TRANSFORMING PATHOLOGY

Personalized Medicine & Pathology

Medicorx Sp102nd Avenue Dawson Creek

BC V1G

Personalized Medicine- Friend or Foe?

What is it? Why now? When will it be real? Call to Action for Pathologists

Successful When it Leads to Innovation and Improves

Standard of Care.

Fails When We Settle for “Trial and Error” Medicine AS the Standard of Care.

Old Paradigm: Trial and Error Medicine

Personalized Medicine

Personalized Medicine

New Paradigm: Personalized MedicineLinking Tests to Action and Therapy

Observation Test Action Predictable Response

Breaking The Cycle of Trial and Error Medicine

Diagnosis Save Lives Diagnosis Save Money

Personalized Medicine Why is it Important?

Drug SelectionBreast Cancer Herceptin® HER2

Drug DosageColorectal Cancer Camptosar® UGT1A1

Drug EfficacyChronic Myelogenous Leukemia Gleevec® Quant BCR-ABL

Disease Status Chronic Lymphocytic Leukemia Campath® Minimal Residual Disease

Recurrence RiskBreast Cancer Oncotype DX® Multivariate Analysis

PredispositionBreast Cancer BRACAnalysis® Gene sequencing, risk analysis

Personalized Medicine Test Categories

Personalized Medicine Saves Lives

80 Years Ago

Leukemia or Lymphoma60 Years Ago

Chronic LeukemiaAcute LeukemiaPreleukemia

Indolent LymphomaAggressive Lymphoma

100 Years Ago

“Disease of the Blood”

Today

38 Leukemia types identified:Acute myeloid leukemia (12 types)Acute lymphoblastic leukemia (2 types)Acute promyelocytic leukemia (2 types)Acute monocytic leukemia (2 types)Acute erythroid leukemia (2 types)Acute megakaryoblastic leukemiaAcute myelomonocytic leukemia (2 types)Chronic myeloid leukemiaChronic myeloproliferative disorders (5 types)Myelodysplastic syndromes (6 types)Mixed myeloproliferative/myelodysplastic syndromes (3 types)

51 Lymphomas identified:Mature B-cell lymphomas (14 types)Mature T-cell lymphomas (15 types)Plasma cell neoplasm (3 types)Immature (precursor) lymphomas (2 types)Hodgkin’s lymphoma (5 types)Immunodeficiency associated lymphomas (5 types)Other hematolymphoid neoplasms (7 types)

5 YearSurvival

~ 0%

70%

Molecular CharacterizationStandard Practice In Hematologic Oncology

Morphology Evaluation+

Fluorescence-Activated Cell Sorting+

Cytogenetic Analysis+

Molecular Analysis

Expanded Characterization and Response Prediction

Personalized Medicine Reduces Ineffective Treatment in Colon Cancer

kras Testing

Do Not Treat

Treat with Erbitux

Treat with Erbitux

TreatmentSuccess

Personalized Medicine is Cost Effective in Treatment of Colon Cancer

60% reduction in cost per success

40% of patients spared side effects from ineffective treatment

Overall success rate is unchanged at 25%

Erbitux Treatment Cost Comparisons with and without kras Testing to Direct Personalized Treatment

$22,800

$97,022

$38,000

$156,554

$0

$50,000

$100,000

$150,000

$200,000

Average Treatment Cost (perperson)

Average Treatment Cost (persuccess)

With kras Testing Without kras Testing

Personalized Medicine is Beneficial in Treatment of Pancreatic Cancer

SuspectedPancreatic

Cancer

Watch AndWait

Pancreatectomy

IncreasedRisk

InsulinInsufficiency

SuspectedPancreatic

Cancer

PathFinderTGDiagnostic

Benign ConditionDo Nothing

Pancreatic CancerTreat Aggressively

TwoBad

Choices

InformedChoices

70%

30%

Disease 1 Year Survival

Lung cancer 42%

Colorectal cancer 76%

Chronic myeloid leukemia (CML) 63%

Heart failure 74%

End stage renal disease 78%

Patients Don’t Have Time for Trial & Error

93%

THANK YOU