Description of the video:

Fred Cate:
Hello, and welcome to our webinar today part of our continuing series of webinars looking at the grand challenges at indiana university and their impact on the people of indiana and more broadly around the country. Today we look at Precision Health Initiative, the first grand challenge, and we're focused in particular on its initiative focused on triple negative breast cancer. And there'll be more explanation about what that is in just a moment but let me say we're going to do this very informally there'll be a few opening questions i'm going to ask just to introduce our various panelists and give them a chance to talk at any time you can enter in questions into the QA and those we will get to. I promise you, we'll see that they all get answered. If we don't answer them all now we'll certainly uh we'll certainly do so in writing later.

So my first and happy job today is rather than introduce all the panelists at once we're going to do it one at a time. And I want to first introduce Dr. Brian Schneider. Brian Schneider is the Vera Bradley Chair of Oncology at the IU School of Medicine he has many, many other titles but most important to this, he is co-leader of the triple negative breast cancer research team that's part of the IU Grand Challenge of Precision Health Initiative. And so Brian, i'm going to hand it over to you.

Dr. Brian Schneider:
All right. Well, thank you Fred. I'm really excited to talk a little bit about some of the advances that we've done here at IU and triple negative breast cancer, which I think important so everybody's kind of on the same page.

Let's go over what exactly triple negative breast cancer is. And you know as we think about cancer, cancer is simply uncontrolled growth of our own cells and so an analogy I often use with many of my patients is it's like an automobile where the gas pedal is kind of stuck on. So to me good precision medicine is being able to identify that gas pedal and dislodge it without causing a lot of damage.

So in many ways you know breast cancer is probably one of the hallmark diseases in terms of precision medicine. It's been over 60 years ago that two of those gas pedals were discovered. One the estrogen receptor the other the progesterone receptor, which simply means a lot of breast cancers have too many of these receptors or too many of these gas pedals. And so simple things like the hormone estrogen actually is like pouring gasoline on a fire and so scientists through lowering estrogen levels or using simple tablets have been able to kill many cancer cells with a very precise approach without a lot of side effects.

As we fast forward to the 1990's another gas pedal called her2 was discovered and what's important about her too is it's common in breast cancer but importantly some drugs were developed drugs like herceptin which substantially improved the survival of patients with this tough disease and in the year 2005
02:56
a few pivotal studies showed we could
02:58
markedly improve the cure rate by
03:00
targeting her too
03:02
so 2005 is a pivotal year at this time
03:05
we have really good precision approaches
03:08
for those that have the estrogen
03:09
receptor
03:10
the progesterone receptor and now her
03:13
too
03:14
this leaves everybody else those that
03:16
don't have those three
03:18
gas pedals and this became termed triple
03:21
negative breast cancer
03:23
so in many ways a derogatory term in
03:26
that what it's not
03:27
as opposed to what is it so what makes
03:30
triple negative breast cancer though
03:32
important in my mind is number one we
03:34
don't have good targeted therapies
03:36
so we're using a lot of the
03:37
old-fashioned chemotherapy
03:39
that works by non-specifically killing
03:41
cells
03:42
and in the course of doing this causes a
03:44
lot of damage to our normal cells
03:47
another important fact about triple
03:49
negative breast cancer is it
03:50
preferentially impacts young women
03:52
and also black women but i think far and
03:55
away most importantly
03:56
it has a high mortality rate so it
03:58
claims a lot of lives so this has been
04:00
something we've been really passionate
04:02
about here at iu
04:03
is taking the triple negative aspects
04:05
and really trying to uncover the
04:07
positive
04:09
but you know i think again as we think
04:11
about today
04:12
the most important part of all of this
04:14
is how does it touch people how does it
04:15
touch our patients
04:17
and so we are blessed today to have an
04:20
amazing
04:21
story from one of our own meredith
04:23
mcmahon
04:24
who's going to tell a little bit about
04:25
her journey meredith
04:27
is someone i've known for over a decade
04:30
now
04:31
a friend she is a survivor
04:34
she is also an amazing health care
04:36
provider so she is
04:38
the practice administrator for the
04:39
division of hematology oncology at riley
04:42
children's hospital
04:44
so in addition to hearing her story
04:46
about breast cancer you're going to be
04:47
hearing this from somebody who takes
04:49
amazing care of
04:50
patients as well meredith
04:55
thanks dr schneider um so as he
04:58
mentioned i
04:58
um i am actually a nurse by training and
05:00
i was a nurse in pediatric oncology
05:03
um and i happened to be um at work
05:07
uh one day when i sort of was
05:11
discovered this diagnosis i um
05:15
um was had
05:19
i had a young child i had a 10 month old
05:20
at the time that i was breastfeeding
05:23
and for those of you who have been um
05:26
have
05:26
breastfed your children you realize you
05:28
are touching your breasts more than you
05:30
ever have in your whole life and i felt
05:32
a lump and i thought it was
05:34
a clogged milk duct um i had experienced
05:38
that once before i called my ob and i
05:39
said you know i just can't quite seem to
05:41
get this clogged milk dug duck to
05:44
resolve
05:45
and um she said yeah let's let's just
05:48
get an ultrasound and see
05:49
so i said okay i'm at work i was at work
05:52
i went down
05:53
i was at iu north and i happened to be
05:55
able to go to their breast center there
05:57
and
05:58
and had an ultrasound done and they said
06:00
you know i think we should do a biopsy
06:02
and i was by myself but again yeah i was
06:06
uh 30 years old and i had a toddler and
06:09
i was invincible right those were the
06:10
things were going through my head i
06:11
didn't think that i was going to need
06:13
anybody else with me
06:15
at the time and so i go down and they do
06:17
the biopsy and immediately say you know
06:19
there are some abnormal cells here
06:21
we think you should call your husband
06:23
and it's like
06:24
whoa what does that mean
06:27
my mother also happens to be a breast
06:29
cancer survivor and she
06:31
had breast cancer she was a bit older
06:34
she was 45 but also premenopausal
06:36
so i was pretty familiar with this i was
06:39
young when she went through treatment
06:40
but i had seen that i had seen it been
06:42
there
06:42
done that and sort of always had that in
06:44
the back of my mind and
06:46
so this was a Wednesday, April 7th, I can
06:49
remember it and then on April 9th got
06:51
the pathology back to determine that it
06:53
was um triple negative breast cancer
06:56
and uh also happened to be my my
06:59
mother's birthday so it's
07:00
it sticks in my mind um that April 9th
07:03
was that day and um met dr schneider
07:06
that next week
07:08
and we came up with a plan pretty
07:11
quickly
07:13
to treat this cancer and i remember him
07:15
saying
07:16
that uh the the outcomes
07:19
he didn't put it in these terms but i
07:21
knew the outcomes weren't good we talked
07:22
about it
07:23
we knew what that was but that wasn't
07:25
what it was going to be for me
07:27
um i i
07:31
knew that i had um a young family that i
07:34
wanted to be there for and that i wanted
07:35
to
07:36
um see my son grow up and get older and
07:40
very fortunate to have been able to do
07:42
that
07:44
so we started i had a por porta cap
07:47
placed so
07:49
an implanted central access where i got
07:51
all my chemotherapy
07:53
i did pretty standard
07:57
breast cancer therapy at the time
07:59
because as dr schneider mentioned that's
08:01
what was available
08:03
so it's called
08:06
ac taxol basically so it's three
08:08
different drugs that's what you get
08:10
you get um adriamycin
08:14
cytoxan and taxol and so that's
08:17
sort of the course that you go through
08:19
that was the standard of therapy
08:22
i dr schneider can connect correct me if
08:25
i'm wrong but there was
08:26
um just a little bit of residual disease
08:29
and then went in to have
08:30
a mastectomy and it's funny what you
08:34
think you
08:34
want to control at the time because
08:37
you're diagnosed with cancer you've lost
08:39
all control of pretty much everything
08:41
that's go that was
08:42
that was normal in your life um
08:45
it's now being controlled by this cancer
08:47
and this cancer treatment
08:49
and so i decided to just have a single
08:51
mastectomy at the time
08:53
because i wanted to knowing that i was
08:55
going to survive this
08:57
i wanted to
09:00
be able to breastfeed future children
09:02
with the other breasts
09:03
again probably not the most logical
09:05
thinking at the time but
09:07
it's all about i think for a patient
09:09
it's about what you can control
09:11
um so i had a single mastectomy and then
09:13
went on to have um
09:15
six weeks of radiation um after that
09:18
so this what started on April 9th
09:22
ended on november 4th of that same year
09:26
2010
09:27
i went on to have that following spring
09:31
another mastectomy i had the other
09:33
prophylactic mastectomy i had the other
09:35
breast removed
09:36
and reconstruction on both breasts
09:40
so what totaled i think about at the
09:43
time
09:44
um eight rounds of chemotherapy
09:47
seven surgeries and
09:51
uh six weeks of radiation therapy
09:54
and then all of a sudden came to a
09:56
screeching halt
09:57
and all of this support and all of this
10:00
it was a course of probably a little
10:01
over a year by the time reconstruction
10:04
and everything was done
10:05
um everything came to a screeching halt
10:08
and it was all gone and all the support
10:10
was gone and
10:11
and not that dr schneider was gone but
10:12
all of a sudden i wasn't seeing him
10:14
all the time i was seeing him very
10:16
rarely and it's
10:18
it's you're thrown out into this world
10:20
of
10:22
well you're a survivor now good job you
10:24
did it
10:25
um and your focus has changed
10:29
um and you know i think this
10:32
speaks a lot to the work that they're
10:34
doing now and i'm very fortunate to have
10:37
to to be a survivor and to be in this
10:39
place
10:40
um and i think that's sort of
10:44
i will kind of turn it back over to them
10:46
for a second
10:47
and i can sort of share a little bit the
10:49
later part of my story
10:50
maybe after they talk because i think
10:52
that's another big piece of it that sort
10:54
of hit
10:55
um gosh seven years later down the road
10:58
but we'll we can get back to that
11:01
thanks meredith i i have to admit as you
11:04
were telling the story i was kind of
11:05
reliving it so i was getting a little
11:07
uh emotional so i i appreciate you uh
11:11
being willing to share that with
11:12
everybody here it's very powerful
11:15
so you know the way you described it is
11:17
is perfectly
11:19
exact in terms of how we approach triple
11:21
negative breast cancer
11:23
uh the way we often do it will be
11:24
chemotherapy up front and this affords
11:27
us you know the ability
11:28
to make sure the tumor is shrinking in
11:30
real time
11:32
but also allows us to understand what
11:34
the disease looks like at the time of
11:35
surgery and
11:36
you know somewhere around a third of
11:38
patients will have no cancer left at the
11:41
time of surgery it's all dead scar
11:43
tissue and
11:44
what i can tell them is that their cure
11:45
rate's good it's probably around 90
11:47
percent and that's fantastic
11:49
for the other you know two-thirds of the
11:51
population
11:53
who have residual tumor in that specimen
11:56
even though the tumor's been removed the
11:58
risk of recurrence
11:59
plummets from about 90 percent down to
12:02
about 50 percent
12:03
and so you know as a meredith was
12:05
alluding to for many of these patients
12:07
now they've just gone through
12:08
intense chemotherapy surgery radiation
12:11
and now they're left with a flip of the
12:12
coin in terms of you know is this going
12:14
to come back and claim my life and i
12:16
i think mentally daunting uh to be frank
12:18
and so
12:19
this is an area that we have really
12:21
tried to invest some
12:24
energy in terms of trying to make things
12:26
better and so what i may do is turn it
12:28
over to dr radovish to talk a little bit
12:30
about some of the research we've done
12:31
kind of in this area absolutely
12:35
good morning everybody and thank you for
12:36
being here today emeritus thank you so
12:38
much for sharing your story really
12:40
powerful and
12:41
really i think sets the stage for what
12:43
we're trying to do as dr schneider
12:45
mentioned improve
12:46
outcomes particularly for women who are
12:47
at high risk of their cancer coming back
12:50
as dr schneider mentioned that in women
12:52
in which the chemotherapy does not melt
12:54
all the tumor away where we have
12:55
residual disease
12:56
we know these patients are at high risk
12:58
of their cancer relapsing particularly
13:00
within about three years
13:01
and unfortunately when it does relapse
13:03
it unfortunately comes back with a
13:04
vengeance it particularly comes back to
13:06
stage four disease and
13:07
unfortunately lethal and as you can
13:10
imagine for
13:11
a woman with triple negative breast
13:12
cancer who just completed chemotherapy
13:14
who just
13:15
completed surgery and radiation as brian
13:17
mentioned it comes a really scary time
13:19
worried that this cancer is going to
13:20
come back i've had some patients
13:22
describe to me is that
13:24
every headache they experience every
13:25
back pain they experience anything
13:27
that's abnormal they experience is the
13:29
fear that this cancer is coming back
13:32
and so we set out to actually see if we
13:34
can really
13:35
uh improve outcomes for these patients
13:36
these patients so about
13:38
oh five years ago or not or so uh dr
13:41
schneider and i
13:42
launched a clinical trial specifically
13:44
for this patient population
13:45
it's called bre-12158 where we took
13:48
women who had residual disease after
13:50
chemotherapy
13:51
and then we actually genomically
13:53
analyzed our tumor to determine what
13:55
were all the
13:55
typos in that tumor that we could maybe
13:57
potentially attack with targeted drugs
14:00
we assigned women genomically directed
14:01
therapy uh based on those markers
14:04
and currently actually going to report
14:06
the results of that trial later this
14:07
year
14:09
but in the interim we kind of performed
14:11
a pretty cool analysis
14:12
where we actually drew just a simple
14:14
blood sample after
14:16
surgery and asked can we detect the
14:18
presence of something called
14:20
circulating tumor dna and what this is
14:23
is dna from tumors that are literally
14:25
shed from tumors that float around in
14:27
the circulation that one can take a very
14:29
simple blood test and actually measure
14:31
for the presence of this material
14:34
and what we found was if we detected
14:35
this material after surgery
14:37
unfortunately those patients are going
14:38
to relapse they're at really high risk
14:39
of their cancer coming back
14:41
however if we didn't detect it those
14:43
patients tend to do really quite well
14:46
actually having a quite uh quite
14:48
favorable long-term survival
14:50
and actually what was it really
14:52
interesting is that we found that this
14:53
circulating tumor dna
14:54
was even more predictive than every
14:57
standard used clinical parameter to date
14:59
more predictive than how big the tumor
15:01
was more predictive of whether the lymph
15:03
nodes were involved
15:04
more predictive of whether the tumor
15:06
looked nastier under the
15:07
microscope or didn't and so we've been
15:09
really excited by
15:10
these results and we believe is going to
15:12
make an important headway in how we
15:14
design future clinical trials for this
15:16
patient population
15:20
it's interesting i think about what the
15:22
work they're doing and i'm so thankful
15:24
for
15:24
um all the women that will unfortunately
15:28
have to walk the same road that maybe
15:30
they will have a little bit more peace
15:31
of mind
15:33
or at least a little more direction once
15:35
their therapy is done because i think
15:37
that's
15:37
um some of the things you think about i
15:39
i remember
15:40
emails to dr schneider to be like i've
15:42
had this back pain for a little bit
15:43
and i i just don't know i don't think
15:46
it's anything but what if it is
15:48
do we need to do anything and there's
15:50
always that
15:51
in the back of your mind and um
15:54
you know it's it's amazing that you guys
15:57
are able to
15:58
to look at this circulating dna now to
16:01
know
16:02
to maybe be able to provide a little bit
16:04
of a little bit of peace of mind when
16:06
you really don't have any yeah you know
16:09
meredith
16:10
it's a good point i you know after the
16:12
uh dr radovich presented these data at
16:15
our
16:15
big international meeting uh my mailbox
16:18
got flooded by patients across the world
16:20
with can i do this test and you know
16:22
i think the answer today is we got a lot
16:24
more work to do
16:25
it's a great test but it doesn't really
16:27
tell us what we should do yet and
16:29
you know this has really been a large
16:31
part of the work that we're moving
16:32
toward
16:33
uh you know to the the precision health
16:35
initiative in terms of what how can we
16:37
use this information to now make things
16:39
better and
16:40
you know we have designed a clinical
16:42
trial that we're very proud of that
16:44
should be opened in the next month or so
16:46
that'll take advantage of this amazing
16:48
you know technology
16:50
what we hope is that for patients who
16:52
have uh
16:53
no evidence of that circulating tumor
16:55
dna that dr radovich talked about we'll
16:57
be able to
16:58
think about maybe even decreasing the
17:01
amount of chemotherapy patients need so
17:03
we can think
17:04
about improving quality of life and so
17:06
forth
17:07
but then really focus on identifying
17:10
gas pedals within that group that does
17:12
have circulating tumor dna
17:14
so we can start to make a big impact and
17:16
hopefully intersect with that patient's
17:18
destiny in terms of improving outcomes
17:20
and milan i don't know if you want to
17:21
talk a little bit about that trial
17:24
yeah we are really excited about this
17:27
new trial it's
17:28
going to be called the persevere trial
17:30
and i think it's going to
17:32
really set the stage for real how trials
17:34
in this space are done in the future
17:36
across tumor types for that matter
17:38
and so what this trial will do will be
17:39
similar to our previous study where
17:41
women with triple negative breast cancer
17:43
who have residual disease after
17:44
chemotherapy
17:45
will be enrolled but this time we're
17:47
going to
17:48
assess for the presence of ct dna if
17:51
they're positive for ct dna as mentioned
17:53
we know they're at high risk of their
17:54
cancer coming back
17:56
so what we're going to use is we're
17:57
going to use the genetic information and
17:59
the ct dna
18:00
as well as genetic information from the
18:01
tumor to really figure out what's all
18:03
gone haywire in the cancer
18:05
and then match a therapy to those
18:08
alterations
18:09
to those mistakes and that we see in the
18:11
dna
18:13
uh for women uh who are do not have ct
18:15
dna or negative who we think are going
18:17
to
18:17
do quite well uh they're going to be
18:19
assigned treatment to physicians choice
18:21
and their doctor can choose not to use
18:22
any therapy maybe potentially
18:24
de-escalate
18:25
or use some of the standard used
18:26
standardly used chemotherapy for triple
18:28
negative breast cancer
18:30
we are really excited this is going to
18:32
open at 20 sites across the u.s and i'm
18:34
going to roll 200 women
18:36
and again we think is a trailblazer in
18:39
terms of how to
18:40
stratify risk in this high-risk setting
18:48
so if i could just jump in for for a
18:51
second i think one of the things that
18:52
some people are interested in is
18:54
from the very beginning why this was
18:56
called precision health
18:58
and i think you've suggested a lot of it
18:59
but if i could if i could just ask you
19:01
maybe to close the circle on this so
19:04
it's the idea that we would have
19:05
completely individualized treatments or
19:08
that we would have different categories
19:09
of treatments
19:10
why do we think of this as as precision
19:12
health um dr schneider or dr radovic
19:16
yeah you know dr kate you bring up a
19:18
good point and you know i think what
19:19
precision health seeks to do is really
19:21
disrupt an antiquated dogma we've had in
19:23
cancer treatment which is
19:25
we take a group of patients with the
19:26
same diagnosis and treat them with the
19:28
same drug and expect the same response
19:30
and the reality is that doesn't happen
19:32
some patients do well with a particular
19:33
drug and some don't
19:35
there's no such thing as the average
19:36
patient um and so
19:38
here with precision health exactly we
19:41
want to tailor therapy to the individual
19:43
alterations in a particular tumor to the
19:45
individual Achilles heels or gas pedals
19:47
as dr schneider mentioned
19:49
for each patient and i think this really
19:51
portends what we think is the future of
19:53
cancer therapy where
19:54
we always do consider the the site of
19:56
origin like what organ it came from
19:58
breast or colon or pancreatic
20:00
but we actually pay more special
20:01
attention to what makes that cancer tick
20:04
and what makes a cancer tick is what we
20:05
want to go after with those targeted
20:07
therapies
20:10
and do we um dr snyder mentioned right
20:12
at the start that this
20:14
uh disease particularly uh
20:16
disproportionately affects black women
20:18
and i'm curious about the work that's
20:20
being done at iu at the school of
20:22
medicine at IU Health
20:24
uh to to address that that issue in
20:26
particular and the difference that it's
20:28
making in the lives of black women
20:31
yeah you know i'll highlight a couple of
20:33
things there's some really i think
20:35
important groundbreaking work here at
20:37
indiana university
20:38
in terms of helping overcome disparities
20:40
and it has been clear now for quite some
20:42
times that black women
20:44
have inferior outcomes in terms of
20:46
curability with their breast cancer
20:48
and the reasons for that are likely
20:50
multifactorial and i'll get into those
20:52
but
20:52
one of those is really understanding
20:54
kind of the background or normal breast
20:56
and
20:56
you know one of the things we have here
20:58
at indiana university is
21:00
the only normal breast bank in the world
21:03
this is led by anna marina storniolo
21:05
where we're really able to understand
21:07
that encyclopedia of what makes
21:09
normal different and that really i think
21:11
sets the stage
21:12
so we can understand what's abnormal you
21:15
know other
21:16
work that i think is important again as
21:18
we think about some of the causes for
21:21
the inferior outcome certainly some of
21:23
those are social
21:24
construct issues uh less insurance
21:28
difficulty getting care biology is
21:30
different so we know that black women
21:32
have more of this
21:33
triple negative breast cancer but one
21:35
thing our group identified about six or
21:38
seven years ago is that
21:39
african-american patients have more
21:42
toxicity from therapy
21:43
more side effects globally one in
21:46
particular that we
21:48
found which was dramatically higher in
21:51
black patients was neuropathy
21:53
and neuropathy is a inflammation of the
21:56
nerves so patients describe their
21:57
fingers and toes going numb
22:00
kind of like when you're out in the
22:01
snowstorm here some describe it as
22:03
burning pain
22:06
for some it's dramatic it's difficult
22:08
for them to walk down a set of stairs
22:10
i've had a patient or two tell me
22:12
they're afraid to hold their baby
22:13
because they're going to drop her
22:15
so it can really be impactful in terms
22:17
of quality of life
22:19
but interestingly what we found is that
22:21
this toxicity
22:22
also makes it such that doctors will
22:25
reduce the dose
22:26
inordinately they will stop the drug
22:29
this ultimately results in them getting
22:31
less of the curative drug and making
22:34
survival outcomes worse as well
22:37
and so upon identifying really this side
22:39
effect paradigm
22:40
you know playing a role we embarked on a
22:43
clinical trial here called
22:45
eaz171 this is a clinical trial to the
22:48
nci cooperative group system
22:50
across all north america this clinical
22:53
trial
22:54
will enroll only black women and it's
22:56
the first of its kind
22:58
ever and so we're very very proud of
22:59
this because we think this is the way to
23:01
really tackle the disparity issue
23:03
this trial will try to find the best
23:06
drug
23:07
for african american patients in terms
23:09
of toxicity which we hope will also
23:12
result in better efficacy and so i think
23:15
this is one kind of novel approach that
23:16
we've taken here to really try to
23:18
minimize the disparities that are seen
23:23
thank you and meredith your story is so
23:26
compelling and
23:27
like dr schneider i also i mean i found
23:30
it quite
23:31
quite moving but i'm curious for your
23:33
perspective as both a health
23:35
professional
23:36
and also a patient who has successfully
23:39
fought this
23:40
disease as you watch precision health is
23:42
it
23:43
is is it exciting is it is it daunting
23:46
to have to relive
23:47
all of this is it i'm curious i mean i'm
23:50
i'm grateful for your willingness to
23:52
share with us today but i'm also
23:54
curious about sort of the personal side
23:55
of that
23:58
yeah thank you um it is so exciting to
24:01
me
24:01
i i have been fortunate enough to see it
24:04
with some of our pediatric patients and
24:05
i
24:06
um i like to think that uh
24:09
knowledge is knowledge is power right
24:11
sometimes it's it's scary because we
24:14
know more than we want to know but
24:15
otherwise um i like you know it really
24:18
is powerful to know
24:20
and for them to discover and have this
24:23
research going on to be able to really
24:25
truly predict the best drug
24:28
for a person's diagnosis i was obviously
24:32
treated with very standard therapy and
24:35
and it's not lost on me how fortunate i
24:38
am to have had minimal toxicities i did
24:40
have a few of the
24:41
neuropathies um that that dr schneider
24:44
spoke of but to have minimal
24:46
toxicity um and to come out
24:49
healthy and i was able to have a second
24:52
child
24:52
as soon as dr schneider gave me the
24:54
green light and so i have
24:56
two uh beautiful young boys that keep me
24:59
very busy
25:00
um but um i
25:03
i see the it's interesting we have a
25:07
another story that is it's not
25:09
necessarily precision health but just to
25:11
show the
25:12
sort of the advances in what's happened
25:14
um over the years dr schneider in one of
25:16
our annual visits said to me hey there's
25:18
been
25:19
some advancements in bracket testing and
25:22
so
25:22
um dr schneider can tell you a little
25:25
bit about exactly what bracket testing
25:27
is
25:28
but essentially i was tested at the very
25:30
beginning
25:32
we look at we did a i met with a genetic
25:35
counselor we went through an entire
25:37
um family tree
25:40
to see what traits were there and my
25:42
mother who had premenopausal breast
25:44
cancer at the time they weren't
25:46
i mean she we didn't know there was
25:48
triple negative we didn't know what it
25:49
was
25:50
um so um anyway
25:53
we he said i think we should repeat your
25:56
bracket testing and i said oh sure why
25:57
not
25:58
it's it's not going to change the course
26:00
of anything it's seven years down the
26:01
road
26:02
well come to find out um i got a phone
26:05
call from him and he said
26:07
hey uh as i mentioned they're looking at
26:10
different deletions now
26:11
and actually you do have a bracha
26:13
mutation
26:15
um and it is putting you at increased
26:18
risk for
26:19
ovarian cancer so uh it was almost like
26:23
being diagnosed with cancer
26:25
all over again even though i knew i
26:27
wasn't
26:28
but all over again seven years later
26:32
that sense of that loss of control that
26:35
all of a sudden my body becomes somebody
26:37
else's again i now have to have
26:39
my ovaries removed and um
26:42
again like i mentioned knowledge is
26:44
power is power because now my family has
26:46
been tested my siblings have been tested
26:48
we know information
26:51
for future generations that we otherwise
26:54
wouldn't have known
26:55
because the science is allowing us to do
26:57
that so i've since had now a
26:59
um total hysterectomy and i feel um
27:02
very good about that like i mentioned
27:06
it's that whole
27:07
loss of control um
27:10
but i also know that i'm in control of
27:12
my own destiny i was able to
27:15
um make the choice to have that
27:17
hysterectomy
27:19
and allow my family
27:23
the ability to have some knowledge as
27:26
well
27:27
so i think it's really exciting there's
27:29
so much that they are doing
27:31
that can help these women in the future
27:35
and i'm just really proud to
27:38
be a part of that in some way shape or
27:41
form
27:44
well thank you for your willingness to
27:46
thank you for your success
27:48
um i i want to just before we turn to
27:50
questions from the audience
27:52
um i want to introduce uh tatiana farooq
27:55
who actually in many ways feels like the
27:56
one person who probably never needs an
27:58
introduction on a call like this
28:00
but she's executive associate dean for
28:01
research affairs and many other titles a
28:03
distinguished professor
28:05
but most importantly for this she is the
28:07
pi of the precision
28:09
health initiative and i have to say
28:12
listening to meredith talk it feels like
28:13
maybe she just gave the best
28:16
definition of precision health is the
28:18
more we can
28:19
put the patient in control the the more
28:21
that the
28:22
the tools empower the patient so i'd
28:24
like to hand it over to you both to
28:27
maybe put this in a little broader
28:28
context of the of the amazing work that
28:31
the president health initiative is doing
28:33
and also to talk about next steps
28:36
that'd be great okay so let me um let me
28:39
tell you one other thing that some
28:40
people
28:40
i'm listening may know i'm also a
28:42
geneticist and so
28:44
um i i think i just want to say one
28:46
thing in response um
28:47
also to meredith so i too want to really
28:49
thank you for your
28:50
honesty um and for sharing your story
28:53
you also um if i can just tuck in
28:55
also just told the story of genetics we
28:58
started by getting the number of
28:59
chromosomes wrong for those of you who
29:01
don't know that story
29:02
um we think we understand about braca we
29:04
offer bracket testing and then
29:06
we learn more and that's really the
29:08
essence of precision healthy at one
29:10
point all of you talked about the circle
29:12
and and the good and the bad is we have
29:14
so much still to learn
29:16
and so what you've experienced meredith
29:18
is is are our increasing knowledge
29:21
and so i i just want to start by sort of
29:24
giving you an explanation of that and as
29:25
geneticists
29:26
um we too keep saying knowledge is power
29:28
and we keep getting more and sometimes
29:30
we reinterpret what we've learned and
29:31
that's sort of a fact
29:33
let me also put it in a broader context
29:34
so we actually did and it means that
29:36
this is a discussion but
29:38
what you um let me a little bit of
29:39
context of what do we have in precision
29:41
health how are we able to do all the
29:42
things we've described to you here
29:44
so we have a piece that's called genomic
29:47
medicine and you've just witnessed what
29:48
genomic medicine is
29:50
how do we take our knowledge about
29:52
genetics how do we use that knowledge to
29:54
develop personalized care how do we
29:55
develop new treatments
29:57
we pair that with a drug discovery
29:59
component and i'll tell you there's
30:00
going to be a release that will come out
30:02
after this
30:04
from another member who's part of
30:05
precision health and works particularly
30:07
in breast cancer and his name is
30:08
jean-ben-lou
30:09
and he is a vera bradley breast cancer
30:11
professor in innovation
30:13
and why that's important is we're
30:14
looking for innovation in terms of our
30:16
treatments
30:17
and i'll give you a side story because i
30:19
think it tucks in beautifully with what
30:20
we've described with this
30:21
triple negative breast cancer is not one
30:23
thing and so he's focused on a subset of
30:26
women who have a particular
30:27
genetic finding when they do testing in
30:30
the tumor
30:31
and what he's been trying to develop is
30:33
how can we pair
30:34
the current treatments that we have with
30:36
new therapies
30:38
and what i think is fascinating about
30:39
the stories it ties us back to a
30:41
mushroom
30:41
and looking at what we can learn from
30:44
mushroom toxins
30:45
and developing a new treatment in a dish
30:48
in
30:49
in a laboratory right now so before dr
30:52
schneider has
30:53
everybody contacting him by email
30:54
wanting to know about this new treatment
30:56
and how do i get it
30:57
where we're starting right now is
30:59
studying in a laboratory developing
31:01
something that appears to be responsive
31:03
in women with a particular kind of
31:05
triple negative breast cancer
31:07
and there are a series of steps that
31:08
have to occur next but the point is
31:10
we're trying to grow our arsenal and
31:12
target it to specific groups of
31:14
individuals that right now we can't
31:16
treat as well so
31:17
i want to also give you a little bit of
31:18
hope and that paper is coming out and
31:20
just give you a feel for that
31:22
the other piece i want to make sure you
31:23
all realize is
31:25
this this approach that we've taken
31:27
looking at genomic medicine and clinical
31:29
care
31:30
thinking about drug development also
31:32
thinking about delivery and how can we
31:33
deliver care
31:35
is encompassed in breast cancer but also
31:37
in a series of other disorders that
31:39
we've
31:39
we're tackling and approaching as part
31:41
of precision health because they're so
31:43
important
31:44
and we believe there's an opportunity to
31:46
make fundamental changes and outcomes
31:48
for
31:48
for hoosiers and for people around the
31:50
world so you've heard i think that we're
31:52
going to be tackling and having a
31:54
webinar around pediatric cancer and
31:56
sarcomas in particular
31:58
that is an area um i almost feel like
32:00
meredith you may be back telling us
32:01
about it from the
32:02
from the health care provider side but
32:04
that's an incredibly important area and
32:06
many people
32:07
have been hearing about that in terms of
32:09
um
32:10
Tyler Trent that's gotten a lot of
32:12
publicity in terms of our work in that
32:13
area
32:14
there's also work in terms of
32:15
gestational diabetes multiple myeloma
32:18
and also alzheimer's disease we're in
32:20
different places in these disorders but
32:22
we're really looking forward
32:23
to having a similar opportunity to give
32:25
you a an explanation of what we've been
32:27
doing the
32:28
progress that we've made and i think
32:30
it's only possible
32:31
through this precision health initiative
32:33
being able to focus resources
32:35
tackle a couple of really important
32:36
problems and just bring
32:38
a group of really innovative researchers
32:41
and clinicians together
32:42
to say let's really focus on this and
32:44
make a difference
32:45
over the next five years and truthfully
32:48
it's a story that goes on for
32:49
for decades we will not solve everything
32:52
that i'm describing here
32:53
but will make significant progress and
32:55
you're already beginning to hear the
32:56
story
32:57
and i think that's probably a good place
32:59
to end um do you think so too fred and
33:01
maybe
33:01
and maybe start to take questions yeah
33:03
let's do thank you very much so
33:05
i've got to hand over now to um this is
33:07
like a tag team match here
33:09
christine drury who works in the office
33:12
of communications for the vice president
33:13
for research
33:14
and maybe you would like to uh provide
33:17
us the questions
33:18
absolutely thank you so much fred thank
33:20
you tatiana and
33:22
all the panelists um as we know meredith
33:26
is the star of our show
33:27
and the q a is reflecting that so
33:30
um the first question for meredith you
33:33
touched on this
33:34
uh briefly with your siblings but this
33:37
participant would like to know have you
33:39
talked with your children
33:41
about their family-based genetic risk
33:44
or how to navigate that or have you
33:46
planned for a conversation
33:48
as they get older i know you have sons
33:51
so um may not be as relevant but what
33:54
are your thoughts
33:56
i think dr schneider could probably
33:58
allude to this but it is still
33:59
it is um i believe still relevant to
34:01
them i have not had the conversation
34:04
with them
34:04
they are 11 and 7. um so they're pretty
34:07
young
34:08
they know i had cancer they obviously
34:10
one wasn't even alive the other doesn't
34:12
remember it
34:13
um so we've not had that conversation i
34:15
will i do plan to talk to them about it
34:18
i do plan for them to have gene testing
34:21
done when the time comes
34:23
um my siblings children who are a little
34:25
bit older they are
34:26
um a little more knowledgeable about it
34:29
unfortunately my sister did not carry
34:31
um the mutation or does not have the
34:33
mutation so
34:34
um but no i do plan to have that
34:36
conversation even though they are
34:38
boys yeah i want to chime in there and
34:40
thank you meredith for saying that this
34:42
is a really important point and meredith
34:44
nailed it first of all men are at
34:47
increased
34:48
risk of breast cancer if they carry a
34:49
bracket mutation also with a certain
34:51
type of bracket mutation increased risk
34:53
of prostate cancer and other cancers
34:55
the other thing is men have little
34:56
babies who turn out sometimes to be
34:58
little girls and
35:00
it breaks my heart how many times
35:02
they've never been warned about this
35:03
possibility and the fact that their
35:05
young daughters could ultimately go on
35:06
to die of breast cancer and so
35:08
it is really critical that regardless of
35:11
sex that this is
35:12
discussed and the appropriate testing is
35:15
done
35:16
can i tuck in that's also an entire
35:18
field of genetic counseling and i just
35:20
want to stress that that is
35:21
i'm talking to a genetic counselor
35:23
discussing um
35:24
you know how to make that decision about
35:26
testing how to have that discussion with
35:28
children both sons and daughters it's an
35:31
incredibly important part of this
35:32
process
35:33
we also have a clinic called the
35:35
indianapolis cancer clinic so if
35:36
individuals just want to explore
35:38
whether or not testing is is something
35:40
that they should be considering
35:42
there's wonderful opportunities um and
35:44
iu health has great
35:45
um programs that can help with that
35:48
well i i think that when i have those
35:51
conversations too and i
35:52
agree with there's fantastic genetic
35:55
counselors and i've
35:56
met with a couple of them and they're
35:57
just great but i think the work that dr
36:00
schneider and dr radovich are doing
36:02
hopefully by the well i hope that it
36:04
never happens but if that ever happens
36:06
down the line
36:07
for my sons or grandchildren or whatever
36:09
that
36:10
they've already come up with exactly the
36:12
target in therapy and they won't have to
36:14
have chemotherapy
36:15
and radiation and surgeries and all of
36:17
those things so
36:19
i'm hopeful that the this research can
36:22
continue so that we get to that point
36:24
that
36:25
we don't have to have these
36:26
conversations over and over
36:28
we hope so too so
36:32
more uh comments for meredith and
36:35
questions uh thank you for sharing your
36:37
story it's very touching
36:39
this participant says my own mother
36:41
passed away because of a very aggressive
36:44
breast cancer about a decade ago at age
36:46
50.
36:47
i'm not sure exactly which subtype of
36:50
cancer but it might have been triple
36:52
negative
36:52
as a daughter i'm always thinking i
36:54
might have a high risk
36:56
so i want to ask our professionals how
36:58
can i prevent or know
37:00
early about the possibility of cancer do
37:03
i just follow the general guidance i can
37:05
find online or is there an educational
37:07
program i can participate in
37:09
what would you recommend
37:13
dr schneider do you want to i'll start
37:15
there and i'm going to turn it over to
37:17
tatiana too because
37:18
clearly as as Tatiana mentioned we have
37:21
an amazing medical
37:22
genetics department here who really
37:24
focuses on doing the appropriate testing
37:27
we also have a high-risk breast cancer
37:29
program here
37:30
led by tara ballinger which looks at
37:33
patients who
37:34
in some cases don't even have a genetic
37:36
mutation that they inherited but
37:38
maybe other risk factors whether it be
37:40
family history or otherwise so
37:42
there are definitely resources here at
37:44
iu health for those
37:46
patients Tatiana yeah let me add to that
37:48
too so i think the particular case we're
37:50
talking about here um would be
37:52
an individual be very appropriate for
37:53
that referral into the indiana familial
37:55
cancer clinic
37:56
as dr schneider also mentions um high
37:58
risk
37:59
clinics as well i think it'd be
38:01
important to gather a family history one
38:02
of the things that i thought was really
38:04
helpful meredith as you spoke is you
38:05
kind of talked about your family history
38:07
and that's exactly what someone will
38:08
look at a genetic counselor will start
38:10
to look at is
38:11
you know who else in the family how
38:13
closely related are they to you what was
38:15
the history of that
38:16
of that particular individual's breast
38:18
cancer you made a great comment meredith
38:20
no one no one said that your mother had
38:21
triple negative breast cancer
38:23
you know there's i work in number
38:24
disorders depending on when the
38:26
generation was that the individual had
38:27
that disorder we called it different
38:29
things
38:29
it was just called breast cancer and so
38:32
having somebody walk through
38:34
um this idea of taking a family tree
38:36
asking about different family members
38:38
you know we've talked about things
38:39
lurking in men and not realizing that we
38:40
need to be asking around
38:42
the women around a man and looking at
38:44
that family history so i'd really
38:46
recommend that as a starting place you
38:47
know really getting a good handle on the
38:49
family history
38:50
and looking at what are the appropriate
38:51
options for genetic testing
38:53
there's different kinds of testing
38:55
that's most appropriate given that
38:56
family history
38:57
and so i think a genetic counselor or um
39:00
someone like dr schneider in
39:01
coordination is really a great way to
39:03
get that history and to get that process
39:04
started
39:05
and i think there are a couple other
39:06
questions that probably touch upon that
39:08
and so
39:08
um glad to also give a warning to
39:11
perhaps some of the resources we're
39:12
describing that they they might be
39:13
getting some calls
39:17
thank you tatiana along these same lines
39:20
we've gotten the same question written
39:24
in a variety of ways so
39:26
we talked a little bit about the
39:27
importance of familial history
39:30
what does the group think about
39:31
performing genetic testing
39:33
in the general population for cancer
39:36
versus those who already have a family
39:39
history of cancer
39:42
would you like me to start or where
39:44
would you all like to start oh you want
39:45
you would like her i'd be glad to
39:47
so one of the i would just say the pros
39:49
and cons let me put this into a broader
39:51
context
39:52
you've got companies like 23andme and so
39:55
one of the things that i think we should
39:56
sort of need to talk about is there's
39:58
direct-to-consumer testing there's
40:00
testing that can be done
40:02
as part of healthcare and treatment and
40:04
developing options
40:05
let me just start by saying different
40:06
kinds of testing are more
40:08
or less complete and that's probably one
40:10
of the first things to be aware of when
40:12
thinking about
40:13
what kind of if someone's proposing to
40:15
go off and and do this
40:17
there is some screening in terms of
40:20
breast cancer risk for example through
40:21
23andme
40:22
nothing near as comprehensive or with
40:25
the genetic counseling that we've been
40:26
describing that would occur if you did
40:27
that through
40:28
a provider if you think about population
40:31
based testing
40:32
um i think dr schneider and dr radovich
40:34
may come up with may have some just
40:36
comment about this too
40:37
there are individuals who do learn about
40:38
risk that they might not be aware of you
40:40
can think about individuals who are
40:41
adopted
40:42
who may not know very much about their
40:43
family history and therefore wouldn't
40:45
have any kind of a reason to be aware of
40:47
an increased risk
40:48
i think what's important is i think
40:51
doing any of that testing in the context
40:53
of understanding also what could be
40:55
found
40:55
and i think um meredith has given us
40:57
sort of a great context
40:59
she received information knowing that
41:01
there's a diagnosis
41:02
that there's diagnosis of breast cancer
41:04
individuals learning about increased
41:06
risk and
41:06
what kind of increased risk that is
41:08
without the context of
41:10
you know um what that what that what the
41:13
relative risk of that is what the
41:14
proportion of risk
41:15
it's difficult to interpret genetic
41:17
counseling i'm talking to providers is
41:19
really essential in that context
41:21
it's also something that goes into your
41:23
um medical record depending on how
41:25
you've done that we can have a little
41:26
bit of discussion around that
41:27
so there are a number of issues i guess
41:29
i would just stress um
41:31
probably um i want to leave you with not
41:33
something you want to just jump into
41:34
without some
41:35
some guidance and discussions i think
41:36
with others others want to speak up to
41:38
them
41:40
so you know i think as dr fruit
41:42
mentioned this is a really evolving
41:43
field and i do envision a future one day
41:46
when
41:46
all of us know our genetic code and we
41:48
know the risks we have for particular
41:50
diseases some people even talked about
41:52
it being done at the same time you do a
41:53
heel stick for other metabolic diseases
41:55
for babies and
41:56
we'll all have this genetic information
41:58
but i would i'd caution as dr frood
42:00
mentioned
42:00
it's also a scary thing to do about six
42:04
years ago my laboratory bought a genome
42:05
sequencer
42:06
and i had a new graduate student who had
42:08
to train on it i didn't want him to
42:09
train on precious cancer samples
42:11
so i said for the fun of it i gave him
42:13
my dna to run on the genome sequencer
42:15
and i thought oh this is going to be
42:16
really cool
42:17
and became it was really cool until to
42:19
the moment i sat down to analyze my
42:20
results
42:21
and i you know as they just training
42:23
exercise you
42:24
look through your results and you say my
42:26
goodness i'm fearful i'm going to find
42:27
something that you know may implicate my
42:29
children or
42:30
or whatnot uh now contrary to popular
42:32
belief
42:33
there was nothing genetically messed up
42:34
in me uh
42:37
being okay uh however i i think it
42:40
really shines the light the fact that if
42:41
you're gonna get this information you
42:42
have to prepared to accept it and you
42:44
have to be prepared to know how to act
42:45
on it
42:46
and i think we are still certain in the
42:48
early stages if we were to do
42:49
population-based sequencing
42:50
how are we going to handle all these
42:52
people we'll find that have cardiac
42:53
genetic diseases or
42:55
cancer predisposition or neuro other
42:57
types of diseases we have to be ready
42:58
for that and so
42:59
maybe one day in the future we will but
43:01
that's a really evolving landscape at
43:03
this point
43:04
yeah the only minor i think those are
43:06
exactly spot on the thing i want to just
43:09
emphasize again that was was kind of
43:11
highlighted is that
43:12
many of the tests that are done are not
43:14
complete and the thing i have found is
43:16
that patients have a sense of being
43:18
relaxed that they feel they're not at
43:20
increased risk when in reality
43:22
they didn't even have all the
43:23
appropriate testing done so i i would
43:26
just say that
43:26
as we're as we're starting to do this
43:28
make sure it's being done
43:30
in concert with an an expert and a
43:32
professional who can help really
43:33
interpret the results
43:40
so thanks everybody uh my son
43:43
joined us he's supposed to be with his
43:46
grandmother
43:47
so uh let me ask a question about
43:51
um this knowledge with men do men have
43:54
an increased
43:55
risk of getting breast cancer if their
43:57
mom had breast cancer
44:03
so so i'll take a bit of a stab so the
44:06
the starting point is breast cancer in
44:08
men's really rare
44:09
okay so that just a couple of thousand
44:12
men a year will get breast cancer
44:14
but certainly we see that a large
44:18
percentage of the men who have breast
44:20
cancer are those who carry a mutation
44:22
as meredith mentioned a brachawan or
44:23
breca 2 mutation and so
44:26
you know i think the mom just having
44:28
breast cancer again would depend on her
44:30
age does she carry a specific mutation
44:33
if she carried the mutation did it get
44:35
passed down to him
44:36
and those would be the sort of things
44:38
that we would begin to think through in
44:39
terms of
44:40
discussing the risk i think as we talk
44:43
about male breast cancer though
44:45
the biggest thing i can mention is is
44:47
it's about awareness
44:49
there have been a lot of guys who will
44:51
have you know
44:52
something under their nipple and they
44:55
don't even think that they have breasts
44:56
or could get breast cancer and
44:58
breast cancer often will spread to the
45:00
armpit lymph nodes and they'll fill a
45:02
you know a lymph node under there and
45:04
they assume they just got a
45:05
you know hair follicle infected and so
45:08
unfortunately
45:09
men present much later when which they
45:12
shouldn't because you can feel stuff
45:13
because the breast is
45:14
is uh significantly smaller but simply
45:18
aren't aware and so i think this is more
45:20
of an awareness campaign and
45:21
men who've been touched in some way in
45:23
their life
45:25
with breast cancer should be thinking
45:26
about it
45:31
thank you dr schneider um karn geppert
45:34
wonders
45:35
is the circulating tumor dna testing
45:38
being done
45:38
outside of research uh in other words
45:41
in general oncology practice maybe dr
45:44
radovich yeah no that's a really great
45:47
question and
45:48
interestingly one that we get often as
45:50
schneider mentioned from patients who
45:51
contact us
45:52
after the results of the study so
45:55
circulating tumor dna is used a lot in
45:57
oncology practice for patients with
45:59
metastatic tumors stage four cancers
46:02
we actually have two fda approved assays
46:04
on the market uh that allow us to use
46:06
that information to help
46:07
guide targeted therapy for patients with
46:09
metastatic tumors
46:10
and it's actually a platform that dr
46:12
shire and i use for our patients in the
46:14
iu health precision genomics program
46:16
it's a great way to non-invasively uh
46:19
determine the mutations in a particular
46:21
cancer
46:22
but it's application for predicting
46:25
relapse like we had in our study and its
46:27
application for early detection
46:28
is still very much a research tool where
46:31
it is not ready yet for clinical prime
46:33
time
46:34
uh because namely as dr scheier alluded
46:36
to earlier
46:37
we know this information can help
46:39
predict who is at high risk or relapse
46:41
we don't know yet if therapeutically
46:42
intervening actually improves outcomes
46:45
and so our new trial persevere will
46:47
answer that question and we're hopeful
46:49
that our trial along with others in the
46:51
field will begin to
46:52
advance this technology for use in the
46:54
relapse setting for general uh for
46:56
general practice
46:59
thank you dr radovich the question about
47:02
the persevere
47:03
study what are the strategies for
47:05
identifying and recruiting black women
47:08
to participate
47:09
in that particular study
47:13
yeah this is a fantastic uh
47:16
question it and unfortunately black
47:18
women are underrepresented in clinical
47:20
trials
47:21
throughout the us that's that's a
47:23
problem and you know especially as you
47:25
think about trying to focus on a
47:26
disparity
47:27
if the patients you're focusing on
47:29
aren't in that trial it's very hard to
47:31
derive
47:32
conclusions from it so in the clinical
47:35
trial prior to eas 171 that dr radovich
47:38
had alluded to bre 12158
47:42
we really did want to focus on trying to
47:43
get african-american patients involved
47:45
in that clinical trial and so we were
47:48
using
47:48
a variety of approaches led by casey
47:50
bales here in terms of recruiting using
47:52
things like facebook and
47:54
social media that's a little bit beyond
47:57
my skill set
47:58
and you know what we learned is it
48:00
didn't work all that well first um
48:02
we then partnered with a couple of
48:04
groups here in indianapolis area the red
48:06
alliance and pink forever
48:08
these are two community groups really
48:10
dedicated to
48:11
overcoming disparities with breast
48:13
cancer and we invited them to really
48:15
become partners in these trials
48:18
and my goodness you know i learned so
48:20
much from this and you know as they
48:22
they first did a really critical
48:23
analysis of what we were doing and they
48:25
said look you're doing it wrong
48:26
you know the recruitment material that
48:28
you're doing is not touching the
48:30
patients you're trying to touch
48:32
it wasn't culturally sensitive it wasn't
48:34
in the way that would make them be moved
48:36
to
48:37
to join and so they gave us some amazing
48:39
advice
48:40
they helped us build an entire uh photo
48:43
library that really i think connected
48:45
with the patients
48:46
uh they helped put together some videos
48:49
to talk a little bit about neuropathy
48:51
and the importance of clinical trials
48:53
and you know it it was a game changer in
48:56
terms of how it impacted our
48:58
accrual uh in bre-12158 and we're
49:01
implementing
49:02
a lot of those same tools in eac 171.
49:06
i just want everyone to hear that dr
49:08
schneider just publicly asked for help
49:09
setting up a tick tock channel on
49:11
snapchat
49:12
at your discretion he would welcome that
49:14
help
49:20
thank you dr schneider it's a really
49:22
important work
49:24
and um fred that was the last of our
49:27
audience questions i would encourage the
49:29
audience to continue to use the q a
49:32
button on your screens for more
49:34
questions they've been really thoughtful
49:36
uh critical questions and fred you may
49:39
have some additional
49:40
as well i always have questions thank
49:42
you very much
49:44
um i do think one of the things that
49:46
this occurs in the context of a grand
49:48
challenges discussion
49:49
is to know what it what difference the
49:52
grand challenge has actually made in
49:54
other words
49:55
is it money is it people is it attitude
49:57
is it
49:58
something else um what what difference
50:01
does it make that this has been
50:03
uh well the university is not really
50:05
first but biggest grand challenge on
50:07
precision health and
50:08
frankly i would i would ask all of you
50:10
that but maybe dr schneider we could
50:12
start with you
50:15
yeah you know so you know i think in
50:17
general
50:19
uh when you look at major breakthroughs
50:21
in communities
50:23
it is always a function of a concerted
50:26
effort of a lot of people
50:27
right a focus a you know a call to
50:31
action for a specific
50:32
uh win if you will and i think that's
50:35
what the precision health initiative has
50:36
done here
50:38
leadership i think have done a really
50:39
good job of picking out some diseases
50:42
that we need to make advances in for our
50:44
patients
50:45
they've focused efforts you know
50:47
emotionally scientifically
50:49
intellectually financially and i think
50:52
we always see our biggest uh steps
50:54
forward
50:55
uh when there's focused attention from a
50:57
group of really diverse
50:58
uh people
51:02
others my response to that is all the
51:05
above
51:07
and honestly and and more so than that
51:10
you know one of the
51:11
things i'm probably most proudest of is
51:13
uh when i see these trials that we've
51:15
run through phis that last slide
51:17
that last slide shows all the sites
51:18
across the us that participate in all
51:20
the patients who have benefited
51:22
and what that tells me is that what
51:24
we're doing here at iu doesn't just
51:25
benefit hoosiers but
51:26
it's benefiting patients all across the
51:28
country and frankly around the world
51:30
and i think the ability to translate our
51:32
discoveries to be practical to
51:34
practices and research groups across the
51:36
world is important
51:37
i think we should be proud of that i
51:39
think we as hoosiers have something
51:41
that a lot of maybe folks don't
51:43
understand that's the concept of hoosier
51:44
hospitality and hoosier collaboration
51:47
and i have to say the intellect in our
51:48
university across disciplines
51:50
has been so integral whether it be
51:52
genomics
51:53
oncology supercomputing down in
51:55
bloomington drug discovery all working
51:57
together to make these advances happen
51:59
something we should be proud of as an
52:00
organization
52:03
i'll also add hoosier humility um
52:06
so i think we also don't spend enough
52:08
you know we're not very good at saying
52:10
we've just done a really great job
52:12
and i do think that that's something
52:14
that this also highlights
52:15
i also think you just you tell people
52:17
you know there's so many things that you
52:18
can be doing
52:19
but you say we're really going to focus
52:21
and in the next five years we're going
52:22
to make a difference in
52:24
triple negative breast cancer it kind of
52:26
rallies everybody
52:27
focuses everyone um it really kind of
52:30
puts puts your blinders off we spend so
52:31
much time taking them off but sometimes
52:33
we actually want them on
52:34
and so that we sort of have a laser
52:36
focus and if you think about a lot of
52:37
advances that occur in the world it's
52:39
because people took a laser focus on it
52:41
and just worked on that um and i guess
52:43
the thing i'd like to give hope is
52:46
when you do things like this and you do
52:47
a laser focus what you've learned
52:50
and what you've gained whether it's
52:51
science whether it's the approach
52:53
you it's much easier to then apply it to
52:55
the next thing so one of the things that
52:57
i think comes up is well
52:58
something that somebody may be listening
52:59
and going well i'm really glad you're
53:00
working on these five things you've
53:01
named but what about the thing
53:02
i really care about that's affecting my
53:04
family and
53:06
i think i also want to put out that hope
53:08
that what we're learning
53:09
and it's different things across these
53:11
different areas that we're focusing on
53:13
is going to translate into advances we
53:15
can make in other areas then we'll take
53:16
the blinder off and let everyone
53:18
see you know how we've made those
53:20
advances so it really has like a ripple
53:22
effect it's going to make a difference
53:24
going forward
53:25
um so i just want to also stress that
53:26
and give also a little bit of hope to
53:28
people who
53:28
um you know know the things we're
53:30
talking about are important but also
53:32
care passionately about another disorder
53:34
you're not forgotten
53:37
so one of the things which we often talk
53:39
about with grand challenges
53:40
is that their success would be measured
53:44
by their impact
53:45
and i actually remember early in this
53:47
process 2015 when we first announced
53:50
this a
53:50
very distinguished faculty member coming
53:52
to visit me and saying
53:54
you know do you really mean that you
53:56
know we normally measure success by
53:58
articles published and presentations
54:00
given and
54:01
i'm like look those are all great things
54:02
as academics we all care about that
54:04
but i absolutely mean it and more
54:06
importantly i think the president and
54:08
the board of trustees mean it that
54:10
that we will measure success by lives
54:12
changed by
54:14
health restored by economies improved um
54:17
by injustice resolve that these will be
54:20
the impact and this seems like a
54:22
particular area where
54:25
that type of difference is being made
54:28
but i'm just curious how
54:29
as you look ahead
54:32
not how you will measure the success of
54:34
grand challenges but
54:36
what do you see in the five-year or
54:38
10-year
54:39
horizon in other words what do we have
54:41
to look forward to
54:42
in terms of this impact
54:46
so i can start and so um only because i
54:48
think we're not going to get to
54:49
alzheimer's disease for a while and for
54:51
those of you who don't know that that's
54:52
actually the area that i work in so i
54:53
can i can give you a tuck in
54:55
and a call out for other things so i
54:57
think one of the things that i think is
54:58
really
54:59
you know i wouldn't say maybe not
55:00
directly supported by phi but you can
55:02
call it as a
55:03
precision health initiative adjacent is
55:05
what we've got in terms of alzheimer's
55:07
we now have a drug discovery center
55:09
we have a model animal that we can do to
55:11
model the things that we learn in humans
55:13
so there's an example of kind of
55:15
triangulating and trying to put
55:17
something all in the same institution
55:19
um and it's a it's a real center so we
55:21
have great
55:22
impact in terms of the participants that
55:25
we're involving the variety the range
55:27
we've got right next to it a way to
55:29
model what we learn um in humans right
55:31
away into
55:32
various animal models and then we can
55:34
use what we learned in humans and animal
55:35
models
55:36
to evaluate drug discovery and i think
55:38
that kind of
55:39
triangle if you can imagine i'm doing it
55:41
as a circle but it's really a triangle
55:43
that's the potential and what we need to
55:44
be doing more of and that's what i think
55:46
we're also trying to grow again
55:48
the success in one area and we move it
55:50
from one to the other we've got a
55:51
similar
55:52
um story that we do in breast cancer i
55:54
would say um but we need to be doing
55:55
that in warriors that's really
55:57
um putting all of that in one place is
55:59
how you really fundamentally change um
56:02
i think in the largest way i know what
56:03
the rest of you think but you you have
56:05
the greatest impact when it's
56:06
all really operating well and smoothly
56:09
in your institution it gives you a real
56:11
way to to move rapidly i don't know what
56:12
the rest of you think but i think that's
56:14
part of being a game changer for area
56:17
one thing i envision over the next five
56:19
years is a continued
56:20
democratization of advances in precision
56:22
medicine to the majority of our patients
56:24
and
56:25
we're already seeing that today uh some
56:27
of you know dr schneider and i lead a
56:28
statewide program to provide genomics
56:30
to patients we have clinics in downtown
56:33
india in lafayette and arnett and in
56:35
blooming i'm sorry lafayette muncie in
56:36
bloomington
56:37
and the fifth one opening on the north
56:38
side of india later this year where most
56:40
patients can get access to genomic
56:42
sequencing within a week of referral
56:44
and i think as we continue to advance
56:46
our technologies
56:47
here at the university our advances in
56:49
genomics or advances informatics or
56:50
advances in drug development
56:52
we're passionate about translating that
56:54
to patient care as fast as possible
56:56
so what i think we'll see over the next
56:57
several years is continuing
57:00
and my hope is uh just like all
57:01
technologies in medicine it
57:03
starts off as a niche product and it's
57:05
done specialized centers
57:06
but eventually it becomes like a ct scan
57:08
in cbc and i hope that one day we'll see
57:11
genomics the same way
57:12
and it's those advances that will apply
57:14
to patients broadly
57:18
i totally agree with you i think that
57:21
that is the future
57:22
and being able to apply that in as many
57:23
different areas as possible
57:27
so we are close to out of time but i
57:29
invited additional questions we've
57:31
gotten two extra ones
57:33
if you're willing to stay just an extra
57:35
minute i'm going to see if we can just
57:36
quickly get these answered so that we
57:38
live up to my uh my promise uh that we
57:41
would
57:41
answer these uh answer these questions
57:44
and so the first question is could you
57:45
see the blood test uh being able to be
57:47
used with women at high risk
57:49
as a screening test for better defining
57:52
risk
57:54
uh yes and i want to i want to thank
57:56
connie
57:57
for that wonderful question and she's so
57:59
she's been a supporter of brian ice
58:00
since we were we babies here at
58:02
iu a long long time uh so thank you
58:06
uh and the answer is absolutely yes and
58:08
even more so uh we are doing that
58:10
experiment right now with the samples
58:12
from the ktb to look at the idea of
58:13
using ctda for high risk so 100
58:16
i think there is a future of using ct
58:18
dna particularly in high risk early
58:20
detection a lot of studies ongoing
58:22
right now in the field and we're engaged
58:25
as well
58:27
and then we also have a question about
58:29
how the precision health initiative
58:31
um parallels um the the type of work and
58:34
the focus we've seen on developing the
58:36
covid vaccine
58:37
in other words is this a if are there
58:40
are there comparisons are there lessons
58:42
to be learned is that sort of
58:43
focused intensive effort the the way of
58:46
the future of
58:47
addressing these vaccine challenging
58:49
health issue
58:50
yeah so this uh questioner did a much
58:52
more elegant job of just describing this
58:55
than i did but that was exactly where i
58:56
was going with this too
58:58
is that you know i think what you saw
59:01
with covet 19 and the development of
59:03
vaccines and
59:04
an incredibly short lifespan it is
59:06
really awe-inspiring and and potentially
59:08
has the
59:09
uh has the potential to change change
59:12
our future as we know it and
59:14
and certainly that is a similar sort of
59:16
approach that you know i think we've
59:17
taken
59:18
here and again as tachyana mentioned the
59:21
goal then is to take these lessons
59:23
learned
59:23
uh and then move them across different
59:25
diseases so absolutely
59:28
thank you and then just one last
59:30
question that snuck in under the wire
59:31
but it made it so i'm going to beg your
59:34
tolerance to
59:35
consider it do we have hard data that
59:36
demonstrates a survival benefit
59:39
for patients whose tumors undergo
59:41
genomic profiling
59:46
so i'll i'll i'll take a first swipe and
59:48
then i'll i'll uh
59:50
switch it over to milan so these tests
59:52
are
59:53
testing that question is incredibly
59:54
difficult to do because we are
59:56
again the idea of pro genomically
59:59
profiling transcends
60:01
the way we did things in the past which
60:03
is comparing therapy a
60:05
versus therapy being a given disease
60:07
type here we're taking a look at
60:08
specific pathways
60:10
the data to date though have shown that
60:12
those patients who do get genomic
60:14
profiling you know appear to do better
60:17
i think you know it has now become i
60:19
think essentially mainstay in the way we
60:21
approach metastatic disease
60:23
i think clinical trials like persevere
60:27
though which are addressing this
60:28
question the curative setting
60:30
are really poised to show whether or not
60:32
we can actually improve cure rates and
60:34
ultimately
60:34
that's the promise of precision medicine
60:36
and we hope it's real
60:38
milan yeah no 100 agree and
60:41
uh you know in particular when you
60:42
identify the genomic alteration you
60:44
treat the patient with the drug that's
60:46
matched that's where we're seeing some
60:47
amazing results particularly recent lung
60:49
cancer with several genomic targets a
60:51
couple in breast cancer and so on
60:52
um i think that's where we're seeing
60:54
some really great prospective trials
60:57
showing that a genomically directed
60:58
approach with a particular biomarker and
61:00
drug is efficacious for patients
61:02
but as dr schneider mentioned uh we're
61:04
really going to make our impact is when
61:05
we translate these findings into the
61:07
curative setting where the goal is not
61:09
just
61:09
overall survival but being able to
61:11
improve tier rate i think the more to
61:13
come in that arena
61:16
okay so let me just say again thank you
61:18
very much to all of our panelists
61:20
meredith a special thank you to you for
61:22
not
61:23
just sharing your story but also for the
61:25
important critical work you do
61:27
every day at riley we really appreciate
61:30
it we appreciate you taking the time to
61:31
be here with us and
61:33
um really for our three researchers let
61:35
me say again thank you for your time
61:36
thank you for your amazing work that you
61:38
do
61:39
even those of us who may not have the
61:40
particular condition you're researching
61:42
right now
61:43
we all i think get hope when we see this
61:45
type of work being done
61:47
christine thanks very much for handling
61:48
the questions and again i hope you'll
61:50
join us for our future
61:53
installments of our of our grand
61:54
challenge workshop series a chance to
61:56
learn a little bit more about these
61:58
um impact of these investments that iu
62:00
has been making
62:01
across the state and with partners
62:03
throughout indiana thanks very much and
62:05
have a good day and a good weekend