Precision Oncology

1
Precision Oncology Istvan Petak MD,
PhD Semmelweis University, Biochemistry Research
Group KPS DIAGNOSTICS KFT ONCOMPASS MEDICINE ZRT
2
12,7 MILLION 7,6 MILLION 14 GLOBOCAN 2008, WHO
3
ONCOLOGY IN THE POST-GENOMIC ERA
2003
2013
2014lt
30,000 genes
547 genes 2,1 million variations
200lt Targeted Drugs
4
LUNG CANCER TREATED WITH TARGETED THERAPY FOR 1
MONTH
5
ONLY 5-10 OF LUNG CANCER PATIENTS BENEFIT FROM
THE SAME TARGETED DRUG
NOT EFFECTIVE, COSTLY TREATMENT
6
DRUGGABLE DRIVER GENES IN LUNG (NSCLC) CANCER
20 PLANO (2X ) 3 ADENO
4 (M) 22 (2X )
afatinib
TKI258
crizotinib
3 (M) 12 (2X )
FGFR
4-7 (break)
5-15 (M) 5-40 (2X )
MET-MAB crizotinib
HER-2
gefitinib erlotinib
ALK/EML4
C-MET
2 (M)
EGFR
ROS1
AMP HEREG TGFa
imatinib sunitinib
KIT
PDGFR
5-20 (M)
5 (M)
KRAS
PIK3CA
BEZ235
HRAS
NRAS
5 (M)
BRAF
AKT/PKB
PTEN
1 (M)
GSK'436 vemurafenib
1 (M)
MEK
MTOR
everolimus
GSK1120212
7
DRIVER GENES ARE THE BEST TARGETS RR 50-100,
PFS 0,5-1 year /years
BCR/ABL
EML4/ALK
KIT M
EGFR M
BRAF M
ROS1
GEFITINIB ERLOTINIBAFATINIB
VEMURAFENIB
CRIZOTINIB
CRIZOTINIB
IMATINIB SUNITINIB
IMATINIB NILOTINIB DASATINIB BOSUTINIB
MELANOMA NSCLC PML
CML ALL
NSCLC NEUROBLASTOMA
NSCLC
NSCLC SCLC OVARIAN, GASTRIC, BREAST
GIST MELANOMA
8
PRECISION ONCOLOGY
TEST
SELECT
TREAT
200lt TARGETED COMPOUNDS
PERSONALIZED TREATMENT STRATEGY AT PARTNER
ONCOLOGISTS
50lt GENES
9
KPS DIAGNOSTICS 50-60-409 Genes
ONCOMPASSTM MEDICINE (OCM)
10
 MOLECULAR PROFILING IS ADVANCING
Dana-Farber Cancer Center/Harvard University
OncoPanel 305 genes Sloan Kettering Cancer
Center 400 genes MDAnderson Cancer Center 400
genes Columbia University 500 genes Washington
University UW-OncoPlex 194 genes Foundation
Medicine Foundation One /Heme 400
genes MolecularHealth (Germany) 500
genes OncoDNA (Belgium) 65-409 genes
11
MULTIPLEX/NEXT-GENERATION SEQUENCING IN NCCN
GUIDELINES
12
THE RIGHT PATIENT FOR THE DRUG (OR) THE RIGHT
DRUG FOR THE PATIENT
Registered drug 1
Registered drug 1
DRUG (registered, in trial)
PATIENT
Trial drug 2
(HER-2, EGFR, KRAS)
Companion Therapeutics
Companion Diagnostics
13
261 DRUGS
58 GENES
DRUGS IN CLINICAL USE (32) AXITINIB,
BEVACIZUMAB, BORTEZOMIB, BOSUTINIB, CABOZANTINIB,
CETUXIMAB, CRIZOTINIB, DABRAFENIB, DASATINIB,
ERLOTINIB, EVEROLIMUS, GEFITINIB, IMATINIB,
LAPATINIB, METFORMIN, NILOTINIB, PANITUMUMAB,
PAZOPANIB, PERTUZUMAB, PONATINIB, REGORAFENIB,
RUXOLITINIB, SORAFENIB, SUNITINIB, TEMSIROLIMUS,
TRAMETINIB, TRASTUZUMAB, TDM-1, VANDETANIB,
VEMURAFENIB, VISMODEGIB, ZIV-AFLIBERCEPT DRUGS
IN CLINICAL TRIALS (173) AKN-028,  AMG 208, AMG
319, AMG 337, AP26113, ARQ 092, ARQ 736 ,
ASP-3026, AT13148, AT9283, AUY922, AV-412 ,
AXL1717, AZD0424, AZD1480 , AZD2014, AZD4547,
AZD5363, AZD8330 , BAY1000394, BEZ235 , BGJ398,
BGT226, BKM120, BMN 673, BMS-777607, BMS-911543,
BRIVANIB, BYL719, CC-223, CEDIRANIB, CH5424802,
CO-1686, CRENOLANIB, DALOTUZUMAB, DACOMITINIB,
DEMCIZUMAB, DKN-01, DOVITINIB, DS-7423, E-3810,
E6201, EMD 1204831, EMD 1214063, ERISMODEGIB,
FORETINIB, GANITUMAB, GDC-0068, GDC-0623 ,
GDC-0941, GDC-0973, GDC-0980, GOLVATINIB,
GSK1059615, GSK1838705A, GSK2110183 , GSK2126458,
GSK2141795, GSK2636771, GSK343, GSK-461364,
HM61713, IMC-CS4, INIPARIB, JNJ-42756493, KU
55933, LDK-378, LENVATINIB, LESTAURTINIB, LGX818 
, LINSITINIB, LJM716, LY2109761, LY2157299,
LY2606368 , LY2780301, LY287445, MASITINIB,
MEDI-573, MEK-162, MGAH22, MGCD265, MIDOSTAURIN,
MK-0752, MK-2206, MK-8242, MLN1117, MM-302,
MOMELOTINIB, NECITUMUMAB, NERATINIB, NINTEDANIB,
NS-398, OLAPARIB, OLARATUMAB, ONARTUZUMAB,
OSI-027, P7170, PACRITINIB, PD0325901, PD0332991,
PD173074, PF-03084014, PF-04217903, PF-04691502 ,
PF-04856884, PF-477736, PIMASERTIB, PKI-179,
PRI-724, PX-866, R04929097, RABUSERTIB, RAF265,
RAMUCIRUMAB, REBASTINIB, REFAMETINIB,
RIDAFOROLIMUS, RILOTUMUMAB, RO4987655, RO5212054,
RUCAPARIB, SAR125844, SARACATINIB, SARIDEGIB, SCH
900776, SELUMETINIB, SEMAGACESTAT, SGX523,
SR13668, SU-1127, TAE684, TAK-733, TAK-960,
TG101348, TILMACOXIB, TIVANTINIB, TIVOZANIB,
TREBANANIB, TRICIRIBINE, VELIPARIB, VOLASERTIB,
VX-509, WX-554, WHI-P154, X-396, X-82, XL019,
XL147, XL281, XL765, ZM39923, ZSTK474 
58 genes for NGS ABL1, AKT1, ALK, APC, ATM,
BRAF, CDH1, CDKN2A, CSF1R, CTNNB1, EGFR, ERBB2,
ERBB4, FBXW7, FGFR1, FGFR2, FGFR3, FLT3, GNAS,
HNF1A, HRAS, IDH1, JAK2, JAK3, KDR, KIT, KRAS,
MET, MLH1, MPL, NOTCH1, NPM1, NRAS, PDGFRA,
PIK3CA, PTEN, PTPN11, RB1, RET, SMAD4, SMARCB1,
SMO, SRC, STK11, TP53, VHL FISH EGFR, HER-2,
FGFR, ALK, MET, ROS1. PIK3CA
Peták I, Schwab R, Orfi L, Kopper L, Kéri G.
Integrating molecular diagnostics into anticancer
drug discovery. Nat Rev Drug Discov. 2010
Jul9(7)523-35.
14
OncompassTM IT support for precision medicine
15
MOLECULAR TUMOR BOARD
Other Physicians with Experience in Molecular
Oncology Oncologists with experience with the
same therapy or molecular profile Principal
investigators of clinical trials
OCM Information Technologies Special Decision
Support Software Databases, Experts in cancer
biology, genetics, bioinformatics
Treating physicians
Molecular Diagnostics
16
OUR PARTNERS
Amongst many... Köln, Germany Essen,
Germany Barcelona Spain Malaga, Spain London,
UK Leuven, Belgium Milano, It Romania Budapest, Hu
Köln TP (free of charge-several 1000s E) Essen
FV Barcelona TP (1000E, 700E, 400E) Malaga TP
(free of charge) London FV (NHS or
cash) Switzerland FV (charge) Hungary TP
(free) Miláno-coming up
17
LUNG CANCER PATIENT IN CLINICAL TRIAL IN SPAIN
MALAGA
INFORMATION
18
WHO BENEFITS FROM PRECISION ONCOLOGY?
INSURANCE
DOCTORS
PATIENTS
more health benefit for less cost
more success
longer, better life
THANK YOU FOR YOUR KIND ATTENTION! Istvan.petak_at_on
compassmedicine.com