The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
New Avenues in Ovarian Cancer
A Roundtable Discussion
Michael Seiden M.D. Ph.D.
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Translational Research in Ovarian Cancer
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Biology of Ovarian Cancer - 3 treatment categories
Epithelial cancers (majority)
Stromal or sex cord tumors (about 5%)
Germ cell tumors (about 5% and the female
equivalent to testicular cancer)
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Ovarian Cancers
Serous Several distinct
subtypes
Perhaps some
subtypes (Her-2
positive and negative)
Perhaps some subtypes
(some like serous, some
like clear cells)
Likely at least 2 subtypesClear Cell
Endometriod
Mucinous
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Challenges in Science
Intra-tumor genetic variability
Limited knowledge of best treatment for each
subtype of epithelial ovarian cancer
Complexity of the genetics - Most
known about serous tumors
Genetic evolution
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Gene Mutations in Serous Cancer
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Does your Tumor have Microsatellite Instability?
Things to Consider
Seen in patients with Lynch Syndrome
Seen in a subset of patients with clear cell tumors
Consider trial with PD1 or PDL-1 inhibitor (nivolomab (Opdivo),
pembrolizumab (Keytruda), or atezolizumab, (Tencentriq)
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Circulating DNA and Tumor Cells
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Clinical Research
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Clinical Trials 101
Phase I Phase II Phase III Phase IV
Post Approval
Trials
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Phase I
• Typically in patients with extensive prior therapy and usually
platinum resistant tumors
• Earliest trials, example single agent-difungomuctane
• Later Phase I involve novel drug mixed with standard agent-
example-difungomuctane with carboplatin
Dose
Level 1
3 Patients
Dose
Level 2
3 Patients
Dose
Level 3
3 Patients
Dose
Level 4
3 Patients
Toxicity
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Phase I
Pros • Risk are often
uncertain
• Drug effectiveness
often uncertain
• Might get good drug
but at too low of a dose
• Might get a good drug
but at a toxic dose level
• Might get a drug that
proves completely
ineffective
• Careful monitoring
• Earliest access to a
new drug
• Increasing success in
Phase I trials especially
if molecular screening
is required
PROS
CONS
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Phase II
• Typically looks to define the activity and toxicity of a new agent in a
well defined patient population
• Sometimes randomizes patients between 2 new agents or
alternatively one agent delivered over two different schedules in a
pick the winner design
• Typically sets either a response rate or time to progression as
defining an agent as “interesting and worthy for further study”
• Active agents typically progress next to Phase III
13
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
PROS
CONS
Phase II
•Typically some
evidence of activity
and toxicity
•No placebo
•Still limited evidence
of activity in specific
clinical situations
14
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Phase III
• Usually designed to challenge the standard of care or gain
approval of new drug
Taxol, Carboplatin and
New Drug
Taxol and Carboplatin
Woman with first recurrence of Ovarian Cancer
>6 months from completion of platinum
Outcomes
• Response rates & time till tumor progresses
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Phase III
PROS
CONS
• Randomized
• In at least 50% of
phase III studies,
experimental arm is
no better than
standard therapy
• More time and effort
than standard therapy
• Typically getting
either the standard of
care or that same
therapy and a new
agent with
considerable data
supporting its further
evaluation
• Potential access to a
new drug
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Parp Inhibitors
• Olaparib
• Approved for women with BRCA-1/2 mutations
and 3 or more prior lines of chemotherapy
• Niraparib
• Rucaparib
• Velaparib
• Talazoparib
• E7449
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
AKT Pathway
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
AKT Inhibitors
• Pilaralisib
• MK-2206
• TAK-228
• AZD5363
• GSK2110183
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Inhibitors to Interesting Enzymes
• Acalabrutinib
• Sorafenib
• Cabozantinib
• Masitinib mesylate
• Cediranib
• MK-1775/ AZD1775
• ENMD-2076
• NMI900
• Selumetinib
• Ganetespib
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Evaluating Breast Cancer Drugs
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Breast Cancer Drugs
• Ibrance
• Margetuximab
• Neratinib
• Ribociclib
• Abemaciclib
• Acolbifene
• Seribantumab
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Blocking Blood Vessels
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Inhibiting Blood Vessels
• Ramucirumab
• Trebananib
• Fosbretabulin
• Cediranib
• BNC105
• VB-111
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Monoclonal Antibodies
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Antibodies to Interesting Molecules
•Sacituzumab Govitecan-
Anti EGP
•Bavituximab-
Phosphatidylserine
•Glembatumumab vedotin
•Demcizumab
•Olaratumab
•PankoMab-GEX
•IMAB027
•hu3S193
•TRC105
•Monalizumab
•Mirvetuximab soravtansine
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Immune Therapy
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Immuno-oncology
Tumors have mechanisms to silence the immune system
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Immuno-oncology
Improved survival in the most common type of lung cancer
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
PD-1 and PD-1 Inhibitors
• Atezolizumab
• Pembrolizumab
• Nivolumab
• Avelumab
• Durvalumab
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Clinical Responses to Pembrolizumab
Treatment and Mismatch Repair
Le DT et al. N Engl J Med 2015;372:2509-2520
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Clinical Responses to Pembrolizumab Treatment
Le DT et al. N Engl J Med 2015;372:2509-2520
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Vaccines
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Vaccines
•Vigil
•Cvac
•DPX-Survivac
•GEN-1
•Ovapuldencel-T
•Globo-H-GM2-sTn-TF-
Tn
•TVI-Ovary-1
•P53-SLP
•DPX-0907
•CRS-207
•Enadenotucirev
•GALE-301
•Globo822
•TroVax
•Monalizumab
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Immune Enhancers
• Yervoy
• Tremelimumab
• Epacadostat
• Motolimod
• Gen-1
• Ovax
• Ampligen
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
CAR-T Cells
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Stem Cell Poisons?
Stem Cell Theory
Early Drugs
•Odomzo
• BBI503
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Virotherapy
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Avatar Models
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Clinical Trial Challenges
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
FACT
FICTION
Clinical Trials: Fact and Fiction
•Only 4% of patient
enter clinical trials
•Recent study
suggests only 35% of
patients would
consider trials
•Only 40% have a
positive attitude
towards clinical trials
•Most trials contain
placebos or sugar pills
•Most trials are only for
patients who have no
other options
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Patient Concerns in the MSKCC Survey
•Worries over feeling
like “guinea pigs”
Worry over side effects / safety
Uncertainty about insurance
and out-of-pocket costs
Inconvenience of trial
locations
•Concerns about
getting a placebo
Skeptical of a treatment
that is not yet proven to
work
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Considerable extra time to
explain and enroll a patient
RESTRICTIONS
WAITING LIST
TIME
Other Barriers to Clinical Trial
Serious medical illnesses
may preclude patients
“Waiting list” or pretrial testing
could delay treatment
The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
Closing Comments
• Many drugs and scientific developments in active development
• Still much basic science on cancer is needed
• Pharma is an important partner to engage
• Speed of progress is partially dependent on patients participating in
clinical trials
• Thank you for your advocacy

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Expert Roundtable, Michael Seiden, MD, PhD

  • 1. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. New Avenues in Ovarian Cancer A Roundtable Discussion Michael Seiden M.D. Ph.D.
  • 2. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Translational Research in Ovarian Cancer
  • 3. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Biology of Ovarian Cancer - 3 treatment categories Epithelial cancers (majority) Stromal or sex cord tumors (about 5%) Germ cell tumors (about 5% and the female equivalent to testicular cancer)
  • 4. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Ovarian Cancers Serous Several distinct subtypes Perhaps some subtypes (Her-2 positive and negative) Perhaps some subtypes (some like serous, some like clear cells) Likely at least 2 subtypesClear Cell Endometriod Mucinous
  • 5. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Challenges in Science Intra-tumor genetic variability Limited knowledge of best treatment for each subtype of epithelial ovarian cancer Complexity of the genetics - Most known about serous tumors Genetic evolution
  • 6. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Gene Mutations in Serous Cancer
  • 7. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Does your Tumor have Microsatellite Instability? Things to Consider Seen in patients with Lynch Syndrome Seen in a subset of patients with clear cell tumors Consider trial with PD1 or PDL-1 inhibitor (nivolomab (Opdivo), pembrolizumab (Keytruda), or atezolizumab, (Tencentriq)
  • 8. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Circulating DNA and Tumor Cells
  • 9. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Clinical Research
  • 10. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Clinical Trials 101 Phase I Phase II Phase III Phase IV Post Approval Trials
  • 11. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Phase I • Typically in patients with extensive prior therapy and usually platinum resistant tumors • Earliest trials, example single agent-difungomuctane • Later Phase I involve novel drug mixed with standard agent- example-difungomuctane with carboplatin Dose Level 1 3 Patients Dose Level 2 3 Patients Dose Level 3 3 Patients Dose Level 4 3 Patients Toxicity
  • 12. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Phase I Pros • Risk are often uncertain • Drug effectiveness often uncertain • Might get good drug but at too low of a dose • Might get a good drug but at a toxic dose level • Might get a drug that proves completely ineffective • Careful monitoring • Earliest access to a new drug • Increasing success in Phase I trials especially if molecular screening is required PROS CONS
  • 13. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Phase II • Typically looks to define the activity and toxicity of a new agent in a well defined patient population • Sometimes randomizes patients between 2 new agents or alternatively one agent delivered over two different schedules in a pick the winner design • Typically sets either a response rate or time to progression as defining an agent as “interesting and worthy for further study” • Active agents typically progress next to Phase III 13
  • 14. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. PROS CONS Phase II •Typically some evidence of activity and toxicity •No placebo •Still limited evidence of activity in specific clinical situations 14
  • 15. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Phase III • Usually designed to challenge the standard of care or gain approval of new drug Taxol, Carboplatin and New Drug Taxol and Carboplatin Woman with first recurrence of Ovarian Cancer >6 months from completion of platinum Outcomes • Response rates & time till tumor progresses
  • 16. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Phase III PROS CONS • Randomized • In at least 50% of phase III studies, experimental arm is no better than standard therapy • More time and effort than standard therapy • Typically getting either the standard of care or that same therapy and a new agent with considerable data supporting its further evaluation • Potential access to a new drug
  • 17. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved.
  • 18. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Parp Inhibitors • Olaparib • Approved for women with BRCA-1/2 mutations and 3 or more prior lines of chemotherapy • Niraparib • Rucaparib • Velaparib • Talazoparib • E7449
  • 19. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. AKT Pathway
  • 20. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. AKT Inhibitors • Pilaralisib • MK-2206 • TAK-228 • AZD5363 • GSK2110183
  • 21. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Inhibitors to Interesting Enzymes • Acalabrutinib • Sorafenib • Cabozantinib • Masitinib mesylate • Cediranib • MK-1775/ AZD1775 • ENMD-2076 • NMI900 • Selumetinib • Ganetespib
  • 22. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Evaluating Breast Cancer Drugs
  • 23. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Breast Cancer Drugs • Ibrance • Margetuximab • Neratinib • Ribociclib • Abemaciclib • Acolbifene • Seribantumab
  • 24. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Blocking Blood Vessels
  • 25. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Inhibiting Blood Vessels • Ramucirumab • Trebananib • Fosbretabulin • Cediranib • BNC105 • VB-111
  • 26. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Monoclonal Antibodies
  • 27. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Antibodies to Interesting Molecules •Sacituzumab Govitecan- Anti EGP •Bavituximab- Phosphatidylserine •Glembatumumab vedotin •Demcizumab •Olaratumab •PankoMab-GEX •IMAB027 •hu3S193 •TRC105 •Monalizumab •Mirvetuximab soravtansine
  • 28. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Immune Therapy
  • 29. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Immuno-oncology Tumors have mechanisms to silence the immune system
  • 30. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Immuno-oncology Improved survival in the most common type of lung cancer
  • 31. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. PD-1 and PD-1 Inhibitors • Atezolizumab • Pembrolizumab • Nivolumab • Avelumab • Durvalumab
  • 32. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Clinical Responses to Pembrolizumab Treatment and Mismatch Repair Le DT et al. N Engl J Med 2015;372:2509-2520
  • 33. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Clinical Responses to Pembrolizumab Treatment Le DT et al. N Engl J Med 2015;372:2509-2520
  • 34. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Vaccines
  • 35. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Vaccines •Vigil •Cvac •DPX-Survivac •GEN-1 •Ovapuldencel-T •Globo-H-GM2-sTn-TF- Tn •TVI-Ovary-1 •P53-SLP •DPX-0907 •CRS-207 •Enadenotucirev •GALE-301 •Globo822 •TroVax •Monalizumab
  • 36. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Immune Enhancers • Yervoy • Tremelimumab • Epacadostat • Motolimod • Gen-1 • Ovax • Ampligen
  • 37. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. CAR-T Cells
  • 38. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Stem Cell Poisons? Stem Cell Theory Early Drugs •Odomzo • BBI503
  • 39. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Virotherapy
  • 40. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Avatar Models
  • 41. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Clinical Trial Challenges
  • 42. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. FACT FICTION Clinical Trials: Fact and Fiction •Only 4% of patient enter clinical trials •Recent study suggests only 35% of patients would consider trials •Only 40% have a positive attitude towards clinical trials •Most trials contain placebos or sugar pills •Most trials are only for patients who have no other options
  • 43. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Patient Concerns in the MSKCC Survey •Worries over feeling like “guinea pigs” Worry over side effects / safety Uncertainty about insurance and out-of-pocket costs Inconvenience of trial locations •Concerns about getting a placebo Skeptical of a treatment that is not yet proven to work
  • 44. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Considerable extra time to explain and enroll a patient RESTRICTIONS WAITING LIST TIME Other Barriers to Clinical Trial Serious medical illnesses may preclude patients “Waiting list” or pretrial testing could delay treatment
  • 45. The US Oncology Network is supported by McKesson Specialty Health. © 2016 McKesson Specialty Health. All rights reserved. Closing Comments • Many drugs and scientific developments in active development • Still much basic science on cancer is needed • Pharma is an important partner to engage • Speed of progress is partially dependent on patients participating in clinical trials • Thank you for your advocacy

Editor's Notes

  • #30: Nanotechnologies will dramatically change the field of oncology and the genomics will radically change pathology. This a prototype of device of that not only can count but capture circulating tumor cells. These cells can be counted, evaluated by immunohistochemistry, fish, or now sequenced. Indeed, there is now early technology for doing sequencing on circulating tumor cells or cell free DNA. Soon it will be possible to gain significant omic information on tumors without invasive biopsies. The old age of “when tumor is the rumor tissue is the issue” will go away in the next decade!
  • #31: Nanotechnologies will dramatically change the field of oncology and the genomics will radically change pathology. This a prototype of device of that not only can count but capture circulating tumor cells. These cells can be counted, evaluated by immunohistochemistry, fish, or now sequenced. Indeed, there is now early technology for doing sequencing on circulating tumor cells or cell free DNA. Soon it will be possible to gain significant omic information on tumors without invasive biopsies. The old age of “when tumor is the rumor tissue is the issue” will go away in the next decade!
  • #33: Figure 1 Clinical Responses to Pembrolizumab Treatment. The biochemical responses to pembrolizumab treatment are shown in Panel A. Serum levels of protein biomarkers were measured at the start of each treatment cycle, and the values represent percentage changes from baseline. Each line represents one patient; patients were included if their baseline tumor marker values were higher than the upper limit of normal. CA-125 was used as the biomarker for one patient with endometrial cancer, CA19-9 was used for one patient with cholangiocarcinoma and one patient with ampullary cancer, and carcinoembryonic antigen (CEA) was used for all other patients. Radiographic responses to treatment with pembrolizumab, evaluated on the basis of Response Evaluation Criteria in Solid Tumors (RECIST), are shown in Panel B. Tumor responses were measured at regular intervals, and the values shown are the largest percentage change in the sum of longest diameters from the baseline measurements of each measurable tumor. Each bar represents one patient.
  • #34: Figure 1 Clinical Responses to Pembrolizumab Treatment. The biochemical responses to pembrolizumab treatment are shown in Panel A. Serum levels of protein biomarkers were measured at the start of each treatment cycle, and the values represent percentage changes from baseline. Each line represents one patient; patients were included if their baseline tumor marker values were higher than the upper limit of normal. CA-125 was used as the biomarker for one patient with endometrial cancer, CA19-9 was used for one patient with cholangiocarcinoma and one patient with ampullary cancer, and carcinoembryonic antigen (CEA) was used for all other patients. Radiographic responses to treatment with pembrolizumab, evaluated on the basis of Response Evaluation Criteria in Solid Tumors (RECIST), are shown in Panel B. Tumor responses were measured at regular intervals, and the values shown are the largest percentage change in the sum of longest diameters from the baseline measurements of each measurable tumor. Each bar represents one patient.