Comparing Test Results & Treatment Strategies for Advanced Prostate Cancer

Comparing Test Results and Treatment Strategies across 10 Advanced Prostate Cancer Patients” February 22, 2023 Brian McCloskey and Brad Power “Sometimes when you get your hands dirty, you begin to understand how this information can come together.” – Brian McCloskey “One of the things that we're trying to do is to move patients into more sophisticated testing.” – Brian McCloskey

As we approach the one year anniversary of the Prostate Cancer Lab, we have ten very active advanced prostate cancer patients pursuing tests, building a list of treatment options, and developing a strategy for what's next. We wanted to take a step back and reflect on what we are seeing and learning from their experiences.

Brian McCloskey, co-founder of the Prostate Cancer Lab, shared patient stories, aggregated patient data, and drew out patterns and insights from the experiences of the ten active patients in our community. The process for each patient is to share their genomic information from DNA sequencing, RNA sequencing, and other tests, as well as their electronic medical records.

Treatment options are then developed for each patient, including inputs from service providers such as CureMatch, Massive Bio, xCures, Cancer Commons, SHEPHERD Therapeutics, Genomic Expression, and mProbe. This information is then used to facilitate conversations between the patients and their care providers. Mike Yancey and Rick Stanton shared their medical and disease journeys, using their PSA as a timeline, overlaid with different treatments.

What patterns can we see across advanced prostate cancer patients? Are there commonalities in their genomic mutations? TP53 is far and away the most prevalent gene alteration across the ten patients, followed by TMPRSS2/ERG, PTEN, and then a lot of single gene alterations. There is no commonality in the combinations. Some of the patients share one or two gene alterations, but there are no two patients that look the same.

On average, the patients have three alterations or biomarkers. The minimum is one, and the maximum is six. How do you measure patient experiences? Prostate cancer patients have many treatment options (including surgery, radiation, chemotherapies, androgen deprivation therapies, and immunotherapies). Each systemic treatment works for a while, and then it fails, and the patient moves on to another therapy.

Brian looked at the years that each patient is getting for each systemic therapy before failure. For example, Brian has had five systemic therapies over six-and-a-half years. On average, he’s getting just over a year and a quarter from each therapy. Two patients are outliers. On the high end is Ken Anderson, who has gotten just over two years per systemic treatment.

Ken has been “Comparing Test Results and Treatment Strategies across 10 Advanced Prostate Cancer Patients” living with aggressive cancer and bone mets, and he had over 25 rounds of chemotherapy (docetaxel). On the low end, unfortunately, is Mike Yancey, who is getting less than six months per systemic therapy. Any therapy that he takes has no durability.

Once he completes his treatment, he gets two to three months after that, at best, and then the cancer is on the run again, and he needs to find another treatment. What are the major findings about the Prostate Cancer Lab community? We have a really engaged patient group. They are educating themselves and leaning in to try new tests and treatments. Patients are learning from each other.

What have we learned you should do if you are an advanced cancer patient? Use your existing genomic and other data to get a full portfolio of treatment options. There's an opportunity to leverage our treatment matching service partners to get more treatment options. Get deeper diagnostics if you can. If you can get the raw data from your diagnostics vendor, then you can take it to another vendor for additional insights.

For example, Mike Yancey took his raw RNA data from Tempus to SHEPHERD Therapeutics for them to run their RNA seq analysis. Talk to your physician about how to maximize the useful life of your systemic therapies. Refresh your diagnostic data as you see more lines of therapy. Monitor your disease progression, such as getting weekly PSA tests.

Gather your story into a one-page summary, including your PSA over time, overlaid with treatments, and the treatment options you are considering next, so that you can get advice on priorities and strategy.

The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.

You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.

“Comparing Test Results and Treatment Strategies across 10 Advanced Prostate Cancer Patients” Meeting Notes The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.

SUMMARY KEYWORDS patients, data, treatment, psa, cancer, brian, biomarker, rick, mike, mets, systemic therapy, google drive, alterations, oncologist, lab, insights, database, therapy, tumor, working SPEAKERS Kevin Fordney, Mike Yancey, Saed Sayad, Rebecca Driscoll, Brad Power, Brian McCloskey, Rick Stanton Brad Power We're approaching the one-year anniversary of the Prostate Cancer Lab, which we started in March of last year.

It's very appropriate to take stock and see what we've learned and the community that we have built. Brian will share some analysis he's been doing. I want to qualify this. This is the first time that we've shared this. It's a very rough draft. Please think of it not as a finished product. It's just a working document. Our request is that you help us make it better.

If there are questions and things that you think we should be doing, that's the spirit with which we will be sharing. “Comparing Test Results and Treatment Strategies across 10 Advanced Prostate Cancer Patients” Brian McCloskey 01:35 Thanks everybody for joining. I'm going to have a riveting presentation today. Honestly, it's going to be a little bit more of a weather report than anything.

The reason I say that is that as I was exploring and aggregating this data, I remembered my days when I was working in business intelligence and realized that there was a paradigm, which was 80% of the work is in data aggregation and maybe the other 20% is in analytics, or 10% in analytics and then 10% in decision making. Over the course of the past several few days, I realized that that 80% rule is 100% accurate.

It goes to the point that everything that we're doing right now is manual. As we have the president of AWS with us here wearing his shirt, hopefully we'll be able to get to a much more automated process to look at our data. This is very much a crawl, walk, run approach and we're in a crawl stage. “Comparing Test Results and Treatment Strategies across 10 Advanced Prostate Cancer Patients” So let me share with you what I have.

First off, we have 10 patients. One of them wasn't pictured here, but we have 10 patients that are part of the Prostate Cancer Lab. The way that we set this up is that each of the patients is sharing their electronic medical record information and their genomic reports, or "omics" reports, to a Google Drive. I've taken that Google Drive and looked across each of the various patients, and I use a checklist to make sure their documents are complete.

This could become the basis for an analytic tool, but I'm exploring their genomics, primary tumor RNAseq, data from their met tumor, insights from liquid biopsies, germline tests, and other tests such as ARV-7, HLA, IHC, etc. I'm also looking at their electronic medical records. Everyone has some report, whether it's from MD Anderson, UCSF, or wherever, and all of that information is in the Google Drive. I have a section around treatment options.

As you know, we have a marketplace of very generous service providers such as CureMatch, Massive Bio, xCures, Cancer Commons, SHEPHERD Therapeutics, Genomic Expression, CRI, mProbe, and hopefully some others. You're going to see how each patient is tracking through the funnel. Each one of these cells is hyperlinked to the document in the Google Drive. This is the process in terms of how I was looking across our datasets.

This is as basic as you can possibly get, as we're using Excel, Google Drive, and we're not using any kind of analytic tool to connect the data. This is just a starting point. But sometimes when you get your hands dirty, you begin to understand how this information can come together with more sophisticated tools. This is very much a "crawl, walk, run" process.

“Comparing Test Results and Treatment Strategies across 10 Advanced Prostate Cancer Patients” One of the tools that I found yesterday was this cool mapping software, and I wanted to take a look at where all of our patients are. We're all connected, and we are coast to coast, from sea to shining sea. I have pictures for all our patients except for Phil Resch. There are going to be some data gaps in the data here.

We have good coverage of the United States, but hopefully, we're going to be able to fill in all the states and get greater representation across the country. We also want to get more ethnic diversity in our group. If you know people that want to join us, please refer them to us. We've already had a little bit of word-of-mouth marketing, but continue to do that, particularly if you know African Americans.

As many of you may know, African Americans have much higher rates of prostate cancer relative to their population than other racial groups. This is a big focus of the Prostate Cancer Foundation and the American Cancer Society. We need to reflect that in our community as well.

“Comparing Test Results and Treatment Strategies across 10 Advanced Prostate Cancer Patients” One of the things I wanted to look at was how our patients are moving through what I would call our treatment funnel. As I mentioned, our objective is to integrate electronic medical record information and multiomic insights to guide treatment decisions.

If we look at how our patients are moving through that process, we have 10 patients, and the good news is all of them have some electronic medical record information. All of that is integrated into our Google Drive. All of them have some genomic information. We're doing well in terms of collecting the datasets that are required to get treatment decisions. ) and the patients that have taken advantage of those services.

About half of them have varying degrees. Of those five, two have had guided treatment decisions from that insight. If we pull back a little bit, I think that there's some low hanging fruit. Because we have this data, it's easy to leverage it. Low hanging fruit would be going after Cancer Commons, xCures, Massive Bio and CureMatch. The reason I say that is that their processes to ingest information are very simple.

All our patients have the data that's required to feed them. There's really no reason why that number of five shouldn't be ten. I know that it can be sometimes daunting to pull all this information together and have conversations and start these processes. I would offer that if you need my help to do that, I've done it for other folks, I'd be happy to do it for you.

But it is important because what we're trying to do is elevate the conversation between the patient and the care provider. There are two ways that we do that. One is through these Wednesday sessions, where we offer essentially master classes on cutting-edge science. The second way that we facilitate that conversation, or raise the water level of intelligence, is to offer these treatment opportunities.

I can tell you, as I've gone through this process, that it really is very, very helpful. I think you guys have heard that I went into my oncologist and presented 21 different treatment options aggregated across our service providers. My med oncologist went through 21 of them, whittled them down to eight, and then finally to three, and now we're about ready to pull the trigger on one of those.

It's an easy “Comparing Test Results and Treatment Strategies across 10 Advanced Prostate Cancer Patients” process, but I understand that there's a lot going on just to manage your disease. I'm happy to help you with this process. There's a lot of data here, and I'm going to try to simplify this.

We have ten patients here and there are a few core different components that I've considered: age, the years living with this disease from the date of diagnosis, treatment location, treating physician, and Gleason score. Because we're all advanced, I would expect nothing below a Gleason score of eight, and Rick is an outlier here at seven. There are a few folks here that don't have Gleason scores.

That's just something that requires pathology and some follow-up. Sometimes it may be hard to do. I've looked at the met location. As we've heard, 85% of prostate cancer patients have bone mets, and you can see, we track a little bit below that. We've got 6 patients, and about 60% of us have bone mets, and the others have either a combination of soft tissue or lymph node mets, which is interesting. I've also looked at gene alterations.

I've taken just a very brief snapshot of the treatments that all of you have gotten. I have included surgeries and radiation. I didn't get into the number of each of these different elements. ) I've left them off because all of us are getting those. These are looking at second line hormone therapies, chemotherapy, immunotherapy, et cetera. You can see what we have relative to key treatments.

I did a quick scan of the systemic therapies that each has received and pulled an interesting metric which is to look at simply the years that each patient is getting for each systemic therapy. For example, if you look at me, I've had five systemic therapies over six-and-a-half years.

On “Comparing Test Results and Treatment Strategies across 10 Advanced Prostate Cancer Patients” average, I'm getting a year and a quarter, or a year and a third, from each therapy. That's interesting. There are a couple of outliers here. On the high end, you see down at the bottom, is Ken Anderson. Ken has been living with the disease for six years. He's at MD Anderson, and he's got a high Gleason.

He's got aggressive cancer, bone mets, but he only has one alteration, TP53. It's possible that's changed, but I don't think so. He's only been on three treatments. What's really fascinating about Ken is that he had, I believe, over 25 infusions of docetaxel, I want to say 28. T. He's getting just over two years per systemic therapy. 4. He's getting less than six months per systemic therapy.

We're hopeful that he'll get a more durable response with the findings that he has from mProbe, which recommended he take etoposide (a chemotherapy typically used to treat small cell lung cancer) and carboplatin (a chemotherapy). These drugs were completely off the radar before he had his analysis from mProbe. 8, and that's growing. 6 years. That doesn't mean that the patient died, it just means that they were just recently diagnosed.

In this case, it's Eric Hall, who's doing quite well, and it's just that he's very early in his disease. The max is six and a half years. I wanted to create a fancy graph that would have connectors from one patient to another, but I'm going to let you look at this table for connections between this network of patients that we have.

As you're thinking about your next therapy, your gene alterations, and your condition, you should reach out to patients who look like you and that's already happened. Each of you has been amazing in terms of offering insights to other patients. As this network grows, hopefully, we're going to have an even stronger network effect.

I also want to note that I have not included Chad's gene alterations because I need to go through with him a huge report that he has. It was a little confusing. We'll need to take that offline. I know that he has gene alterations, I think he has P53. Rebecca Driscoll 19:23 (from the chat) Is there a plan in place, via consent, to ask for your XML file of the report from the labs? This allows for structured data to be captured and analyzed.

Companies, such as xCures, have a hard time getting these files from labs. But patients can get them, and the most useful version Brian McCloskey 19:25 We don't have a plan to do that right now, Rebecca, but this is clearly something that we need to do. We would need to potentially even partner with you all because I'm pretty sure that xCures has this. Rebecca Driscoll 20:03 They don't. That's why I brought it up.

The laboratories, because of their statements and monetizing data, will not give it to them. They feel like they’re in direct competition.