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CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center Clinical Assistant Professor, Dept. of Medicine, University of Florida College of Medicine

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Page 1: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Recent Developments in Oncology

Robert H. Cassell, M.D., Ph.D.Medical Director, Cassidy Cancer Center

Clinical Assistant Professor, Dept. of Medicine,University of Florida College of Medicine

Page 2: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Recent Developments in Oncology

There have been many new and exciting developments in cancer

• New diagnostic modalities• New ways to predict the outcome and prognosis

of various cancers• New treatment advances

– New surgical techniques– New ways of delivering radiation therapy– New chemotherapy drugs– New supportive therapies

Page 3: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Recent Developments in Oncology – My Favorite

Use of new knowledge in science, including genetics and molecular biology, and the new fields of genomics and proteomics, to develop “rational” therapies to treat cancer

Page 4: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

“CANCER” “CRAB”

Page 5: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

How Do You Treat…

Crabgrass --

Cancer --

Cut It or Tear it Out

Surgery

Page 6: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

How Do You Treat…

Crabgrass --

Cancer --

Cut It or Tear it Out

Surgery

Page 7: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

How Do You Treat…

Crabgrass --

Cancer --

Burn It

Radiation Therapy

Page 8: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

How Do You Treat…

Crabgrass --

Cancer --

Burn It

Radiation Therapy

Page 9: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

How Do You Treat…

Crabgrass --

Cancer --

Poison It

Chemotherapy

Page 10: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

How Do You Treat…

Crabgrass --

Cancer --

Poison It

Chemotherapy

Page 11: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

What If…

• You could understand what makes crab grass crab grass, so that you could do something specific to kill only the crab grass

OR• You could change the crab grass, so it behaved

and looked like normal grass***********

I don't think we can do this with crab grass but we are starting to be able to do this sort of thing with cancer

Page 12: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Terminology

• The current buzzword in medicine is "personalized medicine."

• This means treating each patient as a separate individual based on their characteristics and the characteristics of their disease(s).

• In oncology, we generally use the term “targeted therapy” or, more precisely, “molecularly targeted therapy.”

Page 13: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

What Makes Cancer Cells Cancerous?

• 1) Increased response to growth signals and production of their own growth signals

• 2) Insensitivity to anti-growth signals• 3) Evasion of apoptosis – failure to die at the

right time

Page 14: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

Apoptosis(Programmed Cell Death)

Page 15: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

What Makes Cancer Cells Cancerous?

• 1) Increased response to growth signals and production of their own growth signals

• 2) Insensitivity to anti-growth signals• 3) Evasion of apoptosis – failure to die at the

right time• 4) Limitless replication potential – keep dividing

indefinitely• 5) Sustained angiogenesis (new blood vessels)

Page 16: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

Angiogenesis(New Blood Vessel Growth)

Page 17: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

What Makes Cancer Cells Cancerous?

• 1) Increased response to growth signals and production of their own growth signals

• 2) Insensitivity to anti-growth signals• 3) Evasion of apoptosis – failure to die at the

right time• 4) Limitless replication potential – keep dividing

indefinitely• 5) Sustained angiogenesis (new blood vessels)• 6) Tissue invasion and metastasis

Page 18: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

What Makes Cancer Cells Cancerous?

Other characteristics of cancer cells:• Stem cell or progenitor cell phenotype – they

start out looking like normal (or benign) cells but at a primitive stage of development

• Increased mutation rate• Evasion of, or resistance to, normal immune

responses

Page 19: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center
Page 20: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

Hanahan D, Weinberg RA. The hallmarks of cancer. Cell. 2000; 100(1):57–70.

Page 21: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

“Targeted” Cancer Treatment

How does it work? Attack targets which are specific for the cancer

cell and are critical for its survival or for its malignant behavior

Why is it better than chemotherapy?More specific for cancer cells –

chemotherapy hits rapidly growing cellsnot all cancer cells grow that rapidlysome normal cells grow rapidly

Possibly more effective

Page 22: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

Cancer Targets

From National Cancer Institute, US National Institutes of Health.

Page 23: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

Cancer Targets

From National Cancer Institute, US National Institutes of Health.

Page 24: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

Cancer Targets

From National Cancer Institute, US National Institutes of Health.

Page 25: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Targets

• The targets currently being used are those that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression.

• The focus is on proteins that are involved in cell signaling pathways, which form a complex communication system that governs basic cellular functions and activities, such as cell division, cell movement, how a cell responds to specific external stimuli, and even cell death.

• We use the term “signal transduction” to refer to the actions of these proteins.

Page 26: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center
Page 27: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

TK TKATP ATP

Cell Cell ProliferatioProliferationn

AntiapoptAntiapoptosisosis

AngiogenesAngiogenesisis

Gene Transcription

Cell Cycle Progression

+

MetastaseMetastasess

SurvivSurvivalal

Tumor Cell StimulationTumor Cell Stimulation

Page 28: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Targeted Therapy

• The first molecular target for targeted cancer therapy was the cellular receptor for the female sex hormone estrogen, which many breast cancers require for growth. When estrogen binds to the estrogen receptor (ER) inside cells, the resulting hormone-receptor complex activates the expression of specific genes, including genes involved in cell growth and proliferation.

Page 29: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Therapy Targeted at the Estrogen Receptor

• Selective estrogen receptor modulators (SERMs)– tamoxifen (Nolvadex)– toremifene (Fareston)

• Estrogen receptor inhibitor and destroyer– fulvestrant (Faslodex)

• Estrogen synthesis inhibitors – aromatase inhibitors (AIs)– anastrozole (Arimidex)– letrozole (Femara)– Exemestane (Aromasin)

Page 30: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

TK TK TK

Strategies to Inhibit Signaling

---- --

tyrosine tyrosine kinase kinase

inhibitorinhibitorss

““-ibs”-ibs”

Anti- mAbsAnti- mAbs

““-mab”-mab”

Anti-ligand Anti-ligand mAbsmAbs

““-mab”-mab”

ATP

Page 31: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

Philadelphia Chromosome

Page 32: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

Philadelphia Chromosome

(BCR-ABL Translocation)

Page 33: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

BCR-ABL Translocation

Page 34: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

RASBRAF

MEK

ERK

Oncogenes

CRAF

PI3K

AKT

mTor

PTEN

CDK4CDK2

p16

Cyclin D

c-met

Page 35: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

RASBRAF

MEK

ERK

Targeted inhibitors in development

PI3K

AKT

mTor

PTEN

CDK4CDK2

p16

Cyclin D

PD0325901

AZD6244

Sorafenib

RAF-265

PLX4032

R115777

SCH66336

PD332991 CYC202

temsirolimus everolimus

AP23573

GSK690693VQD-002

BMS-387032

SF1126 XL147

XL880c-met

Page 36: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

Signal Pathways in the Cancer CellSignal Pathways in the Cancer Cell

Page 37: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

The “Nibs”

Small molecule tyrosine kinase inhibitors (or TKIs) – generic names end in “-nib”

Generally oral

Side effects vary, depending on which enzymes they inhibit (what their target is)

Eight are FDA-approved, numerous others are in development

Several are effective against cancers resistant to most previous therapies

Page 38: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

FDA-Approved TKIs

Generic Name Brand Name Cancer

Imatinib Gleevec CML, GIST, others

Dasatinib Sprycel CML, ALL

Nilotinib Tasigna CML

Gefitinib Iressa Lung

Erlotinib Tarceva Lung, Pancreas

Lapatinib Tykerb Breast

Sorafenib Nexavar Kidney, Liver

Sunitinib Sutent Kidney

Page 39: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Monoclonal Antibodies

Another type of targeted therapy – they are large molecules produced through genetic engineering

They usually have to be given IV

Side effects can include reactions to non-human proteins

They can cause cell damage in several ways, most often by attacking cell-surface receptors

Page 40: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

VEGF PDGF

HGFNRPs

EphTGFβ bFGF Ang

Endothelial cell & Pericyte

BRAF

MEK

ERK

RASPI3K

AKT

mTor

Tumor

Page 41: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Trastuzumab

• Monoclonal antibody against epidermal growth factor receptor 2 (EGFR2, HER-2)

• Very effective against breast cancers in which HER-2 is “over-expressed” (more than usual amount per cell) (about 20% of all breast cancers)

• Often used in combination with chemotherapy

Page 42: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Cetuximab

• Monoclonal antibody against epidermal growth factor receptor 1 (EGFR1)

• Effective in colon cancer and head and neck cancer; possibly useful in lung cancer

• Used with chemotherapy and with radiation therapy

Page 43: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Bevacizumab

• Monoclonal antibody against vascular endothelial growth factor (VEGF), which stimulates angiogenesis (growth of new blood vessels into tumor)

• Deprives tumors of the blood supply they need for growth and invasion

• Effective against cancers of colon, lung, breast, kidney, and brain

Page 44: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Monoclonal Antibodies

FDA-Approved “Naked” (Non-Conjugated) MoAbs

Generic Name Brand Name Target Cancer(s)

Alemtuzumab Campath CD52 CLL

Bevacizumab Avastin VEGF Multiple

Cetuximab Erbitux EGFR1 Colon, H&N

Panitumumab Vectibix EGFR1 Colon

Rituximab Rituxan CD20 Lymphomas

Trastuzumab Herceptin HER-2 Breast

Page 45: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center
Page 46: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Monoclonal Antibodies

• Conjugated antibodies currently approved– Radio-conjugated antibodies

• Tositumomab (Bexxar)• Ibritumomab (Zevalin)• Both used against refractory lymphomas

– Toxin-conjugated antibody• Gemtuzumab ozogamicin (Mylotarg)• Used against AML

Page 47: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Monoclonal Antibodies In Development

• Epratuzumab

• Matuzumab• Nimotuzumab• Zalutumumab• Pertuzumab• Mapatumumab• Lexatumumab• Volociximab• Pemtumomab• Labetuzumab

• ch806• CP-751,871• IMC-A12• VEGF-Trap• IMC-18F1• IMC-1121B• IMC-3G3• Vitaxin• CNTO 95

Page 48: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center
Page 49: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Types of MoAbs

Structure % Human Example Comments

Mouse 0 Tositumomab, Ibritumomab

Radio-conjugates

Chimeric 65 Cetuximab, Rituximab

Humanized 95 Trastuzumab

Human 100 Panitumumab Transgenic mice

Page 50: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Nomenclature of MoAbs

• Last syllable is always –mab• Next to last syllable

-u- human (100%) : Panitumumab -zu- humanized (95%) : Trastuzumab -xi- chimeric (65%) : Rituximab -o- mouse, -a- rat, -e- hamster, -i- primate : Tositumomab

• Previous syllable– -tu(m)- for tumor in general [-ma(r)- breast, -pr(o)- prostate, -

co(l)- colon, etc.]– -ci(r)- for circulatory : Bevacizumab

Page 51: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

New Directions

• Combination of different targeted therapies (multiple TKIs, TKI with MoAb; occasionally multiple MoAbs)

• Combination with standard chemotherapy or with radiotherapy

• Targeted agents to “clean up” after surgery• Use with other novel agents

Page 52: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Other Novel Types of Cancer Therapies Now in Use

• Proteasome inhibitors (Bortezomib)• mTOR inhibitors (Temsirolimus, Everolimus)• DNA demethylating agents (Azacytidine,

Decitabine)• Histone deacetylase inhibitors (Vorinostat)• Translocation targeters (retinoic acid)• Antiangiogenic agents (Thalidomide,

Lenalidomide)

Page 53: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Other Novel Types of Cancer Therapies in Development

• Integrin inhibitors (Volociximab)• “Death” receptor stimulants• Telomerase inhibitors• Apoptosis promoters• DNA repair inhibitors (PARP inhibitors, etc.)• Heat shock protein targeters• Antagonists of specific gene mutations• Antisense agents

Page 54: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Biotherapeutic Agents

• Interferons• Interleukins• Cancer Vaccines• Immunomodulatory agents• Colony stimulating factors• Monoclonal antibodies• Gene therapy

Page 55: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Take Home Points

• Molecularly targeted therapy is a new way of approaching cancer treatment

• It is based on recent scientific advances in molecular biology, chemistry, and genetics

• It involves the rational selection of drugs which target specific processes in cancer cells that make them different from normal cells

• A number of targeted therapies are currently available and many others are in development

• Targeted therapies are frequently effective but are not perfect: There are side effects to the treatments, and there may be development of resistance

• Targeted therapies are increasingly being used in combination with other targeted therapies or with other treatment modalities

• We definitely will be hearing much more about targeted therapies for cancer in the future

Page 56: CASSIDY CANCER CENTER Compassion, Innovation, Trust Recent Developments in Oncology Robert H. Cassell, M.D., Ph.D. Medical Director, Cassidy Cancer Center

CASSIDY CANCER CENTERCompassion, Innovation, Trust

Thank You for your Attention

Cassidy Cancer CenterWinter Haven Hospital

200 Ave. F, NEWinter Haven, FL 33881-4131

863-292-4670www.winterhavenhospital.com/facilities/CCC