Description of the video:

00:00
hello and welcome to our webinar today
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uh
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part of our continuing series of
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webinars looking at the grand challenges
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at indiana university and their impact
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on the people of indiana and more
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broadly around the country
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today we look at precision health
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initiative the first grand challenge and
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we're focused in particular
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on its initiative focused on triple
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negative breast cancer and there'll be
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more explanation about what that is
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in just a moment but let me say we're
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going to do this very informally
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there'll be
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a few um opening questions i'm going to
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ask just to introduce our various
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panelists and give them a chance to talk
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at any time you can enter in questions
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into the q a
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and those we will get to i promise you
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we'll see that they all get answered if
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we don't answer them all now
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we'll certainly uh we'll certainly do so
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in writing later
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so um my first and happy job today is
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rather than introduce all the panelists
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at once we're going to do it
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one at a time and i want to first
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introduce
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dr brian schneider and brian schneider
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is the vera bradley chair of oncology
01:02
at the iu school of medicine he has many
01:05
many
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other titles but most important to this
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he is co-leader of the triple negative
01:10
breast cancer research team
01:12
that's part of the iu grand challenge of
01:15
precision health initiative
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and so uh brian i'm going to hand it
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over to you
01:20
all right well thank you fred and really
01:23
excited to talk a little bit about
01:25
some of the advances that we've done
01:27
here at iu and triple negative breast
01:28
cancer
01:29
but i think important so everybody's
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kind of on the same page
01:33
let's go over what exactly triple
01:35
negative breast cancer is
01:37
and you know as we think about cancer
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cancer is simply
01:40
uncontrolled growth of our own cells and
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so
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an analogy i often use with many of my
01:46
patients is it's like an automobile
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where the gas pedals kind of stuck on
01:50
so to me good precision medicine is
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being able to identify
01:54
that gas pedal and dislodge it without
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causing a lot of damage
01:59
so in many ways you know breast cancer
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is probably one of the hallmark diseases
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in terms of precision medicine
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it's been over 60 years ago that two of
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those gas pedals were discovered
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one the estrogen receptor the other
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progesterone receptor
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which simply means a lot of breast
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cancers have too many of these receptors
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or too many of these gas pedals
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and so simple things like the hormone
02:20
estrogen actually is like pouring
02:22
gasoline on a fire
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and so scientists through lowering
02:26
estrogen levels or
02:27
using simple tablets have been able to
02:30
kill many cancer cells with a very
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precise approach
02:34
without a lot of side effects as we fast
02:36
forward to the 1990s
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another gas pedal called her2 was
02:41
discovered
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and what's important about her too is
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it's common in breast cancer
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but importantly some drugs were
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developed drugs like
02:48
herceptin which substantially improved
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the
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survival of patients with this tough
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disease and in the year 2005
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a few pivotal studies showed we could
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markedly improve the cure rate by
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targeting her too
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so 2005 is a pivotal year at this time
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we have really good precision approaches
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for those that have the estrogen
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receptor
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the progesterone receptor and now her
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too
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this leaves everybody else those that
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don't have those three
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gas pedals and this became termed triple
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negative breast cancer
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so in many ways a derogatory term in
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that what it's not
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as opposed to what is it so what makes
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triple negative breast cancer though
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important in my mind is number one we
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don't have good targeted therapies
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so we're using a lot of the
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old-fashioned chemotherapy
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that works by non-specifically killing
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cells
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and in the course of doing this causes a
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lot of damage to our normal cells
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another important fact about triple
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negative breast cancer is it
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preferentially impacts young women
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and also black women but i think far and
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away most importantly
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it has a high mortality rate so it
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claims a lot of lives so this has been
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something we've been really passionate
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about here at iu
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is taking the triple negative aspects
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and really trying to uncover the
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positive
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but you know i think again as we think
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about today
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the most important part of all of this
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is how does it touch people how does it
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touch our patients
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and so we are blessed today to have an
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amazing
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story from one of our own meredith
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mcmahon
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who's going to tell a little bit about
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her journey meredith
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is someone i've known for over a decade
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now
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a friend she is a survivor
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she is also an amazing health care
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provider so she is
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the practice administrator for the
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division of hematology oncology at riley
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children's hospital
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so in addition to hearing her story
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about breast cancer you're going to be
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hearing this from somebody who takes
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amazing care of
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patients as well meredith
04:55
thanks dr schneider um so as he
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mentioned i
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um i am actually a nurse by training and
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i was a nurse in pediatric oncology
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um and i happened to be um at work
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uh one day when i sort of was
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discovered this diagnosis i um
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um was had
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i had a young child i had a 10 month old
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at the time that i was breastfeeding
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and for those of you who have been um
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have
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breastfed your children you realize you
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are touching your breasts more than you
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ever have in your whole life and i felt
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a lump and i thought it was
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a clogged milk duct um i had experienced
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that once before i called my ob and i
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said you know i just can't quite seem to
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get this clogged milk dug duck to
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resolve
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and um she said yeah let's let's just
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get an ultrasound and see
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so i said okay i'm at work i was at work
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i went down
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i was at iu north and i happened to be
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able to go to their breast center there
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and
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and had an ultrasound done and they said
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you know i think we should do a biopsy
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and i was by myself but again yeah i was
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uh 30 years old and i had a toddler and
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i was invincible right those were the
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things were going through my head i
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didn't think that i was going to need
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anybody else with me
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at the time and so i go down and they do
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the biopsy and immediately say you know
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there are some abnormal cells here
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we think you should call your husband
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and it's like
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whoa what does that mean
06:27
my mother also happens to be a breast
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cancer survivor and she
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had breast cancer she was a bit older
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she was 45 but also premenopausal
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so i was pretty familiar with this i was
06:39
young when she went through treatment
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but i had seen that i had seen it been
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there
06:42
done that and sort of always had that in
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the back of my mind and
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so this was a wednesday april 7th i can
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remember it and then on april 9th got
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the pathology back to determine that it
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was um triple negative breast cancer
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and uh also happened to be my my
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mother's birthday so it's
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it sticks in my mind um that april 9th
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was that day and um met dr schneider
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that next week
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and we came up with a plan pretty
07:11
quickly
07:13
to treat this cancer and i remember him
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saying
07:16
that uh the the outcomes
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he didn't put it in these terms but i
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knew the outcomes weren't good we talked
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about it
07:23
we knew what that was but that wasn't
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what it was going to be for me
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um i i
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knew that i had um a young family that i
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wanted to be there for and that i wanted
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to
07:36
um see my son grow up and get older and
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very fortunate to have been able to do
07:42
that
07:44
so we started i had a por porta cap
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placed so
07:49
an implanted central access where i got
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all my chemotherapy
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i did pretty standard
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breast cancer therapy at the time
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because as dr schneider mentioned that's
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what was available
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so it's called
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ac taxol basically so it's three
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different drugs that's what you get
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you get um adriamycin
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cytoxan and taxol and so that's
08:17
sort of the course that you go through
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that was the standard of therapy
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i dr schneider can connect correct me if
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i'm wrong but there was
08:26
um just a little bit of residual disease
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and then went in to have
08:30
a mastectomy and it's funny what you
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think you
08:34
want to control at the time because
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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
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it's now being controlled by this cancer
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and this cancer treatment
08:49
and so i decided to just have a single
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mastectomy at the time
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because i wanted to knowing that i was
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going to survive this
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i wanted to
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be able to breastfeed future children
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with the other breasts
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again probably not the most logical
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thinking at the time but
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it's all about i think for a patient
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it's about what you can control
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um so i had a single mastectomy and then
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went on to have um
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six weeks of radiation um after that
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so this what started on april 9th
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ended on november 4th of that same year
09:26
2010
09:27
i went on to have that following spring
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another mastectomy i had the other
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prophylactic mastectomy i had the other
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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
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uh six weeks of radiation therapy
09:54
and then all of a sudden came to a
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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
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did it
10:25
um and your focus has changed
10:29
um and you know i think this
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speaks a lot to the work that they're
10:34
doing now and i'm very fortunate to have
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to to be a survivor and to be in this
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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
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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
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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
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patients will have no cancer left at the
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time of surgery it's all dead scar
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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 iiu 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 trento 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 tadiana 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 tadiana 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