2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

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Advanced Biliary Tract Cancers By Laura Williams Goff, MD, and Jordan D. Berlin, MD Overview: Single-agent management of metastatic biliary tract cancers with 5-fluorouracil (5-FU) or gemcitabine has shown limited efficacy, although 5-FU has been shown to be more effective than best supportive care alone. An analysis of phase II trials has suggested that platinums enhanced the efficacy of single-agent fluoropyrimidines. In a phase III randomized trial comparing single-agent gemcitabine with gemcitabine plus cisplatin, the gemcitabine/cisplatin combination significantly improved median overall survival (OS) BILIARY TRACT cancers consist of a somewhat heterogeneous group of tumors that include gallbladder cancer, extrahepatic biliary tract cancer, and intrahepatic cholangiocarcinoma. The exact incidence of each of these cancers is difficult to discern from annual cancer statistics because, for example, intrahepatic cholangiocarcinoma is still combined with hepatocellular carcinoma despite the fact that these are biologically distinct entities. In 2011, 9,250 new cases and 3,300 deaths from biliary tract cancers and gallbladder cancer (excluding intrahepatic cholangiocrcinoma) were anticipated. 1 Cancers of the biliary tract are often found at late stages when resection is not feasible and treatment options are limited. Overall, 5-year survival rates are estimated to be approximately 15%. Cytotoxic Chemotherapy The systemic treatment of biliary tract cancers has largely been based on cytotoxic chemotherapy. Data comparing 5-FU–based chemotherapy with best supportive care demonstrated that median survival times are significantly prolonged (6.0 months vs. 2.5 months) with treatment. 2 In addition, the time before declines in quality of life was prolonged with 5-FU–based chemotherapy. Rates of response to either single-agent 5-FU or 5-FU with leucovorin range up to approximately 20% with survival times up to 8 months. Similarly, single-agent gemcitabine has been explored as an alternative treatment option for biliary tract cancers. Response rates for single-agent gemcitabine have ranged from 16% to 36% and survival times from 6 months to 16 months. 3 Phase II study of combinations of gemcitabine with either 5-FU or its oral prodrug, capecitabine, has not clearly improved on the results of single-agent phase II data. 4 The most promising results came from the combination of gemcitabine and capecitabine with a response rate of 31% in 45 patients and an OS of 14 months. 5 However, studies combining 5-FU or gemcitabine with platinums have yielded very promising response rates. 4 Therefore, a study was undertaken to evaluate the effects of gemcitabine plus cisplatin compared to gemcitabine alone. 6 This study had an initial randomized phase II portion (ABC-01) and, when its endpoints were met, the trial proceeded to phase III (ABC-02). The ABC-02 trial demonstrated a significant benefit in both response rate and PFS favoring the gemcitabine/cisplatin arm. Most importantly, OS increased from 8.1 months for those treated with singleagent gemcitabine to 11.7 months for those treated with gemctiabine/cisplatin. These results have established the standard of care for biliary tract cancers at the current time. and progression-free survival (PFS), which established a new option for standard of care. However, the future of cancer medicine lies in newer, targeted agents. In the management of biliary tract cancers, preliminary evidence with epidermal growth factor receptor inhibitors has already demonstrated activity. This article reviews systemic therapies for metastatic biliary tract cancers as they relate to current and emerging standards of care. KEY POINTS ● Single-agent management of advanced biliary cancers with 5-fluorouracil or gemcitabine yields short survival times. ● Adding cisplatin to gemcitabine significantly improves progression-free survival and overall survival for patients with biliary tract cancers. ● Targeted therapies are being evaluated in patients with biliary tract cancers, showing some preliminary evidence of activity for epidermal growth factor receptor inhibition. Targeted Agents Because of the limited likelihood that cytotoxic therapy will substantially change the natural history of biliary tract cancers, investigation is now focusing on the use of targeted agents. One of the first agents studied in biliary tract cancers was erlotinib, an oral tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR). EGFR is overexpressed in most biliary tract cancers. 7 In a singleagent, multi-institutional study, erlotinib produced rare responses (8%) in 42 patients. 8 Although the median time to tumor progression was only 2.6 months, 17% of patients were progression-free at 6 months and OS was 7.5 months. Because adding EGFR inhibition to chemotherapy has worked in other diseases such as colorectal cancer, investigators have added cetuximab to gemcitabine and oxaliplatin in a phase II study. A small randomized trial comparing the combination of gemcitabine plus oxaliplatin with gemcitabine/oxaliplatin plus erlotinib has been reported. 9 In the 133 randomly assigned patients, there was a trend toward a PFS benefit from adding erlotinib, but OS was identical for both arms at 9.5 months. However, the EGFR pathway is actually a complex network and has interactions with several other pathways. Others have tried From the Vanderbilt Ingram Cancer Center, Nashville, TN. Authors’ disclosures of potential conflicts of interest are found at the end of this article. Address reprint requests to Jordan D. Berlin, MD, Vanderbilt Ingram Cancer Center, 777 Preston Research Building, 2220 Pierce Ave., Nashville, TN 37232-6307, email: jordan. berlin@vanderbilt.edu. © 2012 by American Society of Clinical Oncology. 1092-9118/10/1-10 281
to optimize the use of erlotinib by adding other targeted agents. One phase II study of combined EGFR and vascular endothelial growth factor inhibition with erlotinib and bevacizumab showed promising results. 10 In 53 patients, six (12%) patients had confirmed partial responses. Median time to progression was 4.4 months and OS was 9.9 months. Other investigators have evaluated targeting different proteins downstream of EGFR for better results. Some evidence of activity has been seen with MEK inhibition and biliary tract cancers. 11 However, better understanding of these pathways in biliary tract cancer will help us to better use the new, targeted therapies for patients with biliary tract cancers. Authors’ Disclosures of Potential Conflicts of Interest Author Employment or Leadership Positions Consultant or Advisory Role Jordan D. Berlin NCI (L) Amgen; Arno Therapeutics; AstraZeneca; Celgene; Clovis Oncology; Genentech; Novartis; Otsuka; Roche; Sanofi Laura Williams Goff Abbott Laboratories 1. Siegel R, Ward E, Brawley O, et al. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA: Cancer J Clin. 2011;61:212-236. 2. Glimelius B, Hoffman K, Sjoden PO, et al. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol. 1996;7:593-600. 3. Anderson CD, Pinson CW, Berlin J, et al. Diagnosis and treatment of cholangiocarcinoma. Oncologist. 2004;9:43-57. 4. Eckel F, Schmid RM. Chemotherapy in advanced biliary tract carcinoma: a pooled analysis of clinical trials. Br J Cancer. 2007;96:896-902. 5. Knox JJ, Hedley D, Oza A, et al. Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial. J Clin Oncol. 2005;23:2332-2338. 6. Valle JW, Wasan HS, Palmer DD, et al. Gemcitabine with or without cisplatin in patients (pts) with advanced or metastatic biliary tract cancer (ABC): Results of a multicenter, randomized phase III trial (the UK ABC-02 trial). J Clin Oncol. 2009;27:15s (suppl; abstr 4503). 282 Conclusion Management of biliary tract cancers has previously been limited to fluoropyrimidines; however, over the last several years, new two-drug combinations have been developed with evidence of better activity than single-agent regimens. Although gemcitabine/cisplatin have been established as a standard option for these cancers, other two-drug regimens appear to have similar results. Now that the era of targeted agents for biliary tract cancers is starting, it is important that we improve our understanding of the biology of the disease and how best to use these new classes of agents to improve the outcomes for patients with these deadly diseases. Stock Ownership Honoraria REFERENCES Research Funding Bristol Myers Squibb; OSI Pharmaceuticals; Sanofi Expert Testimony BERLIN AND GOFF Other Remuneration 7. Lee CS, Pirdas A. Epidermal growth factor receptor immunoreactivitiy in gallbladder and extrahepatic biliary tract tumours. Pathol Res Pract. 1995;191:1087-1091. 8. Philip PA, Mahoney MR, Allmer C, et al. Phase II study of erlotinib in patients with advanced biliary cancer. J Clin Oncol. 2006;24:3069- 3074. 9. Lee J, Park SH, Chang HM, et al. Gemcitabine and oxaliplatin with or without eroltinib in advanced biliary-tract cancer: A multicentre, open-label, randomised, phase 3 study. Lancet Oncol. 2012;13:181- 188 10. Lubner SJ, Mahoney MR, Kolesar JL et al. Report of a multicenter phase II trial testing a combination of biweekly bevacizumab and daily erlotinib in pateints with unresectable biliary cancer: A phase II consortium study. J Clin Oncol. 2010;28:3491-3497. 11. Bekaii-Saab T, Phelps M, Li X, et al. A multi-institutional study of AZD6244 in patients with advanced biliary cancers. Cancer Res. 2009; (suppl; abstr LB 129)
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AMERICAN SOCIETY OF CLINICAL ONCOLO
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American Society of Clinical Oncolo
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American Society of Clinical Oncolo
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New Looks and Challenges for Cooper
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Genitourinary Cancer Best Use of Im
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Research and Standard of Care: Lung
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Practice Management and Information
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2012 ASCO Annual Meeting Disclosure
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Matti S. Aapro, MD Clinique De Geno
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Hedy Lee Kindler, MD The University
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Douglas E. Wood, MD University of W
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Mary Lou Smith, JD, MBA Research Ad
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ASCO and Conquer Cancer Foundation
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Letter from the Editor The theme of
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Adjuvant Therapy for Older Women wi
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TREATMENT FOR OLDER WOMEN WITH BREA
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MANAGEMENT OF T1 BREAST CANCERS the
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MANAGEMENT OF T1 BREAST CANCERS Tab
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MANAGEMENT OF T1 BREAST CANCERS Tab
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MANAGEMENT OF T1 BREAST CANCERS 93.
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MANAGEMENT OF T1 BREAST CANCERS 1 c
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ADJUVANT ENDOCRINE THERAPY reductio
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ADJUVANT ENDOCRINE THERAPY which ra
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ADJUVANT ENDOCRINE THERAPY assay is
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A DICKENS TALE OF THE TREATMENT OF
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TREATMENT OF ADVANCED BREAST CANCER
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A FRESH LOOK AT DUCTAL CARCINOMA IN
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Ductal Carcinoma In Situ, and the I
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DCIS AND INFLUENCE OF RISK FACTORS
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KEY QUESTIONS IN THE LOCO-REGIONAL
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POSTMASTECTOMY RADIATION AND PARTIA
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The Appropriate Extent of Surgery f
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SURGERY FOR EARLY-STAGE BREAST CANC
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BIOLOGY AND LOCAL THERAPY DECISIONS
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Clinical and Imaging Surveillance F
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SURVEILLANCE FOLLOWING BREAST CANCE
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SURVEILLANCE FOLLOWING BREAST CANCE
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Advanced Imaging Techniques for the
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IMAGING TECHNIQUES FOR BREAST CANCE
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IMAGING TECHNIQUES FOR BREAST CANCE
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Update of the Oxford Overview: New
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UPDATE OF THE OXFORD OVERVIEW Fig.
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UPDATE OF THE OXFORD OVERVIEW Overv
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Gene Patents and Personalized Medic
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GENE PATENTS AND EFFECTS ON PERSONA
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Chemoprevention for Breast Cancer:
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CHEMOPREVENTION FOR BREAST CANCER T
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CHEMOPREVENTION FOR BREAST CANCER C
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CONTROVERSIES IN PROSTATE CANCER: P
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PROSTATE CANCER RISK REDUCTION men
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PROSTATE CANCER RISK REDUCTION Auth
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PSA SCREENING: HARMS WITHOUT CLEAR
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GLIOBLASTOMA: TAKING THE STANDARD O
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FUTURE DIRECTIONS IN GBM THERAPY pr
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ESTABLISHING TREATMENTS FOR GLIOBLA
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Current Concepts in Brain Tumor Ima
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CONCEPTS IN BRAIN TUMOR IMAGING tum
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CONCEPTS IN BRAIN TUMOR IMAGING Aut
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PERSPECTIVES ON HEADLINE-MAKING NEW
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TTF THERAPY IN GLIOBLASTOMA Fig. 1.
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TTF THERAPY IN GLIOBLASTOMA istics.
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TTF THERAPY IN GLIOBLASTOMA because
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Limitations of Adaptive Clinical Tr
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LIMITATIONS OF ADAPTIVE CLINICAL TR
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LIMITATIONS OF ADAPTIVE CLINICAL TR
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Capturing the Patient Perspective:
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PATIENT-REPORTED OUTCOMES AS TRIAL
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PATIENT-REPORTED OUTCOMES AS TRIAL
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NEW LOOKS AND CHALLENGES FOR COOPER
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NCI NATIONAL CLINICAL TRIALS NETWOR
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Successful Integration of Cooperati
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COG: GIVING NEW MEANING TO COOPERAT
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A Critical Review of the Enrollment
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BLACK PATIENTS AND CANCER CLINICAL
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BLACK PATIENTS AND CANCER CLINICAL
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Trastuzumab Emtansine (T-DM1): Hitc
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T-DM1 AND THERAPEUTIC ANTIBODIES ag
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TARGETING CD30 IN HODGKIN LYMPHOMA
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TARGETING CD30 IN HODGKIN LYMPHOMA
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EARLY DRUG DEVELOPMENT: CASTING A W
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Table 1. Response Rates in Expanded
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Drug Development in the Era of Pers
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that the core pathway is not comple
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This situation is not surprising, g
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Practical Management of Immune-Rela
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the anterior pituitary axis is invo
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TARGETING CRITICAL MOLECULAR ABERRA
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Abl suppression; and 3) the early e
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50% 50% 100% Change in Tumor Size m
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vanced solid tumors, even if they a
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Targeting Molecular Aberrations in
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date. With the advent of gene expre
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consortium to facilitate the testin
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ETHICAL CHALLENGES OF HEALTH CARE R
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HEALTH CARE REFORM AND ONCOLOGY dev
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HEALTH CARE REFORM AND ONCOLOGY aut
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INTERNATIONAL VARIATION IN UNDERSTA
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midcareer physician; in one cross-s
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Table 1. Recommendations for Person
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stances (e.g., stage of career, fam
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elationship” is also acknowledged
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Conclusion In more individualistic
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The Oncologist’s Duty to Provide
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an external observer, but to the pe
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MEDICAL ERRORS IN CANCER CARE: PREV
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DISCLOSING MEDICAL ERRORS Disclosur
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DISCLOSING MEDICAL ERRORS Author’
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PREVENTING MEDICAL ERRORS more diff
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“PERSONALIZED” ONCOLOGY FOR COL
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0.001), progression-free survival (
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mately 40% of patients with colorec
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Table 1. Tumor Marker Utility Gradi
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treatment (tx) for metastatic color
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The Interventional Radiologist Role
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effect. The most common drug that h
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gone forever, no further therapy is
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is irrelevant if it is already rese
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Resection and Thermal Ablation of L
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Author’s Disclosures of Potential
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Minimally Invasive Surgery of Recta
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outcomes; local, wound-site, and di
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Authors’ Disclosures of Potential
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CAO/ARO 04 study—which added oxal
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STAGE III COLON CANCER: WHAT WORKS,
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Table 1. Comparison of Fluoropyrimi
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tients with stages II and III color
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ized by high fruit, vegetable, poul
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Exercise Change trial: a randomized
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A New Direction for Pancreatic Canc
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OLDER PATIENTS WITH ADVANCED CANCER
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OLDER PATIENTS WITH ADVANCED CANCER
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RECENT CLINICAL HIGHLIGHTS IN GYNEC
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GLOBAL ADVANCES IN GYNECOLOGIC ONCO
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GLOBAL ADVANCES IN GYNECOLOGIC ONCO
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The European Society of Gynaecologi
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ESGO EDUCATIONAL AND RESEARCH ACTIV
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UPFRONT TREATMENT OF OVARIAN CANCER
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ANTIANGIOGENICS AND PARP INHIBITORS
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ANTIANGIOGENICS AND PARP INHIBITORS
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Intraperitoneal Treatment in Ovaria
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INTRAPERITONEAL TREATMENT IN OVARIA
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Dose-Dense Chemotherapy and Neoadju
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CHEMOTHERAPY FOR OVARIAN CANCER Fig
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CHEMOTHERAPY FOR OVARIAN CANCER whi
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UTERINE SARCOMA: CHALLENGING CASES
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HISTOLOGIC FEATURES AND MANAGEMENT
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SURGICAL OPTIONS FOR UTERINE SARCOM
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SURGICAL OPTIONS FOR UTERINE SARCOM
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PATIENTS WITH HPV-POSITIVE OROPHARY
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HPV-INDUCED OROPHARYNX CANCER analy
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HPV-INDUCED OROPHARYNX CANCER fract
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Important Early Advances in Squamou
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EARLY ADVANCES IN SCCHN Fig 1. Targ
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Application of Genomic and Proteomi
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GENOMIC AND PROTEOMIC TECHNOLOGIES
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GENOMIC AND PROTEOMIC TECHNOLOGIES
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TREATMENT OF THYROID CANCERS: NEW I
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EVALUATION OF ADVANCED THYROID CANC
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EVALUATION OF ADVANCED THYROID CANC
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Systemic Therapeutic Approaches to
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APPROACHES TO ADVANCED THYROID CANC
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AVOIDING OVERDIAGNOSIS AND OVERTREA
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Table 1. Prevalence of Prostate Can
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Table 3. Potential Risks and Benefi
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Overdiagnosis and Overtreatment of
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een reached by other modeling effor
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east cancer community have FDA-appr
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COSTS OF CANCER CARE: AFFORDABILITY
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REDUCING THE COST OF CANCER CARE Fi
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REDUCING THE COST OF CANCER CARE Th
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REDUCING THE COST OF CANCER CARE de
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Why Hasn’t Genomic Testing Change
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tigators should develop prospective
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MANAGEMENT OF CHRONIC LYMPHOCYTIC L
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PREDICTIVE PARAMETERS IN CLL Table
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PREDICTIVE PARAMETERS IN CLL patien
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Transplant in Chronic Lymphocytic L
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WHEN TO OFFER TRANSPLANTATION IN CL
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WHEN TO OFFER TRANSPLANTATION IN CL
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NEW DEVELOPMENTS IN MYELOPROLIFERAT
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SMALL-MOLECULE INHIBITORS FOR MPN S
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SMALL-MOLECULE INHIBITORS FOR MPN L
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Insights into the Molecular Genetic
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GENETICS OF MYELOPROLIFERATIVE NEOP
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Classification of Myeloproliferativ
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CLASSIFICATION AND PROGNOSIS OF MPN
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CLASSIFICATION AND PROGNOSIS OF MPN
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AROUND THE WORLD IN ALMOST 80 MINUT
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LUNG CANCER IN BRAZIL Fig. 1. Relat
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LUNG CANCER IN BRAZIL Fig. 3. Chara
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LUNG CANCER IN BRAZIL Author’s Di
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LUNG CANCER IN CHINA Fig 1. Chinese
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LUNG CANCER IN CHINA well equipped
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Research and Standard of Care: Lung
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LUNG CANCER IN ROMANIA ● Protecti
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LUNG CANCER IN ROMANIA reimbursemen
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A New Model: Physician-Patient Coll
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PHYSICIAN ENGAGEMENT IN ONLINE PATI
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PHYSICIAN ENGAGEMENT IN ONLINE PATI
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LUNG CANCER SCREENING 101 CHAIR Chr
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LUNG CANCER SCREENING The concern i
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LUNG CANCER SCREENING Fig. 1. Guide
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LUNG CANCER SCREENING Fig. 2. Guide
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LUNG CANCER SCREENING 19. Montes RP
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Molecular Testing of Non-Small Cell
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MOLECULAR TESTING AND NSCLC Fig 1.
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MOLECULAR TESTING AND NSCLC logic d
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THYMOMA AND THYMIC CARCINOMA: UPDAT
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MANAGEMENT OF THYMIC CARCINOMA recu
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MANAGEMENT OF THYMIC CARCINOMA Refe
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The Creation of the International T
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ITMIG AS A MODEL FOR RARE DISEASES
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Thymoma: From Chemotherapy to Targe
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SYSTEMIC TREATMENT OF THYMOMA Study
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SYSTEMIC TREATMENT OF THYMOMA cance
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What Is the Best Strategy for Incor
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TREATMENT OF FOLLICULAR LYMPHOMA Fi
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TREATMENT OF FOLLICULAR LYMPHOMA me
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TREATMENT OF FOLLICULAR LYMPHOMA ou
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TREATMENT OPTIONS IN INDOLENT LYMPH
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CONTROVERSIES IN MYELOMA: INDUCTION
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TRANSPLANTATION FOR MYELOMA Alterna
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TRANSPLANTATION FOR MYELOMA compare
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TRANSPLANTATION FOR MYELOMA autolog
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Maintenance Therapy for Myeloma: Ho
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NEW OPTIONS, NEW QUESTIONS: HOW TO
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THERAPIES FOR PATIENTS WITH METASTA
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Chemotherapy-Induced Nausea and Vom
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INCIDENCE AND PREVALENCE OF CHEMOTH
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New Frontiers in Mucositis By Dougl
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MUCOSAL INJURY CAUSED BY CANCER THE
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Short- and Long-term Cardiovascular
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Recent Advances in Cardiotoxicity o
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CARDIOTOXICITY OF ANTICANCER THERAP
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CARDIOTOXICITY OF ANTICANCER THERAP
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The Oncologist as the Patient with
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THE ONCOLOGIST AS THE PATIENT OR RE
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Prolonged Febrile Neutropenia in th
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FEBRILE NEUTROPENIA IN PEDIATRIC CA
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FEBRILE NEUTROPENIA IN PEDIATRIC CA
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TREATMENT APPROACHES IN CHILDREN wh
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TREATMENT APPROACHES IN CHILDREN th
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GENETIC COUNSELING OF THE PATIENT W
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CANCER PREDISPOSITION IN CHILDHOOD
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HOW TO MANAGE VERY RARE PEDIATRIC C
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RARE CANCER IN CHILDREN Registries
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Genetic Alterations in Childhood Me
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GENETIC ALTERATIONS IN CHILDHOOD ME
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Desmoid-Type Fibromatosis in Childr
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CHEMOTHERAPY FOR DESMOID TUMOR Tabl
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CHEMOTHERAPY FOR DESMOID TUMOR 14.
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Targeting the Insulin-Like Growth F
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TARGETING THE IGF SYSTEM Fig. 1. Th
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TARGETING THE IGF SYSTEM malignanci
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Hedgehog Pathway in Pediatric Cance
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HEDGEHOG PATHWAY IN PEDIATRIC CANCE
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HEDGEHOG PATHWAY IN PEDIATRIC CANCE
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Development and Refinement of Augme
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ABFM THERAPY FOR PEDIATRIC ALL than
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ABFM THERAPY FOR PEDIATRIC ALL Auth
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RADIOTHERAPY FOR PEDIATRIC HODGKIN
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RADIOTHERAPY FOR PEDIATRIC HODGKIN
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Role of Doxorubicin in Rhabdomyosar
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DOXORUBICIN IN RHABDOMYOSARCOMA 8.
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Identification of Novel Biologic Ta
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NOVEL TARGETS IN THE TREATMENT OF D
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Is Biopsy Safe in Children with New
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SAFETY OF DIPG BIOPSY IN CHILDREN F
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SAFETY OF DIPG BIOPSY IN CHILDREN 1
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CHILDREN WITH DIFFUSE INTRINSIC PON
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Communication and Decision Support
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COMMUNICATION AND DECISION SUPPORT
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Planning for the Future: The Role o
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present in the office suite but doe
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Summary and Care Plan are provided.
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DOING IT RIGHT, AND FOR LESS: IMPLE
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CLINICAL PATHWAYS STANDARDIZING PER
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CLINICAL PATHWAYS STANDARDIZING PER
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The Future of Oncology Care with Pe
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quantity. Determining the appropria
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THE ASCO QUALITY ONCOLOGY PRACTICE
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IMPROVING VALUE OF CARE IN ONCOLOGY
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PHYSICIAN WELLNESS: COPING WITH REP
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also provides insight on how clinic
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good resource for exploring the pri
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of death or following death and inc
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telephone call to the family, sendi
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New Insights in Cross-Cultural Comm
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CROSS-CULTURAL COMMUNICATION Sideba
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THE ONCOLOGIST, THE PATIENT, AND TH
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estimate of the proportion of their
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exactly the same treatment, even th
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How to Decide Whether to Offer and
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NONSTANDARD THERAPIES FOR ADVANCED
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NONSTANDARD THERAPIES FOR ADVANCED
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TARGETED THERAPIES IN TARGETED OR U
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TARGETED THERAPY IN SARCOMA rates a
Page 793 and 794:
TARGETED THERAPY IN SARCOMA seen in
Page 795 and 796:
TARGETED THERAPY IN SARCOMA recepto
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Adjuvant Treatment of Gastrointesti
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ADJUVANT THERAPY IN HIGH-RISK GASTR
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Management of Tyrosine Kinase Inhib
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TKI-RESISTANT GIST Primary Imatinib
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TKI-RESISTANT GIST Table 2. Clinica
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BIOLOGIC PRINCIPLES OF TARGETED COM
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COMBINING TARGETED AGENTS IN CLINIC
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COMBINING TARGETED AGENTS IN CLINIC
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Combination Therapies Building on t
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COMBINATIONS FOR MELANOMA agents th
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MECHANISMS OF RESISTANCE TO TARGETE
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RESISTANCE MECHANISMS TO MAPK INHIB
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RESISTANCE MECHANISMS TO MAPK INHIB
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Mechanisms of Resistance to Targete
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RESISTANCE TO TARGETED THERAPIES IN
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RESISTANCE TO TARGETED THERAPIES IN
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Translating PI3K-Delta Inhibitors t
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THE STORY OF CAL-101 6% of patients
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PI3 Kinase in Cancer: From Biology
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PI3 KINASE IN CANCER Fig. 1. The PI
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PI3 KINASE IN CANCER Fig. 3. In viv
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This publication is supported by an
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2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

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