Shaw: VUS is 95% of the variants they see. Their website for their knowledge base for decision support: https://t.co/K3f3S6ZNZz #Tricon
2:00pm February 21st 2017 via Hootsuite
Shaw: Shows a figure from '11 JAMA https://t.co/6idiXfwFMP showing every gene is not equally actionable #Tricon
1:59pm February 21st 2017 via Hootsuite
Shaw: One person's actionable alteration is another's germline varient. Gives illustration of a MET mutation. #Tricon
1:58pm February 21st 2017 via Hootsuite
Shaw: Of 429 pts w/mutations in highly actionable genes: 17% never came back. Of those who came back: 2/3'rds never went on another #Tricon
1:53pm February 21st 2017 via Hootsuite
Shaw: Lack of enrollment not due to lack of available matched trials. MDAnderson has a lot of clinical trials. #Tricon
1:51pm February 21st 2017 via Hootsuite
Shaw: % of pts with potentially actionable gene: 40% (o 2K); ultimately 4% went to a clinical trial. #Tricon
1:50pm February 21st 2017 via Hootsuite
Shaw: 'We are all equally bad at doing this" - who tested, how much to sequence, how to pay for it, how to demonstrate effectiveness #Tricon
1:48pm February 21st 2017 via Hootsuite
Shaw: "NGS 'big' data are necessary, but insufficient, to drive precision medicine" #Tricon
1:47pm February 21st 2017 via Hootsuite
Shaw: Doesn't matter how many genes you sequence - only 125 'actionable' genes. 1/2 of FMI's panel - you can't match to a drug #Tricon
Shaw: NGS cost decrease 'leads to increases in data generation'. 'Same exact crappy hit rate' 11% for 50 genes; 5% for WES #Tricon
1:46pm February 21st 2017 via Hootsuite
Shaw: Only unless you have particular cancers with particular markers. Most the time - sequential chemo #Tricon
1:43pm February 21st 2017 via Hootsuite
Shaw: Away from population work getting to individual pt shift. 'We are not providing PM to the majority of our pts' #Tricon
1:42pm February 21st 2017 via Hootsuite
Kenna Mills Shaw (Sheikh Khalifa @kennamshaw MD Anderson TX) Precision oncology decision support #Tricon
1:41pm February 21st 2017 via Hootsuite
Q: OncoSkins at Dana Farber? Gray: A version is being used now. Wants to build more applications on top @stacywgray is her handle :) #Tricon
1:40pm February 21st 2017 via Hootsuite
Gray: Moving beyond academic cts, need for reimbursement for genetic counseling, and testing info returned to pt #Tricon
1:38pm February 21st 2017 via Hootsuite
Gray: Shows summary slide of challenge of 'actionability', access. Trial participation from 11% down to 5% https://t.co/gcDfwLOFwP #Tricon
1:37pm February 21st 2017 via Hootsuite
Gray: 10% have OOP costs of >$18K. 84% of oncologiest consider OOP costs. Need to think about systemic solutions #Tricon
1:35pm February 21st 2017 via Hootsuite
Gray:Tractable challenges: pt's "financial toxicity". 25% spend most or all savings during cancer trtmt #Tricon
Gray: Instead of static PDFs, OncoSkins project to innovate genomic reporting, want to publish this soon. #Tricon
1:34pm February 21st 2017 via Hootsuite
Gray: Innovation is needed to support providers w/result comprehension, increase confidence in genomic knowledge #Tricon
1:33pm February 21st 2017 via Hootsuite
Gray: Also ID'd the need for physician education. Need to explain tests, decide, sequence, return results, understand findings #Tricon
1:32pm February 21st 2017 via Hootsuite
Gray: Oncologist want to provide seq data to pts 80% predictive for clin trial; 60% for off-label; 55% prognostic favorable #Tricon
Gray: Most pts want somatic and germline results - typically >90%. CanSeq study '16 https://t.co/Qf2WIe2V1P #Tricon
1:30pm February 21st 2017 via Hootsuite
Gray: https://t.co/S58yFEEEpZ EHR problems - mentions https://t.co/JNKlPL0OKx - where data was locked in PDFs, system from '91 #Tricon
1:29pm February 21st 2017 via Hootsuite
Gray: Some providers express low confidence in genomic knowledge. Dana Farber - survey of Dr. attitudes https://t.co/zkme1EilFN #Tricon
1:26pm February 21st 2017 via Hootsuite
Gray: Insufficience evidence: only 6% of NCCN guidelines based on high-level evidence. Abernathy '10 - only 5 datapts used #Tricon
1:24pm February 21st 2017 via Hootsuite
Gray: Dealing with two genomes: the germline and somatic; can unearth cancer susceptibility in germline as well. #Tricon
1:21pm February 21st 2017 via Hootsuite
Gray: Providers struggle to keep up with 'rapidly evolving science'; the microenvironment. Understanding of tumor evolution #Tricon
1:20pm February 21st 2017 via Hootsuite
Gray: Points out that patients are not populations. Uses example of PD1 https://t.co/imUKGtiGQl Inadequate genomic knowledge in pop #Tricon
1:19pm February 21st 2017 via Hootsuite
Gray: Starts with the Wagle melanoma figure from this '11 ref https://t.co/86QkdvNpCf #Tricon
1:17pm February 21st 2017 via Hootsuite
Stacy Gray (City of Hope, CA) Precision cancer medicine at the bedside - the provider perspective #Tricon
1:15pm February 21st 2017 via Hootsuite
Karin: Mouse IgA knockouts - enhances CR carcinogenesis in mice. Shows fecal seq in IgA-deficient mice - a battle bet bad/good bact #Tricon
11:43am February 21st 2017 via Hootsuite
Karin: Now moves onto secretory IgA - mg's secreted into the feces daily. https://t.co/cuXSnsrtcL PIgR https://t.co/967c5rb4tg #Tricon
11:39am February 21st 2017 via Hootsuite
Karin: When APC is lost, has data showing loss of JAM-A and MUC2 proteins, losing the tight junction barriers between colon cells #Tricon
11:33am February 21st 2017 via Hootsuite
My new title is 'Super Tweeter' (I think I'll update my profile...) https://t.co/YTL5ycD9fX
11:31am February 21st 2017 via Hootsuite
Karin: Shows 16S RNA FISH of CR tissues: assoc'd with localized permeability to microbes and/or their products #Tricon
11:29am February 21st 2017 via Hootsuite
Karin: Shows data where IL-23 signaling promotes CR ca, T-assoc macrophages and NF-kB producing IL-23: look for IL-23 inducer #Tricon
11:27am February 21st 2017 via Hootsuite
Karin: Inactivating APC in mice, look at IL-23 and IL-17 elevation, upregulated in spontaneous colon ca https://t.co/1GigszIrLb #Tricon
11:25am February 21st 2017 via Hootsuite
Karin: Inflammatory genes IL-23 etc expression associated with poor prognosis https://t.co/lgdz4TZ9qg #Tricon
11:23am February 21st 2017 via Hootsuite
Karin: APC in colitis-assoc'd doesn't show up early (it's a gatekeeper) until much later. Colitis assoc'd: cytokines IL-23, IL-17 #Tricon
11:21am February 21st 2017 via Hootsuite
Karin: The key is to detect early, and treat early. First target - colitis-assoc'd cancer (i.e. Crohn's, IBD). #Tricon
11:19am February 21st 2017 via Hootsuite
Karin: CR ca: in 70% of cases follows a pre-defined pathway. '10 review of inflammation https://t.co/uOQjptfmTw Only 10% 5y OS StgIV #Tricon
Karin: Then chemokines, cytokines recruit lymphocytes, can create oxidation and other effects that can cause cancer #Tricon
11:17am February 21st 2017 via Hootsuite
Karin: C-R ca is 2nd or 3rd leading cause of death. Unified theory of inflammation: response to injury, pathogens or flora invade #Tricon
11:16am February 21st 2017 via Hootsuite
Michael Karin (UCSD SoM CA): Tumor elicited inflammation in colorectal cancer #Tricon
11:15am February 21st 2017 via Hootsuite
Powell: Can detect below 0.1% mutant via qPCR or NGS, exhibiting here at #Tricon
11:14am February 21st 2017 via Hootsuite
Powell: Doing a clinical study in China, w/Zhejiang Univ and John Radcliffe Hosp (Bodmer) #Tricon
11:13am February 21st 2017 via Hootsuite
Powell: For Coloscape, 4 genes and 20 mutations; for early c-r ca, 62% sens in their preliminary studies. Picking up early muts #Tricon
11:12am February 21st 2017 via Hootsuite
Powell: Coloscape - is a kit to provide to hospital labs, unlike Cologuard's central lab model. Cologuard sens for pre-ca is 41% #Tricon
11:11am February 21st 2017 via Hootsuite
Powell: XNA removes all wild-type background noise. Shows KRAS w/ and w/o Qclamp. Have done liquid biopsy, shown concordance #Tricon
11:10am February 21st 2017 via Hootsuite
