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Ricardo Alvarez
Managing Director of Operation Merit Medical Tijuana, MERIT MEDICAL SYSTEMS INC

Ricardo Alvarez, ESMO 2018 – Mutational Landscape from Clinical Sequencing

🎥 Nov 02, 2018 📺 Touch Medical Media ⏱ 5m 👁 131 views
Ricardo Alvarez, Medical Director of the Breast Cancer Center & Director of Cancer Research, Cancer Treatment Centers of ...
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About Ricardo Alvarez

Ricardo Alvarez, who previously served as Medical Director of the Breast Cancer Center and Director of Cancer Research at Cancer Treatment Centers of America, has discussed the use of next-generation genomic sequencing in advanced cancer patients. At ESMO 2018, he presented data from approximately 8,000 samples from 7,600 patients collected over five years, noting that 28 to 30 percent of mutations were actionable and could be treated with targeted therapy. He stated that patients receiving biomarker-directed treatment responded better and that the program helped identify clinical trials, though he cited cost and limited trial access as barriers, with some patients receiving off-label treatments. Alvarez has also described his work at Clinica Esperanza, an HIV clinic in San Francisco serving mostly Latino, uninsured, or underinsured patients. He outlined a multidisciplinary model of care that includes harm reduction counseling and artistic programs to improve self-esteem and medication adherence. He noted that advocacy efforts helped over 120 patients obtain political asylum, which he said transformed their lives by enabling employment and other opportunities.

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Transcript (5 segments)
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Ricardo Alvarez0:03
Approximately 39% of all of our patients had one of these next-generation sequencing tests. By the data that I presented today, probably a third or a quarter of these patients have been treated with biomarker genetic-directed, direct treatment. Therefore, it is a substantial number of patients, considering that this is a new approach of precision medicine.
The data that we presented today was the data that we collected within five years: a total of 8000 samples approximately, corresponding to 7600 patients with advanced cancer who have been tested with one of these molecular platforms, genomic platforms. We found that this personalized medicine program helps physicians to indicate or assign a particular treatment with targeted therapy. Therefore, we found that this is a very important result. We are seeing that all patients with this molecular targeted therapy respond better, and what's most important is the personalized medicine program helps physicians to identify clinical trials. So this has been very, very well taken at our presentation this morning because we are talking about hundreds and hundreds of patients.
The majority of patients candidates for genomic sequencing are patients with breast cancer, lung cancer, colorectal cancer, and unknown primary cancer. In these patients, we found that the frequency of mutations we found is about 28 to 30 percent actionable mutations. These actionable mutations can be treated very effectively with targeted therapy. So this is a group of patients, perhaps the most common types of cancers, where we are seeing that they are treated with targeted therapy.
The limitations are, number one, the cost. The cost is because not all patients have access to participate in these studies. These next-generation sequencing platforms are expensive. The second problem is the targeted therapy. The targeted therapy can be in clinical trials, which is the first option. That's why we try to select all of these patients and enroll them in clinical trials. But sometimes the access to clinical trial systems is not available for all of these mutations. Therefore, we treat many times with off-label use, so obtaining the drug as an off-label use is another second barrier that we found.
The proportion of patients receiving treatment based on one of these next-generation platforms in the United States, we don't have the number. Perhaps it's very difficult to know. What we know is that large, leading cancer institutions, most of the time academic institutions, have complete platforms and sometimes they can offer these to selected patients to participate in these programs. But one of the important key points here is we have seen precision medicine a couple of years ago was only in the research pathways, and now we are seeing on the other side the clinical routine utilization of precision medicine. So now the research and the clinical parts have more fluid communication, and we are seeing more and more patients participate in trials. Patients are treated under biomarker-guided treatment. There are a lot of studies showing that with these highly selected populations, the chance of response and progression-free survival increases, and this is the base approach for the patient.