacer una biopsia, porque si no hacemos una biopsia cuando en el paciente falla el receptor de la tirosina cinasa nunca nos vamos a enterar que el paciente transformo a carcinoma de células pequeñas y nunca le vamos a dar la quimioterapia adecuada.

Al final, mientras estos descubrimientos y otros van avanzando lo que hay que hacer es poner a los pacientes en quimioterapia. Cuando un paciente falla y no podemos documentar la mutación 790, hay que ponerlo en quimioterapia o en un estudio clínico que el paciente pueda calificar.


 

English TRANSCRIPT

When we talk about tyrosine kinase inhibitors resistance, we know that for patients with the 790 mutation, we have the drug osimertinib. The problem is, what do we do with the rest of the patients? As I told you, 60% of the patients that are in tyrosine kinase inhibitors will have the 790 mutation that if we can find them in the blood, urine or in a new biopsy, we will be able to use the new drug.

But, what do we do with the 40% of patients in which we cannot verify the mutation?

There is hope for these patients because nowadays we know that most patients without this mutation have their resistance mechanism via de MET pathway. We have MET and their pathway inhibitors that could be the solution for these patients. The other option is that some patients, in a group of around 10%, make small cell lung cancer. In other words, the original large cell lung cancer transformed into small cell lung cancer. These patients will not respond to any existing targeted therapy because we don’t have a small cell cancer treatment, so we have to put them in chemotherapy. 

That is why it is so important to make a biopsy, because if we don’t make a biopsy when the patients fails with the tyrosine kinase inhibitors, then we will never know that the patient probably transformed into a small cell lung cancer and we will never give him the right therapy.

At the end, while these findings and more research is progressing, what we have to do is put the patients in chemotherapy. When a patient fails with the treatment and we cannot verify 790 mutation, we have to put him in chemotherapy or in a suitable clinical trial.


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #35 Treatment Options for Acquired Resistance to EGFR TKIs: T790M-Positive Disease

Share
 
GRACE Cancer Video Library - Lung

 

We continue to provide informational videos for our Spanish speaking community and welcome Dr. Luis Raez, MD FACP FCCP, Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University.  Dr. Raez joined GRACE to discuss the basics of lung cancer.  In this 35th video for the Spanish lung cancer video library, Dr. Raez discusses treatment options for acquired resistance to EGFR TKIs: T790M-positive disease.


 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
download transcripts
 

Opciones de tratamiento para la resistencia adquirida a los inhibidores de tirosinas cinasa del receptor del factor de crecimiento epidérmico (EGFR): enfermedad positiva en T790M

 Treatment options for acquired resistance to tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR): T790 positive disease. 

 Dr. Luis Raez, MD FACP FCCP

Chief of Hematology/Oncology and Medical Director, Memorial Cancer Institute,
Clinical Associate Professor of Medicine, Florida International University

 

Spanish TRANSCRIPT

Hablando de resistencia en el caso de los receptores de EGFR, hay una mutación nueva que aparece llamada T790M. Es la más popular y se calcula que a veces hasta en el 60% de los pacientes que están en inhibidores de la tirosina cinasa, van a desarrollar mutaciones resistentes en T790M y hay otro 40% con otras etiologías.

Es importante documentar que el paciente tiene esta mutación nueva 790 porque ya tenemos un tratamiento específico, que es el fármaco osimertinib que ya está disponible en Estados Unidos y Europa y próximamente en todo el mundo que es otro inhibidor de la tirosina cinasa. Es un fármaco bien tolerado, no es muy tóxico, se parece a otros inhibidores de la tirosina cinasa. Incluso les diría que es menos tóxica en a lo que se refiere a piel y sistema gastrointestinal.

Lo importante es diagnosticarlo porque si uno no puede probar que el tumor ha hecho una mutación 790, no podemos darle el fármaco. Este fármaco está aprobado específicamente para pacientes que tienen esta mutación. Así que yo creo que es importante que cuando en un paciente falla un inhibidor de la tirosina cinasa, que se le haga una nueva biopsia, una biopsia líquida o una muestra de orina para documentar que el paciente haya hecho una resistencia y que se le haya encontrado la mutación 790 que usualmente no está al comienzo y así poder cambiar la terapia.


 

 

English TRANSCRIPT

Talking about resistance in the EGFR receptor, there is a new mutation called T790M. It’s by far the most popular and around 60% that are currently in tyrosine kinase inhibitor, will develop resistant mutations to T790M, the other 40% will have other etiologies.

It is of great priority to document that the patient has this new 790 mutation, because we already have a new specific treatment. This is the drug osimertinib, a tyrosine kinase inhibitor, already available in United Stated and in Europe, and in the near future worldwide. I would even say that this drug is less toxic in the skin and in the gastrointestinal tract.

The important here is the diagnosis because if one cannot prove that the tumor has made a 790 mutation, then we cannot give him the drug. This drug is approved specifically for patients with this mutation. So, I think, it’s very important that when a patient fails with the tyrosine kinase inhibitor, we should make a new biopsy, a liquid biopsy or an urine test to document that the patient has developed resistance and that he has the 790 mutation which is usually not developed in the beginning. This way, we will be able to change therapy.


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #34 Acquired Resistance to Targeted Therapies: Biology and Different Clinical Patterns

Share
 
GRACE Cancer Video Library - Lung

 

We continue to provide informational videos for our Spanish speaking community and welcome Dr. Luis Raez, MD FACP FCCP, Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University.  Dr. Raez joined GRACE to discuss the basics of lung cancer.  In this 34th video for the Spanish lung cancer video library, Dr. Raez discusses acquired resistance to targeted therapies: biology and different clinical patterns.


 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
download transcripts
 

Resistencia adquirida a terapias dirigidas: biología y diferentes patrones clínicos

Acquired resistance to targeted therapies: biology and different clinical patterns

 Dr. Luis Raez, MD FACP FCCP

Chief of Hematology/Oncology and Medical Director, Memorial Cancer Institute,
Clinical Associate Professor of Medicine, Florida International University

 

Spanish TRANSCRIPT

Lamentablemente, a pesar que es muy emocionante ver como los pacientes que tienen las mutaciones de EGFR y las translocaciones ALK responden al inicio, sabemos que los tumores van a crear resistencia a estos agentes.

Usualmente es a los 10 o 12 meses que la mitad de los pacientes que están en estas terapias blanco, genera resistencia por muchas razones. Por ejemplo, en los receptores de EGFR, aparecen nuevas mutaciones como la mutación EGFRT790. En el caso de las translocaciones de ALK, también aparecen otras variantes nuevas que no están al comienzo que son variantes asociadas y documentadas para resistencia.

A pesar de que hay sensibilidad al comienzo, tenemos que estar alerta y monitorizando ya sea con radiografía o próximamente vamos a tener biopsias líquidas que vamos a poder estar monitorizando en la sangre para ver cuando empiezan la clonas resistentes a aparecer y en qué momento hay que empezar a cambiar la terapia.

Como ustedes saben felizmente, en el caso de la EGFR, cuando aparece resistencia tenemos otras terapias blanco como osimertinib. En el caso de las translocaciones ALK tenemos otras terapias blanco a parte de crisotinib que se usa al comienzo, tenemos ceritinib, alectinib y otros fármacos más que están por venir.

 


 

 

English TRANSCRIPT

Unfortunately, despite the excitement of seeing patients with EGFR mutations and ALK translocations responding great to the treatment, we know that these tumors will create resistance to the therapy.

Usually at 10 or 12 months, half targeted therapy patients create resistance for many reasons. For example, in EGFR receptors, new mutations arise like EGFRT790. In ALK translocations, new variants appear that are associated and documented to resistance.

Despite there is sensitivity at the beginning, we have to be alert and monitoring with a radiography or in the near future with a liquid biopsy where we will be able to monitor blood and see when the resistant clones start to develop, and then change the therapy.

As you know, in EGFR when resistance starts, we have other new targeted therapies like osimertinib. In the ALK translocations, we have other targeted therapies besides crisotinib that is used in the beginning. We also have ceritinib, alectinib and other drugs that are coming.

 


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #18 Acquired Resistance to Targeted Therapies: Biology and Different Clinical Patterns

Share
 
GRACE Cancer Video Library - Lung

 

For our 18th video in the GRACE Spanish Lung Cancer Library, Dr. Brian Hunis, Medical Director, Head and Neck Cancer Program, Memorial Cancer Institute, Miami, Florida, joined GRACE to discuss the basics of Lung Cancer for Spanish-speaking patients and caregivers.  In this video Dr. Hunis addresses acquired resistance to targeted therapies: biology and different clinical patterns.


 

 

 

 


 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
download transcripts

Resistencia adquirida a las terapias dirigidas: Biología y diferentes patrones clínicos.

Lamentablemente inclusive en pacientes que tienen la translocación de ALK, eventualmente los pacientes van a desarrollar una resistencia adquirida, por lo cual la medicación con crizotinib no va a funcionar mas.

Por lo general, estos son pacientes que van a tener un prelapso o una recaída en sistema nervioso central o pulmón. Esos son pacientes a los cuales que uno va a considerar terapia de segunda línea o cambiar a quimioterapia.


Acquired resistance to targeted therapies: biology and different clinical patterns.

Unfortunately, even patients with ALK translocation will eventually develop an acquired resistance, resulting in crisotinib not working anymore.

In general, these patients will have a relapse or re-fall in the central nervous system or lung. In these patients, we will consider a second line therapy or change to chemotherapy.


Denise Brock

Targeted Therapies in Lung Cancer Patient Forum 2016 – Evolving Landscape with Dr. Dara Eisner

Share

Presented by the

Global Resource for Advancing Cancer Education
in collaboration with
the University of Colorado
Cancer Center
 
On August 20, 2016, in collaboration with the University of Colorado Cancer Center, GRACE presented the Targeted Therapies in Lung Cancer Patient Forum in Aurora Colorado.  In this eighth video from the webcast series, GRACE presents the lunchtime keynote discussion: The Evolving Landscape of Molecular Testing in Lung Cancer: Who, How and When? featuring Dr. Dara Eisner.

Download the Agenda and Speaker Bios

(click for speaker slides)
The Evolving Landscape of Molecular Testing in Lung Cancer: Who, How and When?
 


How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.

 

Ask Us, Q&A
Lung/Thoracic Cancer Expert Content

Archives

Share

GRACE Cancer Video Library - Lung Cancer Videos

 

2015_Immunotherapy_Forum_Videos

 

2015 Acquired Resistance in Lung Cancer Patient Forum Videos

Share

Join the GRACE Faculty

Breast Cancer Blog
Pancreatic Cancer Blog
Kidney Cancer Blog
Bladder Cancer Blog
Head/Neck Cancer Blog
Share

Subscribe to the GRACEcast Podcast on iTunes

Share

Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon

Subscribe to
GRACE Notes
   (Free Newsletter)

Other Resources

Share

ClinicalTrials.gov


Biomedical Learning Institute

peerview_institute_logo_243