“The BostonGene Tumor Portrait Report and How to Access It

sually more current than tissue samples, but harder to analyze, and there may be differences between reports from

“The BostonGene Tumor Portrait Report and How to Access It" (Michael Hensley and Michelle Lanman) [#72] different companies due to differences in sensitivity and sequencing depth. BostonGene's liquid biopsy test is going to be available soon. ●A tumor evolution report repeats DNA and RNA tests at different times to let you see how your cancer is evolving.

●Immune system profiling can tell you whether you will likely respond to immunotherapies. If your tumor microenvironment is immune-enriched, and tumor mutational burden high, you have an exceptional opportunity to have a durable benefit of immunotherapy in excess of 70 to 80% in some cancers.

If you have a suppressive tumor microenvironment with a low tumor mutational burden, you have less than a 7% chance of a durable response to immunotherapy. BostonGene's multiplex immunofluorescence platform enables three-dimensional pictures (“spatial imaging”) of the tumor microenvironment, providing a more detailed understanding of how the tumor is interacting with its environment.

How are your test results translated into treatment options and strategies? ●Your primary diagnosis, medical history, and genetic profile from the test results, especially biomarkers, are fed into a matching algorithm linked to the approved evidence-based treatments (the National Comprehensive Cancer Network guidelines) to provide personalized treatment recommendations.

●Algorithms matching biomarkers and treatments and clinical trials are constantly updated with new information from patients and the literature. How can you access these tests? ●You need to request tissue samples from pathology for DNA and RNA sequencing and get a blood draw for liquid biopsy tests. ●Your physician will order the tests through a requisition form.

●You give a saliva or blood sample for the normal DNA collection. ●Once these inputs are in the lab, they will usually have results in 10 to 12 calendar days.

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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.

“The BostonGene Tumor Portrait Report and How to Access It" (Michael Hensley and Michelle Lanman) [#72] Meeting Notes SUMMARY KEYWORDS tumor microenvironment, report, gene, tumor, boston, md anderson, biomarker, immunotherapy, sequencing, tests, information, clinical trial, therapy, liquid biopsy, tissue SPEAKERS

or Portrait Report and How to Access It" (Michael Hensley and Michelle Lanman) [#72] Meeting Notes SUMMARY KEYWORDS tumor microenvironment, report, gene, tumor, boston, md anderson, biomarker, immunotherapy, sequencing, tests, information, clinical trial, therapy, liquid biopsy, tissue SPEAKERS Michael Hensley (62%), Michelle Lanman (15%), Rick Stanton (9%), Robert Gurmankin (9%), Amit Gattani (3%), Richard Anders (3%) OUTLINE 1.

Personalized cancer treatment with BostonGene. (0:02) 2.Genomic sequencing and cancer diagnosis. (2:30) 3.Cancer diagnosis and treatment options using DNA and RNA sequencing. (6:55) 4.Cancer genetic testing and clinical trial matching. (14:25) 5.Immunotherapy and tumor microenvironment analysis. (18:00) 6.Cancer biomarkers and imaging technology. (24:45) 7.

Using RNA sequencing for cancer treatment insights. (31:41) 8.Liquid biopsy and tissue biopsy differences. (35:25) 9.Liquid biopsy accuracy and variability. (41:05) 10.Cancer diagnostics and patient access to information. (48:52) 11.Cancer biomarkers and treatment strategies. (53:44) SUMMARY ●Personalized cancer treatment with BostonGene.

0:02 ○Michael Hensley from BostonGene discusses personalized cancer diagnostic testing. ●Genomic sequencing and cancer diagnosis. 2:30 ○In a future session, BostonGene's Katerina Postovalova will describe BostonGene’s genomic profiling capabilities, highlighting rapid industry advancements.

○BostonGene provides comprehensive genomic profiling for various cancers, including prostate cancer, through their RNA sequencing and deconvolution tool, Cassandra.

○Their reports include a biomarker database based on the patient's primary diagnosis, and they collaborate with the NCCN guidelines to provide personalized treatment recommendations based on the patient's clinical history and genetic profile. ●Cancer diagnosis and treatment options using DNA and RNA sequencing.

6:55 ○The benefits of using both types of sequencing and the importance of comparing normal DNA to tumor DNA. ○The potential of RNA sequencing for identifying fusions and other biomarkers, and the importance of quantitative analysis versus observer variability in pathology labs.

“The BostonGene Tumor Portrait Report and How to Access It" (Michael Hensley and Michelle Lanman) [#72] ○Researchers identify immune-rich and suppressive tumor microenvironments in cancer, with high TMB associated with improved response to immunotherapy.

○Example of a prostate cancer report at MD Anderson, highlighting key information such as patient details, tissue tested, tumor content, and treatment options. ○The importance of understanding the tumor microenvironment and immune enrichment for prostate cancer treatment. ○How BostonGene’s collaboration with NCCN can provide personalized recommendations for patients.

●Cancer genetic testing and clinical trial matching.

onment and immune enrichment for prostate cancer treatment. ○How BostonGene’s collaboration with NCCN can provide personalized recommendations for patients. ●Cancer genetic testing and clinical trial matching. 14:25 ○The process of creating a BostonGene Tumor Portrait involves requesting tissue samples from pathology and marrying them with DNA collection for analysis.

○MD Anderson prioritizes clinical trial matches based on patient history and institution. ○BostonGene has a financial assistance program for eligible patients. ●Immunotherapy and tumor microenvironment analysis. 18:00 ○Understanding the tumor microenvironment and how it responds to therapy.

○Doctors usually address information learned about the tumor microenvironment through medication and radiation. This information can be used to change treatment approaches for prostate cancer patients. ○Researchers aim to validate the potential of changing tumor microenvironments to improve immunotherapy responses. ●Cancer biomarkers and imaging technology.

24:45 ○Rick Stanton discusses commercial availability of CODEX technology, which is expensive and not reimbursed for all patients. ○Michelle Lanman explains CODEX is a spatial imaging platform used by BostonGene, allowing for precise location of gene expression levels in tumors. ○The potential of using gene expression analysis to better understand cancer.

○While the technology is expensive, it could be offered as a fee-for-service. ○MD Anderson has customized two platforms for bladder cancer and prostate cancer. ○BostonGene is able to portray the tumor microenvironment and identify subclones, which can lead to new biomarker targets and improved cancer treatment.

○BostonGene is working to escalate clinical trial matches at MD Anderson by providing valuable insights and advocating for their trials. ●Using RNA sequencing for cancer treatment insights. 31:41 ○Rick Stanton discusses using immunohistochemistry to identify specific proteins in tumors. ○Rick Stanton shares how he uses RNA sequencing data to inform his cancer treatment decisions.

●Liquid biopsy and tissue biopsy differences. 35:25 ○Michelle Lanman provides valuable insights on spatial imaging and immuno- profiling, highlighting the importance of understanding the tumor microenvironment. ○Amit Gattani asks about calibration issues between liquid biopsy reports from different companies ○Michelle Lanman cites differences in sensitivity and sequencing depth.

○Blood is harder to analyze than tissue for cancer cells. ○Marketing efforts may vary between companies. ●Liquid biopsy accuracy and variability.

“The BostonGene Tumor Portrait Report and How to Access It" (Michael Hensley and Michelle Lanman) [#72] ○Differences in liquid biopsy tests, including gene panels and technology used, can result in variations in reported findings. ○Challenges with liquid biopsies, including true negatives and false positives.