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Long-term Canakinumab Treatment Lowering Inflammation Independent of Lipid Levels for Residual Inflammatory Risk Benefit – Personalized Medicine for Recurrent MI, Strokes and Cardiovascular Death

 

Reporter: Aviva Lev-Ari, PhD, RN

 

Major findings from the trial were presented earlier this year. The trial was designed to test whether canakinumab, which lowers inflammation independent of lipid levels, could reduce risk of a future cardiovascular event by reducing inflammation among people who have had a prior heart attack and who have persistently elevated levels of the inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) despite aggressive care.

Overall, the trial found a 15 percent reduction in risk of recurrent heart attacks, strokes and cardiovascular death among participants who received canakinumab at doses of either 150 or 300 milligrams given once every three months.

SOURCE

https://hms.harvard.edu/news/banishing-inflammation?utm_source=linkedin&utm_medium=social&utm_campaign=hms-linkedin-general

 

Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled trial

Prof Paul M Ridker, MD'Correspondence information about the author Prof Paul M Ridker

,

Jean G MacFadyen, BA

,

Brendan M Everett, MD

,

Prof Peter Libby, MD

,

Tom Thuren, MD

,

Prof Robert J Glynn, PhD

on behalf of the

Findings

Baseline clinical characteristics did not define patient groups with greater or lesser cardiovascular benefits when treated with canakinumab. However, trial participants allocated to canakinumab who achieved hsCRP concentrations less than 2 mg/L had a 25% reduction in major adverse cardiovascular events (multivariable adjusted hazard ratio [HRadj]=0·75, 95% CI 0·66–0·85, p<0·0001), whereas no significant benefit was observed among those with on-treatment hsCRP concentrations of 2 mg/L or above (HRadj=0·90, 0·79–1·02, p=0·11). For those treated with canakinumab who achieved on-treatment hsCRP concentrations less than 2 mg/L, cardiovascular mortality (HRadj=0·69, 95% CI 0·56–0·85, p=0·0004) and all-cause mortality (HRadj=0·69, 0·58–0·81, p<0·0001) were both reduced by 31%, whereas no significant reduction in these endpoints was observed among those treated with canakinumab who achieved hsCRP concentrations of 2 mg/L or above. Similar differential effects were found in analyses of the trial prespecified secondary cardiovascular endpoint (which additionally included hospitalisation for unstable angina requiring unplanned revascularisation) and in sensitivity analyses alternatively based on median reductions in hsCRP, on 50% or greater reductions in hsCRP, on the median percent reduction in hsCRP, in dose-specific analyses, and in analyses using a causal inference approach to estimate the effect of treatment among individuals who would achieve a targeted hsCRP concentration.

Interpretation

The magnitude of hsCRP reduction following a single dose of canakinumab might provide a simple clinical method to identify individuals most likely to accrue the largest benefit from continued treatment. These data further suggest that lower is better for inflammation reduction with canakinumab.

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Reporter and Curator: Dr. Sudipta Saha, Ph.D.

 

A mutated gene called RAS gives rise to a signalling protein Ral which is involved in tumour growth in the bladder. Many researchers tried and failed to target and stop this wayward gene. Signalling proteins such as Ral usually shift between active and inactive states.

 

So, researchers next tried to stop Ral to get into active state. In inacvtive state Ral exposes a pocket which gets closed when active. After five years, the researchers found a small molecule dubbed BQU57 that can wedge itself into the pocket to prevent Ral from closing and becoming active. Now, BQU57 has been licensed for further development.

 

Researchers have a growing genetic data on bladder cancer, some of which threaten to overturn the supposed causes of bladder cancer. Genetics has also allowed bladder cancer to be reclassified from two categories into five distinct subtypes, each with different characteristics and weak spots. All these advances bode well for drug development and for improved diagnosis and prognosis.

 

Among the groups studying the genetics of bladder cancer are two large international teams: Uromol (named for urology and molecular biology), which is based at Aarhus University Hospital in Denmark, and The Cancer Genome Atlas (TCGA), based at institutions in Texas and Boston. Each team tackled a different type of cancer, based on the traditional classification of whether or not a tumour has grown into the muscle wall of the bladder. Uromol worked on the more common, earlier form, non-muscle-invasive bladder cancer, whereas TCGA is looking at muscle-invasive bladder cancer, which has a lower survival rate.

 

The Uromol team sought to identify people whose non-invasive tumours might return after treatment, becoming invasive or even metastatic. Bladder cancer has a high risk of recurrence, so people whose non-invasive cancer has been treated need to be monitored for many years, undergoing cystoscopy every few months. They looked for predictive genetic footprints in the transcriptome of the cancer, which contains all of a cell’s RNA and can tell researchers which genes are turned on or off.

 

They found three subgroups with distinct basal and luminal features, as proposed by other groups, each with different clinical outcomes in early-stage bladder cancer. These features sort bladder cancer into genetic categories that can help predict whether the cancer will return. The researchers also identified mutations that are linked to tumour progression. Mutations in the so-called APOBEC genes, which code for enzymes that modify RNA or DNA molecules. This effect could lead to cancer and cause it to be aggressive.

 

The second major research group, TCGA, led by the National Cancer Institute and the National Human Genome Research Institute, that involves thousands of researchers across USA. The project has already mapped genomic changes in 33 cancer types, including breast, skin and lung cancers. The TCGA researchers, who study muscle-invasive bladder cancer, have looked at tumours that were already identified as fast-growing and invasive.

 

The work by Uromol, TCGA and other labs has provided a clearer view of the genetic landscape of early- and late-stage bladder cancer. There are five subtypes for the muscle-invasive form: luminal, luminal–papillary, luminal–infiltrated, basal–squamous, and neuronal, each of which is genetically distinct and might require different therapeutic approaches.

 

Bladder cancer has the third-highest mutation rate of any cancer, behind only lung cancer and melanoma. The TCGA team has confirmed Uromol research showing that most bladder-cancer mutations occur in the APOBEC genes. It is not yet clear why APOBEC mutations are so common in bladder cancer, but studies of the mutations have yielded one startling implication. The APOBEC enzyme causes mutations early during the development of bladder cancer, and independent of cigarette smoke or other known exposures.

 

The TCGA researchers found a subset of bladder-cancer patients, those with the greatest number of APOBEC mutations, had an extremely high five-year survival rate of about 75%. Other patients with fewer APOBEC mutations fared less well which is pretty surprising.

 

This detailed knowledge of bladder-cancer genetics may help to pinpoint the specific vulnerabilities of cancer cells in different people. Over the past decade, Broad Institute researchers have identified more than 760 genes that cancer needs to grow and survive. Their genetic map might take another ten years to finish, but it will list every genetic vulnerability that can be exploited. The goal of cancer precision medicine is to take the patient’s tumour and decode the genetics, so the clinician can make a decision based on that information.

 

References:

 

https://www.ncbi.nlm.nih.gov/pubmed/29117162

 

https://www.ncbi.nlm.nih.gov/pubmed/27321955

 

https://www.ncbi.nlm.nih.gov/pubmed/28583312

 

https://www.ncbi.nlm.nih.gov/pubmed/24476821

 

https://www.ncbi.nlm.nih.gov/pubmed/28988769

 

https://www.ncbi.nlm.nih.gov/pubmed/28753430

 


Diagnostic and Prognostic value of structural MRI: preliminary evidence of common and specific gray matter changes in Depression and Anxiety patients

Reporter: Aviva Lev-Ari, PhD, RN

 

Cortical thickening in the insular cortex, a brain region vital to perception and self-awareness in Patients with

  • Social anxiety disorder (SAD)
  • Major depressive disorder (MDD)

greater cortical thickness may reflect a

  • compensatory mechanism that is related to inflammation or other aspects of the pathophysiology,” she said.
  • greater anterior cingulate cortical thickness could be the result of both the continuous coping efforts and emotion regulation attempts of MDD and SAD patients.”

Image Source: There are significant cortical thickness differences among the three groups. All regions survived clusterwise-correction (p<0.001).(Credit: Radiological Society of North America)

SOURCE

MRI Uncovers Brain Abnormalities in People with Depression and Anxiety

https://www.mdtmag.com/news/2017/11/mri-uncovers-brain-abnormalities-people-depression-and-anxiety?et_cid=6181014&et_rid=461755519&location=top&et_cid=6181014&et_rid=461755519&linkid=https%3a%2f%2fwww.mdtmag.com%2fnews%2f2017%2f11%2fmri-uncovers-brain-abnormalities-people-depression-and-anxiety%3fet_cid%3d6181014%26et_rid%3d%%subscriberid%%%26location%3dtop


Cracking the Genome – Inside the Race to Unlock Human DNA – quotes in newspapers

Reporter: Aviva Lev-Ari, PhD, RN

 

Cracking the Genome

SOURCE
Paperback
, 352 pages
ISBN:

9780801871405
October 2002
$29.00
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Cracking the Genome

Inside the Race to Unlock Human DNA

In 1953, James Watson and Francis Crick unveiled the double helix structure of DNA. The discovery was a profound moment in the history of science, but solving the structure of the genetic material did not reveal what the human genome sequence actually was, or what it says about who we are. Cracking the code of life would take another half a century.

In 2001, two rival teams of scientists shared the acclaim for sequencing the human genome. Kevin Davies, founding editor of Nature Genetics, has relentlessly followed the story as it unfolded week by week since the dawn of the Human Genome Project in 1990. Here, in rich human and scientific detail, is the compelling story of one of the greatest scientific feats ever accomplished: the sequencing of the human genome.

In brilliant, accessible prose, Davies captures the drama of this momentous achievement, drawing on his own genetics expertise and on interviews with the key scientists. Davies details the fraught rivalry between the public consortium, chaperoned by Francis Collins, and Celera Genomics, directed by sequencer J. Craig Venter. And in this newly updated edition, Davies sheds light on the secrets of the sequence, highlighting the myriad ways in which genomics will impact human health for the generations to come.

Cracking the Genome is the definitive, balanced account of how the code that holds the answer to the origin of life, the evolution of humanity, and the future of medicine was finally broken.

Kevin Davies is the founding editor of Nature Genetics and is currently editor-in-chief of Bio•IT World. He graduated from Oxford University and holds a Ph.D. in genetics from the University of London.

“For an up-to-the-minute account of one of the most dramatic periods in present-day science, Cracking the Genome is an essential read.”

“A superb job… A tantalizing glimpse of the ethical perils and technological possibilities awaiting humanity.”

“A rollicking good tale about an enduring intellectual monument.”

“The race is over, and Davies was there, all along, providing the running commentary—and there, too, at the finish line. In Cracking the Genome, he hands out the prizes.”

“Davies has tracked one of the most important stories ever to unfold. Davies helps readers understand how the deciphering of our genetic code will revolutionize our lives while posing serious ethical dilemmas.”

“An impressive job of contextualizing the science within a political, economic, and social framework, creating a lively tale as accessible to non—specialists as it is to scientists.”

“Investors and others looking for a quick primer on the science and business of biotechnology will find this a useful guide.”

“In Davies’ prose, this story of molecular biology and the Human Genome Project is as compelling as any Arthurian legend. In a fast-moving approachable style, Davies captures the uncovering of biology’s Holy Grail, relying on his own expertise in genetics and interviews with key players such as Collins and Venter.”

SOURCE

Where Does Kaiser Permanente Stand on Doctor Choice? Interview with George Halvorson, CEO, Kaiser Permanente, CA

 Reporter: Aviva Lev-Ari, PhD, RN

 

George Halvorson – All Videos

SOURCE

https://www.sharecare.com/video/healthmakers/george-halvorson/all-videos

34 Videos

 


Tweets by @pharma_BI and @AVIVA1950 for #PMConf  at The 13th Annual Personalized Medicine Conference, From Concept to the Clinic, November 14–16, 2017, Joseph B. Martin Conference Center, Harvard Medical School, 77 Avenue Louis Pasteur Boston, MA 02115

Curator: Aviva Lev-Ari, PhD, RN

 

@pharma_BI

@AVIVA1950

 

All TWEETS from LPBI’s Twitter.com handles at #PMConf 

@pharma_BI

@AVIVA1950

  1. Aviva Lev-Ari Retweeted Gary An

    nice comment

    Aviva Lev-Ari added,

  2. Narrative plan unsupported by facts

  3. Robert C. Green, M.D., M.P.H., Director, Genomes2People Research Program, Professor of Medicine (Genetics), Brigham and Women’s Hospital, Broad Institute and Harvard Medical School pharmacogenomics can harm if odds are so low adherence will be lower

  4. Michael Snyder, Ph.D., Stanford W. Ascherman Professor, Chair, Department of Genetics, Director, Center of GenomiPersonalized Medicine, Stanford University School of Medicine Personal sequencing for multiple etiologies rich people are sequenced

  5. Tom Miller, M.S., Founder, Managing Partner, GreyBird Ventures LLC duty to call up therapies that will not work, balance addressed by PM – diagnostics in PM clinical utility from patient selection for the therapy the patient will respond to

  6. Sandro Galea, M.D., School of Public Health, Boston University US expense on Health care the highest in the World comes on the expense of housings, mental health, education – curative vs preventive care MDs are insentiviced to keep patients sick

  7. Robert C. Green, M.D., Broad Institute and HMS Platinum vs gold standard 59 genes will identify 80,000 will get the disease and 47,000 will never get the disease, is the technology the reason for investment vs Family history?

  8. Bryce Olson, Global Marketing Director, Health and Life Sciences Group, Intel Corporation Genome sequencing found his Pi3K Pathway – PIK3CA p.E54 – Anti Inhibitor for Pi3K = Precision Medicine

  9. Sean Khozin, M.D., M.P.H., Associate Director (Acting), Oncology Center of Excellence, FDA 21st Century – metastatic solid tumors – 900 patients: accommodated plan Lab developed Tests: new approach Efficiency, transparency

  10. innovation INFORMS at NIH Center of Excellence – data collection and analysis of multiple data types Biometric sensors collecting data on cancer patients collaboration with Academia, single arm vs randomized decentralized devices are collecting data

  11. FDA considers N of One, small samples, EGFR drug was approved in 2 1/2 years since Phase 1 of NDA New trial designs: reduce bias and alternative end points narrow criteria for participation, more personalized and more patient-centered innovation

  12. Sean Khozin, M.D., M.P.H., Associate Director (Acting), Oncology Center of Excellence, FDA Advances of technology of biomarkers, disease indication Accelerated approval by FDA a collaborative of speeding the process companion diagnosis assays

  13. Unmet need, commitment is there, innovation and connectivity drive access, collaboration not competition – helps Precision medicine in emerging nations. Access to PM anywhere in the world suggested Kristin Pothier, MS, Global Head, Life Sciences EY

  14. Stephen L. Eck, M.D., Ph.D., President, CEO, Aravive Biologics; Board Chairman, PMC Laxo – A molecular target to be found by diagnostics TEST — as a basis to develop a drug Pricing and value – dimensions of Value to society How PM is done today?

  15. Marc S. Williams, MD Geisinger Clinical Genomics vs Physician specialist (i.e.,hypercholestoralemia), both in same place – paper and EMR Outcomes – tracking patients over decades – systems in place to capture the data Virtual Cycle Clinical data

  16. Timothy Cannon, M.D., Inova Molecular Tumor Board, 5 hospital in VA, Precision Genomics Cancer Therapy Poor understanding of molecular results by MDs, Refractory Patients no Forum to discuss other options 220 patients presented beyond InovaOncologi

  17. Scott A. Beck, Mayo Clinic, MN, AZ PM, Genomics sequencing, BioEthics, IT, Translational Perspective in Epi-genomics, Discovery to Translation Applicattions Pharmacy- Formulary – EMR – Champions from Disease areas to practice environment Testing

  18. payment dominates delivery of care, future PM from Genomics cost to patients Transform acceptability of PM suggested Ronald A. Paulus, M.D., M.B.A., President, CEO, Mission Health, NC, ex-Geisinger, CIO

  19. Genomics based PM to be turned into Wellness Strategy – the path not yet knows said Jeffrey R. Balser, M.D., Ph.D., Dean, Vanderbilt University School of Medicine; President, CEO, Vanderbilt University Medical Center, Nashville, TN

  20. Millianlian Diabetics NOT on Medicare, Analytics: iPhone telling patient dishes to order since SYSTEM KNOWS BLOOD SUGER 24×7 – target care by Analytics Genomics paid by NIH PM Analytics is built at Vanderbilt University MC, Jeffrey R. Balser, CEO

  21. Survival of patient with mutation and targeted drug LIVE LONGER David B. Roth, M.D., Ph.D., Simon Flexner Professor Chair, Pathology and Laboratory Medicine, Perelman School of Medicine at University of Pennsylvania

  22. Lotte Steuten, Ph.D., School of Pharmacy at University of Washington, Seattle aggregate big data , models as evidence, has value to clinical, the model under development NGS Profile of Patient vs current standard of care.

  23. David B. Roth, M.D., Ph.D., UPenn Director, Penn Center for Precision Medicine 5000 patients underwent genome sequencing Interpretation is the issue that is hard Health IT are still in silos: Pharmacy data, financial data, EMR

  24. Michael Pellini, M.D., M.B.A., Chairman, Board of Directors, Foundation Medicine; Board Member, Personalized Medicine Coalition, we know there is value in PM we need to work together on the challenges — to prove the value in PM

  25. Andrea Stern Ferris, M.B.A., President, Chairman of the Board, LUNGevity Foundation – PATIENT to be included in the conversation patient after successful treatment have hope work pay taxes pay to health plans continue family life

  26. Molecular Era, NEJM, 2017, 377, 1813-1823, BRAF in Melanoma – 80% do not need additional therapy vs 20% benefitted in the Non-Molecular Era, data by Dane J. Dickson, CureOne (formerly MED-C); Oregon Health and Science University

  27. CURES – CAR-T are they cures??? A teen-ager’s Value-based Price: $475,000 x years lived suggests  Steven D. Pearson, M.D., M.Sc., Founder, President, Institute for Clinical and Economic Review (ICER)

  28. Of 134 drugs in development – 42 have the potential to become Personalized medicine therapies, said Stephen J. Ubl, President, CEO, PhRMA

  29. Transplantation vs enhancement – resistance to senescence and pathogens to be achieved by gene editing suggests George M. Church, Ph.D., Professor of Genetics

  30. Regulatory oversight on engineering embrios is coming, metric of success in recruitment of patients said Arthur L. Caplan, Ph.D., Drs. William F. and Virginia Connolly Mitty Chair, Director, Division of Medical Ethics, New York Univ

  31. CRISPR does not handle all mutation many require a different editing tool said George M. Church, Ph.D., Professor of Genetics, Health Sciences and Technology, Harvard-MIT Division of Health Sciences and Technology

  32. understand well enough  the gentic application where CRISPR will assist medicine: Retinal degeneration, two aspects one worked in Japan said Katrine Bosley, CEO, Editas Medicine

  33. Aviva Lev-Ari Retweeted Aviva Lev-Ari

    Amazing Power in hands of informed patients

    Aviva Lev-Ari added,

  34. Patients input and sophistication increased – IRB is not aware of the engagement of Patients and their challenging feedback say Deborah Schrag, M.D., M.P.H, Dana Farber

  35. Physicians needs interfaces, dashboard information delivered to MDs, data sits unused, new tools are needed for the data display by relevance to the MDs – clinicians needs decision support in their office

  36. Standards: Toxicity criteria – library of 882 symptoms, Patient reported outcomes by Patients, Resist criteria applied to imaging data criteria for brain tumors said Deborah Schrag, M.D., M.P.H., Chief Medical Oncology, Dana-Farber

  37. drafting document on Verify data integrity in clinical trials, detect discrepancies compromise the integrity of the data – audits by FDA said Sean Khozin, M.D., M.P.H., Associate Director (Acting), Oncology Center of Excellence, FDA

  38. pre-existing autoimmune disease – not indicated for them Immunotherapy even though patients wish to try said Deborah Schrag, M.D., M.P.H., Chief, Division of Population Sciences, Medical Oncology, Dana-Farber Cancer Institute

  39. Drug approved for one indication, provide new data for supplemental indications said Sean Khozin, M.D., M.P.H., Associate Director (Acting), Oncology Center of Excellence, FDA

  40. Eric G. Klein, Pharm.D, Eli Lilly Aggregate burden of disease, existence of co-morbidities Genomics: WHY is explained – precise tools data vs intelligence – interoperability Past clinical trial, replicate studies retrospective data

  41. linkages vs computational techniques we do not have consistent data, data structured Vital sign or WBC count – we have data standardization is evolving said Deborah Schrag, M.D., M.P.H., Chief, Dana-Farber Cancer Institute

  42. use data sets prospective vs retrospective studies asked Amy Abernethy, M.D., Ph.D., Chief Medical Officer, Chief Scientific Officer, Flatiron Health; Board Member, Personalized Medicine Coalition

  43. Clinical sense vs research context, FDA is more comfortable with other than oncology products beyond drugs, namely diagnostics, diagnostics company seeking partnership with many drug areas Thermo FIscher and Novartis partnership

  44. Cost of CT Scan vs an NGS Test – Genomic testing is much cheaper yet volume is still low said Jacob S. Van Naarden, Chief Business Officer, Loxo Oncology

  45. NGS – time results come back what the mutation mean? NOW results come in few days, data analysis assist the said Joydeep Goswami, Ph.D., M.B.A., M.S., President, Clinical Next-Generation Sequencing, Oncology, Thermo Fisher Scientifi

  46. 3D BioPrinting of Drugs and the innovation storm of agents — are both benefits, value based pricing, elasticities, is that price sufficient to support R&D, dynamic environment said Joshua Ofman, SVP, Global Value, Access, Amgen

  47. Awardee of Leadership in PM, Illumina, HC system not yet ready for Precision Medicine

  48. Amgen and Harvard Pilgrims interpretation of Values related to partnerships: Novartis

  49. at Illimina – Consumer Advocacy added to Technology breakthroughs in genome sequencing said Jay T. Flatley, M.S., Executive Chairman, Illumina

  50. National Genomic Service – Sequencing becoming STANDARD of Care, phynotypes, $10 million to be spent NIH said Jay T. Flatley, M.S., Executive Chairman, Illumina

  51. 13th Annual Leadership in Personalized Medicine Award AWARDEE | Jay T. Flatley, M.S., Executive Chairman, Illumina

  52. 13th Annual Leadership in PM Award to Jay T Flatlet, Illumina


LIVE Day Two – 13th Annual Personalized Medicine Conference, From Concept to the Clinic, November 14–16, 2017, Joseph B. Martin Conference Center, Harvard Medical School, 77 Avenue Louis Pasteur Boston, MA 02115

 

JOSEPH B. MARTIN CONFERENCE CENTER

HARVARD MEDICAL SCHOOL, BOSTON, MA 02115

http://www.personalizedmedicinecoalition.org/Userfiles/PMC-Corporate/file/13th_Annual_PM_Conference37.pdf

Leaders in Pharmaceutical Business Intelligence (LPBI) Group, Boston

pharma_bi-background0238

will cover in REAL TIME the 13th Annual Personalized Medicine, From Concept to the Clinic, November 14–16, 2017, Joseph B. Martin Conference Center, Harvard Medical School, 77 Avenue Louis Pasteur Boston, MA 02115

In attendance, covering LIVE using Social Media

Aviva Lev-Ari, PhD, RN

Editor-in-Chief

http://pharmaceuticalintelligence.com

@pharma_BI

@AVIVA1950

#PMConf

Agenda · Part II  NOVEMBER 16, 2017 · CONFERENCE PROGRAM | AGENDA

7:00 am Registration and Breakfast

8:00 am Opening Remarks

SPEAKER | Stephen L. Eck, M.D., Ph.D., President, CEO, Aravive Biologics; Board Chairman, Personalized Medicine Coalition

  • 2005 at Pfizer new initiative on Personalized Medicine
  • Left to go to Lilly – not to give a drug to  Patients with KRAS mutation – beginning of PM
  • Laxo – A molecular target to be found by diagnostics TEST  — as a basis to develop a drug
  • Pricing and value – dimensions of Value to society
  • How PM is done today

8:10 am Clinical Adoption of Personalized Medicine: A Two-Part Discussion Pioneering health care providers have begun to explore the business models, operational processes, IT infrastructure and educational programs that are needed to catalyze the paradigm shift toward personalized medicine. This two-part session on clinical adoption will examine the strategic and day-to-day challenges clinical organizations face as they seek to integrate personalized medicine in clinical settings — and the solutions they employ to address those challenges.

SESSION CHAIR | Marcia A. Kean, M.B.A., Chairman, Strategic Initiatives, Feinstein Kean Healthcare

Discussion Part 1

8:15 am The Case for Personalized Medicine in the Clinic: The View From the Corner Office Inspiring an organizational commitment to a new way of practicing medicine requires visionary leadership. This fireside chat will highlight the viewpoints and approaches of leaders who are spearheading efforts to adopt personalized medicine at clinical institutions, with an eye on the value proposition for changing existing norms and practices.

MODERATOR | Howard L. McLeod, Pharm.D., Medical Director, The DeBartolo Family Personalized Medicine Institute, Chair, Department of Individualized Cancer Management, Senior Member, Division of Population Sciences, Moffitt Cancer Center; Board Member, Personalized Medicine Coalition

Jeffrey R. Balser, M.D., Ph.D., Dean, Vanderbilt University School of Medicine; President, CEO, Vanderbilt University Medical Center, Nashville, TN

  • Vanderbilt University Medical Center [$500 Million in Grants] is a HealthCare System, split from Vanderbilt University School of Medicine [1200 Medical Residents], now they are like Partners
  • BioMedical Informatics very strong at Vanderbilt University School of Medicine
  • Jeffrey R. Balser, M.D., Ph.D. was first student of Dan, A pioneer in Personalized Medicine
  • PM and Non-Oncology: PLAVIX – DSS when MD order drugs DSS trigger No PLAVIX to this patient, made second decision in real time by MDs
  • Nashville – four flagship hospitals, largest HMO not for profit in the country
  • PM at Vanderbilt University Medical Center – 25 drugs – given ONLY after Genomic sequencing
  • Millianlian Diabetics NOT on Medicare, Analytics: iPhone telling patient what dishes to order since SYSTEM KNOWS BLOOD SUGER 24×7 – target care by Analytics
  • Genomics paid by NIH
  • PM Analytics is built at Vanderbilt University Medical Center said Jeffrey R. Balser, M.D., Ph.D., Dean, Vanderbilt University School of Medicine; President, CEO, Vanderbilt University Medical Center
  • what is the economics benefit of Genomic sequencing: DSS on Drugs – Peterson is documenting drug class by economic benefit – bundle to show value
  • Genomics based PM is on drugs — polimorthism – this drug will not work
  • Disease counseling is harder than drug = wellness strategy is the Fututre
  • Genomics based PM to be turned into Wellness Strategy – the path not yet knows said Jeffrey R. Balser, M.D., Ph.D., Dean, Vanderbilt University School of Medicine; President, CEO, Vanderbilt University Medical Center, Nashville, TN
  • Research Investment is R&D, decisions made to guide all research and investment in PM initiative – not generating money. Pilot studies leads to grants. One study is on Economic benefit of PM

Ronald A. Paulus, M.D., M.B.A., President, CEO, Mission Health, NC, ex-Geisinger, CIO

  • 8 most western counties in NC
  • small group of Genetists:
  1. PM and Oncology and – Cancer therapy from a Genomics stand point
  2. PM and Non-Oncology – Drug-Drug interactions
  3. Clinicians needs actionable information
  4. Primary care practices to adopt PM – HOW, where, why? what will be out of pocket expense to the individual
  5. subsidization is a must
  6. payment dominates delivery of care, future PM from Genomics cost to patients
  7. Transform acceptability of PM suggested Ronald A. Paulus, M.D., M.B.A., President, CEO, Mission Health, NC, ex-Geisinger, CIO

Discussion Part 2

9:00 am Practicing Personalized Medicine: Lessons From the Front Lines To successfully integrate personalized medicine into a health system, administrators and clinicians must also design and implement new processes related to program infrastructure and informatics; help educate physicians and patients about the field; and inspire cultural change within the institution. During this panel discussion, a group of early adopters will share lessons learned from implementing pilot programs across the United States.

MODERATOR | Daryl Pritchard, Ph.D., Senior Vice President, Science Policy, Personalized Medicine Coalition

Bonnie J. Addario, Founder, Chair, Bonnie J. Addario Lung Cancer Foundation; Board Member, Personalized Medicine Coalition; Lung Cancer Survivor

Scott A. Beck, M.B.A., Administrator, Center for Individualized Medicine, Mayo Clinic, MN, AZ

  • PM, Genomics sequencing, BioEthics, IT, Translational Perspective in Epi-genomics,
  • Discovery to Translation Applicattions
  • Pharmacy- Formulary – EMR – Champions from Disease areas to practice environment
  • Testing offering, approve value
  • 25 Projects: PharmacoGenomics Testing to patients, change drug before repeat endoscopy

Timothy Cannon, M.D., Clinical Director, Inova Schar Cancer Institute Molecular Tumor Board

  • 5 hospital in VA,
  • Precision Genomics Cancer Therapy
  • Poor understanding of molecular results by MDs, Refractory Patients – no Forum to discuss other options
  • Molecular Tumor Board for Inova Health System: 220 patients presented beyond Inova
  • Oncologists had concerned that patients are aware of drug that MD can’t deliver to client

Peter Hulick, M.D., M.M.Sc., Medical Director, Center for Personalized Medicine, NorthShore University HealthSystem

  • 4 hospitals – 950 MDs
  • PCP to get engaged
  • Neurology
  • Genetic Assessment tool DSS offers PCP option for electronic ordering of the Genetic Testing, Results appear in Patients’ charts
  • Proactive testing
  • 20,000 patients in the system to be tested for pharmaco-genomics testing

Marc S. Williams, M.D., F.A.A.P., F.A.C.M.G., F.A.C.M.I., Director, Genomic Medicine Institute, Geisinger – Central PA

  • 30% of providers are Geisinger the rest are not
  • Genomics: PM — Microbiome bank – broad user consent: recontact and return results
  • Genomics Medicine Institute – 2014 Partnership with Regeneron – genomics sequencing and profiling — all result to be used by Geisinger
  • 170,000 patient consented – 90% responded, 8,000 sequences available
  • 80 gene with potential actionability – interpretation by Scientists
  • Pathologic calls return results –
  • Clinical Genomics vs Physician specialist (i.e.,hypercholestoralemia), both in same place – paper and EMR
  • Outcomes – tracking patients over decades – systems in place to capture the data
  • Virtual Cycle Clinical data – dashboards were created to deliver results per week.
  • 1/2 people do not need criteria
  • Geisinger will disseminate internationally

10:15 am Networking Break (sponsored by Moffitt Cancer Center)

10:45 am Harvard Business School Case Study — Intermountain Healthcare: Pursuing Precision Medicine Intermountain has a long history of being at the forefront of health care quality improvement and the development of treatment protocols. In 2013, Intermountain Precision Genomics (IPG) was started with Dr. Lincoln Nadauld as its Executive Director. IPG focused on stage 4 cancer patients and performed three distinct functions: genomic sequencing, interpretation of sequencing results with recommendations for precision therapies, and drug acquisition and reimbursement. A paper published in February 2017 reported that in addition to having a higher quality of life, patients who received the targeted therapies had progression-free survival rates of almost twice as long as other patients. The purpose of our case discussion will be to assess these efforts, to consider their broader applicability and to review IPG’s plans for the future.

PRESENTER | Richard Hamermesh, D.B.A., Co-Faculty Chair, Harvard Business School Kraft Precision Medicine Accelerator

12:00 pm Overview of the International Landscape for Personalized Medicine

PRESENTER | Kristin Pothier, M.S., Global Head, Life Sciences, Parthenon-EY

  • Precision Medicine in the Globe – stackholder ecosystem
  • India
  • Latin America
  • USA
  • Africa
  • EU
  • APAC
  • Middle East

Regional Spotlight:

China – strength emerging 1.4 Billion people, 4.2 million annual incidence of Cancer – systemic challenges will limit access

Brazil – 440,000 cancer incidents a year, 207 Million Corporate, Hospital, Government, Academic research, collaboration vs competition, collaboration will win

Dubai – 28.5 Million population

Qatar

UAE – Initiative to sequence the entire population, 6,000 done

Saudi Arabia

Middle East – 0.4 oncologist for 100,000

Summary – Unmet need, commitment is there, innovation and connectivity drive access, collaboration not competition – helps Precision medicine in emerging nations. Access to PM anywhere in the world suggested Kristin Pothier, M.S., Global Head, Life Sciences, Parthenon-EY

12:30 pm Bag Lunch

1:30 pm Personalized Medicine at FDA: An Inside Look at the Agency’s Priorities for the Field

INTRODUCTION | Cynthia A. Bens, Vice President, Public Policy, Personalized Medicine Coalition

KEYNOTE | Sean Khozin, M.D., M.P.H., Associate Director (Acting), Oncology Center of Excellence, FDA

  • Advances of technology of biomarkers, disease indication
  • Accelerated approval by FDA a collaborative of speeding the process
  • companion diagnosis assays and drug or biologics
  • FDA considers N of One, small samples, EGFR drug was approved in 2 1/2 years since Phase 1 of NDA
  • New trial designs: reduce bias and alternative end points
  • narrow criteria for participation, more personalized and more patient-centered
  • innovation INFORMS at NIH Center of Excellence – data collection and analysis of multiple data types
  • Biometric sensors collecting data on cancer patients
  • collaboration with Academia, single arm vs randomized, decentralized
  • devices are collecting data in clinical trials
  • 21st Century – metastatic solid tumors – 900 patients: accommodated plan
  • Lab developed Tests: new approach
  • Efficiency, transparency

2:00 pm The Patient Perspective on Personalized Medicine

INTRODUCTION | Susan McClure, Founder, Publisher, Genome magazine; Board Member, Personalized Medicine Coalition

  • Precision medicine and relevant information for Patients
  • Genomic sequencing is the Opening Gate to PM

KEYNOTE | Bryce Olson, Global Marketing Director, Health and Life Sciences Group, Intel Corporation

  • genome sequencing found his Pi3K Pathway – PIK3CA p.E54 – Anti Inhibitor for Pi3K = Precision Medicine

2:30 pm Patient 2.0: Exploring the Future of Personalized Medicine Many observers speculate that the coming wave of gene editing, gene therapy, direct-to-consumer genetic tests and the personalized use of wearables will change the psychology, sociology, economy and efficacy of health care. Informed by the previous panel discussions, this conversation will examine the future of personalized medicine and the merits of these emerging trends.

MODERATOR | Robert C. Green, M.D., M.P.H., Director, Genomes2People Research Program, Professor of Medicine (Genetics), Brigham and Women’s Hospital, Broad Institute and Harvard Medical School

  • Neurologist first , Geneticist thereafter
  • Platinum vs gold standard
  • 59 genes will identify 80,000 will get the disease and 47,000 will never get the disease
  • is the technology the reason for investment vs Family history
  • pharmacogenomics can harm, if odds are so low than adherence will be lower

Sandro Galea, M.D., M.P.H., Dr.P.H., Dean, Robert A. Knox Professor, School of Public Health, Boston University

  • Skeptical of societal aspects: race, 50% of the country health getting better vs 50% getting worse but enthusiast on technology
  • US expense on Health care the highest in the World comes on the expense of housings, mental health, education – curative vs preventive care
  • MDs are insentiviced to keep patients sick
  • Folic Acid
  • Nudge behavior
  • invest in long livivng

Tom Miller, M.S., Founder, Managing Partner, GreyBird Ventures LLC

  • duty to call up therapies that will not work, balance addressed by PM – diagnostics in PM
  • clinical utility from patient selection for the therapy the patient will respond to
  • fantasy: Medical decision making to be made to avoid un neccesary care

Michael Snyder, Ph.D., Stanford W. Ascherman Professor, Chair, Department of Genetics, Director, Center of Genomics and Personalized Medicine, Stanford University School of Medicine

  • Personal sequencing for multiple etiologies
  • rich people come to get sequenced
  • libraries
  • Providers to be incentivized if patients are health

3:30 pm Closing Remarks

SPEAKER | Edward Abrahams, Ph.D., President, Personalized Medicine Coalition