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How uniform is cancer care in Europe ?

Brussels - European Parliament, February 18 th - 2014. How uniform is cancer care in Europe ?. Towards Personalised Therapies. Marco A. Pierotti Fondazione IRCCS Istituto Nazionale dei Tumori - Milan OECI Past President. MOLECULAR MECHANISMS OF CANCER :

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How uniform is cancer care in Europe ?

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  1. Brussels - European Parliament, February 18th - 2014 How uniform is cancer care in Europe? Towards Personalised Therapies Marco A. Pierotti Fondazione IRCCS IstitutoNazionaledei Tumori - Milan OECI Past President

  2. MOLECULAR MECHANISMS OF CANCER: THE BEGINNING OF A NEW ERA Cancer genetics Multiple-stepprocess APC Hyper- Methylation APC KRas DCC TP53 April 2003

  3. TOWARDS P4 MEDICINE PREDICTIVE PREVENTIVE PERSONALIZED PARTICIPATORY (David J. Galas and Leroy Hood)

  4. to provide the right drug to the right person at the right dose THE GOAL OF P4 MEDICINE

  5. THE NEW SCENARIO High-throughputtools Molecularcharacterizationoftumors Molecularclassification

  6. MOLECULAR TAXONOMY OF BREAST CANCER ER- ER+ • Association of discovered classes with survival and other clinical variables (Sørlie, PNAS 2001) Class sub-type discovery (Perou, Nature 2001) Validation of findings assigning class labels defined from class discovery to independent data sets (Sørlie, PNAS 2003)

  7. MOLECULAR DIAGNOSTIC Severalpathways are deregulated in humancancer p-Akt, 42% PTEN, 15%–41% HER2, 30%–36% PI3-K, 18%–26% EGFR, 6% EGFR, 32%–60% p-Akt, 23%–50% Ras, 30% PTEN, 24% HER2, 5% PI3-K, 4% Breast Lung TSC1/TSC2 IGF-1/IGF-1R VHL NET TGFa/TGFb1, 60%–100% VHL, 30%–50% IGF-1/IGF-IR, 39%-69% p-Akt, 38% PTEN, 31% TSC1/TSC2 Ras, 50% p-Akt, 46% PTEN, 35% PI3-K, 20%–32% EGFR, 8% HER2, 3% Kidney Colon

  8. THE NEW SCENARIO Discovery of the molecular basis of cancer Switch from the concept of cancer drug as a cytotoxic compound to the knowledge based targetedtherapy

  9. THE NEW SCENARIO High-throughputtools Molecularcharacterization of tumors Molecularclassification Targetedtherapy

  10. IMATINIB/GLEEVEC AS A PARADIGM FOR TARGETING KINASES BCR/ABL inhibitors and CML therapy

  11. Targeted Therapies: some numbers Targeted cancer therapies SaurabhAggarwal Nature Reviews Drug Discovery 9, 427-428 (June 2010)

  12. Targeted Therapies: some numbers OncKive The Rising Cost of Cancer Care in the Era of Individualized Therapy: A Q&A With Thomas J. Smith, MD Anna Azvolinsky, PhD May 2012

  13. The goal of targeted therapies: To chronicise cancer BUT Genetic instability ≠ diabetes or cardio vascular conditions RESISTANCE

  14. Ultimate goal • From chronicization • to eradication • with • combinatorial targeted therapies • and • macro/micro environment modifications

  15. THANK YOU! Marco A. Pierotti Fondazione IRCCS IstitutoNazionaledei Tumori - Milan OECI Past President

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