Gevolgen van PATH project voor NSCLC - Zorg … van PATH project voor NSCLC Hoe tillen we...

1

10de avondsymposiumGroningen, 1 november 2017

Nieuwe ontwikkelingen in de behandeling van NSCLCGevolgen van PATH project voor NSCLC

Hoe tillen we Moleculaire Diagnostiek van NSCLC naa r hoger plan ?

Ed Schuuring

KMBP (Klinisch Moleculair Bioloog in de Pathologie) voor Pathologie van UMCG, Friesland, Hoogeveen, Zwolle en Martini/Winschoten

Head Laboratory Molecular Pathology, UMCG Groningen

DisclosuresConsultant/Advisory Board:

AstraZeneca, Roche, Pfizer, Novartis, Amgen, BioCartis, QCMD, ESP, IQNPATH, Cancer-ID

Speaker’s fee:Abbott, Novartis, Roche, Biocartis, Illumina

Grants/Sponsoring:Pfizer, Biocartis, BMS, Roche, Boehringer Ingelheim

Stock/Royalties:None

All transferred to UMCG-account

2

Molecular profiling of lung cancer in 2017Molecular Pathology

Li JCO 2013

To define which patients for what drug benefit most (personalised therapy)

Wild type

del746-750

Traditional histopathological classification

>2009: Molecular Tumor Profiling

“1st”

“last”

5% neoplastic cells

>50% neoplastic cells

Images with courtesy of Erik Thunnissen, VUMC

This example represents a typical biopsyin our clinical practice (lung cancer)

NGS analysisToday’s tissue-management lung cancer (2017)

Presentation Ed Schuuring, 1 November 2017, Hoogkerk

3

More analysis from one biopsy?Today’s tissue-management lung cancer (2017)

HE first

HE last

Diagnostic stain TTF1

DNA isolation NGS mutation analysis

RNA isolation MET exon skipping

Diagnostic stain mucin

Diagnostic stain P63/p40

ALK IHCNTRK FISH

ROS1 FISHRET FISH

MET FISHNGR1 FISH

Presentation Ed Schuuring, 1 November 2017, Hoogkerk

Turn-around-time (TAT) and hands-on-time

PD-L1 IHC

Molecular Pathology of lung cancer:

Optimal molecular testing

In Northern part of the Netherlands

4

Next Generation Sequencing: Ion Torrent Personal Genome Machine (PGM)

• >50 hotspot regions in 24 genes (83 amplicons) (UMCG-PGM-v02b panel) for mutation screening in lung cancer, melanoom, colon carcinoma, GIST

• TAT: ~4-5 days (2 runs per week)

Molecular Oncological Pathology at UMCG: www.MolOncoPath.nl

AKT1_17 ESR1_534-537 KIT_exon11 MET exon 14-intron 14

ALK_1151-1156 GNA11_183 KIT_exon13 MET intron 13-exon 14

ALK_1174-1206 GNA11_209 KIT_exon14 NRAS_117-146

ALK_1269-1275 GNAQ_183 KIT_exon17 NRAS_12-13

BRAF_600 GNAQ_209 KIT_exon18 NRAS_61

BRAF_exon11 GNAS_201 KIT_exon8 PDGFRA_exon12

EGFR_492 GNAS_227 KIT_exon9 PDGFRA_exon14

EGFR_exon18 H3F3A_27-36 KRAS_117-146 PDGFRA_exon18

EGFR_exon19 H3F3B_35-37 KRAS_1213 PIK3CA_1047

EGFR_exon20 HRAS_117-146 KRAS_61 PIK3CA_542-549

EGFR_exon21 HRAS_1213 MAP2K1_111-124 POLE_286

ERBB2_exon19 HRAS_61 MAP2K1_203 POLE_411

ERBB2_exon20 IDH1_132 MAP2K1_264 ROS1_2032

ERBB2_exon21 IDH2_140-172 MAP2K1_382 ROS1_2155

ESR1_463 JAK2_617 MAP2K1_53

(inclusief MET-exon14-skipping en gatekeeper ROS/ALK mutatie)

Predictive markers testing using in-situ-hybridization (FISH)ISH-based detection methods for rearrangements, deletions, CNV/amplication of clinical relevant targeted genes (UMCG/2016)

BRISH HER2

Polysomy ALK

Amplification HER2

Break-apart ALK

Polysomy MET

Amplification FGFR1

amplification MET

Break-apart ROS

Break-apart RET

5

Long AJSP 2012

Predictive markers testing using immunohistchemistryAntibodies specific for clinical relevant proteins of mutated targeted genes (UMCG/2017)

Specifiek IHC tegen

BRAF-V600E

FISH-ALK-positief

FISH-ALK-negatief

Specifeke IHC voor ALK-breuk

Positieve NSCLC

1+ 2+ 3+

MET-IHC

0-3 score

Specifiek anti-

exon19-del IHC

Specifiek anti-

L858R-del IHC

Kozu Lung cancer 2011

Methods to detect predictive molecular aberrations in Molecular Pathology of lung cancer (2017)

NGS-mutation: EGFR, ALK, ROS, RET, KRAS, BRAF, PIK3CA, MET, KIT

FISH-rearrangement: ROS, RET, (ALK), NTRK1, NGR1

FISH-amplification/CNV: MET, HER2, FGFR1, EGFR1

IHC: HER2, ALK, ROS1, PD-L1

RTPCR: MET exon14-skipping


6

Molecular diagnostics of lung cancer for treatment planning using gene-targeted therapy in NL

dutch guidelines

In 2007: starting with EGFR-mutation screening

In 2013: Dutch guideline in NSCLCOnly EGFR-mutation analysis

In 2013: ALK-translocation (Registration crizotinib July 2012)

In July 2015: revisited Dutch guideline for NSCLC:(1) EGFR, ALK; (2) HER2, BRAF, RET and ROS1

Dutch Oncoline guideline for NSCLC (July 2015):(1) EGFR, ALK; (2) HER2, BRAF, RET and ROS1

CAP-IASLC-AMP guideline for NSCLC (Aug 2017) (Hanna JCO 2017)

EGFR, ALK, ROS and PD-L1 (recommendation HER2, BRAF and RET)

NCCN guideline for NSCLC (2016) for adca and never-smokers SCC

(1) EGFR, ALK; (2) as part of broad profiling (HER2, MET, BRAF, RET, ROS1)

ESMO guideline for NSCLC (2013/2016) (Kerr Ann Oncol 2013; Novello, 2016)

co-testing EGFR and ALK (recommend KRAS, BRAF, HER2 and ROS1)

Molecular diagnostics of lung cancer for treatment planning using gene-targeted therapy

international guidelines

7

Studie Fase Type tumor Doel

NVALT 15 III plano - FGFR1 Stadium IIIB/IV met FGFR1 amp: nintedanib

NVALT-17 III adeno - EGFR mut 1e lijn intercalated vs erlotinib NVALT-19 II mesothelioom 1e lijn maintenance gemcitabine na chemotherapie (cis/pem)

IL-09 plano 1e lijn carbo/taxol/orale fosfoinositide 3-kinase remmer

LO-41 II plano HER3 remmer + carbo/taxol LO-45 I/II SCLC - Extensive disease PARP remmer + carbo/etoposide LO-24 II adeno - BRAF mutatie V600E 1e lijn stadium IV. BRAF/MEK remmer

LO-27 III adeno - ALK translocatie 1e lijn LDK of cisplatine/pemetrexed LO-36 II adeno - ALK translocatie LO-36 II adeno - ALK translocatie LO-40 II adeno –EGFR mutatie T790M+ 2e lijn: stadium IV bij EGFR resistentie: 3e generatie TKI

LO-48 Ib/II adeno - EGFR + c-MET amp.; geen T790M

2e/3e lijn: c-MET remmer + gefitinib

LO-54 III adeno - EGFR mutatie +/- T790M 3e en volgende lijnen; 3e generatie EGFR remmer vs chemotherapie, cross over mogelijk na chemotherapie

CompassionateUse

Ceritinib NSCLC –EML4-ALK Bij resistentie voor crizotinib Alectinib NSCLC – EML4-ALK Bij geen behandelopties meer voor ALK+ patienten

Nivolumab NSCLC - plano & adenocarcinoom 2e lijns therapie na platinum doublet

Sunitinib NSCLC - PDGFR mutatie indien PDGFR mutatie aanwezig na platinum doublet

Sunitinib NSCLC - RET translocatie indien RET translocatie aanwezig na platinum doublet

Nieuwe predicitieve biomarkers in kader van klinische trials bij longkanker in umcg (www.moloncopath.nl/longziekten)

Bezocht op 24022017

Molecular Pathology of lung cancer in UMCG and North-Netherlands (2017)







8

Uitdagingen mbt moleculaire pathologie in PA-labs in Nederland in 2017

• Verschillende moleculaire predictieve markers

• Verschillende moleculaire detectiemethoden

• Geen/weinig informatie over huidige behandelmethoden

• Geen gestandaardiseerde verslaglegging

• Kosten spelen rol bij keuze (uitgebreidheid) testen

9

national consortium of >38 pathology-labs, medical oncologists, pulmonologists, NVALT, NVMO, NVVP, PALGA

Goal: To introduce a NGS assay to create optimal and equal access to targeted therapies for all (lung, melanoma, GIST, CRC) cancer patients in the Netherlands

Project PATH (Predictive Analysis for THerapy)

Optimizing access to personalized cancer therapy in the

Netherlands; from tissue to therapy.

CALL ZONMW GGG: PERSONALISED MEDICINE – ONCOLOGY

http://www.netwerk-path.nl

elke patiënt de juiste uitslag en advies


Optimizing access to personalized cancer therapy in the

Netherlands; from tissue to therapy.

Het doel van het PATH-project:

• Optimalisatie van predictieve diagnostiek>> leren van best practices >> samen naar nog betere diagnostiek

• Standaardisatie van rapportage en interpretatie van moleculaire resultaten>> in PALGA >> allemaal dezelfde taal spreken

• Inrichten van multidisciplinair expertise netwerk van moleculaire tumorboards>> samen naar betere vertaling naar de kliniek >> therapie op maat

• Opzetten infrastructuur voor (toekomstig) Health Technology Assessment (HTA) onderzoek>> Effectiviteit organisatie van predictieve moleculaire diagnostiek>> Kosteneffectiviteit moleculaire testen

10

WP 2Ed Schuuring , Petra Nederlof, Bastiaan Tops, Astrid Eijkelenboom

Veerle Coupé ; Eddy Adang; Erik Thunnissen

WP 3Harry Groen ;Hans Gelderblom; Katrien Grünberg

WP 4Stefan Willems ; Henk-Jan van Slooten; Paul Seegers

WP 1Marjolijn Ligtenberg ;Katrien Grünberg

Predictive gene Aberrations Cancer type Targeted agent

ALK SNVs, Fusion-transcript Lung Crizotinib, Ceritinib

BRAF SNVs Skin (melanoma) Vemurafenib

EGFR SNVs Lung Gefitinib, erlotinib

ERBB2 (Her2) amplification Breast Trastuzumab

KIT SNVs GIST Imatinib, Sorafenib

KRAS SNVs Colon Cetuximab, Panitumumab

NRAS SNVs Colon Cetuximab, Panitumumab

PDGFRA SNVs GIST Imatinib, Sorafenib

ROS1 Fusion-transcript Lung Crizotinib, Ceritinib

BRCA1 SNVs, CNVs Ovary Olaparib

BRCA2 SNVs, CNVs Ovary Olaparib

List of predictive genetic biomarkers and accompanying

targeted agents that are currently (2017) approved for

treatment of solid tumours in The Netherlands

11

PATH-WP2 task forcegene-panel (2017 – for implementation)

• Clinical relevant: direct impact on targeted therapy:> Dutch (concept) onco-guidelines> Ongoing Dutch clinical trials> Information from pharma (2017/drup-study)> literature

• Lung cancer, CRC, GIST and melanoma• Variants (mutations, deletions, fusions, CNV)

Design mutation/gene panel: Leon van Kempen, Leonie Kroeze, Bas Tops, Arja ter Elst, Ed SchuuringsmMIP-design/validation: Leonie Kroeze, Astrid Eijkelenboom, Marjolijn Ligtenberg

PATH-v02D DNA gene panel(Oct 2017: implementatie in 4 centers using smMIP-NGS)

Predictive gene Aberrations Predictive gene Aberrations

AKT1 SNV JAK2 SNV

AKT2 SNV KIT SNV + CNV

AKT3 SNV KRAS SNV + CNV

ALK SNV + CNV MAP2K1 SNV

ARAF SNV MDM2 CNV

BRAF SNV + CNV MET SNV + CNV

DDR2 SNV MTOR SNV

EGFR SNV + CNV NRAS SNV

ERBB2 SNV + CNV PDGFRA SNV + CNV

FGFR1 CNV PIK3CA SNV

FGFR2 CNV POLE SNV

FGFR3 CNV PTEN SNV

GNAS SNV RAF1 SNV

GNAQ SNV ROS1 SNV

GNA11 SNV TP53 SNV + CNV

HRAS SNV

IDH1 SNV MSI

IDH2 SNV AMELX/Y

Consortium (Dutch University Laboratories of Molecular Pathology)Consensus on NGS mutation panel > each patient in NL receives same opportunities for therapy


12

Hiatt JB, et al. Genome Res. 2013 May;23(5):843-54

Single molecule Molecular Inversion Probes for NGS PATH-panel

single molecule tag

Single molecule tag to identify independent biological template molecules:Higher specificityHigher sensitivity

Molecular Pathology of lung cancer in UMCG and North-Netherlands (2017)







13

PATH-RNA-gene panel: gene-composition (in development)

Predictive gene Aberrations

NTRK1 Fusion-transcript

MET Exon 8/14 skipping

EGFR Viii deletion

ALK Fusion-transcript

FGFR3 Fusion -transcript

BRAF Fusion-transcript

RET Fusion-transcript

ROS1 Fusion-transcript

PDGFRA Fusion-transcript

NRG1/FGFR1 ? Fusion-transcript

Consortium (Dutch University Laboratories of Molecular Pathology)Consensus on NGS mutation panel > each patient in NL receives same opportunities for therapy


RNA-based assays to detect fusionscommercial kits becoming available now

• ALK RGQ RT-PCR kit (Qiagen)• Ion AmpliSeq RNA fusion Lung Cancer Panel (Life Techn) (RUMC, DNA, LUMC)• EML4-ALK Fusion Gene Detection Kit (Amoy Diagnostics)• EML4-ALK Fusion Gene Detection Kit (Entrogen)• RNA-seq (NGS-approach; ???)• nCounter Nanostring Lung Panel (UMCG/NKB)• RNA SPET Panel Nugen (UMCG/NKB)• Archer Fusionplex CTL Panel (NKI, Erasmus, LUMC)Lung Cancer• Lung Cancer Qiaseq Targeted RNAscan panel (RadboudMC)

� Validated in 4 PATH-labs on same samples (what test should we use ?)� in single run “all” fusions tested (cost-effective)� possibility to add targets (NGR1, MET-skipping)� Validate predictive value to select good responders� RNA vs DNA from FFPE-tissue

14

RNA-based assays to detect fusionsfor ALK, RET, NTRK AND ROS

nanostring UMCG (first data)

2/2 RET-fusions; 3/3 ALK-fusions; 3/3 ROS-fusions; 4/4 negative controls

Next-step: ad NGR1 and MET-exon14 skipping

University of Alabama Comprehensive Cancer Center R esearch Retreat, Birmingham, AL, October 6, 2014

Molecular results might as well be ……hieroglyphs

ALK, APC, ASXL1, ATM, BAP1, BCR-ABL, BRAF, BRCA1, BRCA2, CEBPA, CRAF (RAF1), CSF1R, CTLA4,CTNNB1, DDR1, DNMT3A, ERBB1 (EGFR), ERBB2 (HER2), ESR1, FGFR4, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MAP2K1 (MEK1), MAP2K2 (MEK2), MAPK3 (ERK1), MET, MLL (KMT2A), MPL (TPOR), MYC, MYD88, NOTCH1, NPM1, NRAS, PARP1, PDGFRA, PDGFRB, PIK3CA, PML, PTEN, PTPN11, RARA, RB1, RET (MEN2), RUNX1, TET2, TP53, VEGFA, VEGFR1 (FLT1), VEGFR2 (KDR), VEGFR3 (FLT4), VHL, WT1, mTOR

List of actionable

cancer biomarkers, 2015 AD

Hieroglyphs on stone

tablet, 5000 BC

Courtesy of Mark Bogulski, MD, Genome Health Solutions

15

Nation wide Digital Pathology Database (since 1991)

Courtesy of S. Willems, UMCU

Standarization of molecular data (NGS) reporting> launching first molecular-module (KRAS, EGFR, BRAF) (dec 2015)

> launching molecular-module for NGS data (oct 2017)> linking to clinical databases and registries (2018)

Options for Quality-control, TAT, identifying rare mutation, etc

16

• Example: NSCLC with EGFR: c.2281G>A; p.(D761N)

• Example: NSCLC with PIK3CA: c.3140A>G; p.(H1047R)

• Example: NSCLC with PIK3CA: c.3140A>G; p.(H1047R) 80% and p(L858R) 35%

• Example: AKT3 amplificatie 80%, EGFR amplificatie 50%, KRAS amplificatie 20%, TSC1 A944T mutatie 10%, MDM2 amplificatie 7%, MCL1 amplificatie 3%, TP53 Y234C mutatie 2%, EPHA5 A454N mutaties 1%, MYST3 amplificatie 1%

Reporting Mutation Analysis dataHandling of unexpected, difficult, rare mutations?

Treatment options ?

Btumortype

genenset

NGS analyse

moleculaire tumor board

tumorspecifieke verandering

gen a gen b gen c, mut X gen b

analyse en moleculaire interpretatie

A C DC D

A B C D

behandelingop maat


Regulier MDO

17

Btumortype

genenset

NGS analyse

Moleculaire Tumor Board

tumorspecifieke verandering

gen a gen b gen c, mut X


A C DC D

A B C D

behandeling op maat

gen b

Regulier MDO

Interpretation of Mutation Analysis DataHandling of unexpected, difficult, rare mutations?

Treatment options/advice ?

Using 3D-modeling, drug designand predicting interaction

Groningen Research Institutefor Pharmacy (drug design)

(1) KMBP/pathologist search for information on general treatment advice and interpretation in PA-report(2) assistance with specific treatment advice via the Molecular Tumor Board Groningen (every Friday MTB-meeting)(3) Using databases, variant calling, 3-D modelling

18

Every Friday from 1400-1500 hrs we discuss requests for advice (since Nov 2014)

www.moloncopath.nl

Molecular Tumor Board Groningen (in dutch)

Prof dr Ed Schuuring, KMBPDr Arja ter Elst, KMBPProf dr Anke van den Berg, KMBPDr Nils ’t Hart, lungpathologistProf dr Wim Timens, lungpathologistProf dr Harry Groen, pulmonologistDr Jeroen Hiltermann, pulmonologistDr Anthonie van der Wekken, pulmonologistProf dr Geke Hospers, medical oncologistDr Hilde Jalving, medical oncologistDr Matthew Grover, drug-design pharmocologistDr Leon van Kempen, KMBP-traineeDr Maarten Niemantsverdriet, KMBP-trainee

This expert forum combines the expertise of clinical molecular biologists in pathology, pathologists, medical oncologists, molecular pharmacologist and pulmonologists

Verslaglegging mutatieanalysemoleculaire interpretatie

Materiaal (FFPE-blokje) ontvangen voor consult van MZH (MZH:T00-0000-II1).

Moleculaire interpretatie (UMCG):Er is een mutatie aangetoond in EGFR: c.2573T>G; p.(L858R).Er zijn geen mutaties waargenomen in de andere mutatie-hotspots in EGFR, BRAF, KRAS, ERBB2 (HER2), KIT, ALK, NRAS, PDGFRA en PIK3CA.

Klinische interpretatie:Longcarcinomen (met name NSCLC) met een activerende mutatie in EGFR reageren in het algemeen goed op therapie gericht tegen EGFR. Indien u een behandeladvies of informatie wenst over lopende trials, kunt u contact opnemen met onze Moleculaire Tumor Board via [email protected] (zie www.MolOncoPath.nl).

19

Moleculaire Tumor Board in UMCG en regio-Noord

Jos Stigt, Saskia Offermans, Clemens Prinsen (Isala, Zwolle)

PATH Expert netwerk• Netwerk van Moleculaire Tumorboards (MTBs)

• Vertaling moleculaire info naar behandeladviezen

• Terugkoppeling naar moleculaire database

• Faciliteert toegang tot klinische trials

• Nationaal expert platform

• Casusoverleg

• ICT infrastructuur voor delen van informatie en decision support tools

• Contact met farma, CPCT, gezondheidsautoriteiten, etc

� Harmonisatie mbt interpretatie, advies en rapportage� Gedeelde database (variant/advies/respons)� Landelijke database (overview observed variants and biology)

20

Landelijkplatform

predictievediagnostie

k

Hub

Noordoost

Hub

Noordwest

Hub

Midden

Hub Zuidwest Hub

Middenwest

Hub

Zuid

Hub

Oost

CMDP

NVALT

BOM

CPCTFarma

Path

Path

Path

Path

Path

Path

Path

Path

Path

Path

Path Path PathPathPath Path

Path Path

Path

Path

Path

Path

Path

Path

Path

Path

Path

Path

PALGA

Trial alert

Pharma Scientific socsCPCT

Proposal to organise national program for optimal targeted treatmentTo exchange info on experience, training, education, ongoing trials

All hospitalsRegional hubsInteraction with important stakeholders

Regional Molecular Tumor BoardsNational tumor board ForumLinking PA with clinical databases

Noord-oost

HUB

management UMCG

PA

UMCG

Groningen

PA

Martini Groningen

PA

Isala

Zwolle

PA

Enschede

PA

TREANT

Hoogeveen

PA

Friesland

Leeuwarden

Moleculaire Pathologie in de regio Noord


Optimizing access to personalized cancer therapy in

the Netherlands; from tissue to therapy.

21

Noord-oost

HUB

Coordination UMCG

PA

UMCG

Groningen

PA

Martini Groningen

PA

Isala

Zwolle

PA

Enschede

PA

TREANT

Hoogeveen

PA

Friesland

Leeuwarden

Moleculaire Pathologie in de regio Noord

Noordelijk Netwerk voor Moleculaire Pathologie:

• Afstemming met pathologen en oncologen• Zelfde pakket aan MD-testen• Vergelijkbare zorg voor elke patient• Centrale MD-testen (complexe assays)• Lokale testen (voor lage TAT)• Kosten-effectiviteit• Kwaliteit• Regionaal overleg, bijscholing met oncologen• Scholing voor AIOS

2017:• UMCG centrale Moleculaire Tumor Board (nov 2014)• Lokale boards binnen netwerk• Bij-/nascholing pathologen/oncologen

Predictive molecular testing anno 2017

Patient with cancer ?

liquidbiopsy

Molecularprofiling

diagnosis

Molecularprofiling

diagnosis

tissuebiopsy

22

Can peripheral blood be used to determine the presence of the tumor ?

Plasma:

* DNA and circulating tumor DNA (ctDNA)* RNA and circulating tumor RNA (ctRNA)* Proteomic/immunological tumor markers* Pharmacokinetics ([drug])

Leukocytes and circulating tumor cells (CTC) Platelets and tumor RNA

Mutatie testen UMCGFFPE-biopten met >2% neoplastische cellenCirculerend tumor DNA in celvrij plasma

EGFR-T790M bij resistentie TKI (tagrisso/osimertinib)

• FDA-approved for EGFR-T790M-positive cases ( nov 2015)

• EU-approved for EGFR-T790M-positive cases (feb 2016)

• FDA-approved T790M-test cobas-EGFR-mutation test v2 (nov 2015; UMCG ref-lab for NL)

EGFR-del19/L858R voor behandelkeuze

• Dutch onco-guideline (july 2015)

• UMCG-ISO15189-validated ddPCR EGFR mutation test

BRAF-V600E voor behandelkeuze/monitorig melanoom

KRAS-common voor behandelkeuze/monitoring CRC

KIT-exon 11 voor behandelkeuze/monitoring GIST

extra kosten, snellere TAT, meer biopten met uitslag (beperkt genen), andere logistiek

EGFR-plasmatest: logistiek aanvragen op www.moloncopath.nlVia apart extern plasma-aanvraagformulier

Op verzoek versturen we pakket met info, formulier en bloedbuizen)

23

Molecular Pathologie UMCG-teamMD-technicians:• Ingrid de Boer-Huitema• Annelies ten Caat• Erik Nijboer• Paskal van Norel• Rianne Pelgrim• Inge Platteel• Martin Schipper• Jantine Sietzema• Tom Artz• Frank Scherpen• Klaas Kooistra

Molecular Tumor Board Groningen (in dutch)Ed Schuuring, KMBPArja ter Elst, KMBPAnke van den Berg, KMBPNils ’t Hart, lungpatholoogWim Timens, lungpatholoogHarry Groen, pulmonologistJeroen Hiltermann, pulmonologistAnthonie van der Wekken, pulmonologistGeke Hospers, medisch oncologistLucy Hijmering-Kappelle, pulmonologistHilde Jalving, medisch oncoloogSjoukje Oosting, medisch oncoloogMathew Glover, drug-design (GRI of Pharmacy)Maarten Niemantsverdriet, KMBPioLeon van Kempen, KMBPio

Saskia Offermans, pathologist IsalaClemens Prinsen, KMBP IsalaJos Stigt, pulmonologist Isala

Gallop-studie: Pieter Boonstra, Marco Tibbesma, Arja ter Elst, Ed Schuuring, An ReynersPATH-consortiumNVALT-plasma-studies: Lisestte Bosman, Arja ter Elst, Harry Groen, Ed Schuuring

KMBP:•Elise van der Logt (PAF, UMCG)•Arja ter Elst•Anke van den Berg•Ed Schuuring (UMCG, HGV, MZH, PAF, Isala)•Maarten Niemantsverdriet (KMBPio 2016-2020) (Isala, UMCG)•Leon van Kempen (KMBPio 2016-2018)

Pathologists:•Wim Timens•Nils ‘t Hart•Arjan Diepstra (moleculaire patholoog)

Gevolgen van PATH project voor NSCLC - Zorg … van PATH project voor NSCLC Hoe tillen we...

Documents

Transcript of Gevolgen van PATH project voor NSCLC - Zorg … van PATH project voor NSCLC Hoe tillen we...