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Can we cure cancer ?
- 1. Can We CureCancer ?
- 2. Can We CureCancer ? Aladdin Maarraoui, MD, FACP. Clinical Professor, Gulf Medical University Consultant and Chief of Hematology Oncology Mafraq Hospital, Abu Dhabi, UAE
- 3. ينفعنا ما علمنااللهم علمتنا بما انفعنا و الراحمين أرحم يا علما زدنا و May Allah teach us what benefits us and benefit us of what he taught us and increases our knowledge.
- 4. Who are you? •Who are you cancer? • Are you the Emperor of terror? • Are you a ghost that enters without a notice? • Are you a prison that locks patients in? • Why are you so cruel? • Why are you so heartless? • How many sweet people you intend to harm?
- 5. The Truth is: •You start and end with people. • You are being defeated more and more. • We started to know how you sneak into bodies and we are detecting you very early. • Your risk factors are being recognized. • You are like a puzzle. But the puzzle pieces are found every day. • You cannot disguise anymore.
- 6. Can we improvecancer mortality? • In the western world and since year 2000, cancer mortality dropped by nearly 2% a year. • This does not mean that cancer incidence is less, but this is the result of risk factors awareness, detection at an early stage and new treatment strategies.
- 7. Trends in lungcancer mortality rates by sex in select countries, 1950-2006. Jemal A et al. Cancer Epidemiol Biomarkers Prev 2010;19:1893-1907 ©2010 by American Association for Cancer Research
- 8. The First UAENon-Communicable Disease Conference, January, 2014 Under Patronage of H.H. Sheikh Hamdan Bin Rashed Al Maktoum.
- 9. Our Goal is: todecrease cancer mortality 20% by year 2025
- 12. The First Cancer SurvivorsDay in UAE was in 2007
- 16. The Human GenomeProject • It mapped the human genome at the University of Utah. Started in 1990 and completed in 2003 at cost of 3 billion dollars. • Human beings have 20,500 genes.
- 17.
- 18. How Many GenesGive Cancer • Not too many. • May be 300 genes out of the 20,500 genes.
- 19.
- 20. The problem isnot with the car. It is with the driver!
- 21. [TITLE] Presented By PaulA. Bunn, MD at 2013 ASCO Annual Meeting
- 22.
- 23.
- 24. 1: 84 year-oldFemale • Never smoked cigarettes. • Diagnosed with locally advanced lung cancer in 10, 2010 • Her symptoms were hoarseness and dyspnea on exertion. • She previously received single agent chemotherapy on and off with partial response. • She came to Mafraq Hospital in December, 2012.
- 26. Gene testing • EGFRmutation (Leucine 858 Arginine) of exon 21. • Plans for chemotherapy and radiotherapy were put off. • We started targeted therapy 1 tablet per day.
- 27.
- 28. 11, 2015 Cancerstarted to grow again
- 29.
- 31.
- 33. On 13/11/2015 FDAApproved AZD 9291for EGFR resistant lung cancer
- 34. Company stocks immediatelywent up!
- 35. I contacted thecompany • Patient will get the drug for free on their early access compassionate program. • Ethics & Research Committee and Pharmacy & Therapeutics Committee are notified. • The drug is on its way.
- 36. 2: 53 year-oldUAE Male • Patient is a past smoker. • Developed abdominal discomfort and bloating. • He went to Munich, CT scans showed Lt. lower lobe lung cancer and Liver metastasis. • Bronchial biopsy showed lung cancer on 23/3/13. • He underwent 1 cycle of cisplatin + Taxol chemotherapy.
- 41. Gene testing • Cancercells showed EML4-Alk mutation in 65% of cells. • Chemotherapy is stopped. • We started targeted therapy1 tablet PO BID.
- 42. Follow up PETCT showed complete anatomical and metabolic response
- 45.
- 46. 3- Trastuzumab blockscell proliferation
- 49.
- 52.
- 53. Before Anti-angiogenic drug (on22/3/2010)
- 54.
- 55.
- 56. 5- Case of relapsedbrain tumor 27 Sept 2012 12 May 2013
- 57.
- 58.
- 60.
- 61.
- 62. It gets acceleratedto 2/3 of speed of light using a synchrotron.
- 63. Speed is generatedby large magnets.
- 64. Charged carbon ionsare directed to the treatment rooms.
- 65.
- 67. Treatment Room withRobotic Couch
- 68. 8- • Survival rateof kidney cancer by stage in 2012.
- 69. Case of stageIV Kidney cancer. On targeted therapy pill 4 weeks on 2 weeks off June 2011 July 2014
- 70. 9- Colon cancermetastatic to the Liver
- 71.
- 73.
- 74. 10- PD-1 andPDL-1 Inhibitors
- 75.
- 76. The PD-1 PathwayInhibits Effector Phase of T-Cell Activity Quezada SA, Peggs KS. Br J Cancer. 2013;108:1560–1565. Pardoll DM. Nat Rev Cancer. 2012;12:252–264. Ribas A. N Engl J Med. 2012;366:2517–2519. Keir ME, et al. Annu Rev Immunol. 2008;26:677–704. Nishimura H, et al. Int Immunol. 1996;8:773–780. PD-1, is a cell surface co- inhibitory receptor expressed on T cells that inactivates antigen specific T-cells in the tumor microenvironment. Its normal role is to down- regulate T-cell activity in peripheral tissues and limit collateral tissue damage during the immune response. 76
- 77. Quezada SA, PeggsKS. Br J Cancer. 2013;108:1560–1565. Pardoll DM. Nat Rev Cancer. 2012;12:252–264. Ribas A. N Engl J Med. 2012;366:2517–2519. Keir ME, et al. Annu Rev Immunol. 2008;26:677–704. Nishimura H, et al. Int Immunol. 1996;8:773–780. PD-1, is a cell surface co- inhibitory receptor expressed on T cells that inactivates antigen specific T-cells in the tumor microenvironment. Its normal role is to down- regulate T-cell activity in peripheral tissues and limit collateral tissue damage during the immune response. 77
- 78. NSCLC Cells mayEvade Immune Surveillance by Exploiting the PD-1 Checkpoint Pathway • Tumor cells may block immune responses via the PD-1 immune checkpoint pathway by expressing the dual PD-1 ligands, PD-L1 and PD- L2 • PD-L1 and PD-L2 engage the PD-1 receptor on T cells, inactivate T cell signaling, proliferation and effector function to allow tumor cells to evade the immune response Freeman G, et al. PNAS.2008;105:10275–10276. Pardoll DM. Nat Rev Cancer. 2012;12:252–264. Zou W, Chen L. Nat Rev Immunol. 2008;8(6):467–477. Rozali EN, et al. Clin Dev Immunol. 2012;2012:656340. 78
- 80. Abu Dhabi Achievement(source HAAD) Reduction in late stage breast cancer, from 64% in 2007 to 16% in 2012 Target 15-20%, similar to other countries such as UK and US
- 83. DISCLAIMER: The informationcontained in this presentation is for general information purposes intended for cancer patients, caregivers, and community. The images and information are provided by Cancer Patient Care Society (CPCS) - Rahma from various websites and resources. We endeavour to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the source, contents or related graphics in this presentation.