e c ision Me dic ine Pr Ready for prime time? Halifax April 5 th - PowerPoint PPT Presentation

e c ision Me dic ine Pr Ready for prime time? Halifax April 5 th 2017

Outline • De finitio n Pre c iso n Me dic ine • Co nc e pt o f PM a s it a pplie s to c a nc e r • Curre nt sta te • F uture po ssib ilitie s • Q&A

ACRI Snapshot • Cre a te d in 1998 • No t fo r pro fit re se a rc h o rg a niza tio n • Ove r 60 e mplo ye e s • Co ntrib ute to the g lo b a l e ffo rts to finding so lutio ns a g a inst c a nc e r b y b e tte r unde rsta nding o f c a nc e r b io lo g y a nd b ring disc o ve rie s to pa tie nt

Definition of Precision Medicine e c ision me dic ine ( PM ) is a me dic a l mo de l tha t Pr pro po se s the c usto miza tio n o f he a lthc a re , with me dic a l de c isio ns, pra c tic e s, a nd/ o r pro duc ts b e ing ta ilo re d to the individua l pa tie nt. I n this mo de l, dia g no stic te sting is o fte n e mplo ye d fo r se le c ting a ppro pria te a nd o ptima l the ra pie s b a se d o n the c o nte xt o f a pa tie nt’ s g e ne tic ma ke up o r o the r mo le c ula r o r c e llula r a na lysis.

Obama: Precision Medicine Initiative Is First Step to Revolutionizing Medicine Doctors have always recognized that every patient is unique, and doctors have always tried to tailor their treatments as best they can to individuals. You can match a blood transfusion to a blood type — that was an important discovery. What if matching a cancer cure to our genetic code was just as easy, just as standard? What if figuring out the right dose of medicine was as simple as taking our temperature?” - President Obama, January 30, 2015

Non-targeted therapy era Previously, we knew that traditional chemotherapy could be effective to a percentage of patients however it E ffe c tive in 40% was ineffective in the rest of patients and all patients were exposed to the potential side- effects.

Why is PM needed? All c a nc e rs a re diffe re nt • Muta tio n pa tte rn va ry fro m c a nc e r to c a nc e r o Pre se nc e o r a b se nc e o f c e rta in muta tio ns will • dic ta te if a g ive n ta rg e te d tre a tme nt will wo rk De ta ile d info rma tio n o f the pa tie nt’ s c a nc e r will • de te rmine the c o urse o f a c tio n fo r tha t spe c ific pa tie nt

Evolving mutations lead to cancer ONC=o nc o g e ne T SG=tumo r suppre sso r g e ne

Foundation of PM in Oncology I de ntify the mo le c ula r g e no type o f c a nc e r using to o ls • suc h a s Ne xt Ge ne ra tio n Se q ue nc ing in o rde r to find Ac tio na b le muta tio ns fo r whic h a ta rg e te d the ra py e xists o Pro g no stic ind ic a to rs o • Se le c t the ta rg e te d the ra py spe c ific fo r the pa tie nt’ s c a nc e r e ithe r with a va ila b le tre a tme nts o r unde r a c linic a l tria l Mo nito r tre a tme nt re spo nse a nd de te c t e a rly re la pse • (liq uid b io psy)

Targeted Therapies

Explosion of Targeted Therapies

EGFR blockade selects for resistance sub-clones 1 st line Tx 3 rd line Tx? 2 nd line Tx Gefitinib EAI045 Osmertinib

Opportunties • Re se a rc h drive n drug de ve lo pme nt • Ac c e le ra tio n with ne w te c hno lo g ie s • Ge no mic sc re e ns • Who le g e no me se q ue nc ing • De ve lo pme nt o f dia g no stic a nd mo nito ring te sts • L iq uid b io psy

Precision Medicine Mo ving a wa y fro m o ne size fits a ll to b e tte r tre a tme nts fo r • o ptima l pa tie nt re spo nse Old way New Way “One size fits all” Tailored to patient Need for Liquid Biopsy

Liquid Biopsy: Definition L iq uid b io psy is a minima lly inva sive sa mpling o f a b io lo g ic a l fluid tha t c a n d e te c t c e ll de rive d ma te ria l tha t indic a te s the pre se nc e o f a n unde rlying pa tho lo g y suc h a s c a nc e r. T he c e ll de rive d ma te ria l ma y b e a c tua l c e lls, nuc le ic a c ids, pro te ins, me ta b o lite s o r a ny o the r b io ma rke r.

Tumour derived information from liquid biopsy • Circulating Tumor Cells (CTCs) • Cell-Free (cf) DNA • Exosomes and microvesicles* *Collectively known as Extracellular vesicles

Not available once cancer removed Always available

Liquid Biopsy: enabling real time monitor of disease T issue Biopsy L iquid Biopsy

Exosome Liquid biopsy to monitor current state of a given cancer Exosome Liquid biopsy Do plasma exosomes provide a more representative snapshot of all tumour sub-clones? Detect changes in real time • Tumor heterogeneity • Treatment response • Treatment resistance • Disease relapse

Real-time monitoring of mutational status using liquid biopsy I de ntify a c tio na b le muta tio ns in pla sma tha t • re pre se nt the e ntire spe c trum o f tumo ur sub -c lo ne s Ne xt g e ne ra tio n se q ue nc ing o • I de ntify the ra py re sista nc e pro file s tha t a ppe a r during tre a tme nt Pro vide re a l-time mo nito ring o f pa tie nts •

ME -Microvesicle Enrichment Kit @ Product licensed for research applications and sold by NEP

Co lla b o ra to rs a nd L ic e nse e s Ne w E ng la nd Pe ptide * • Me rc k • E xa c tis I nno va tio n • Cynve nio Bio syste ms* • Altnia Gro up* • Co dia c Bio sc ie nc e s • L ife T e c hno lo g ie s • Bio ve ndo r* • E xo so mic s Sie na * • *L ic e nse e s o r in ne g o tia tio ns

Outstanding questions and issues • Co st$$$ • I nc re a sing numb e r o f c o stly the ra pie s fo r fe we r pa tie nts • Multiple line s o f the ra py • Co st o f te sting • T ra nsla te s into te ns pe rha ps hundre ds o f tho usa nd $ pe r ye a r fo r tre a tme nt • I s c a nc e r b e c o ming a c hro nic dise a se ?

T e a m a t wo rk

Funding partners

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