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New Cancer Technology: Is Easy Detection a Reality?

Panel discussion at SXSW, March 13, 2016
with Kevin Conroy, Sam Hanash & Luke Timmerman

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New Cancer Technology: Is Easy Detection a Reality?

  1. 1. FINDING CANCER Is Easy DetectionA Reality? Moderator: Elaine Schattner, MD, MA, Physician & Patient Advocate, NewYork, NY Kevin Conroy Chairman & CEO Exact Sciences Madison,WI Sam Hanash, MD, PhD Professor of Cancer Prevention and Molecular Pathology The University ofTexas MD Anderson Cancer Center Houston,TX LukeTimmerman Biotech Journalist Founder and Editor,Timmerman Report Seattle, WA
  2. 2. Session Plan: Up For Debate:Why Screen For Cancer? 1. Debate? Pros & Cons of Early Detection A Bit of History, Stats & Facts 2. Liquid Biopsy: ctDNA, CTCs… Grail? Cancer Detection vs. Monitoring Q & A 3. Cologuard for Colon and Rectal Cancer Screening Q & A 4.What Limits Adoption of Novel Detection Methods? Science #Education…#Regulation…#Costs… Is DTC marketing appropriate? Q & A #cancertech 2
  3. 3. Early Cancer Detection: Pros & Cons Point: If screening is accurate, it could result in less treatment and better outcomes. Save Lives, Extend Lives MinimizeTreatment less toxic drugs, smaller surgery Cure? Lower costs of care? Counterpoint: Screening can lead to false alarms, evaluation and treatment of people who have slow-growing, “benign” tumors. Overtreatment surgery, medication, radiation toxicity, even death needless worry & grief Costs without reason #cancertech 3
  4. 4. Cervical Cancer:A Detection Success Story high-grade cervical cell dysplasia History: Before 1960, cervical cancer was a common cause of illness and mortality in U.S. women. Now: In years since screening with Pap smears began, cervical cancer is infrequent; deaths are rare. (The Milbank Quarterly, Vol. 90, 2012) Future: Can we prevent cervical cancer by immunizing against HPV?. (Dr. E. Uthman, Wikimedia) #cancertech 4
  5. 5. Cancer Care is Expensive Mariotto et al. NCI 2011;103(2): 117–28. #cancertech 5
  6. 6. #cancertech 6 Cancer Is a Leading Cause of DeathWorldwide Annual toll: US: 1.7 M cases, 595,690 deaths Global: 14 M cases, 8 M deaths Toll expected to surpass 20M in 2020 Many cancer are stage III or IV at diagnosis. Within the U.S. and globally, this varies – and is changing.
  7. 7. NewTech! #cancertech 7
  8. 8. Cell-free DNA (cf-DNA) Circulating tumor DNA (ctDNA) Circulating tumor cells (CTCs) Exosomes Micro-RNA Other What is a Liquid Biopsy? A CTC lights up the androgen receptor in a metastatic prostate cancer cell (image from Epic Sciences, San Diego) DNA sequence from a normal and tumour cell (WellcomeTrust image) Blood is chock-full of stuff #cancertech 8
  9. 9. Is Screening Blood for Cancer Feasible, orWise? #cancertech 9
  10. 10. Fishing Expedition? Deadliest Catch, (Discovery image) Q & A #cancertech 10
  11. 11. Liquid Biopsies: For Detection or Cancer Monitoring? Breaking Bad, early episode (AMC) Around the time ofWalter White’s lung cancer diagnosis: MightWalter have benefited from early detection? Breaking Bad, Season 5 (AMC) Late inWalter White’s journey: Might he have benefited from monitoring during treatment? #cancertech 11
  12. 12. #cancertech 12 134,490 new diagnoses 15,690 26,120 41,780 40,890 49,190 158,080 Esophageal Prostate Pancreas Breast Colorectal Lung Annual cancer deaths $20 billion projected annual treatment costs in 2020 Colon Cancer:America’s Second Deadliest Sources: CDC, MMWR 2013; ACSCancer Stats & Figures (2016)
  13. 13. #cancertech 13
  14. 14. Poop and Looking Inside: Ways to Check for Signs of Colon and Rectal Cancer NCI image (TereseWinslow, illustrator) Colon cancer screening (image: U.S. government, Navy) #cancertech 14
  15. 15. How Does Cologuard Compare with FOBT and Other Colorectal Cancer Screening Methods? #cancertech 15
  16. 16. Early Colorectal Cancer Detection is Critical And Underused: 9 out of 10 survive 5 years Diagnosed in Stages I or II Diagnosed in Stage IV 1 out of 10 survive 5 years 60% of patients diagnosed stages III-IV Stagnant screening rates: (Inadomi JM, et al. Adherence to Colorectal Cancer Screening, a Randomized Clinical Trial of Competing Strategies. Arch Intern Med. 2012;172(7):575-582). 50% 52% 59% 58% (only 38% for colonoscopy)* 80% 80% 2005 2008 2010 2013 2018 2020 #cancertech 16
  17. 17. How Does CologuardWork? #cancertech 17  Stool DNA test: looks for hidden blood and 11 biomarkers (10 DNA & 1 protein)  Completed at home, returned via UPS, no medication, no prep, no sedation  FDA-approved & covered by Medicare  Included in American Cancer Society guidelines & U.S. Preventive Services Task Force draft guidelines Cologuard vs. other non-invasive options:
  18. 18. What’s the Experience with Cologuard? #cancertech 18 71% Patient compliance* 88% Patients rated experience positive 42% Patients never screened before *Patient compliance rate: number of valid test results reported divided by the number of collection kits shipped to patients 60 or more days prior to December 31, 2015 – information from Exact Sciences, for ages 50 -74 Source: Colorectal Cancer Screening with Multi-target stool DNA-basedTesting Previous Screening History of the Initial Patient Cohort, poster presented at American College of Gastroenterology'sAnnual Scientific Meeting (ACG 2015), Oct. 16-21, 2015 Q & A
  19. 19. What Limits Use of New Cancer ScreeningTools? Role of Education: Need for better education of doctors in modern science including genetics - How do practicing physicians learn about new tech? - Greater education of the public, in science? Screening Guidelines: Costs & Iffy Insurance Coverage: Regulatory Issues: #cancertech 19
  20. 20. Finding Cancer in Other Body Fluids? #cancertech 20
  21. 21. Is Advertising OK? #cancertech 21 Q & A
  22. 22. What’s the Future of Early Cancer Detection? Q & A, General Discussion #cancertech 22
  23. 23. Thank you! #cancertech Kevin Conroy @ExactSciences Sam Hanash @MDAndersonNews LukeTimmerman @ldtimmerman Elaine Schattner @ESchattner