The IX t h Makassed Medical Congress - American University of Beirut

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T h e I X t h M a k a s e d M e d i c a l C o n g r e s s after R-CHOP induction [4]. Rituximab is an active drug in CLL when used as a single agent. However, the combination of rituximab with fludarabine and cyclophosphamide (R-FC regimen) demonstrate particularly high rates of OR, complete response (CR) and duration of PFS in previously untreated and relapsed/refractory CLL [5,6]. In randomized trials R-FC demonstrated higher OR rate, CR rate and PFS than FC in previously untreated and relapsed/refractory CLL. The U.S. Food and Drug Administration and European Commission approved rituximab in combination with fludarabine and cyclophosphamide for use in patients with previously-treated and untreatrd CLL. The approval was based on clinically meaningful and statistically significant increases in PFS [5,6]. Rituximab seems to be also an effective and safe agent for the treatment of immune thrombocytopenias (ITP), autoimmune haemolytic anaemia (AIHA), cold agglutinin disease (CAD) and pure red cell aplasia (PRCA)[7]. A new generation of mAbs has been developed to have augmented antitumor activity by increasing CDC or ADCC activity and these mAbs are now in clinical trials [8-10]. Ofatumumab is a second-generation, fully human, anti-CD20, IgG1 mAb in phase I, II and III trials for hematological malignancies, autoimmune diseases such as rheumatoid arthritis and multiple sclerosis [8]. Ofatumumab recognizes a different CD20 epitope to rituximab and has demonstrated a higher CDC potential than rituximab. In April 2010, the European Medicines Agency granted a conditional marketing authorization for ofatumumab, for the treatment of Fludarabinerefractory CLL patients. Veltuzumab, as a second-generation, humanized, anti-CD20, IgG1 mAb in phase II trials for NHL, CLL and autoimmune diseases including immune thrombocytopenic purpura. Veltuzumab has enhanced binding avidities and a stronger effect on CDC compared with rituximab. GA-101 is a third–generation, humanized and glycoengineered anti-CD20 IgG1 mAb, for a potential treatment of B-cell malignancies [10] . Compared with classical type I CD20 antibodies (eg, rituximab) GA-101 binds with high affinity to the CD20 type II epitope, which results in induction of ADCC that is 5- to 100-fold greater than by rituximab. GA-101 also exhibits superior caspase–independent apoptosis induction compared with rituximab while CDC activity is low. In a phase I/II trial GA-101 has demonstrated a similar safety profile to rituximab and promising efficacy in patients with relapsed/refractory CD20+ lymphoid malignancies. GA-101 is a promising therapeutic agent for CD20+ B-cell lymphoid malignances, including NHL and CLL. References 1. Robak T. Leuk Lymphoma. 2004 F;45:205-19. 2. Coiffier B, Lepage E, Briere J et al. N Engl. J Med 2002; 346: 235-42. 3. Marcus, R., K. Imrie, P. Solal-Celigny, et al. J Clin Oncol, 2008. 26: 4579-86. 4. van Oers MH, Klasa R, Marcus RE, et al. Blood. 2006;108:3295-301. 5. Hallek M, Fingerle-Rowson G, Fink A, et al. Blood. 2009:Abstract 535. 6. Robak T, Dmoszynska A, Solal-Céligny P, et al. J Clin Oncol. 2010;28:1756-65. 7. Robak T. Eur J Haematol. 2004;72:79-88. 8. Robak T. Curr Opin Mol Ther. 2008;10:294-309. 9. Wierda WG, Kipps TJ, Mayer J, et al. J Clin Oncol. 2010;28:1749-55. 10. Robak T. Curr Opin Investig Drugs. 2009;10:588-96. 74
NEW ORAL ANTICOAGULANTS Ismaïl Elalamy MD “Thrombosis, both venous and arterial, is a major cause of morbidity and mortality worldwide. Consequently, there is an ongoing search for new antithrombotic drugs, particularly novel anticoagulants. Recently, this armamentarium undergoes a major change with the introduction of new specific and oral anticoagulants that are likely to fulfil many of the unmet needs of current warfarin and heparin therapies. A direct thrombin inhibitor, dabigatran etexilate, and a direct factor Xa inhibitor, rivaroxaban are actually marketed for an easier and safer venous thromboembolism prevention following orthopaedic surgery. Large ongoing trials try to demonstrate that these drugs would also simplify and optimize stroke prevention in atrial fibrillation, treatment of venous thromboembolism and prevention of ischemic events in acute coronary syndrome. This presentation reviews the latest developments of new anticoagulants and focuses on those which have been approved or are in advanced development”. ADVANCES AND CHALLENGES IN PEDIATRICS ONCOLOGY Rima Fuad Jubran MD, MPH Cancer is the leading cause of disease related mortality in children in the United States and approximately 12, 4000 children are diagnosed in the U.S. every year. During this talk we will discuss the history of major advances in pediatric oncology therapy and approach to patients. We will discuss the future challenges for the field as well as overall strategies for developing more effective therapies for high risk pediatric cancers. Finally we will talk about cancer survivorship and issues faced by survivors. BREAST SCREENING WITH MRI FOR HIGH RISK WOMEN IN ADJUNCT TO MAMMOGRAPHY Nagi Atallah, MD The demand for breast MRI is increasing. Image quality is improving. The sensibility is high and with high resolution. Image specificity is higher, based on enhancement or DWI or spectroscopy. Screening high risk women represent 70% of the indications in the USA in response to the recommendations of the ACS. What is high risk women? - Women with genetic mutation (BRCA), with strong family history or personal history of breast or ovarian cancer Life time risk >20-25% is considered as high risk depending on the risk models (Gail or Tyrer-Cuzick). Used for risk estimation (NCI, IBIS). Breast MRI is done in adjunct to mammography because there are some DCIS or ILC that do not enhance. In that group of women MRI alone detects twice more cancers than mammography alone. But there are some radiologists or other specialists that believe we are living the impending decline of screening mammography. 75
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The IX th Makassed Medical Congress
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CONGRESS PRESIDENT Said Sayegh, MD,
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GENERAL INFORMATION
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• Target Audience: Physicians, Pr
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Durriya Sinno, MD Pediatrics Americ
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Moderators
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PEDIATRICS Bassem Abou Merhi, MD Pe
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Maroun Sokhn, MD Pediatrics Saint G
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Scientific Program
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Session 3: Intensive Care Neonatolo
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Session 1: Pediatric Intensive Care
Page 23 and 24: 8:00 - 8:05 08:05 - 08:10 Welcome r
Page 25 and 26: Cardiology Session III: Interventio
Page 27 and 28: Cardiology Session VI: Intervention
Page 29: Cardiology Symposia (NON-CME) Frida
Page 32 and 33: T h e I X t h M a k a s e d M e d i
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