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Caris Centers of Excellence Virtual Molecular Tumor Board - December 23, 2015 (No Audio)

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Slide deck from Caris Life Sciences' Virtual Molecular Tumor Board (VMTB) on December 23rd hosted by Dr. John Marshall at COE network member MedStar Georgetown University Hospital

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Caris Centers of Excellence Virtual Molecular Tumor Board - December 23, 2015 (No Audio)

  1. 1. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Virtual Molecular Tumor Board December 23, 2015 Host: MedStar Georgetown University Hospital Leader: Dr. John Marshall Cases: • Lung cancer with BRCA2 mutation • Colon adenocarcinoma with BRCA2 mutation
  2. 2. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Patient 1
  3. 3. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. History • Male, mid-60’s, non-smoker • Diagnosed with Lung cancer, adenocarcinoma – Poorly differentiated – T1N0M1, bony metastases in left ileum • Bronchoscopy confirmed adenocarcinoma of the lung • MRI confirms lesions in the left ileum • Tissue sent for Caris Molecular Intelligence tumor profiling
  4. 4. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Pathology H&E 20x
  5. 5. The information contained in these slides is provided for educational purposes only and has been permanently de-identified.
  6. 6. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. BRCA sequencing results
  7. 7. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Germline Testing
  8. 8. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Discussion • Stage 4 lung adenocarcinoma EGFR/ALK/ROS1 negative • Confirmed germline BRCA2 mutation – Additional genetic counseling implications – Lack of typical family history for HBOC • Treatment: – Carboplatin/ Alimta/ Avastin – Radiation to bony metastases – Denosumab q 6 weeks for bony mets
  9. 9. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Raymond et al, JNCI 2016
  10. 10. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Recommendations from authors 1. Discuss the possibility of germline findings when consenting patients for tumor testing 2. Ascertain patient’s wish for disclosure of germline findings 3. Involve genetic counselors and other specialists when necessary for interpretation of somatic sequencing results Raymond et al, JNCI 2016
  11. 11. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Patient 2
  12. 12. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. History • Early 60’s presents with colon mass – biopsy positive for adenocarcinoma – Unusual path and presentation and eventual testing showed a bile duct cancer with spread to the colon • Initial treatment on c-met gem/cisplatin trial, immediate SBO requiring surgery. • SBO/TPN currently treated with gem/cis off study – some improvement. • Tissue sent for Caris Molecular Intelligence Profiling
  13. 13. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Family history • No significant history of cancer • Jewish ancestry
  14. 14. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. BRCA2 pathogenic mutation
  15. 15. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. CNV analysis
  16. 16. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Molecular Tumor Summary • BRCA2 R2336H, exon 13, pathogenic mutation • EGFR exon 21 VUS • KRAS, NRAS, HRAS wildtype • No gene amplifications • IHC: – Predicted response: 5-FU, Taxanes, Cetuximab – Non-response: Irinotecan
  17. 17. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Discussion • BRCA2 pathogenic mutation – Genetic counseling? – Somatic versus germline? – BRCA1 but not BRCA2 previously reported to have some elevated colon cancer risk (Phelan et al 2014, BJC). – More data emerging from expanded germline panel studies – broader syndrome phenotypes are being observed
  18. 18. The information contained in these slides is provided for educational purposes only and has been permanently de-identified. Next Molecular Tumor Board: January 26, 2016 5pm ET (4pm CT) Host: Fox Chase Cancer Center Leader: Dr. Namrata Vijayvergia

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