“Highlights in the management of colorectal cancer” The Mediterranean School of Oncology 43th course “Highlights in the management of colorectal cancer” Rome, 1-2 February 2007

The Mediterranean School of Oncology An educational program of: Consorzio Interuniversitario Nazionale per la Bio-Oncologia

A Consortium among 14 Italian Universities Ancona Messina Bologna Napoli Federico II Catanzaro Palermo Chieti-Pescara Perugia Ferrara Roma La Sapienza Foggia Teramo L’Aquila

CARCINOMA DEL COLON-RETTO SCENARIO GLOBALE 2a causa di morte per cancro nei paesi occidentali! ~1,000,000 nuovi casi ~ 500,000 decessi/anno Alla diagnosi: 70-80% malattia localizata, resecabile 50% stadio II 35% stadio III ~40% (~400,000/anno) ripresa di malattia dopo chirurgia potenzialmente curativa

Anni ’90: ottimizzazione del 5-FU Levamisole LD leucovorin 5-FU HD leucovorin Bolus Infusione continua

Median overall survival (months) Sopravvivenza mediana CRC metastatico, Ia linea Best supportive care ~4–6 months 12–14 months 5-FU/LV ~15–16 months IFL or FOLFIRI 18.3 months 5-FU/LV + bevacizumab 19–20 months FOLFOX4 or CAPEOX 20.3 months IFL + bevacizumab 20.6 months FOLFOX6  FOLFIRI 25.1 months IFL + BV  OX 6 12 18 24 Median overall survival (months)

Nel 2007, cosa si può attendere un paziente affetto da carcinoma metastatico del colon-retto? Risposte oggettive :50-70% Tempo alla progressione :8-11+ mesi Soparvvivenza globale :24-26+ mesi

Oltre la I linea Ia linea FOLFOX + Bevacizumab Va linea FOLFOX + Cetuximab IIa linea Irinotecan + 5-FU (Bevacizumab) VIa linea FOLFOX + Cetuximab + Bevacizumab IIIa linea Cetuximab +Irinotecan VIIa linea XX +YY IVa linea Cetuximab + Bevacizumab+ Irinotecan ………….

Come identificare i pazienti R e NR alla terapia?

CRC – Criteri di selezione usuali 100 100 pazienti trattati con CT dopo 5 anni: 70 sono viventi anche senza CT (o-treated) 75 20 sono deceduti nonostante la CT 50 Usando il profilo d’espressione genica Only 22.5% of pts will be overtreated 25

Patient goes to Familiy doctor/health center Population-based screening Investigations & diagnostic testing Cancer diagnosed Cancer not diagnosed Treatment Palliative care Continuing treatment Follow-up Relapse Terminal care Cure Long-term survival Bereavement

1. Foreign students (in English); 2. Italian residents Two classes: 1. Foreign students (in English); 2. Italian residents All courses are accredited for CME by Ministero della Salute, Italy or/and ESMO

By December 2006: 42 courses >2200 students 10 600 Courses/year 8 Students/year 500 6 400 4 300 By December 2006: 42 courses >2200 students 2 200 2000 2001 2002 2003 2004 2005 2006

Scholarships Available to candidates <30 years of age. To apply for a scholarship: a brief curriculum vitae; a letter of presentation from an authorised officer at the institute of affiliation.  For information: www. unich.it/mso.cinbo

MSO - 2007 Course Calendar 1-2 February :Highlights in the management of colorectal cancer (E) 16-17 February :Tumori del rene e melanoma: progressi della ricerca traslazionale e clinica 19-20 March :Cardiotossicità da farmaci antitumorali: basi genetiche, diagnosi, prevenzione e terapia 18-19 April :Highlights in the management of breast cancer (E) 25-26 May :Presente e futuro della terapia del dolore neuropatico in oncologia 8-9 June :Personalized diagnostic and therapeutic strategies in oncology (E) 20-21 July :Sessualità e cancro 5-6 October    :I tumori dell’ovaio 26-27 October :New oncology drugs pipeline update: from bench to bedside (E) 23-24 November :Controversie in oncologia (E) Courses in English

The “Formazione a Distanza in Oncologia” (FADO) Program A MSO/CINBO’s pilot project Consorzio Interuniversitario Nazionale per la Bio-Oncologia

FADO Program Designed to build or enhance professional knowledge, skills, and leadership in oncology and related disciplines through distance/online education & training. Teaching is made via satellite technology.

Target audience 1. Residents in medical oncology; 2. Ph.D. students (Dottorato di Ricerca) in oncology and related disciplines Consorzio Interuniversitario Nazionale per la Bio-Oncologia

Technologies & services: FADO - Partners Organization & management: Technologies & services:

The Mediterranean Task Force for Cancer Control (MTCC) A MSO/CINBO’s pilot project Consorzio Interuniversitario Nazionale per la Bio-Oncologia

MTCC “An innovative project to raise awareness about cancer prevention and early detection via satellite technology” courses in modular print format videoconferences; lectures-seminars-lessons; To provide a forum for “distance learning discussion among CINBO member Universities and selected medical Institutions within the mediterranean area”

1st Meeting of the Mediterranean Task Force for Cancer Prevention and Early Detection October 4th, 2005 Taormina, Italy With the participation of delegates from: Albania Algeria Croatia Egypt France Greece Italy Jordan Lebanon Lybia Morocco Palestine Portugal Syria Slovenia Spain Tunisia Turkey