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Printable Handouts
Navigable Slide Index
- Introduction
- mTOR inhibitors
- mTOR inhibitor-induced stomatitis
- Combination therapies
- Mucositis interventions
- Pipeline of OM interventions
- Prediction of risk
- Risk of toxicity
- The precision medicine initiative
- We’re heading towards personalized medicine
- Not all patients are at equal risk
- Treatment related risk factors
- Genomically based risk factors
- Genetic determinants of toxicity work at 3 levels
- Drug metabolism mutations
- What are our goals for translational genomics?
- The basics of genomics
- Genes & SNPs
- Candidate gene (1)
- Candidate gene (2)
- Disappointing candidate gene study results
- Gene & SNP functionality is cooperative
- Moving away from one key, one lock
- Genome wide association studies
- Detecting cooperative genes or SNPs
- Risk prediction: A clinical example
- Study design
- Optimal network
- Analytical method
- Results
- Exploratory validation using post hoc methodology
- What do we want in a treatment?
Topics Covered
- Risk of toxicity
- Genomically based risk factors
- Candidate genes
- Genome wide association studies
- Gene/SNP networks
Links
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Therapeutic Areas:
Talk Citation
Sonis, S.T. (2017, June 29). Soreness and ulcers 5: biology, diagnosis and management of cancer regimen 2 [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 14, 2024, from https://doi.org/10.69645/TGTG8474.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Stephen T. Sonis, Consultant: Clinical Assistance Programs
Soreness and ulcers 5: biology, diagnosis and management of cancer regimen 2
Published on June 29, 2017
27 min
Transcript
Please wait while the transcript is being prepared...
0:00
Welcome to the second part of our lecture on mucositis.
In this component of the lecture,
we're going to talk a lot about personalized medicine,
precision medicine as it applies to mucositis and toxicities in general,
and a lot about how genomics can be used to accomplish that objective.
0:20
Let's talk about mTOR inhibitors a little bit.
They're used very commonly now in breast cancer and patients with renal cancers.
mTOR inhibitors are mammalian target of rapamycin kinase inhibitors.
They work well, as I said,
in renal cell cancers.
They work well in patients with breast cancers.
But the pathway is very complex.
There are chances for error and they're
0:46
associated with a very high incidence of a form of stomatitis that is,
in fact, dose limiting and treatment limiting with this group of patients.
And here, you can see an example of a patient being treated for
breast cancer with mTOR inhibitor-induced stomatitis.
You can see that these lesions differ in their appearance from
the lesions that we talked about with cytotoxic therapy.
They're much more aphthous-like.
There's an area of grayish necrosis surrounded by epithelium.
Frequently, these lesions occur on the soft palate which makes
it excruciatingly painful for patients to try to eat.
So, about 40% of patients who get
mTOR inhibitors now have to stop treatment or dose de-escalate.
Unlike cytotoxic therapy with conventional chemotherapy,
the kinetics or the trajectory of
mTOR inhibitor-associated stomatitis is much more acute.
Usually happens within five to seven days after treatment,
and these patients when they start treatment just continually take it.
They don't stop and start like patients do getting cycle chemotherapy.
So, it's a big problem for these patients.
And just if you take a look at this clinical image,
and then look at this clinical image,
which is a patient that has chemotherapy-induced mucositis,
you can see how the clinical appearance is very different and unique.
So, the important thing is to keep in mind that although we're talking about mucositis
today primarily associated with radiation cytotoxic chemotherapy,
the drug pipeline is very very robust.
And what's likely to happen is that there are going to be
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