Functional Testing for Cancer: The SAGE Oncotest™ and Personalized Treatment
Featuring: Chris Apfel, MD, PhD, MBA
In short
Dr. Chris Apfel, co-founder of SageMedic Corp., explains how the SAGE Oncotest™ works by growing hundreds of live 3D 'microtumors' from a patient's own tumor tissue and testing dozens of drugs on them — delivering results in 7 to 10 days. The goal is to identify which treatments are most likely to work for that specific person before they endure ineffective therapy. This is most relevant for patients with advanced solid tumors that can't be surgically removed or have stopped responding to earlier treatments.
- •Functional testing requires fresh, live tumor tissue or malignant fluids — fixed or formalin-preserved samples won't work, so ask your care team early whether a biopsy can be collected and sent promptly.
- •Testing at various drug doses, including higher-than-normal levels, helps rule out drugs that won't work and flag those most likely to shrink your tumor — potentially doubling the odds of a tumor response, according to Dr. Apfel.
- •The SAGE Oncotest preserves the tumor's microenvironment and three-dimensional structure, which may give a more realistic picture of how your cancer will behave than tests that look at single cells alone.
- •If you have a solid tumor that is non-resectable or has failed first- or second-line therapies, you can ask your oncologist about requesting the SAGE Oncotest or inquire with SageMedic about participation in their pilot or tissue donation studies.
Watch on Cancer Patient Lab YouTube
Ask anything about this — free, no signup
Instant answers grounded in real guidelines, not the internet.
Identifying the Most Effective Treatment on the Tumor Rather than Trying It Out on the Patient” Brad Power January 31, 2024 “What really drove me was my personal experience and the realization that, while we often like to believe at major institutions that the future is here now, the reality is, if one of you is affected, and you have been, that we often are still living in the past.
Meeting Summary
As an advanced cancer patient you want a wide range of treatment options and a good idea whether you will respond to any treatment. As we have heard in our discussions with Tony Letai, Robert Nagourney, First Ascent, Travera, and SEngine, "functional testing" directly tests cancer drugs on your live cancer cells to see what the drugs do. It is a way to identify treatment options and predict which treatment is going to be best for you.
It bases your decisions on trying it, not on theorizing about what might work. Chris Apfel, MD, PhD, MBA is uniquely qualified to talk about the latest practices in functional testing.
He was a successful anesthesiologist, intensivist, and clinical researcher whose work has been cited over 20,000 times by other doctors and whose clinical prediction model has several million hits on Google and is now standard of care in many institutions, including Stanford. He was surprised that genomic testing wasn’t the answer when his father was diagnosed with late-stage lung cancer.
Moreover, his father, who had taken care of his wife when she struggled with ovarian cancer, refused therapy unless he could tell his father with great certainty that a treatment would work. The experiences of his parents drove Dr. Apfel to search for more effective approaches for cancer patients.
He left his faculty position as a practicing clinician at UCSF, got an MBA from Wharton to complement his scientific and medical experience, and, together with his wife, Dr. Brigitte Apfel, also a physician, founded SageMedic Corp. and developed the SAGE Oncotest™ with the latest in functional testing technology. How is the SAGE Oncotest similar to other functional tests?
The reason why functional testing has the power to make a prediction on what will work is because it's done on live tissue. Like other functional tests, the SAGE Oncotest requires live tumor tissue or “malignant fluids” (excess fluids with cancer cells that accumulate in the body). Patients who show low or no evidence of disease, or have hard-to-reach tumors, will have trouble getting enough fresh cancer cells.
SageMedic and others apply the candidate drugs at various doses, including in amounts greater than normally found in the body, such that if there is no response at that level, that drug can be ruled out, and if the tumor cells die, then that drug is a good candidate. How is the SAGE Oncotest different from other functional tests?
“Identifying the Most Effective Treatment on the Tumor Rather than Trying It Out on the Patient” Rather than older methods of growing organoids (cancer cells multiplied in the lab) for functional testing, SageMedic has developed a process and platform to create hundreds of “microtumors” (copies of the tumor tissue) in their lab in a day. They can then test dozens of drugs and drug combinations with results in 7 to 10 days.
Other tests using older organoid technology are accurate if you get a result, but often you don't get a result, and it can take months. Rather than looking at single cells as in some other functional tests, SageMedic’s microtumors retain the tumor microenvironment and heterogeneity of the biopsy and the three dimensionality that is emphasized these days to understand not just the cancer cells but what is going on around them.
Single cell functional tests claim results in two days, but these results haven’t been proven in clinical trials. How can you access the SAGE Oncotest and work with SageMedic?
•You can request the test for your care, especially if you have solid tumors that cannot be surgically removed or have recurred and have failed first- or second-line therapies.
•You can collaborate in pilot validation or tissue donation studies. 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, 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. “Identifying the Most Effective Treatment on the Tumor Rather than Trying It Out on the Patient” Meeting Notes SUMMARY KEYWORDS patient, tumor, oncologist, drugs, tissue, assay, dose, functional testing, therapies, biopsy, test, treatments, cells, question, chris, developed, sensitivity, dose response curves, number, results SPEAKERS Chris Apfel (72%), Brad Power (9%), Glenn Sabin (5%), Arra Yerganian (4%), Amit Gattani (4%), Brian McCloskey (3%), Roger Royse (1%), John Powers (1%), Jeff Krolick (1%) OUTLINE 1.Functional testing services for cancer patients. (0:00) 2.Cancer research and personalized medicine. (2:52) 3.Using in vitro assays to predict cancer treatment response. (9:14) 4.Personalized cancer treatment using tumor microenvironment. (15:54) 5.Personalized cancer treatment using AI-powered drug sensitivity analysis. (22:04) 6.Cancer testing and treatment options. (29:09) 7.Personalized cancer treatment using tissue samples. (36:11) 8.Personalized cancer treatment dosing. (42:43) 9.Personalized cancer treatment strategies. (49:21) 10.Cancer diagnostic test development and commercialization. (55:42) 11.Cancer treatment and drug development. (1:01:18) SUMMARY
•Chris Apfel, a scientist and MD by background, co-founded a startup to provide functional testing services after experiencing the challenges of his parents' cancer treatment.
•He shares his personal story and discusses how functional testing can help patients make informed decisions about their treatments, with examples from his work at UCSF.
•Chris Apfel thanks others for introductions, shares personal experience with cancer research.
•His personal experience with cancer treatment inspires him to create a unique solution for personalized chemotherapy treatment.
•Cancer patients often lack effective treatments due to lack of driver mutations and tumor heterogeneity.
•Chris Apfel highlights the potential of in vitro testing for cancer treatment personalization, citing study with 90% negative predictive value.
•In vitro tumor growth is challenging due to limited proliferative materials, with low success rates (30% in some cases) and long growth times (3-6 weeks). “Identifying the Most Effective Treatment on the Tumor Rather than Trying It Out on the Patient”
•An oncologist's belief that a treatment doesn't work may be due to lack of data, not actually testing its effectiveness.
•Chris Apfel highlights the need for clinical trials to prove the effectiveness of chemosensitivity testing, with over 75% of oncologists surveyed expressing interest in using the test despite potential lack of insurance coverage.
•He suggests developing a new assay to improve upon existing chemosensitivity testing methods, citing the need to better understand tumor resistance and improve patient outcomes.
•He explains that their method uses fresh cancer biopsies to create live 3D microtumors within a day, mimicking the patient's body and retaining the microenvironment and heterogeneity of the biopsy.
•The method aims to double the tumor response, significantly improve progression-free survival, and improve quality of life, while reducing costs.
•Researchers use confocal microscopy to analyze drug effectiveness in multiple myeloma cells, predicting high accuracy in tumor resistance prediction.
•Dr. Konieczny's team tested various drugs for a patient with lung metastasis, finding that doxorubicin and cyclophosphamide were most effective.
•Developer of Sage direct tests for non-resectable solid tumors, including ovarian, glioblastoma, and pancreatic cancer.
•Brad Power asks Chris about the input source needed for functional testing and the types of treatments tested, mentioning chemo and targeted therapies.
•Chris Apfel explains that functional testing requires fresh tissue, as fixed or formalin-preserved tissue is not viable, and their technology can work with minimal tissue samples, including tumor samples from pleural effusions or corneal biopsies.
•He explains that tissue samples can be obtained from bone for cancer diagnosis and treatment.
•Roger Royse questions the effectiveness of using tumor tissue for cancer treatment, citing preciousness of pancreatic tissue and limited predictive value of liquid biopsies.
•Researchers need 100 milligrams of tissue to test six main drugs on pancreatic cancer cells, but often have difficulty obtaining enough tissue due to limited access to tumor tissue.
•Patient with prostate cancer discusses the potential for keeping biological tissue alive in the lab for drug resistance testing.
•Researchers have not yet tested whether exposing tissue to drug X in a lab setting can accurately predict its effectiveness in a patient's body.
•Patients can have vastly different plasma concentrations of the same drug dose due to individual factors such as body fat, metabolism, and gender.
•Chris Apfel emphasizes the importance of personalized dosing for cancer treatment, citing their own family experience.
•A researcher advocates for low-dose combination therapy to reduce side effects and improve cancer treatment outcomes.
•Nik Schork, a key figure in the Aveiro trial, can provide valuable insights on precision medicine for bone cancer. “Identifying the Most Effective Treatment on the Tumor Rather than Trying It Out on the Patient”
•Early-stage tumors are more likely to be eradica eradicated with adjuvant therapy, while later-stage tumors may have different sensitivity profiles and require personalized combination therapies.
•Oncologists face hurdles in using innovative treatments due to insurance coverage and liability concerns.
•Chris Apfel discusses potential strategies for commercializing their cancer treatment assay, including partnering with oncologists and developing a high- quality registry.
•Oncologists and researchers discuss developing a nonprofit-for-profit hybrid model to address unmet needs in cancer care.
•Chris Apfel discussed the challenges of treating rhabdomyosarcoma, including the lack of effective treatment options and the potential for cancer to return after initial remission.
•He also mentioned that there is a need to eradicate cancer cells as much as possible and get them below the detection level, but the standard of care for high-grade tumors is chemotherapy with a 30% success rate.
•He explains that the company is not focused on analyzing individual tumor cells, rather their test is mimicking the tumor microenvironment of the tissue sample.
•He notes that the company's approach can provide treatment effectiveness within a few hours, but most drugs require at least 2-3 days to show a reliable treatment effect. “Identifying the Most Effective Treatment on the Tumor Rather than Trying It Out on the Patient”
Full transcript
Brad Power
I'm Co-founder and CEO of the Cancer Patient Lab. This is another weekly session of our webinar series. Today, we're pleased to have Chris Apfel and colleagues to talk to us about his company and the functional testing services that they provide. Chris is a scientist and MD by background. I'm sure he will tell his personal story.
He saw some experiences with his parents that encouraged him to try and solve some of the problems that patients face. He was at UCSF and then decided to launch a startup to provide functional testing services. We've had half a dozen sessions on functional testing, including one with Robert Nagourney of the Nagourney Cancer Institute. Chris got to know Robert Nagourney in his learning about this area.
There are a lot of resources that we have if you're interested in functional testing. I got functional testing from Tony Letai’s lab at Dana Farber. I shared those results last week. You can see examples of how a functional test can help you make decisions about some of the treatments you may be considering, especially the ones that look like they might be more effective. Chris Apfel 2:51 Thank you very much for the wonderful introduction.
I also have Arra Yerganian here. He is our board member and an advisor. We are working very closely together. And we have Rajesh Nitianandan, who is our cancer scientist in our lab. He is doing a lot of the hard work with colleagues and the team that we have at Sage Medic.
Arra Yerganian
“Identifying the Most Effective Treatment on the Tumor Rather than Trying It Out on the Patient” I was struck by the introductions of many of you on the call. I know that cancer touches just about everybody in some way, shape, or form. I was fortunate enough to grow up in a home where I was exposed to the science of cancer research literally every day.
My dad ran the Children's Cancer Research Labs at Children's Hospital in Boston for 47 years. He was the chief scientist at the Jimmy Fund, which is the Dana Farber Cancer Institute today, and I saw his tireless efforts in trying to eradicate something that was devastating, and made great strides in lessening the impact and improving longevity for young young people as they grow older. I met Chris about a year and a half ago.
I had previously been in healthcare but as a business and strategy and marketing leader. I was the Chief Marketing Officer at One Medical ( One Medical is a membership-based primary care service with in-person care and online resources, including a mobile app. ), then I was in the same role at Sutter Health.
I was struck by how frustrating the standard of care is for those who are really trying to do something different, and create pharmacotherapies, or treatment options, that are unique. Chris impressed me because I saw something that was quite genuine. His personal story is remarkable. Both parents succumbed to cancer. His father refused treatment because he saw how badly the treatment went for his mother. It was an eye opener.
As opposed to just clenching his fists and moving on, Chris decided to try to solve the problem. What he's done over the past many years is through tireless efforts create an impact project that enables individuals to have at the time of tumor biopsy, a sample brought to the Sage labs in Redwood City, and within a very short period of time tested against many chemotherapies, and then ensuring that the right chemotherapy treatment is then provided.
We look at this and say, “Wow! ” But many have tried, and many have failed. What Chris is going to describe to you is really how Sage Medic has made this quite unique. I'm thoroughly impressed with Chris and the team for what they've been able to accomplish. I'm a friend of Chris, but also a board member, and really feel that this passion play of his can change patient outcomes across the globe. He's getting some pretty wild attention as a result.
“Identifying the Most Effective Treatment on the Tumor Rather than Trying It Out on the Patient” Chris Apfel 6:42 You mentioned a number of important points. We're not leveraging all the possibilities and technologies that are currently in development. We have developed the next generation of an extreme drug resistance assay.
We believe that this will make a huge difference for the millions of cancer patients where genomic testing often doesn't work. “Identifying the Most Effective Treatment on the Tumor Rather than Trying It Out on the Patient” That's one important message that you are probably all aware of, but few others are: in the majority of cases patients do not have driver mutations.
We all believe that with genomic testing, we often call it “precision medicine”, but the reality is that only one out of four patients has driver mutations according to the National Cancer Institute's MATCH trial, as Dr. Letai mentioned in one of his presentations. Then if you look at how many patients get FDA-approved targeted therapies, and how many really benefit from it, we are getting below 10%.
So the majority of patients do not have driver mutations nor potential target therapies. That's the devastating state. Most will get therapies where we actually don't know which therapies are likely to work best. When my dad was diagnosed with lung cancer, I was asking Dr. ” One of the arguments was tumor heterogeneity and the tumor microenvironment. Probably somewhere if you put it in vitro (in a test tube), it's different.
It's surprising to me because as an anesthesiologist and intensivist, when somebody has an infection, what we often do is culture the specimen of the bacteria in order to understand which antibiotics are likely to be most effective. We do those in vitro live cells, basically live cell assays, but we don't do it in the oncology space. So I took a look myself.
Want to learn more about your specific case?
Upload your medical records and ask Navis questions tailored to your diagnosis.