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Clinical Implementation of Genomic Cancer Medicine Lincoln Nadauld MD, PhD Director, Cancer Genomics Intermountain Healthcare Consulting Assistant Professor.

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Presentation on theme: "Clinical Implementation of Genomic Cancer Medicine Lincoln Nadauld MD, PhD Director, Cancer Genomics Intermountain Healthcare Consulting Assistant Professor."— Presentation transcript:

1 Clinical Implementation of Genomic Cancer Medicine Lincoln Nadauld MD, PhD Director, Cancer Genomics Intermountain Healthcare Consulting Assistant Professor Stanford University, School of Medicine

2 High Jump Standard: Scissor Kick

3 Innovation: Fosbury Flop

4 What does Dick Fosbury have to do with Genomic Cancer Medicine?

5 INNOVATION

6 Overview What is Genomic Cancer Medicine? (case study) Intermountain Clinical Cancer Genomics Program Outcomes Future Vision and Next Steps

7

8 Clinical Case, continued 2009 Advanced disease (L ovary) Surgery and radiation Genomic analysis of tumor

9 An unexpected gene mutation 10p10q Nadauld et al., Genome Biology FGFR2

10 A drug for FGFR2! =

11 What is Genomic Cancer Medicine? (a primer)

12 The Human Genome 46 chromosomes 20,000 genes 1 Human Genome

13 Normal and Aberrant Genes insulin albumin grow die KRAS P53 ** grow die x

14 B. Vogelstein, Science Number of Mutations in Human Cancers

15 Genome Aberrations Faulty Genes 1.FGFR1 2.P53 3.MEK1 4.EGFR 5.HER2 *drug 1* *drug 2* *drug 3* *drug 4* Genomic analysis Cancerous cell

16 ccr.cancer.gov Genomic Targets

17 Could Genomic Cancer Medicine Add Value?

18 Value in Healthcare Value Quality-adjusted outcome Cost =

19 Build a Model!

20 Overview What is Genomic Cancer Medicine? Intermountain Clinical Cancer Genomics Program Outcomes Future Vision and Next Steps

21 Clinical Cancer Genomics Program Genomic Testing Personalized Medicine Clinic Molecular Tumor Board Treatment delivery

22 Cancer Genomics Workflow Day 1 Day 2-3 Day 4-5 Day 6-7 Day Day 13 Day 14 Molecular Tumor Board Results and Treatment Tumor Biopsy or FFPE Pathology Review Sample Prep Analytics Day 8-9 Molecular analysis (NGS) Personalized Medicine Clinic

23 Molecular Tumor Board Multi-institutional participants Experts in Cancer Genomics Interpretation of Genomic Findings

24 Intermountain Cancer Genomics

25 Overview What is Genomic Cancer Medicine? Intermountain Clinical Cancer Genomics Program Outcomes Future Vision and Next Steps

26 Patient Case: Colon Cancer 40s yo man with metastatic colon cancer Progressed through multiple treatments Genomic analysis: HER 2 amplification

27 Patient Case: Colon Cancer (cont’d)  he and his 5 children are thrilled Chemo Targeted drug 2 doses Chemo Targeted drug 3 doses

28 Patient Case: Lung Cancer 56 year old man with metastatic lung cancer Progressed through standard chemotherapy regimen Genomic analysis: BRAF mutation

29 Patient Case: Lung Cancer (cont’d) Targeted treatment x 9months BeforeAfter

30 Patient Case: Melanoma 52 year old woman with metastatic melanoma Progressed through standard treatment Genomic analysis: cKIT alteration

31 Patient Case: Melanoma 8 months on targeted therapy for c-kit mutation:

32 Patient Case: Lung Cancer 79 year old man with metastatic lung cancer (lung) Progressed through carbo/gemcitabine, docetaxel Genomic analysis: FGFR1 amplification

33 Patient Case: Lung Cancer Targeted, 3 moTargeted, 6 mo Chemo Pt now on treatment >20 months, an oral pill He reports feeling “very optimistic about life.”

34 Genomic Testing: Impact on Management n= 195

35 Genomic Medicine Stats Actionable Mutations and Targeted Therapy No. of patients (percent) Genomic diagnostic performed210 Adequate Tissue available or re-biopsied195 No. of mutations 0 4 (2%) 1 19 (10%) 2 23 (12%) 3 37 (19%) >3 111 (57%) No. of actionable mutations156 No. of patients with actionable mutation132 (68%) No. of pts with actionable gene and received targeted tx 99 (51%)

36 Summary New technologies are changing medicine now Data to support the use of new tech is accumulating Genomic cancer medicine appears to yield superior outcomes

37 Next Steps—Cancer Genomics Monitor Outcomes Publish outcomes and cost data Make Cancer Genomics broadly available (precisioncancer.org) Conduct Randomized Prospective Trial

38 Future Vision Multi-disciplinary Genomics Cardiovascular genomics (high risk patients) Neonatal genomics (hyperbilirubinemia) Neurosciences (alzheimer’s, ALS, Autism) Infectious Disease (rare infections)

39 Acknowledgements CPHCC Intermountain Leadership Cancer Clinical Program NIH/National Cancer Institute Stanford University Stanford Genome Tech Center U of Oklahoma Sypase


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