1. Molecular & Genomic Pathology in the Management of Cancer: Teaching...Who, When, What and How Antonia R. Sepulveda MD., PhD Columbia University, NY, NY

2. Notice of Faculty Disclosure In accordance with ACCME guidelines, any individual in a position to influence and/or control the content of this ASCP CME activity has disclosed all relevant financial relationships within the past 12 months with commercial interests that provide products and/or services related to the content of this CME activity. The individual below has responded that he/she has no relevant financial relationship(s) with commercial interest(s) to disclose: Antonia R. Sepulveda MD., PhD.

3. HeItadline Molecular mechanisms underlying cell function - Physiology - Pathology

4. Colorectal Cancer Molecular Mechanisms & Pathways

5. Molecular Testing: It Used to be “Simple” One order – One test – One result – One interpretation – One clinical application

6. Molecular Pathology: Solid Tumors Personalized Diagnostics for Targeted Therapies Colon CancerLung CancerMelanoma KRAS mt BRAF mt MSI MLH1 ……… EGFR mt KRAS mt BRAF mt EML4Alk ……… BRAF mt KIT mt ……… Esophageal-Gastric Breast Her2 neu IHC / FISH GISTs KIT PDGFRA GISTs KIT PDGFRA

7. BRAF V600E A: 30% T: 70% A T Colorectal Cancer: MSI-H Sporadic? HNPCC/LS? MLH1 Loss PMS2 Loss

8. Then came Gene Panels and Exome and Genome…

9. Molecular Genomic Pathology Heat Map: NGS-Tumors Courtesy of Helen Fernandes PhD

10. What is the role of Pathologists and Pathologists in Training in the Genomic Era?

11. Molecular Rotation: Residents Molecular Pathology (4 weeks) Cytogenetics - tumor (4 weeks) Cytogenetics - constitutional (2-4 weeks) Immunogenetics (2 weeks) Lectures Journal Club

12. Molecular Genetic Pathology Fellowship Knowledge of the principles of Molecular Genetic Pathology: – Basic molecular biology, genetics, testing methodologies, laboratory management Clinical application in: – Inherited disorders, oncology and gene targeted therapies, infectious disease, hematology, immunogenetics and pharmacogenetics

13. Molecular & Genomic Pathology in the Management of Cancer: Teaching...Who? Trainees: Residents Fellows: Molecular Genetic Pathology Anatomic Pathology Subspecialties Practicing Pathologists

14. Molecular & Genomic Pathology in the Management of Cancer: Teaching… When and How? -Lectures: General: technical considerations Integrated in subspecialty Anatomic Pathology -Journal Club -Tumor Boards and Multidisciplinary subspecialty conferences -CME conferences

15. Molecular & Genomic Pathology in the Management of Cancer: Teaching… When and How? Practice, Practice, Practice -Rotations through dedicated service (PGM) -Integration in Surgical and Cytopathology reports -Molecular Oncology Case review conferences

16. Molecular & Genomic Pathology in the Management of Cancer: Teaching...What? - Molecular mechanisms of disease -Technical approaches -Result interpretation -Correlation with surgical/cytopathology diagnosis -Integration with clinical setting -Indications for targeted therapy -Indications as predictors of disease development or recurrence

17. Molecular & Genomic Pathology in the Management of Cancer: Teaching...What? Identifying a Curriculum -Local Institution -Societies: AMP Training & Education Committee Curriculum development task forces: Molecular Pathology Residency Training MGP Fellow Training and Curriculum in Genomics

18. Molecular & Genomic Pathology in the Management of Cancer: Sailing ahead!