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How “Cancer Poop” Is Changing Cancer Care | The Eye Believe Podcast · The Eye Believe Podcast

• 0:03
  hey everybody
• 0:03
  welcome back to the Eye Believe Podcast
• 0:05
  I'm your host Danet Peterson
• 0:06
  and I'm here to chat with you guys about CT DNA
• 0:09
  and just kind of getting beyond the scans
• 0:11
  and we've got Dr Ma
• 0:12
  joining us from university of Wisconsin
• 0:15
  he's with the Carbone Cancer Center
• 0:17
  and you guys might recognize him from our
• 0:18
  Eye Believe seminars that we've had
• 0:20
  in the last couple of years
• 0:21
  he's been one of the medical oncologists
• 0:23
  who has participated in panels
• 0:24
  and talked about Hepzato Kit
• 0:26
  talked about just generally
• 0:28
  just about metastatic treatment
• 0:29
  and we are so excited to have you here with us
• 0:31
  Doctor Ma thanks for joining us
• 0:33
  thank you Danet
• 0:34
  for having me join this podcast
• 0:36
  looking forward to talking to you all
• 0:37
  yeah of course
• 0:38
  so okay
• 0:39
  I've been a uveal melanoma patient for almost six years
• 0:42
  and CT DNA is something that I have kind of heard
• 0:44
  noised about for probably the last four or five uh
• 0:48
  and you know in my oncologist office
• 0:50
  initially it was kind of like a well
• 0:52
  like
• 0:52
  we can't really find CT DNA of uveal melanoma in the blood
• 0:56
  it's like looking for a needle in a haystack
• 0:58
  and now we're kind of moving more toward okay
• 1:01
  but there there's some tests that are getting better
• 1:04
  they're getting more precise
• 1:06
  so if a patient with uveal melanoma
• 1:09
  probably metastatic or you know
• 1:10
  potentially high risk
• 1:11
  is hearing about CT DNA for the first time today
• 1:13
  in this episode
• 1:14
  what's maybe one of the most valuable insights
• 1:16
  you think they should walk away with our discussion
• 1:18
  or from our discussion with yeah uh
• 1:22
  no great question Danet
• 1:23
  I think
• 1:24
  as you kind of mentioned right
• 1:25
  this type of technology
• 1:27
  you know has really just sort of exploded
• 1:29
  you know sort of in the last couple of years
• 1:31
  you know
• 1:32
  previously you know
• 1:33
  it was something that we had more so done
• 1:35
  you know in a more preclinical setting
• 1:38
  and later we're starting to realize that
• 1:40
  you know we are able to pick up
• 1:41
  you know traces of DNA from your cancer in your blood
• 1:45
  and nowadays
• 1:46
  it's sort of reaching the opportunity for providers
• 1:49
  such as myself oncologist
• 1:51
  being capable of actually ordering these tests
• 1:53
  and being able to not only uh
• 1:55
  detect it but also quantify
• 1:58
  you know the amount of CT DNA in your blood
• 2:00
  and so you know
• 2:01
  this sort of technology has really just been exploding
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  uh not necessarily just in uveal melanoma
• 2:06
  but across different other cancers as well
• 2:09
  uh people are using them as a means to
• 2:11
  you know uh
• 2:12
  for surveillance you know
• 2:13
  to actually see if your cancer might be returning
• 2:16
  well before your scans come up
• 2:19
  um but we're also utilizing it
• 2:20
  as well for patients who are on treatment
• 2:22
  and tracking how that CT DNA level
• 2:25
  if it's going up you know
• 2:26
  if it's treatment's not working
• 2:28
  or if the DNA levels going down if
• 2:30
  if treatment is actually working
• 2:32
  so this sort of technology has been uh
• 2:34
  pretty phenomenal has been exploding
• 2:36
  becoming more readily available
• 2:38
  and I think uh
• 2:39
  coming out of this podcast
• 2:40
  I think what you should be aware of is
• 2:42
  these tests are available
• 2:43
  and I would say
• 2:44
  feel free to ask your provider
• 2:46
  if this is something that uh
• 2:48
  they feel comfortable ordering in their practice um
• 2:51
  and if it's something that
• 2:51
  you know yourself might be interested in doing
• 2:54
  yeah absolutely
• 2:56
  so um
• 2:57
  like he said you guys
• 2:58
  if you're listening please
• 2:59
  you know
• 3:00
  go into this maybe with your notes ready to be taken
• 3:02
  drop some comments in the comments
• 3:03
  if you're watching on YouTube
• 3:05
  and you have any questions
• 3:06
  and
• 3:06
  we'll try to get those answers back in a future date
• 3:10
  but but um
• 3:10
  before we dive into the CT DNA kind of test
• 3:13
  specifically um
• 3:15
  Doctor Ma
• 3:15
  can you just tell us a little more about your practice
• 3:17
  and how often you work with patients
• 3:19
  with metastatic uveal melanoma
• 3:21
  yeah absolutely
• 3:22
  so Danet as you mentioned
• 3:24
  so I'm a medical oncologist
• 3:26
  at the university of Wisconsin
• 3:27
  Carbone Cancer Center
• 3:28
  and the bulk of my practice is patients with melanoma
• 3:32
  and advanced skin cancer but
• 3:34
  I would say about 15 to 20% of my patient population
• 3:38
  are patients with metastatic uveal melanoma
• 3:41
  um and so in terms of like
• 3:43
  my practice
• 3:44
  and how I've been for example
• 3:46
  incorporating things like CT DNA
• 3:49
  I've been utilizing it in
• 3:50
  in actually two different specific realms
• 3:53
  one of which is
• 3:54
  for surveillance and the other is actually for
• 3:57
  for treatment monitoring
• 3:58
  to know if a patient's actually benefiting
• 4:00
  or responding to treatment
• 4:02
  now there's a couple of caveats
• 4:04
  you know
• 4:04
  typically when I say I use CT DNA in my practice
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  because
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  at this point
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  you know there's still ongoing studies right now
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  primarily to validate the use of CT DNA
• 4:17
  in in patients with advanced stage skin cancer
• 4:20
  uveal melanoma as well
• 4:21
  and as well as other solid cancers
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  and so um
• 4:24
  for my practice I would say um
• 4:26
  I've had discussions with patients
• 4:28
  about incorporating CT DNA
• 4:30
  in terms of monitoring and treatment
• 4:33
  but
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  but for the most part
• 4:34
  for my practice I do treat a good number of patients
• 4:37
  with uveal melanoma using a wide variety of other
• 4:40
  approved treatment options
• 4:41
  as well as clinical trials
• 4:43
  yeah absolutely
• 4:44
  so in managing like
• 4:46
  your case load of patients who have uveal melanoma
• 4:48
  what do you find as an oncologist
• 4:50
  makes treating metastatic uveal melanoma unique
• 4:53
  compared with like
• 4:54
  cutaneous melanoma or just other um
• 4:56
  other skin cancers yeah
• 4:58
  so I think you know
• 4:59
  when we treat patients with cutaneous melanoma
• 5:02
  you know we have a wide variety of different
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  systemic therapy options
• 5:06
  and we've actually seen a lot of great success
• 5:08
  with those treatment options
• 5:09
  particularly modern day immunotherapy
• 5:12
  also known as immune checkpoint inhibitors
• 5:14
  in fact
• 5:15
  you know
• 5:15
  we've seen a good number of these patients potentially
• 5:18
  you know even being cured with this therapy
• 5:20
  which is sort of unheard of years ago
• 5:23
  you know stage 4 patients
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  with cutaneous melanoma
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  but the problem particularly with uveal
• 5:30
  melanoma is that
• 5:31
  you know we don't have the same sort of luxury
• 5:33
  of having the same benefit
• 5:35
  with those therapies
• 5:36
  we use for stage 4 cutaneous melanoma
• 5:39
  and so the challenge we have right now is that
• 5:41
  you know
• 5:41
  there's only two FDA approved treatment options
• 5:44
  we can use for stage 4
• 5:46
  uveal melanoma and there are some logistical challenges
• 5:49
  with using some of those particular treatments
• 5:52
  you know for example
• 5:52
  for Tebentafusp you have to be
• 5:54
  you know
• 5:54
  HLA-A0201 positive to be eligible for the therapy
• 5:58
  and then for um
• 5:59
  the melphalan percutaneous hepatic perfusion therapy
• 6:02
  also known by the commercial name of Hepzato kit
• 6:05
  these patients have to only have liver only
• 6:08
  or liver dominant disease
• 6:09
  in order to be eligible and so
• 6:11
  you know as a medical oncologist
• 6:13
  we're sort of faced with you know
• 6:15
  what type of treatment options can we use
• 6:17
  that's FDA approved
• 6:18
  or using off label treatment options
• 6:20
  such as modern day immunotherapy
• 6:22
  to treat these patients yeah
• 6:24
  no for sure
• 6:25
  it's such a tricky thing
• 6:27
  so CT DNA let's kind of like
• 6:29
  help people understand if you're
• 6:30
  you know somebody's listening
• 6:31
  they just are like well
• 6:32
  what is what is a CT DNA test
• 6:34
  so do you wanna go ahead and define what that is
• 6:37
  yeah so
• 6:38
  you know the way I sort of described
• 6:40
  you know CT DNA is
• 6:42
  you know like every single cell in our body has
• 6:44
  you know DNA right
• 6:46
  that's like the foundation
• 6:47
  the building block of everything that sort of exists
• 6:49
  that's what leads to creation of things like proteins
• 6:51
  right
• 6:53
  similarly your cancer also has its own sort of like
• 6:57
  unique DNA right
• 6:58
  it's a little bit distinct from your own normal
• 7:01
  healthy tissue
• 7:02
  and so one of the things that we've sort of
• 7:04
  developed over the years
• 7:05
  is that we've started to recognize that these cancers
• 7:09
  in your body have their own
• 7:10
  sort of DNA makeup
• 7:11
  and you can physically try to detect them
• 7:13
  specifically in your blood
• 7:15
  now you might be sort of wondering well
• 7:17
  why CT DNA or why DNA in general
• 7:21
  and the way I sort of like to think about it is like
• 7:23
  DNA could be sort of seen as like
• 7:25
  a byproduct you know
• 7:26
  as cells you know
• 7:28
  die or turn over
• 7:29
  they're releasing that DNA into your bloodstream
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  it's like a byproduct think of it as sort of like
• 7:35
  one of the patients he's kind of described it to me
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  and I love it is you know
• 7:37
  think about CT DNA is cancer poop
• 7:41
  that you can sort of detect in your blood right
• 7:43
  and so you can actually detect it and quantify and
• 7:46
  and actually measure it as well
• 7:48
  I'm sorry
• 7:49
  um so
• 7:49
  that's actually how we can actually use the test
• 7:52
  nowadays to actually detect it
• 7:54
  so no
• 7:55
  that's great
• 7:56
  I was I have long thought
• 7:57
  I mean I've never heard of that
• 8:00
  I have kind of come to my own conclusion of it
• 8:02
  of the cancer noise test
• 8:04
  that's how I describe it to my family and friends
• 8:06
  but I like cancer poop a little better hahaha
• 8:08
  I'm sorry yeah okay
• 8:10
  that's that's a really good analogy um
• 8:12
  but that makes a lot of sense
• 8:14
  so
• 8:19
  I guess in the treatment space of melanoma
• 8:21
  of uveal melanoma what made you curious about
• 8:24
  just incorporating the testing into your own practice
• 8:27
  yeah so
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  you know what I will say is like
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  for years you know
• 8:32
  before the availability of circulating tumor DNA
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  you know I think the biggest challenge I face is that
• 8:38
  you know scans are typically what we use
• 8:40
  you know to monitor
• 8:41
  and see if a patient's benefiting from treatment
• 8:44
  or if their cancer has you know
• 8:46
  relapsed or recurred and I think a lot of times
• 8:49
  the frustrating thing is that
• 8:51
  you know all these
• 8:51
  although our scans are getting so much better
• 8:53
  over the years CT scans
• 8:56
  pet scans MRI's um
• 8:57
  there's still a lot of limitations
• 8:59
  you know it hasn't been
• 9:01
  you know sort of
• 9:01
  the best modality to pick up things
• 9:04
  like microscopic disease right
• 9:06
  you know there's certain thresholds
• 9:07
  where you wouldn't be able to detect it on say
• 9:10
  a pet scan MRI
• 9:11
  or CT scan and I really sort of thought to myself
• 9:14
  you know
• 9:15
  is there a better or newer technology that exists where
• 9:17
  you know maybe that's something that doesn't require
• 9:20
  you know exposure to radiation
• 9:22
  is there something that maybe
• 9:23
  doesn't require something as expensive
• 9:25
  like going through a scanner
• 9:27
  or taking up a much of a patient's time
• 9:30
  you know in order to to
• 9:31
  to to find out about the results and
• 9:33
  you know sort of
• 9:34
  the emergence of you know
• 9:36
  circulating tumor DNA
• 9:37
  has sort of been sort of a welcoming thing
• 9:39
  in my eyes because it's an alternative modality for us
• 9:43
  you know to sort of supplement
• 9:45
  you know potentially
• 9:46
  imaging
• 9:46
  to help detect cancer a lot better in the blood
• 9:50
  well and like
• 9:51
  if you think about too like
• 9:52
  those of you guys listening
• 9:53
  if you've ever had scans scans
• 9:55
  even if even
• 9:56
  even if you're on like
• 9:57
  a clinical trial and you have a more frequent scan like
• 10:00
  happening whether maybe they're doing an MRI
• 10:02
  like every
• 10:03
  I don't know like
• 10:03
  six to eight weeks I feel like
• 10:04
  is a pretty standard protocol for
• 10:06
  for clinical trials at least
• 10:08
  but even if you're having those scans
• 10:10
  there's definitely that aspect of like okay
• 10:12
  you're waiting you're trying the treatment
• 10:14
  and then the imaging
• 10:16
  can only show the treatment response so fast
• 10:19
  and I think that can be really kind of like
• 10:21
  an anxiety ridden period of time for patients
• 10:24
  I don't know if you guys can relate but
• 10:27
  but I feel like that's how it's been for me
• 10:29
  so it's kind of nice to have that kind of
• 10:30
  in between option I suppose
• 10:33
  yeah absolutely
• 10:35
  I mean as I said
• 10:36
  I think the CT DNA space has really
• 10:38
  just emerged pretty quickly
• 10:39
  and as of right now
• 10:40
  we're still waiting for studies to really prove
• 10:42
  you know can CT DNA eventually replace imaging
• 10:46
  I I think that that might
• 10:47
  potentially be the direction we go
• 10:49
  but you know
• 10:50
  as of right now
• 10:51
  while we're still trying to learn more and more
• 10:52
  about how CT DNA can be used
• 10:55
  what it's able to detect
• 10:56
  what's the sensitivity of the test
• 10:58
  you know right now I sort of see it as more of a
• 11:00
  a complementary test in addition to imaging um
• 11:04
  but you know
• 11:04
  to your point DNA
• 11:05
  I think one of the things I really like about
• 11:07
  you know ctdna is that
• 11:09
  you know when Tebentafusp
• 11:11
  you know was sort of being studied
• 11:12
  you know what they really learned was that
• 11:14
  and what we've learned especially in the uveal melanoma
• 11:16
  community is that
• 11:18
  maybe scans are maybe not the best test
• 11:21
  used to actually assess the benefit of treatment
• 11:24
  in patients with metastatic uveal melanoma
• 11:27
  you know what we've learned
• 11:28
  is that patients can benefit from treatment
• 11:31
  despite that ugly tumor getting bigger on your scans
• 11:35
  you know with Tebentafusp
• 11:36
  even though we don't see a lot of great tumor shrinkage
• 11:40
  what we learned particularly for Tebentafusp
• 11:42
  is that even though we extended the survival
• 11:44
  with the treatment and that's how it got FDA approved
• 11:48
  but what we learned is that almost 80%
• 11:50
  if not more actually had a circulating tumor DNA
• 11:54
  or CT DNA reduction during the course of therapy and
• 11:57
  and
• 11:58
  that might actually explain why the drug works so well
• 12:01
  even though we don't physically see shrinkage
• 12:03
  on the actual scans yeah
• 12:05
  and I mean you're right
• 12:06
  like that can be a really kind of mind blowing thing
• 12:08
  as a patient to wrap your head around
• 12:10
  is like well
• 12:10
  you're telling me that the treatment is working
• 12:12
  that it's helping but the tumor was
• 12:15
  I don't know
• 12:16
  it got bigger because it was inflamed briefly
• 12:18
  or it was the same size the entire time
• 12:20
  which obviously stability is fine
• 12:22
  but like
• 12:23
  in the cancer world
• 12:24
  I think there's this kind of expectation for us
• 12:26
  as patients
• 12:26
  that we would love to always just see shrinkage
• 12:28
  and I I would venture to say as doctors
• 12:30
  you guys would love to see that too
• 12:32
  but that doesn't always that's like
• 12:34
  not the cut and clear
• 12:35
  only way to show treatment works or that it's helping
• 12:38
  um
• 12:39
  anyway I
• 12:40
  I love what you said though
• 12:42
  yeah absolutely
• 12:43
  I mean you
• 12:44
  you can imagine as an oncologist
• 12:45
  you know
• 12:45
  it's always disheartening when a scan comes back and
• 12:48
  you know it's growing
• 12:49
  getting much worse but
• 12:51
  you know
• 12:51
  I think CT DNA offers that opportunity for us to
• 12:54
  kind of say maybe
• 12:55
  you know we need to think about this other result right
• 12:58
  maybe there's a positive
• 12:59
  or a silver lining to what we're seeing so far
• 13:01
  with treatment
• 13:02
  especially at this particular time point during
• 13:04
  yeah it
• 13:04
  it like
• 13:05
  it offers
• 13:06
  it just offers more information about what we're seeing
• 13:09
  like exactly
• 13:10
  and when we have more information
• 13:12
  we can ask more questions
• 13:13
  and when we ask more questions
• 13:14
  usually we have better medical practice
• 13:18
  and I think that's always a good thing
• 13:20
  okay so like
• 13:22
  we've got multiple CT DNA tests
• 13:24
  I know I've had multiple different types
• 13:25
  over the course of the last 5
• 13:27
  6 years as a patient just trying to make that attempt
• 13:30
  right at finding the cells
• 13:31
  the microscopic disease
• 13:33
  before it ever showed up in scans
• 13:34
  and you know
• 13:35
  some of them were not as you know
• 13:37
  they were just kind of like
• 13:38
  dismissed as uh
• 13:39
  maybe that one's not precise enough
• 13:40
  this one this one's not doing what we wanted
• 13:42
  um but you mentioned earlier
• 13:44
  and I I know that you told me earlier
• 13:45
  that you use a lot of the Signatera test
• 13:48
  so as a as a platform
• 13:50
  why did that stand out to you as a physician
• 13:52
  when you decided to start more regularly using CT
• 13:54
  DNA with patients
• 13:56
  yeah so
• 13:58
  you know
• 13:58
  Signatera really became a platform that I commonly use
• 14:01
  because um
• 14:02
  you know
• 14:02
  it sort of emerged initially in the colon cancer space
• 14:06
  and you know it
• 14:07
  it really had sort of um
• 14:08
  skyrocketed in terms of like
• 14:10
  commercial availability and so
• 14:12
  you know as somebody like myself
• 14:13
  who was really trying to look for other modalities
• 14:16
  to assess treatment benefit
• 14:18
  or to survey patients um
• 14:20
  this is really
• 14:21
  the one that just became so readily available
• 14:23
  and so I've really just kind of incorporated
• 14:25
  and this sort of this particular test into my practice
• 14:29
  and
• 14:29
  and you know
• 14:30
  with Signatera I would say
• 14:31
  I've been using it now for the last several years
• 14:34
  I have definitely found a lot of great benefit
• 14:36
  in its use for both surveillance
• 14:39
  treatment monitoring
• 14:40
  but you know
• 14:40
  there's a lot of limitations as well
• 14:42
  and you know
• 14:43
  as you can imagine the CT DNA space
• 14:46
  it's a lot of competition right now
• 14:47
  there's a lot of companies
• 14:48
  who are trying to develop newer technologies
• 14:51
  to to use this not only for
• 14:53
  you know say
• 14:53
  melanoma but other tumor types
• 14:56
  and there's even some platforms
• 14:57
  CT DNA platforms are also just specifically for uveal
• 15:00
  melanoma and so it's gonna be exciting to see
• 15:02
  you know as this technology
• 15:04
  is becoming more readily available
• 15:06
  on the commercial side it's gonna
• 15:07
  hopefully get a lot better in terms of detection and
• 15:10
  as well as for monitoring
• 15:11
  yeah okay
• 15:12
  so CT DNA can just be that like
• 15:15
  I mean I guess for sake of
• 15:16
  like a
• 15:17
  a simple explanation of how do you have a CT DNA test
• 15:21
  it's just a blood test right
• 15:23
  like they just draw your blood
• 15:24
  okay so if it's just a blood test
• 15:27
  I've kind of heard some
• 15:28
  some noise about between Natera and like
• 15:30
  other CT DNA d and
• 15:32
  oh my goodness
• 15:33
  other CT DNA tests that there can be
• 15:35
  like a tumor informed kind of a test
• 15:37
  so if it's a tumor informed CT DNA test
• 15:41
  what does that mean yeah
• 15:43
  great question because
• 15:44
  you know how I would sort of
• 15:45
  categorize
• 15:46
  the two main CT DNA tests that are available nowadays
• 15:49
  it's really two main ones
• 15:51
  one of them
• 15:51
  that's what we call tumor informed
• 15:53
  and the other is tumor agnostic
• 15:56
  so to talk a little bit about tumor informed
• 15:58
  which is what Signatera is
• 16:00
  so
• 16:00
  what you're doing is
• 16:01
  you're actually building a CT DNA test
• 16:04
  that is very explicit
• 16:06
  for the cancer that you're focused on
• 16:08
  and so what that commonly entails
• 16:10
  is that you have to submit a tumor tissue
• 16:13
  that was either biopsied or surgically removed
• 16:16
  and what you're doing is you're actually
• 16:18
  building a personalized test for that one patient
• 16:20
  for that specific patient right
• 16:23
  so what's really nice and advantageous about it is that
• 16:26
  you know as you're detecting
• 16:27
  or trying to detect CT DNA in your blood
• 16:30
  it is very specific
• 16:32
  it's very specific for that one cancer right
• 16:35
  and so
• 16:36
  that particular test is really using the genomic
• 16:38
  or the DNA features of your cancer
• 16:40
  that we're attempting to to monitor
• 16:42
  now contrast to that is
• 16:45
  you know we have the tumor agnostic
• 16:47
  which is you know
• 16:48
  you don't physically
• 16:49
  go into the patient's physical cancer
• 16:52
  to build the test what you're sort of doing
• 16:55
  is you're sort of generalizing mutations
• 16:58
  that you would typically expect with your cancer
• 17:02
  and so for this particular audience
• 17:04
  right where we're talking about uveal melanoma
• 17:07
  some of the most common mutations we typically see
• 17:10
  you know
• 17:10
  with uveal melanoma would be like BAP1 mutation
• 17:13
  SF3b1
• 17:14
  GNA11
• 17:16
  GNAQ so
• 17:17
  because if you encompass those four main mutations
• 17:21
  you can sort of just develop a test
• 17:23
  without physically
• 17:24
  going into the patient's previous biopsy
• 17:27
  or surgery specimen
• 17:28
  and you can just attempt to try to monitor
• 17:31
  the physical presence
• 17:32
  of that particular DNA alteration in the blood
• 17:35
  and so there's pros and cons
• 17:36
  as you can imagine to both
• 17:38
  but for the uveal melanoma space
• 17:40
  what's really nice is that
• 17:41
  if you encompass those four mutations
• 17:43
  I think you've captured at least 90%
• 17:45
  if not more of the uveal melanoma tumors
• 17:48
  DNA that you can detect in the blood
• 17:50
  you know
• 17:52
  when it comes to both
• 17:52
  in terms of sensitivity and specificity
• 17:55
  there's probably some variability between the two
• 17:57
  but as of right now
• 17:58
  those are kind of the main two major platforms
• 18:01
  yeah for sure
• 18:02
  okay so tumor informed versus tumor agnostic
• 18:05
  what's your personal preference
• 18:07
  yeah I mean
• 18:09
  like there's no
• 18:09
  nothing's on the line here
• 18:11
  you're not you're not being like yeah
• 18:13
  you know
• 18:13
  told that you have to only represent one company
• 18:16
  but like
• 18:16
  what's your personal preference as an oncologist
• 18:18
  as a researcher yeah
• 18:20
  I I have to say I
• 18:21
  I mean I kind of like the idea of both of them
• 18:23
  to be honest right
• 18:24
  I mean I love tumor inform because you're personalizing
• 18:27
  you know the test for the patient
• 18:29
  for that cancer right
• 18:31
  which I mean
• 18:31
  I really that makes sense to me
• 18:32
  like for sure
• 18:34
  absolutely that feels good
• 18:34
  because I like to feel important
• 18:36
  absolutely you gotta be the star right
• 18:38
  the patients are the star of the show right
• 18:40
  and so when we're talking about tumor informed
• 18:42
  I think
• 18:43
  what's really nice about it
• 18:44
  is that you're personalizing it right
• 18:46
  you're personalizing
• 18:47
  personalizing the approach for the cancer
• 18:48
  and so you know
• 18:49
  in my opinion I think when you're personalizing
• 18:51
  the test is a very high level of specificity
• 18:54
  so then that means you know
• 18:55
  like a false positive
• 18:57
  rate is likely to be very
• 18:58
  very low so that if you detect it in the blood
• 19:02
  you know for sure that you are detecting physically
• 19:05
  your cancer that's in the blood
• 19:08
  whereas I think for tumor inform
• 19:10
  you know tumor agnostic um
• 19:12
  I think the the
• 19:13
  the the challenge particularly for that is
• 19:15
  you know you're not necessarily guaranteed
• 19:17
  you know to necessarily detect
• 19:19
  you know the patient's DNA in your blood um
• 19:22
  because you know
• 19:22
  there might be that 10% chance
• 19:24
  where you may not actually be detecting
• 19:26
  that specific mutation that we thought of
• 19:28
  right for uveal melanoma
• 19:29
  those four main ones I mentioned
• 19:31
  so it really lacks that sort of
• 19:33
  what we call specificity that it's not very specific
• 19:36
  you know to your cancer
• 19:38
  now what I love about tumor agnostic is
• 19:41
  you know you can actually build the test
• 19:43
  the test is already made and
• 19:45
  you don't have to go back to the patient's
• 19:47
  tumor tissue
• 19:48
  the problem with tumor
• 19:50
  you know tumor informed assays
• 19:52
  is that you have to go back to the tumor tissue
• 19:54
  if you don't have enough tumor tissue to build the test
• 19:58
  then you can't participate in tumor informed CT
• 20:00
  DNA monitoring right
• 20:02
  so that's one of the biggest disadvantages I see
• 20:05
  particularly for that
• 20:06
  but you know
• 20:07
  there's definitely pros and cons to both of them
• 20:09
  and I would say you know
• 20:10
  my familiarity has been primarily with more
• 20:12
  the tumor informed CT DNA testing platform
• 20:15
  yeah no
• 20:15
  that makes sense and I wanna
• 20:16
  just for you guys listening
• 20:18
  if you're like well
• 20:18
  but wait like
• 20:19
  talk more about that we're gonna talk more about this
• 20:22
  this is just a little bit of
• 20:23
  like a teaser
• 20:23
  so to speak so please come back
• 20:25
  we're gonna have our webinar
• 20:26
  our next webinar is gonna be covering CT
• 20:28
  DNA in more depth
• 20:30
  we're gonna talk more about the data
• 20:31
  we're gonna talk about you know
• 20:32
  these kinds of kind of clinical questions of like
• 20:34
  okay well
• 20:35
  like I
• 20:36
  I just know somebody out there is listening
• 20:38
  and you're sitting here thinking the question well
• 20:41
  what if I don't have biopsy material
• 20:43
  can I have a biopsy done like
• 20:44
  I have a liver tumor can they just biopsy that
• 20:47
  hold those questions keep them in your head
• 20:49
  we're gonna come back to those kinds of questions later
• 20:52
  but
• 20:53
  Doctor Ma thank you so much for like
• 20:54
  these explanations and just kind of like
• 20:55
  laying them both out there
• 20:57
  openly and honestly I think it's really
• 20:58
  really helpful for our patient audience
• 21:00
  and so I kinda wanna cover
• 21:03
  you know in your clinical practice
• 21:05
  what have you noticed
• 21:07
  like
• 21:07
  in how patients are kind of receiving the information
• 21:10
  do you feel like it's helpful in
• 21:14
  I mean you mentioned how you're kind of
• 21:15
  supplementing it with scans right
• 21:17
  scans are supplemented by the CT DNA
• 21:19
  it's not like you're excluding
• 21:21
  excluding doing scans so
• 21:23
  have you
• 21:24
  have you found that there were moments where the CT
• 21:26
  DNA test that you did helped to like
• 21:28
  clarify something that the imaging alone couldn't
• 21:31
  absolutely no
• 21:32
  great question I mean
• 21:33
  I've seen a
• 21:34
  a wide range of different sort of patient responses
• 21:37
  you know to
• 21:38
  to the test itself and
• 21:40
  you know when I sort of present the test
• 21:42
  you know as something that
• 21:43
  you know if a patient wants to participate in
• 21:46
  you know I would say
• 21:46
  about 90% of individuals are very interested
• 21:49
  you know I think
• 21:50
  you know they
• 21:51
  patients come into it thinking that
• 21:52
  this is sort of a new cool technology
• 21:54
  you know it's a simple blood test
• 21:56
  if if I'm already
• 21:57
  as an oncologist planning to do blood test on you
• 22:00
  what's what's an extra couple tubes of yeah
• 22:02
  what's one or two more you know
• 22:04
  extra tubes of blood you know
• 22:05
  to kind of see you know
• 22:07
  how well you're benefiting from treatment
• 22:08
  so you know
• 22:10
  one of the things I often say
• 22:11
  say to patients that you do have to come into this
• 22:13
  you know with a major caveat
• 22:15
  which is you know
• 22:16
  we still need you know
• 22:17
  prospective studies we need more studies
• 22:20
  to really prove
• 22:21
  that this is something we can actually use in practice
• 22:24
  to actually tell me as an oncologist
• 22:27
  and to tell patients you know
• 22:28
  is the treatment actually working
• 22:30
  and do we actually need to change treatment
• 22:32
  but you know what I would say is how I've
• 22:34
  I've seen the success of you know
• 22:36
  CT DNA testing is that
• 22:37
  it actually
• 22:38
  has helped me clarify a lot of things on imaging
• 22:42
  you know
• 22:42
  sometimes when you get a scan and you see something
• 22:45
  like get bigger or something is like stable
• 22:48
  like your tumor is stable or it's getting bigger
• 22:51
  how I've sort of seen the CT DNA test
• 22:53
  is that if the CT DNA level is sort of going down
• 22:57
  that might actually be a better indicator that
• 23:00
  you know the cancer is
• 23:01
  is dying off that we're not
• 23:03
  we're not able to detect you know
• 23:05
  cancer poop in your blood
• 23:06
  because we just can't detect any viable tumor right
• 23:09
  um and so that's kind of like an indicator for me
• 23:12
  it's a way for me to give me and
• 23:14
  as well as the patient reassurance that that scan
• 23:17
  even though it doesn't look great
• 23:19
  we're seeing a fallen level
• 23:20
  so it's kind of giving
• 23:21
  sort of me and the patient a level of
• 23:23
  of comfort the other thing I've also have noticed
• 23:26
  and have you have seen as well
• 23:27
  is sometimes these scans you'll kind of see these like
• 23:30
  random things that kind of pop up right on your scan
• 23:33
  and you're like oh
• 23:35
  my gosh is my cancer getting worse
• 23:37
  is it spreading and in reality
• 23:39
  that extra additional spot you see on the scan
• 23:42
  it could potentially just be a benign finding
• 23:44
  but the CT DNA level test can actually give you
• 23:46
  that reassurance that you know
• 23:48
  if it's going down
• 23:50
  that extra spot or two or three or whatever you see
• 23:53
  is not necessarily your cancer getting worse right
• 23:56
  yeah and
• 23:56
  and what's really nice is that
• 23:57
  if I'm using a tumor informed CT DNA platform
• 24:01
  it's very specific right
• 24:03
  it's specific for your cancer
• 24:04
  so you know
• 24:05
  it's actually given me you know
• 24:07
  to some extent a lot of good
• 24:08
  you know sort of um
• 24:09
  reassurance about how patients are doing now
• 24:12
  I will admit though
• 24:13
  you know one of the disadvantages
• 24:15
  particularly with using CT DNA
• 24:17
  is that it does come with
• 24:19
  I think in my opinion
• 24:20
  a lot of anxiety as you can imagine right
• 24:23
  you know as you're checking these CT DNA results Danet
• 24:26
  I'd love to hear your thoughts about it too
• 24:28
  but you know
• 24:29
  as these results come back right
• 24:31
  is it great to know about these results every two
• 24:34
  every four weeks every six weeks or
• 24:37
  or is it better to just kind of
• 24:38
  wait until your scans come back right
• 24:40
  and so as part of my practice
• 24:42
  you know I offer the patients an opportunity
• 24:44
  do we wanna check it at every blood draw
• 24:46
  or do we wanna wait until we get it
• 24:48
  alongside with your scans
• 24:50
  right and to some extent
• 24:52
  these results don't often times come back
• 24:53
  you know in 24 hours
• 24:55
  they sometimes take a week or two sometimes
• 24:57
  to come back and so
• 24:59
  you know there's a lot of worry
• 25:00
  a lot of angst about what the results are gonna show
• 25:02
  and so you know
• 25:04
  sometimes these results you know
• 25:05
  come back and sometimes they
• 25:07
  they are discordant you know
• 25:08
  with what we see with the scans
• 25:10
  you know that can happen too
• 25:11
  but you know Danet
• 25:12
  I'd love to kind of hear your thoughts
• 25:13
  you know from a patient perspective
• 25:16
  you know do you find a lot of anxiety
• 25:18
  associated with these results
• 25:20
  so I would say yes and no
• 25:23
  um
• 25:25
  I think and that's one of the tricky things
• 25:26
  I think in the cancer community as patients
• 25:28
  is that we kind of tend to hold space for a lot of like
• 25:30
  both things are true
• 25:33
  and and
• 25:33
  that's one of the things
• 25:34
  that I've just had to really learn to do
• 25:36
  is to hold space for the fact that yes
• 25:37
  it can offer some level of reassurance
• 25:39
  while at the same time
• 25:40
  sometimes it provokes a little more anxiety
• 25:43
  like sometimes both things can be true at the same time
• 25:45
  or at different times
• 25:48
  I appreciate at least like
• 25:50
  just about the Natera platform
• 25:51
  like I like that I get a text message that says like
• 25:53
  hey we've received your test
• 25:55
  you can expect your results by this date
• 25:58
  like that's what I get in my portal
• 25:59
  and so that kind of helps me like
• 26:01
  park the anxiety just like
• 26:03
  on a personal level that just helps me like
• 26:05
  park it and be like okay well
• 26:06
  until we hit that date like
• 26:07
  I'm just not gonna stress about it
• 26:09
  it's fine
• 26:10
  because the test can only come back so fast
• 26:12
  right
• 26:13
  but I will say like
• 26:16
  I wish you know
• 26:17
  in retrospect like for
• 26:18
  for me as a patient like
• 26:19
  we did CT DNA pretty regularly for a little while
• 26:23
  and then we kind of like
• 26:24
  it just it just kind of got forgotten about
• 26:27
  and it was a tumor informed test
• 26:28
  but like
• 26:28
  we just kind of forgot to do it for probably
• 26:30
  like four or five scans
• 26:32
  and I didn't have anything going on
• 26:34
  on my scans at that point
• 26:36
  but then later that year or the
• 26:38
  later the next year was when I had
• 26:40
  you know recurrent disease or new
• 26:41
  new disease showing up in my liver
• 26:43
  and we didn't have a CT DNA
• 26:44
  kind of coinciding with that
• 26:46
  and I wish that we had
• 26:49
  and there you know
• 26:50
  for me there was
• 26:51
  you know it's like what you said
• 26:52
  you kind of gotta take this as data
• 26:55
  and also I think from the uveal perspective
• 26:58
  I look at this as you know
• 27:00
  no different than my doctor doing research
• 27:02
  studies of my blood just period like
• 27:04
  and the only way that research gets better
• 27:06
  and more precise is if I consent to doing it
• 27:10
  like we I
• 27:11
  I guess I just
• 27:12
  I just see this as the kind of thing where like okay
• 27:14
  maybe I'm not in a clinical trial
• 27:15
  this is one of the ways
• 27:16
  I'm participating in the ongoing research
• 27:18
  for the uveal
• 27:18
  melanoma space
• 27:19
  because this kind of test is constantly in trial for
• 27:24
  can we make it better can we get it more precise
• 27:26
  both for you as an individual
• 27:27
  but also for the whole metastatic
• 27:29
  uveal melanoma community so like
• 27:31
  I find it fulfilling empowering
• 27:34
  I don't know like it
• 27:34
  it feels good as a patient
• 27:36
  to feel like I'm participating in that way
• 27:38
  even if sometimes it feels like well
• 27:39
  is this even doing anything for me
• 27:41
  like I don't know
• 27:42
  maybe it is maybe it isn't
• 27:43
  I will say for me
• 27:44
  like in my disease
• 27:46
  I think that we saw a CT DNA increase
• 27:50
  with a much smaller presentation of metastatic disease
• 27:53
  than we expected like
• 27:55
  I went from having a steady zero for almost 2+ years
• 27:58
  like in my CT DNA
• 27:59
  even with known uveal melanoma in my liver
• 28:02
  like with one or two small cancer spots
• 28:04
  that and
• 28:05
  and to your point of the cancer
• 28:07
  you know the cancer noise
• 28:08
  the cancer discard the cancer poop um
• 28:12
  it just meant you know
• 28:13
  looking back it's been helpful because it's
• 28:15
  it's kind of made more sense of that as like okay
• 28:18
  well at that point
• 28:19
  it wasn't as active it wasn't doing whole
• 28:22
  it wasn't doing a whole lot
• 28:23
  and now you know
• 28:24
  when it did get elevated
• 28:27
  it wasn't fun like
• 28:28
  but it was also not crazy
• 28:29
  crazy high and so that you know it
• 28:31
  knowing what I knew about my own baseline
• 28:33
  and just having all these data points of oh
• 28:35
  it was at zero but now it's at like two point something
• 28:38
  it was it was helpful to just see that
• 28:40
  like OK
• 28:40
  yes a little more noisy
• 28:42
  it's talking a little more
• 28:43
  but like that doesn't necessarily mean
• 28:46
  I don't know like
• 28:47
  going from 0 to 2
• 28:48
  is not necessarily the same as seeing your CT
• 28:50
  DNA go from 0 to 5,000 like
• 28:53
  that's a really scary number
• 28:55
  like I think that would be
• 28:56
  that would be anxiety producing
• 28:58
  but at the same time if your scans show you're stable
• 29:00
  and your CT DNA shot up I would wanna know that
• 29:03
  I would wanna know because that would be
• 29:06
  that would be information for me as a patient
• 29:08
  and for my doctor to be like okay
• 29:10
  maybe we need to get on board with what's next
• 29:12
  like maybe
• 29:13
  maybe we need to be prepared
• 29:14
  and we could be wrong right
• 29:15
  the test could it could be
• 29:17
  it could be like fine
• 29:18
  it could turn out in a few weeks to be fine
• 29:19
  but I think it's it's good information to have
• 29:22
  I don't know if that answers your question sorry
• 29:24
  oh it's probably just no no
• 29:26
  I love that you're sharing your perspective because
• 29:28
  you know I
• 29:29
  I often times ask a lot of my patients that
• 29:31
  you know the option to say hey
• 29:33
  you know are we doing this too much
• 29:35
  you know do we want to opt out of doing this particular
• 29:38
  blood test because
• 29:39
  you know
• 29:40
  there are times where patients just can't sleep
• 29:42
  they're wondering what those results are
• 29:44
  and you know
• 29:44
  technically
• 29:45
  as we're still trying to use the CT DNA test about like
• 29:48
  how are we using this test
• 29:49
  to actually change our management
• 29:51
  you know we're not quite there yet
• 29:52
  it's still to some extent
• 29:54
  a degree of like
• 29:55
  you know research
• 29:56
  but but I will admit
• 29:57
  there are so many scenarios that I could tell you Danet
• 30:00
  you know that I've actually utilized the test
• 30:02
  and I've actually for me as a provider
• 30:04
  to find it very helpful so
• 30:06
  so for example
• 30:07
  just kind of like
• 30:07
  on a similar boat as you Danet
• 30:09
  I've had patients where you know
• 30:11
  they've undergone successful treatments
• 30:13
  of their uveal melanoma in the liver
• 30:15
  right whether it's a treatment with radiation
• 30:18
  surgery or Hepzato
• 30:19
  and then I put them through what we call
• 30:21
  a surveillance period you know
• 30:22
  I just do scans you know
• 30:24
  every two to three months
• 30:26
  and sometimes what I will typically do is like
• 30:28
  maybe I might check their CT DNA level
• 30:31
  maybe once a month maybe every two months
• 30:33
  but if at any moment I see that the CT
• 30:36
  DNA level goes from zero to a positive value
• 30:40
  then that might be an impetus for me to say hey
• 30:43
  I need to move up your scans a little bit sooner
• 30:46
  right yeah
• 30:46
  and if I get the scans up sooner
• 30:48
  and I happen to not see
• 30:51
  where the cancer is coming from because right
• 30:53
  if you can measure CT DNA in your blood
• 30:55
  there might be something that the cancer might be
• 30:57
  somewhere in your body then that means
• 30:59
  I might need to use a different imaging modality
• 31:02
  and what I have used in the past is
• 31:05
  if an MRI or a CT scan
• 31:07
  cannot detect where this melanoma DNA is coming from
• 31:11
  I'll use a pet scan and the pet scan has ended up
• 31:14
  for me
• 31:14
  showing that the DNA is actually coming from the bones
• 31:17
  you know
• 31:18
  and that's not as easily detectable based on MRI or CT
• 31:21
  and so you know
• 31:22
  the CT DNA test has actually helped me
• 31:24
  whether I like it or not
• 31:25
  whether it's still research or not
• 31:27
  it's actually told me like
• 31:28
  what I need to do to better inform
• 31:31
  detect the cancer much sooner
• 31:32
  so I can get them on treatment much faster as well
• 31:35
  well yeah
• 31:35
  like and it
• 31:36
  I mean I think it
• 31:36
  it sounds kind of like a okay
• 31:38
  I got this positive result
• 31:39
  I don't see it in the MRI on the liver
• 31:41
  I don't see it in the CT of the lungs
• 31:44
  then I'm gonna keep looking like that
• 31:45
  to me it's
• 31:46
  it's going back to what I said earlier
• 31:47
  like you've got to just keep asking the questions
• 31:49
  and that's what it provokes for you
• 31:50
  as a practice or as a practitioner
• 31:52
  is you get to go okay
• 31:54
  well it's positive somewhere where
• 31:57
  let's see what you know what other ways can we find it
• 32:00
  and and then if you still don't find it
• 32:02
  then now you just know OK
• 32:03
  we're just gonna monitor you a little more closely
• 32:05
  for a little while just to be safe
• 32:07
  right like
• 32:07
  and I guess as a patient
• 32:08
  I like that reassurance
• 32:10
  scans are anxiety producing enough as it is
• 32:13
  I've talked about that a lot
• 32:14
  like
• 32:15
  there's no way to avoid it
• 32:16
  like when we have imaging that comes up
• 32:18
  whether it's every three months
• 32:20
  sooner if you're on a clinical trial
• 32:23
  there's no way to avoid it
• 32:24
  and I think that you know
• 32:26
  sitting with that anxiety
• 32:27
  whether it's yearly or biannual
• 32:30
  or whatever frequency you
• 32:31
  as a patient have to deal with
• 32:33
  we have to just get better at doing that
• 32:35
  because it's it's a disservice to our care as patients
• 32:38
  I think
• 32:40
  to ignore possible information
• 32:42
  that could be helpful in determining okay
• 32:45
  should we do this should we move things up
• 32:46
  should we try something different
• 32:48
  I think those are like
• 32:49
  that's how that's how our treatments um
• 32:51
  the treatment landscape of uveal melanoma
• 32:53
  I think can get better is that
• 32:54
  you know it will get more precise
• 32:55
  and it only gets more precise if frankly
• 32:57
  if we as patients
• 32:58
  are willing to be a little bit uncomfortable
• 33:00
  absolutely no you
• 33:02
  you bring up a great point
• 33:03
  and I love hearing sort of the patient perspective
• 33:05
  I think it helps me and you know
• 33:07
  future researchers as well
• 33:08
  better understand like
• 33:09
  what do we how can we better develop our technology
• 33:11
  so that it becomes informative
• 33:13
  and helpful for patients right
• 33:15
  you know I think the big thing I often think about
• 33:17
  as well is like you know
• 33:18
  how can I make my patients live longer
• 33:20
  and have good quality of life right
• 33:22
  I think those are two important factors I think about
• 33:23
  as a medical oncologist you know
• 33:26
  I'm a firm believer where if you can detect it earlier
• 33:29
  you can treat earlier
• 33:30
  and patients are more likely to have a better outcome
• 33:33
  but what we haven't quite learned yet
• 33:35
  especially was CT DNA testing is
• 33:38
  you know does earlier detection
• 33:39
  and intervening upon it much earlier
• 33:42
  does that translate to better overall survival
• 33:45
  you know I think that's still an area
• 33:47
  I have to say as an area of ongoing research is
• 33:49
  you know how much does being aggressive with management
• 33:52
  earlier on actually translate to a much better outcome
• 33:54
  and so again
• 33:56
  as we're talking about research
• 33:58
  and using this particular test
• 33:59
  I think
• 33:59
  that's something that I look very much forward to and
• 34:02
  and that's why I I love it
• 34:03
  when patients are willing to participate in studies
• 34:06
  you know for a rare cancer like uveal melanoma
• 34:09
  we can only get better at treating it
• 34:10
  if patients agree and participate in studies
• 34:13
  you know to be involved in it and
• 34:15
  and we're very excited to publish
• 34:16
  a lot of the literature and data
• 34:18
  on using this test for this disease
• 34:20
  yeah I know
• 34:21
  I'm so excited so
• 34:22
  like we said
• 34:22
  we've got more coming for you guys this year
• 34:24
  really in the next like
• 34:26
  I mean it's spring guys
• 34:27
  like we've got lots coming
• 34:29
  but we've got our upcoming webinar
• 34:31
  and we're gonna have Doctor Ma back
• 34:32
  as well as
• 34:34
  some people who are gonna be representing
• 34:35
  kind of the scientific I don't know
• 34:37
  the scientific research side of things from Natera
• 34:40
  and we're gonna you know
• 34:41
  potentially
• 34:41
  bring in another doctor or two who are gonna help part
• 34:43
  participate in that webinar
• 34:45
  we've got some more like
• 34:46
  personal experiences about CT DNA coming your way
• 34:49
  and then
• 34:50
  Doctor Ma
• 34:51
  you have a publication coming out at ASCO this summer
• 34:53
  correct yeah
• 34:55
  we're we're
• 34:55
  or it's it's been submitted
• 34:57
  yeah yeah
• 34:57
  we've submitted a few abstracts
• 34:59
  really highlighting the utility and use of CT DNA
• 35:02
  and so
• 35:03
  you know we'll find out
• 35:04
  hopefully in the next couple months or so
• 35:05
  but we're excited to kind of
• 35:07
  you know publish more on this
• 35:08
  you know
• 35:08
  CT DNA platform and how it could be used in practice
• 35:12
  yeah absolutely
• 35:12
  okay so just to wrap up
• 35:14
  if you're listening and you're like
• 35:16
  okay but what do I bring to my doctor like
• 35:17
  what do I say
• 35:18
  what would you recommend a patient
• 35:21
  bring to their own physician
• 35:22
  if they're wanting to
• 35:22
  just ask about this in their next appointment
• 35:25
  yeah I would say
• 35:26
  you know
• 35:26
  if you're interested in learning more about CT DNA and
• 35:29
  you know
• 35:30
  seeing if it could be somehow integrated in your care
• 35:32
  I think it'd be good to just kind of ask your doctor
• 35:34
  is it something that you know
• 35:35
  they're familiar with
• 35:37
  not only are they familiar with it
• 35:38
  but is it something that they have
• 35:40
  integrated into their practice
• 35:41
  you know it does require a little bit of a workflow
• 35:44
  you know especially in the clinic setting
• 35:45
  to actually get the testing set up
• 35:47
  you know and organizing it
• 35:49
  coordinating the blood test
• 35:50
  so that's what I would encourage is
• 35:52
  you know if you've heard about it
• 35:53
  you're interested in learning more about it
• 35:55
  is it right for me do I have enough tumor tissue
• 35:57
  in order to build the test
• 35:59
  ask your provider and
• 36:00
  you know
• 36:01
  they can always learn a little bit more about it
• 36:02
  and inform you about the options that you can do
• 36:05
  yeah absolutely
• 36:06
  and I would also say too
• 36:07
  that like
• 36:07
  these kinds of tests
• 36:08
  also have really good patient advocate programs
• 36:11
  I know like
• 36:11
  the Signatera test has they have a patient advocacy
• 36:14
  like group where they can help
• 36:16
  they can help you as a patient
• 36:17
  kind of like
• 36:18
  bring it to your doctor if they don't have it set up
• 36:20
  and just kind of like
• 36:21
  show them hey
• 36:21
  this is how we can
• 36:22
  this is how we can get it integrated into your practice
• 36:25
  I found Signatera to be really
• 36:26
  really pleasant to work with
• 36:28
  as a patient
• 36:29
  from the you know
• 36:30
  getting the results standpoint to also just like
• 36:32
  talking with them in the back end of like
• 36:34
  like even for the billing and things
• 36:36
  at least my my experience so far
• 36:37
  has been that they kind of behave a little more like
• 36:39
  Castle BioSciences
• 36:41
  which is like you know
• 36:42
  at least for uveal patients
• 36:43
  if your insurance is struggling to
• 36:45
  you know foot the Bill or
• 36:47
  or to say yeah
• 36:47
  we're gonna do this
• 36:49
  Natera has been really good about utilizing
• 36:53
  just good ways to appeal on your behalf
• 36:55
  so that this does not become something that you
• 36:57
  as the patient have to like
• 36:58
  foot the bill for but again
• 37:00
  we can like
• 37:00
  we can talk more about that
• 37:01
  and kind of get into the nitty gritty of that
• 37:03
  in next episodes and in the webinar
• 37:05
  anyway okay
• 37:06
  well Doctor Ma
• 37:06
  this has been so fun uh
• 37:08
  I feel like the science
• 37:09
  the science stuff is so fun to talk about
• 37:11
  but I feel like you do such a good job of just
• 37:13
  bringing it to the patients
• 37:15
  and also giving us some fun analogies
• 37:17
  I would like I would like a poop emoji
• 37:20
  like I would like that to be put up on the screen
• 37:23
  at some point so I'm just
• 37:24
  you know gonna put that out there
• 37:26
  um
• 37:27
  but this has been really great
• 37:29
  and I really like
• 37:29
  I'm with you
• 37:30
  I look forward to seeing how the research can just
• 37:33
  continue to improve and um
• 37:35
  like what a gift it is that we
• 37:36
  as patients can participate to some degree
• 37:39
  yeah I'm excited about the future
• 37:41
  and thank you for having me join this podcast
• 37:43
  absolutely well
• 37:44
  thanks again to you guys for listening
• 37:45
  for subscribing if you haven't already
• 37:47
  on our YouTube channel or the podcast platform
• 37:49
  that you are choosing to listen on
• 37:51
  please share this share it with your doctor
• 37:53
  share it with your friends
• 37:54
  share it with your caregivers
• 37:56
  and just a huge thanks again
• 37:57
  to our current sponsors for the podcast
• 37:59
  we've got Delcath Systems and Ideaya Biosciences
• 38:04
  and just kind of the
• 38:06
  the support from the back end of everything
• 38:08
  so thank you guys for being here
• 38:09
  thanks for participating and we will see you next time
• 8:14
  when CT DNA kind of started first making its name made
• 38:02
  we couldn't do this without the sponsorship