“The Latest Tests for Personalized CancerCare”

“The Latest Tests for Personalized CancerCare” (Tony Magliocco) [#89] Brad Power March 20, 2024 “We're in a revolution in medicine: the change from traditional medicine, where it was essentially surgery and chemotherapy, to a more focused approach to cancer and individualizing treatment, which gives us better results and fewer side effects.

” – Tony Magliocco “We've got a whole host of stuff that's in the experimental stage that would be interesting. We're looking at proteins in the blood instead of looking at nucleic acid, and so on, that may indicate things.

” – Tony Magliocco “Liquid biopsy is your friend… It is very important to keep track of what's happening in real time… A combination of radioimaging and liquid biopsy can be really important. But you need the newer technologies. The older ones can't do it. They're too crude.

” – Tony Magliocco Meeting Summary How can information from diagnostic tests help cancer patients, caregivers, and their doctors make personalized treatment decisions?

Advanced cancer patients, their caregivers, and their medical teams face difficult challenges in accessing and interpreting data from tests to build an integrated picture of an individual patient's disease and interpret the results for treatment decisions.

These challenges include interpretation of new tests, treatment complexity, obsolescence of information, conflicts between test results, and integrating data from multiple tests. This becomes an even larger challenge/opportunity as more diagnostic tests become available, like RNA sequencing, liquid biopsies, proteomics, single cell analysis, and functional testing.

Tony Magliocco, MD, President and CEO at Protean BioDiagnostics Inc., is uniquely qualified to talk about these issues since he spans the boundaries between medical specialties – pathology, clinical care, molecular biology, and testing. He was trained as a medical doctor in Canada and spent 20 years as a surgical pathologist and implemented new technologies in hospitals.

He was recruited to Moffitt Cancer Center to bring next generation sequencing and liquid biopsies to their labs. Building on this experience and a desire to make a difference in community cancer care (where 80% of patients are treated), he launched Protean Biodiagnostics, a "one stop shop" for testing.

Protean's goal is to manage the patient's journey over their life with a focus on test data to deliver personalized medicine with advanced testing, data management, and software to make it easy to interact remotely. They also work with companies to bring new testing technologies to market. What is personalized cancer care?

“The Latest Tests for Personalized CancerCare” (Tony Magliocco) [#89] “Precision medicine” is the population-based selection of targeted therapies based on a diagnostic test, e.g., you have an EGFR mutation, and there is an anti-EGFR drug. “Personalized medicine” is taking a holistic view of you as a patient, including your wellne

technologies to market. What is personalized cancer care?

“The Latest Tests for Personalized CancerCare” (Tony Magliocco) [#89] “Precision medicine” is the population-based selection of targeted therapies based on a diagnostic test, e.g., you have an EGFR mutation, and there is an anti-EGFR drug. “Personalized medicine” is taking a holistic view of you as a patient, including your wellness, preferences, and expectations.

You put your test results together to make the right treatment path for you, including how to sequence and organize treatments if you have more than one treatment option, and decide how to manage your wellness with nutrition or complementary approaches. Why would you want to pursue more personalized cancer care?

●Better outcomes ●Less toxicity, safer ●Avoid treatments that won’t work ●Better fit with your preferences ●Give you a feeling of agency What are the top ten challenges in accessing personalized cancer care? 1.Treatment complexity : A few decades ago there were only one or two new treatments that became available every few years.

But in the last year, there were over 100 approvals from the FDA, many of them targeted therapies that need companion diagnostics. How do you and your medical team decide what is the right therapy for you? How do you bridge between insights in molecular biology and your treatment decisions? 2.Treatment obsolescence : The treatment landscape can completely change every six months.

Whatever you thought you knew was the best next treatment option for you can be wrong based on the latest evidence. 3.Testing access: Every cancer patient should get standard tests for their disease, e.g., an EGFR test for lung cancer, but many do not. Rapid growth of targeted treatments has created an explosion in demand for companion diagnostics. What tests should you get?

How can you access all of the tests that are needed to point to your personalized treatments? 4.Test interpretation : Up to 30% of patients have an incorrect or incomplete diagnosis. Over 60% of oncologists say they have difficulty trying to understand what tests to use, and what the results mean. It is very confusing for anyone trying to keep up with this. Different test results may conflict.

How do you interpret your test results? Does your doctor know what to do with all the possible test results, such as RNA sequencing and proteomics? What do you do if the tests seem to contradict each other? How do you bring together all of your test results into a comprehensive view of your disease and which treatments are best for you? 5.

Expense: How do you pay for the additional tests and test integration? 6.Information technology : How do you take advantage of what new information technology makes possible?

“The Latest Tests for Personalized CancerCare” (Tony Magliocco) [#89] 7.Doctor incentives: Some oncologists are like fundamentalists in a religion: they read

d CancerCare” (Tony Magliocco) [#89] “Precision medicine” is the population-based selection of targeted therapies based on a diagnostic test, e.g., you have an EGFR mutation, and there is an anti-EGFR drug. “Personalized medicine” is taking a holistic view of you as a patient, including your wellness, preferences, and expectations.

You put your test results together to make the right treatment path for you, including how to sequence and organize treatments if you have more than one treatment option, and decide how to manage your wellness with nutrition or complementary approaches. Why would you want to pursue more personalized cancer care?

●Better outcomes ●Less toxicity, safer ●Avoid treatments that won’t work ●Better fit with your preferences ●Give you a feeling of agency What are the top ten challenges in accessing personalized cancer care? 1.Treatment complexity : A few decades ago there were only one or two new treatments that became available every few years.

But in the last year, there were over 100 approvals from the FDA, many of them targeted therapies that need companion diagnostics. How do you and your medical team decide what is the right therapy for you? How do you bridge between insights in molecular biology and your treatment decisions? 2.Treatment obsolescence : The treatment landscape can completely change every six months.

Whatever you thought you knew was the best next treatment option for you can be wrong based on the latest evidence. 3.Testing access: Every cancer patient should get standard tests for their disease, e.g., an EGFR test for lung cancer, but many do not. Rapid growth of targeted treatments has created an explosion in demand for companion diagnostics. What tests should you get?

How can you access all of the tests that are needed to point to your personalized treatments? 4.Test interpretation : Up to 30% of patients have an incorrect or incomplete diagnosis. Over 60% of oncologists say they have difficulty trying to understand what tests to use, and what the results mean. It is very confusing for anyone trying to keep up with this. Different test results may conflict.

How do you interpret your test results? Does your doctor know what to do with all the possible test results, such as RNA sequencing and proteomics? What do you do if the tests seem to contradict each other? How do you bring together all of your test results into a comprehensive view of your disease and which treatments are best for you? 5.

Expense: How do you pay for the additional tests and test integration? 6.Information technology : How do you take advantage of what new information technology makes possible?

“The Latest Tests for Personalized CancerCare” (Tony Magliocco) [#89] 7.Doctor incentives: Some oncologists are like fundamentalists in a religion: they read their Bible and say, “This is what the trial said,” and they can only treat it according to what the trial said. When they deviate from that, that's putting the

r Personalized CancerCare” (Tony Magliocco) [#89] 7.Doctor incentives: Some oncologists are like fundamentalists in a religion: they read their Bible and say, “This is what the trial said,” and they can only treat it according to what the trial said. When they deviate from that, that's putting them at risk. 8.

Resources access : Over 85% of patients are treated at community hospitals, which don’t have the resources of major academic research cancer centers. 9.Fragmented care: Different institutions don’t speak to each other, and often departments and individuals on your medical team don’t speak to each other. 10.

Clinical trials consideration and access : Less than 5% of cancer patients are treated through a clinical trial, which usually provide access to the standard of care plus a new and better treatment option. Some people say, “I don't want to be an experimental animal.” The medical system is biased to favor the standard treatment.

But the outcomes from clinical trials are better, even if you get the standard of care (the control arm) in a clinical trial. Should you consider clinical trials? What do you need to do to get personalized cancer care? 1.Test: Get a wide and deep range of tests about your disease. For example, liquid biopsies are becoming more accurate and predictive and can be easily and inexpensively accessed.

2.Tissue: Manage your tissue so that there is adequate raw material available for tests. 3.Multidisciplinary medical team: You need multidisciplinary care: a surgeon, a radiation oncologist, a medical oncologist, a pathologist, a radiologist, and you may also need a social worker, a mental health specialist, and a pharmacist. 4.

Consult: Get “second opinions” (reviews by experts) about what tests and treatments you should get. 5.Engage: Be the integrator of your care to overcome fragmentation. Use software agents and AI tools to interpret your data to uncover insights about your disease to share with your medical team. 6.Integrate: Look across all your test data to get a comprehensive view of your disease.

Develop theories and models that integrate data across tests. 7.Decision support: Use software tools to match your profile with treatment options, including drugs, drug combinations, and clinical trials. 8.Telemedicine: Access services electronically wherever possible to take advantage of global resources. 9.Data: Gather all your medical and test data in one place for ease of access and sharing.

You want to have a longitudinal view of your journey and capture and keep all test data along the way. 10.Monitor: As your disease evolves and medical practice evolves, you should continuously check to ensure you are getting the latest guidance.

For example, new blood tests for circulating RNA and exosomes can monitor your disease progression (“minimum residual disease“) in very small amounts and help predict how to treat your cancer.

ney and capture and keep all test data along the way. 10.Monitor: As your disease evolves and medical practice evolves, you should continuously check to ensure you are getting the latest guidance. For example, new blood tests for circulating RNA and exosomes can monitor your disease progression (“minimum residual disease“) in very small amounts and help predict how to treat your cancer. How can you access a full range of tests to guide your personalized care?

“The Latest Tests for Personalized CancerCare” (Tony Magliocco) [#89] Protean Biodiagnostics, BostonGene, and Tempus, among others, provide many diagnostic tests and test integration. For example, you can work directly with Protean. They charge $400 to review your data, give an opinion on what testing might be needed to fill gaps, and pointers to treatment options.

If there are any gaps, Protean can run additional tests. They will create an integrated report for you and your doctor. They can also monitor you through your journey. Because Tony is a licensed physician, he can prescribe and consult with your doctor, and advocate for tests and treatments. They can also run a “virtual tumor board” (review of your case by a group of experts).

They lean into new tests. For example, they are the only lab doing a test using very new three-dimensional bulk DNA folding, and their single cell testing allows useful analysis on scarce tissue. You can learn more about testing and personalized treatment guidance by watching Tony’s YouTube channel, “The Cancer Informant”, which you can see here. What does the future hold?

The future of cancer care is not just treating your disease, but personalized wellness. How do you manage your health holistically? Advances in imaging and liquid biopsies will allow you to visualize your cancer as it's going through its evolution almost in real time, so that you can manage your cancer as a chronic disease.

If you see it escaping, you will be able to adjust your treatment and push it back. What can you do to accelerate the transition to more personalized cancer care? You can get early access today through Cancer Patient Lab to several tests in the experimental stage through special arrangements with test providers, such as mProbe, Travera, and Sage Medic.

You could also help create a formal cohort with a universal IRB (Institutional Review Board, a mechanism to protect patients) to coordinate testing, manage a biobank, and aggregate and manage our data. We would collectively evaluate new companies as they come along and decide if we want to use them as a group. You would have the option to volunteer to give urine, blood, or whatever.

You would get the research grade test results back, and you would decide how to use the information. We could see what works, and promote the ones that are useful.

re getting the latest guidance. For example, new blood tests for circulating RNA and exosomes can monitor your disease progression (“minimum residual disease“) in very small amounts and help predict how to treat your cancer. How can you access a full range of tests to guide your personalized care?

“The Latest Tests for Personalized CancerCare” (Tony Magliocco) [#89] Protean Biodiagnostics, BostonGene, and Tempus, among others, provide many diagnostic tests and test integration. For example, you can work directly with Protean. They charge $400 to review your data, give an opinion on what testing might be needed to fill gaps, and pointers to treatment options.

If there are any gaps, Protean can run additional tests. They will create an integrated report for you and your doctor. They can also monitor you through your journey. Because Tony is a licensed physician, he can prescribe and consult with your doctor, and advocate for tests and treatments. They can also run a “virtual tumor board” (review of your case by a group of experts).

They lean into new tests. For example, they are the only lab doing a test using very new three-dimensional bulk DNA folding, and their single cell testing allows useful analysis on scarce tissue. You can learn more about testing and personalized treatment guidance by watching Tony’s YouTube channel, “The Cancer Informant”, which you can see here. What does the future hold?

The future of cancer care is not just treating your disease, but personalized wellness. How do you manage your health holistically? Advances in imaging and liquid biopsies will allow you to visualize your cancer as it's going through its evolution almost in real time, so that you can manage your cancer as a chronic disease.

If you see it escaping, you will be able to adjust your treatment and push it back. What can you do to accelerate the transition to more personalized cancer care? You can get early access today through Cancer Patient Lab to several tests in the experimental stage through special arrangements with test providers, such as mProbe, Travera, and Sage Medic.

You could also help create a formal cohort with a universal IRB (Institutional Review Board, a mechanism to protect patients) to coordinate testing, manage a biobank, and aggregate and manage our data. We would collectively evaluate new companies as they come along and decide if we want to use them as a group. You would have the option to volunteer to give urine, blood, or whatever.

You would get the research grade test results back, and you would decide how to use the information. We could see what works, and promote the ones that are useful.

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.

“The Latest Tests for Personalized CancerCare” (Tony Magliocco) [#89] Meeting Notes KEYWORDS patient, liquid biopsy, oncologist, pathologist, cancer, tumor, work, treatment, happening, therapy, data, diagnostic, rna, pathology, neuro endocrine, doctor, clinical trials, disease, test, testing SPEAKERS Tony Magliocco (72%), Brad Power (10%), Brian McCloskey (10%), Amit Gattani (7%), Allen Morris (1%), Roger Royce (1%), Paul Van Camp (<1%).

OUTLINE 1.Integrating diverse perspectives for cancer patient care. 2.Precision oncology and its challenges in the healthcare system. (3:06) 3.Improving cancer care through telemedicine and AI-powered diagnostics. (7:10) 4.Personalized medicine, clinical trials, and business model. (11:35) 5.Personalized cancer treatment and genetic testing. (18:24) 6.

Medical testing and interpretation with a pathologist. (22:38) 7.Personalized cancer treatment and multidisciplinary care. (26:25) 8.Conflicting cancer diagnoses and treatment options. (33:35) 9.Personalized cancer treatment and liquid biopsy. (36:13) 10.Liquid biopsies, CTCs, and RNA in cancer treatment. (41:37) 11.Cancer diagnosis and treatment using advanced genomics and AI. (46:02) 12.

Liquid biopsy and personalized cancer treatment. (52:09) 13.Liquid biopsy companies and their capabilities. (57:41) 14.Genetic testing and cancer treatment. (1:03:39) SUMMARY ●Integrating diverse perspectives for cancer patient care.

○Brad Power and Brian McCloskey introduce the Cancer Patient Lab, a platform for advanced cancer patients to access educational seminars, a community of patients and industry experts, and testing services.

○Tony Magliocco, the guest speaker, is introduced as a person who can help integrate diverse perspectives on cancer treatment through whole exome sequencing, liquid biopsies, RNA sequencing, and proteomics. ●Precision oncology and its challenges in the healthcare system.

3:06 ○Tony Magliocco shares his expertise in molecular pathology and precision oncology, highlighting advancements and challenges in the field. ○He warns of complexity in precision oncology due to numerous new treatments and lack of coordination in the healthcare system. ●Improving cancer care through telemedicine and AI-powered diagnostics.

“The Latest Tests for Personalized CancerCare” (Tony Magliocco) [#89] ○Tony Magliocco highlights the challenges in cancer care, including difficulty understanding test results and incorrect diagnoses, e.g., the significant gap i