>> Good everything. Dr. Carolyn
Hess, I thatching you for the
kind introduction.
And to our friends
and supporters.
It's my honor today
to present to you
as brief snap shot on our
advances at Indiana University
in cancer precision medicine.
In order to understand
cancer precision medicine
we actually have
to start with a cancer begins.
Interestingly, the journey for
most cancers begin years before
a patient ever feels a lump
or a bump or detects an
abnormality on a CT scan.
It begins when just one cell,
one cell in over forty trillion
in the human body goes rogue
and begins to do things it
was never designed to do.
It goes from a cell that was
designed to support human
life to one that takes it.
It begins to grow and divide
rapidly forming vicious tumors.
It develops the ability to
invade organs and metastasize
leaving lethal effects.
It develops the ability to invade
the immune system so that our own
bodies can't get rid of it.
What causes this first cell to go
rogue is actually the accumulation
of typos in its genetic
code that we call mutations.
And it's the conglomerate that
causes this normal cell to go hey
wire and become a lethal cancer.
In precision medicine we're
focused on understanding how we
can exploit these
individual mutations
and develop therapeutic
strategies that are tailored
to individual patients.
Where we have begun to
understand that if we take
a group of patients with
the same diagnosis and treat
them with the same drug not
everybody gets the same response.
What we know is that some
patients do well with a
particular drug and some do not.
In precision medicine we're
focused on how we use genomics,
and informatics, and drug
development to guide patients to
right therapy for their cancer.
I'm proud to know and I'm proud
to let you know that researchers
at the IU school of medicine
have been at forefront of
precision medicine
for many years long before it was
a buzz term, long before it was
a topic that you read in the
New York Times or Time Magazine.
First pioneered by the
late David Flockhart when
he was recruited to IU
in 2001 creating the first
precision medicine program focused
on how individual
genetic variability,
the genetic variability that makes
you and I different influences how
we respond to drugs and what
side effects we experience.
This program blossomed
into numerous programs in
cancer, cardio vascular
and neuro science,
and now is represented
by the robust research
programs and clinical programs
that we have at IU today.
Through generous support
from a variety of
philanthropic organizations
like the Hundred Voices of Hope,
The Vera Bradly Foundation,
and the Catherine Peachy
Foundation we developed
an extensive research
infrastructure bringing in
technologies and now how
to advance cancer precision
medicine and to make
strides in this disease.
First in breast cancer and then
into other cancers as well.
We've been able to develop
numerous genomics based
clinical trials bringing
experimental cutting-edge
exciting agents
to patients whose tumors
harbor specific abnormalities
matching cutting edge drugs
to individual patients' tumors.
We've been able to advance our
understanding of pharmacogenomics.
Understanding how the
DNA variability that
you and I born with
can predict and hopefully
we can mitigate toxic side
effects from these drugs.
We know that patients
typical sometimes fear the
side effects of therapy just
as much as they
fear the disease.
And now we're working diligently
in using genomic technologies
to be able to detect cancer
at its earliest stages and
hopefully prevent the cancer
from happening giving
patients the best chance of
survival from their disease.
In 2014, we began to realize
that this technology and
know how could not limited
to just our laboratories and
to our clinical trials in
downtown Indianapolis but that
we need to bring the
technology to the masses
of cancer of patients so that the
cancer patients in all of Indiana
could again fit from advances
in genomic technologies and
informatics and drug development.
In 2014, my colleague, Brian
and I started the IU health
precision genomics program.
A clinical program dedicated to
providing cutting edge genomic
technologies for patient care.
In this program,
patients are seen
at specialized clinics where
they're educated on genomics.
They're tumors are analyzed
with the most cutting-edge
genomic technologies
available on the planet.
Analyzed also with the most
cutting-edge computational
technologies and algorithms
and each patient is
reviewed by a comprehensive
molecular tumor board
of over 20 IU faculty and staff
who deliberate the results
and determine the best
therapeutic option or clinical
trial for the patient.
This program has seen over
five thousand patients today
and many patients have benefited
from this genomic based therapy.
But five thousand
patients obviously begins
with your first patient,
and I want to introduce
you to the first patient
who ever came through our
program, Cathy Casebolt.
Cathy was diagnosed with
meta static non-small
cell lung cancer and came
to our program after she was
referred to us by Dr. Larry
Einhorn on a second opinion.
Cathy and her husband Brad were
avid baseball fans and members
of the Reds organization, and
unfortunately, she had succumbed
to her disease about a month
off she saw her in clinic.
Seen here is her celebration
of life at Reds stadium
where over twelve hundred people
came to celebrate Cathy's life.
What I'd like to show you is the
results of her genomic testing.
The first ever clinical
cancer genome at the IU
Simon cancer center.
And what was really fascinating
for her genomic results is that
her tumor harbors a mutation
called a KRASG 12 C. KRAS is
a very well-known gene in cancer
that promotes it's development and
it's growth and is represented
the holy grail in oncology.
For over forty years scientists
have tried to develop drugs
against KRAS to no avail.
Very recently
pharmaceutical scientist
actually were able to develop
a very niche small molecule to
this particular G 12 C mutation.
There is no way that Cathy would
have known nor her doctors that
four and half years later Clin
he canal researchers led
by Dr. Bert O'Neil would
dose the first patient in
the world with a KRASG 12 C
drug at IU Simon cancer center.
This patient, a patient
from Terra Haute with lung
cancer, bravely stepped up
to be the first patient
to receive this new agent.
His tumor ended up responded
to therapy, and what
we've learns very recently based
on published results is that
lung cancer patients who have
this very unique
abnormality responding
exquisitely to this new drug.
This drug is moving rapidly
through clinical trials,
and IU should be proud
to have led the Clin he canal
development of this agent.
I'd like to introduce you
to another one of our
patients, Dorothy Arnold.
Dorothy Arnold was diagnosed
with meta static triple
negative breast cancer and came
to our genomics clinic two
years ago after several lines
of chemo therapy had failed
to stop her tumor growth.
On genomic analysis we had
identified that her tumor had
amplified a gene called PDL 1.
This gene is actually
like a camouflage on
cancer cells whose job is
to tell the immune
system to go away
such that the cancer literally
copied this gene numerous times
or amplified them to really
elicit an autoimmune effect.
At the time we saw Dorothy,
there was a publication out
of the University
of California where six
out of nine patients with
a PDL 1 amplification
responded to drugs that
refer up the immune system.
Dorothy went onto be treated
with immunotherapy and has
had a sustained response
for over two years keeping
her cancer at bay with
those cutting-edge agents.
I'd also like to introduce
you to Glen Brag.
I know many of you in the audience
will be familiar with Glen.
Glen was diagnosed with meta
static colorectal cancer at
just twenty-one years old.
At a time when most kids
are just enjoying their
prime of their college years.
Glen would have a disease
metastasize to a liver
and bladder and over
a period of eight years
will endure five surgeries
and numerous lines
of chemotherapy to
keep the cancer at bay.
We saw her in our clinic
in 2017 just after she
had her last surgery, and
we identified a very, very unique
genomic abnormality that suggested
we could actually control
the cancer with something as
simple as high dose aspirin.
She started the high dose aspirin
in two thousand seventeen and
remains cancer free to date.
Actually a thirty-two years
ago, just a little under
a year ago, she married
her husband, Noah Schmidt
and currently live in Chicago
living the life that she should.
I'm proud to say that this
technology and these capabilities
are not limited just to
downtown Indianapolis but
we've been able to distribute
this across the state because
we believe that all
patients should have access
to cutting edge care.
With clinics in Muncie,
Lafayette, Bloomington, as well as
a complementary pediatric
program at Riley hospital.
Patients in Indiana have access
to the most cutting-edge genomics
and informatics available
on the planet to help
guide therapy for their
particular cancer.
I make a quip often to colleagues
that formers in rural Indiana
truly had better access
to genomic care then
many patients who live
in large metropolitan seen
within a week of referral.
We're proud as Hoosiers that
we can be able to provide
this tangible product
of our research at the IU
school of medicine to patients.
I'll end off with talking
a little bit about where
we're going, and where
we're going is using this
genomic technology to
really advance treatment
in the curative setting,
in the earliest stages of cancer.
We recently published resulted
in breast cancer patients that
after chemo therapy
and surgery,
we can take a simple blood sample
and detect whether cancer is
still present in the body or not.
If this blood sample is
positive for this
circulating tumor material,
we know these patients are at
high risk of their cancer coming
back. However, if negative.
Those patients actually have
a really high probability of
doing well long-term.
So we've begun to decide
a set of clinical trials
focused specifically on
this very high-risk population
of these women where their
cancer could come back.
For our first trial in
triple negative breast
cancer, we've partnered
with folks from Pink Forever and
Red Alliance who are helping us
specifically recruit women
of African American descent
because we know that
African American women
are at much higher risk
of developing triple
negative breast cancer.
We've also partnered with
friends at F 3 plus R to launch
a new clinical trial focused
on using genomic based therapy
across tumor types for
patients whose blood sample
is positive for those
circulating tumor material.
I'll end off with saying that
in addition to being able to
use genomic technologies
to help patients, the best
part of my job is the
people I get to work with.
And what I showed you today is
never the product of one, two,
or three individuals, it
truly takes a village, and to
them, I'm deeply indebted.
With that, I thank you
for your kind attention.
God bless and good night.
