Latest / The Eye Believe Podcast / 🧬 Genetic Metastatic Testing in Uveal Melanoma: Advancements & Challenges 🚀

Transcript

🧬 Genetic Metastatic Testing in Uveal Melanoma: Advancements & Challenges 🚀 · The Eye Believe Podcast

• 0:00
  We have
• 0:00
  Doctor
• 0:00
  moser
• 0:01
  uveal
• 0:01
  Melanoma,
• 0:02
  medical
• 0:02
  oncologist
• 0:03
  here in
• 0:03
  Scottsdale
• 0:04
  and
• 0:04
  our hosting
• 0:05
  doctor
• 0:05
  from
• 0:05
  Honor.
• 0:06
  Health
• 0:07
  Research
• 0:07
  Institute.
• 0:08
  Doctor
• 0:08
  moser
• 0:09
  has a
• 0:09
  special
• 0:09
  focus
• 0:10
  on uveal
• 0:10
  melanoma
• 0:11
  and has
• 0:12
  an active
• 0:12
  translational
• 0:14
  research
• 0:14
  program
• 0:15
  focused
• 0:15
  on
• 0:15
  a better
• 0:16
  understanding
• 0:16
  of this
• 0:17
  rare
• 0:17
  tumor.
• 0:18
  He is
• 0:18
  actively
• 0:19
  developing
• 0:19
  new
• 0:19
  clinical
• 0:20
  trials
• 0:20
  and
• 0:21
  treatment
• 0:21
  options
• 0:21
  for
• 0:22
  patients
• 0:22
  with this
• 0:22
  disease.
• 0:23
  We have.
• 0:24
  Peaches
• 0:25
  Ulrich.
• 0:25
  Doctor
• 0:26
  Ulrich
• 0:26
  has
• 0:26
  extensive.
• 0:27
  Background
• 0:27
  in
• 0:27
  molecular
• 0:28
  and
• 0:28
  cellular
• 0:29
  biology,
• 0:29
  immunology,
• 0:31
  and
• 0:31
  experience
• 0:32
  as a
• 0:32
  molecular
• 0:33
  science
• 0:33
  liaison.
• 0:34
  Throughout
• 0:34
  her
• 0:35
  career,
• 0:35
  she's
• 0:35
  developed
• 0:36
  a deep
• 0:36
  understanding
• 0:37
  of.
• 0:37
  Of the
• 0:37
  intricate
• 0:38
  workings
• 0:39
  of
• 0:39
  molecular
• 0:40
  and
• 0:40
  cellular
• 0:40
  systems,
• 0:41
  with a
• 0:41
  specific
• 0:42
  focus
• 0:42
  on
• 0:42
  immunological
• 0:43
  processes
• 0:46
  Doctor
• 0:46
  Moser
• 0:47
  and
• 0:47
  Doctor
• 0:47
  Ulrich,
• 0:48
  welcome
• 0:48
  to the stage.
• 0:50
  Thank you.
• 0:52
  Well,
• 0:52
  that was a
• 0:53
  long
• 0:53
  introduction,
• 0:54
  but
• 0:54
  it all
• 0:54
  basically
• 0:55
  means
• 0:55
  that I'm
• 0:55
  a little
• 0:56
  pocket
• 0:56
  nerd.
• 0:57
  I studied
• 0:58
  the
• 0:58
  immune
• 0:58
  system
• 0:59
  for a
• 0:59
  very
• 0:59
  long time
• 1:00
  in
• 1:00
  grad school,
• 1:01
  and now
• 1:01
  I work
• 1:02
  with a
• 1:02
  company,
• 1:03
  a
• 1:03
  disclaimer
• 1:04
  called.
• 1:04
  Caris
• 1:05
  but
• 1:05
  essentially
• 1:06
  we do
• 1:06
  somatic
• 1:06
  testing,
• 1:07
  like a
• 1:07
  lot of
• 1:07
  other tests
• 1:08
  that
• 1:08
  I'm sure
• 1:08
  you've
• 1:08
  heard of.
• 1:09
  And so
• 1:10
  I was
• 1:10
  invited
• 1:10
  by Doctor
• 1:11
  Moser
• 1:11
  today
• 1:12
  to talk,
• 1:12
  just in
• 1:13
  general
• 1:13
  about
• 1:14
  somatic
• 1:14
  testing.
• 1:15
  What is it?
• 1:16
  Why do we do
• 1:17
  it?
• 1:17
  How
• 1:17
  do we do
• 1:17
  it?
• 1:19
  slides,
• 1:20
  but we're
• 1:20
  going to
• 1:20
  kind
• 1:21
  of wing
• 1:21
  it today
• 1:21
  and just
• 1:22
  we can
• 1:23
  make this
• 1:23
  a
• 1:23
  discussion
• 1:24
  based
• 1:24
  and
• 1:24
  ask your
• 1:25
  questions
• 1:25
  very
• 1:25
  informally.
• 1:28
  I think
• 1:28
  we all
• 1:28
  know
• 1:28
  about the
• 1:29
  genetic
• 1:29
  testing
• 1:30
  of
• 1:30
  primary
• 1:30
  tumors
• 1:30
  through
• 1:31
  castle
• 1:31
  So I'll
• 1:32
  just
• 1:32
  start
• 1:32
  by giving
• 1:33
  kind of a
• 1:33
  high
• 1:33
  level
• 1:34
  overview
• 1:34
  about,
• 1:35
  you know,
• 1:35
  the
• 1:35
  different
• 1:35
  types of
• 1:36
  genetic testing.
• 1:37
  And then
• 1:37
  we can
• 1:38
  talk
• 1:38
  about
• 1:38
  the
• 1:39
  somatic
• 1:39
  tests
• 1:39
  in
• 1:39
  metastatic
• 1:40
  tumors
• 1:40
  if that's
• 1:41
  okay.
• 1:41
  Yeah.
• 1:42
  So you
• 1:43
  know, as
• 1:43
  most
• 1:43
  of us
• 1:43
  are aware,
• 1:44
  when
• 1:44
  you have
• 1:45
  a tumor
• 1:45
  in the eye,
• 1:46
  we can
• 1:46
  do
• 1:47
  genetic
• 1:47
  testing
• 1:47
  on that
• 1:48
  tumor
• 1:48
  with a
• 1:48
  biopsy
• 1:49
  through
• 1:49
  Castle.
• 1:50
  And
• 1:50
  that's
• 1:50
  really
• 1:51
  a focused
• 1:52
  genetic test
• 1:53
  where
• 1:53
  they're
• 1:53
  looking
• 1:54
  at
• 1:54
  certain
• 1:55
  types
• 1:55
  of RNA
• 1:57
  or DNA
• 1:58
  to try
• 1:58
  to
• 1:59
  predict
• 1:59
  how
• 1:59
  aggressive
• 2:00
  the tumor
• 2:00
  is
• 2:00
  going to be.
• 2:02
  And so
• 2:02
  when
• 2:02
  you have
• 2:03
  genetic
• 2:03
  tests,
• 2:03
  you can always
• 2:04
  gene test
• 2:05
  the person
• 2:06
  or
• 2:06
  the tumor.
• 2:08
  So that's
• 2:08
  one
• 2:08
  of the tests
• 2:09
  where
• 2:09
  we test
• 2:09
  the tumor.
• 2:10
  And we're
• 2:10
  doing it
• 2:11
  in a
• 2:11
  focused
• 2:12
  way
• 2:12
  to try
• 2:12
  to
• 2:12
  predict
• 2:13
  something.
• 2:14
  We
• 2:14
  then have
• 2:15
  where
• 2:15
  you can
• 2:15
  test
• 2:15
  the person.
• 2:16
  So
• 2:17
  I think
• 2:17
  this is
• 2:18
  most
• 2:18
  commonly
• 2:19
  seen in
• 2:20
  breast
• 2:20
  cancer
• 2:21
  right.
• 2:21
  We
• 2:21
  know that
• 2:21
  there's
• 2:22
  different
• 2:22
  mutations
• 2:23
  you can be
• 2:23
  born with
• 2:23
  maybe
• 2:24
  in brca
• 2:25
  where
• 2:25
  we can
• 2:25
  test
• 2:26
  your DNA
• 2:27
  to see
• 2:27
  if
• 2:28
  you are
• 2:28
  at higher
• 2:28
  risk for
• 2:29
  getting cancer.
• 2:31
  And then
• 2:31
  once
• 2:31
  patients
• 2:32
  develop
• 2:32
  metastatic
• 2:33
  cancer
• 2:33
  that
• 2:33
  spread
• 2:34
  and we
• 2:34
  can't
• 2:35
  cut it
• 2:35
  out,
• 2:35
  we can actually
• 2:36
  test
• 2:36
  the tumor
• 2:37
  genetics,
• 2:38
  not for a
• 2:39
  specific
• 2:39
  test or
• 2:40
  prognosis,
• 2:41
  but
• 2:41
  kind of
• 2:41
  as a
• 2:41
  shotgun
• 2:42
  approach
• 2:42
  and say,
• 2:43
  I,
• 2:43
  I call it
• 2:44
  a fishing
• 2:44
  expedition.
• 2:45
  We're
• 2:46
  basically
• 2:46
  testing
• 2:47
  the
• 2:47
  cancer
• 2:47
  to say
• 2:48
  what
• 2:48
  mutations
• 2:49
  or
• 2:49
  changes
• 2:50
  in
• 2:50
  the DNA
• 2:50
  or
• 2:51
  genetics
• 2:52
  has this
• 2:52
  tumor
• 2:53
  developed?
• 2:54
  either
• 2:55
  to better
• 2:55
  understand
• 2:56
  it or try
• 2:56
  to find
• 2:57
  a way
• 2:57
  that
• 2:57
  we can
• 2:58
  exploit
• 2:58
  that and
• 2:59
  use it
• 2:59
  to guide
• 3:00
  treatment.
• 3:00
  And
• 3:01
  that's
• 3:01
  really
• 3:01
  what this
• 3:02
  this talk
• 3:02
  is
• 3:02
  focused
• 3:03
  on, that
• 3:03
  kind of
• 3:04
  fishing
• 3:04
  expedition
• 3:05
  where we
• 3:05
  test
• 3:06
  everything
• 3:07
  to try to
• 3:08
  figure out
• 3:08
  is there
• 3:09
  a better
• 3:09
  treatment
• 3:10
  option
• 3:10
  or a
• 3:11
  personalized
• 3:11
  treatment
• 3:12
  option
• 3:12
  based
• 3:12
  on that
• 3:12
  genetic
• 3:13
  testing.
• 3:14
  And
• 3:14
  that's
• 3:14
  really
• 3:14
  what
• 3:15
  peaches
• 3:15
  specializes
• 3:16
  in.
• 3:16
  In her
• 3:17
  career.
• 3:18
  Thank you.
• 3:18
  I'm
• 3:18
  big on
• 3:19
  analogies
• 3:20
  and
• 3:20
  metaphors.
• 3:21
  I'm
• 3:21
  a visual
• 3:21
  person,
• 3:22
  so
• 3:22
  apologies
• 3:22
  for not
• 3:23
  having
• 3:23
  the slides,
• 3:23
  but I
• 3:24
  think
• 3:24
  about
• 3:24
  somatic
• 3:25
  testing
• 3:26
  as
• 3:26
  essentially
• 3:27
  looking
• 3:27
  at
• 3:28
  a house.
• 3:29
  So as
• 3:29
  an individual
• 3:30
  we are
• 3:30
  organisms.
• 3:31
  We're
• 3:31
  made
• 3:32
  up of
• 3:32
  different
• 3:32
  organs,
• 3:33
  and
• 3:33
  our organs
• 3:34
  are made
• 3:34
  up of
• 3:34
  different
• 3:34
  cells
• 3:35
  in the
• 3:35
  same way
• 3:36
  we have
• 3:37
  if
• 3:37
  we think
• 3:37
  about
• 3:38
  a house,
• 3:39
  a house
• 3:39
  is made
• 3:40
  up of
• 3:40
  different
• 3:40
  rooms,
• 3:41
  and
• 3:42
  every
• 3:42
  room has
• 3:43
  different
• 3:43
  features
• 3:44
  that
• 3:44
  make it
• 3:44
  a
• 3:44
  characteristic
• 3:45
  of
• 3:45
  that room.
• 3:46
  So
• 3:46
  if I walk
• 3:47
  into a room
• 3:48
  and
• 3:48
  there's
• 3:48
  a toilet,
• 3:49
  I think,
• 3:49
  hey,
• 3:49
  that's a
• 3:50
  bathroom.
• 3:50
  If I see
• 3:52
  an oven
• 3:52
  and a
• 3:53
  stove,
• 3:53
  I'm
• 3:53
  thinking
• 3:54
  the
• 3:54
  kitchen,
• 3:54
  a bed,
• 3:55
  a
• 3:55
  bedroom,
• 3:56
  and
• 3:56
  our bodies
• 3:57
  work
• 3:57
  the same way
• 3:58
  and
• 3:58
  just like
• 3:59
  you can
• 3:59
  have
• 3:59
  a house,
• 4:00
  it
• 4:00
  could be
• 4:00
  built in
• 4:01
  the 1960s
• 4:02
  or it
• 4:02
  could
• 4:02
  have been
• 4:03
  built
• 4:03
  yesterday.
• 4:04
  There's
• 4:04
  this
• 4:04
  master
• 4:05
  blueprint
• 4:05
  for houses.
• 4:06
  And
• 4:06
  that's
• 4:07
  how our
• 4:07
  DNA is.
• 4:08
  It's
• 4:08
  our DNA
• 4:08
  is the
• 4:09
  master
• 4:09
  blueprint
• 4:10
  of
• 4:10
  our bodies,
• 4:11
  whether
• 4:11
  it's,
• 4:12
  normal,
• 4:13
  healthy
• 4:13
  tissue.
• 4:14
  And
• 4:14
  sometimes
• 4:15
  what happens
• 4:15
  is those
• 4:16
  blueprints
• 4:16
  get
• 4:17
  messed up
• 4:17
  a little bit,
• 4:18
  and that
• 4:18
  leads to
• 4:19
  our cancer.
• 4:20
  And so
• 4:21
  just like
• 4:22
  a house
• 4:23
  can be
• 4:23
  made,
• 4:23
  and you,
• 4:24
  you walk
• 4:25
  in the door
• 4:25
  and
• 4:25
  there's
• 4:26
  a squeaky
• 4:26
  door.
• 4:27
  Hey,
• 4:27
  WD 40
• 4:28
  kind of
• 4:29
  an easy
• 4:29
  fix
• 4:29
  for it.
• 4:30
  And
• 4:30
  that's
• 4:30
  what
• 4:30
  we're
• 4:30
  looking
• 4:31
  at in
• 4:31
  cancer
• 4:32
  and
• 4:32
  somatic testing.
• 4:33
  What are those
• 4:34
  differences
• 4:35
  from the
• 4:35
  healthy
• 4:36
  tissue
• 4:36
  from the
• 4:37
  the
• 4:37
  manual
• 4:38
  blueprint.
• 4:39
  And how
• 4:39
  can we fix it.
• 4:41
  And so
• 4:41
  with
• 4:41
  a lot of
• 4:42
  traditional
• 4:42
  medicine,
• 4:43
  you know,
• 4:43
  our
• 4:43
  chemo,
• 4:44
  radiation,
• 4:44
  surgery,
• 4:45
  those are
• 4:45
  all
• 4:46
  part of
• 4:46
  the
• 4:46
  toolbox
• 4:46
  that are
• 4:47
  still
• 4:47
  used
• 4:47
  today.
• 4:48
  They're great.
• 4:49
  But with
• 4:50
  somatic
• 4:50
  testing
• 4:51
  it
• 4:51
  doesn't
• 4:51
  only
• 4:52
  tell you
• 4:52
  that
• 4:52
  there is a problem,
• 4:54
  it tells
• 4:54
  you more
• 4:55
  about
• 4:55
  what
• 4:55
  the problem
• 4:56
  is to
• 4:56
  inform
• 4:57
  treatment.
• 4:58
  So
• 4:58
  if you
• 4:58
  walk
• 4:58
  in your house
• 4:59
  and
• 4:59
  there's
• 5:00
  water
• 5:00
  all over
• 5:00
  the floor,
• 5:01
  is
• 5:02
  obviously
• 5:02
  there's
• 5:02
  a problem.
• 5:03
  But is
• 5:04
  it due to
• 5:05
  the
• 5:05
  faucet
• 5:05
  being
• 5:05
  left on,
• 5:06
  a pipe
• 5:07
  broke?
• 5:08
  Or maybe
• 5:08
  the city
• 5:09
  did some
• 5:09
  construction
• 5:09
  down
• 5:10
  the street,
• 5:11
  knowing
• 5:11
  which of
• 5:12
  those problems
• 5:12
  it is.
• 5:13
  The source
• 5:14
  is important
• 5:15
  because
• 5:15
  if you
• 5:16
  know the
• 5:16
  source of
• 5:16
  the problem,
• 5:17
  it
• 5:17
  gives you
• 5:17
  a better
• 5:18
  informed
• 5:18
  on the
• 5:18
  treatment,
• 5:19
  on how
• 5:19
  you're
• 5:19
  going,
• 5:20
  how
• 5:20
  the oncologist
• 5:21
  like
• 5:21
  doctor
• 5:21
  knows
• 5:22
  you're
• 5:22
  going to
• 5:22
  then
• 5:22
  treat
• 5:22
  your cancer.
• 5:24
  And so
• 5:24
  somatic
• 5:25
  testing
• 5:25
  is just
• 5:26
  that
• 5:26
  other
• 5:27
  side of
• 5:27
  traditional
• 5:28
  medicine
• 5:28
  that informs
• 5:29
  you more
• 5:30
  about how
• 5:30
  what is going
• 5:31
  what is different
• 5:32
  in your tumor
• 5:33
  then
• 5:33
  the healthy
• 5:33
  tissue
• 5:34
  and
• 5:34
  how can
• 5:35
  that
• 5:35
  information
• 5:36
  inform
• 5:36
  treatment.
• 5:37
  And so
• 5:38
  there's
• 5:38
  a lot of
• 5:38
  companies
• 5:39
  out
• 5:39
  there,
• 5:39
  just like
• 5:40
  Kerry's
• 5:40
  Tempest
• 5:40
  Foundation,
• 5:41
  lots
• 5:41
  that do
• 5:42
  genetic
• 5:42
  testing,
• 5:43
  but
• 5:43
  all of them
• 5:44
  are
• 5:44
  essentially
• 5:44
  looking
• 5:45
  for three
• 5:45
  major
• 5:46
  things
• 5:47
  changes
• 5:47
  in your
• 5:47
  DNA, in
• 5:48
  your RNA
• 5:50
  and
• 5:50
  protein,
• 5:51
  all these
• 5:52
  different
• 5:52
  things
• 5:52
  that can be
• 5:53
  changed
• 5:53
  in the,
• 5:54
  tumor
• 5:55
  tissue
• 5:55
  versus
• 5:55
  your
• 5:55
  healthy
• 5:56
  tissue.
• 5:59
  Great.
• 5:59
  So I
• 5:59
  think
• 6:00
  that's a
• 6:00
  really
• 6:00
  good
• 6:00
  overview
• 6:01
  of kind
• 6:01
  of what
• 6:01
  this
• 6:02
  testing
• 6:02
  is.
• 6:03
  So any
• 6:03
  questions
• 6:04
  on
• 6:04
  kind
• 6:04
  of the
• 6:04
  basics of
• 6:05
  what is
• 6:06
  somatic
• 6:06
  testing
• 6:07
  which is also
• 6:08
  tumor
• 6:08
  testing.
• 6:09
  Right.
• 6:09
  Somatic
• 6:10
  just
• 6:10
  means
• 6:10
  tumor
• 6:10
  testing.
• 6:13
  about
• 6:13
  that
• 6:13
  before
• 6:14
  we kind
• 6:14
  of go
• 6:14
  in deeper
• 6:15
  and start
• 6:15
  talking
• 6:15
  about
• 6:16
  the
• 6:16
  different
• 6:16
  types
• 6:16
  of tests
• 6:17
  that are
• 6:17
  out
• 6:17
  there.
• 6:17
  when we
• 6:18
  talk
• 6:18
  about,
• 6:19
  somatic
• 6:19
  testing
• 6:20
  features,
• 6:21
  that just
• 6:21
  means
• 6:21
  we're
• 6:21
  testing
• 6:22
  the tumor.
• 6:22
  But
• 6:22
  there's
• 6:23
  obviously
• 6:23
  different
• 6:23
  platforms
• 6:24
  out
• 6:24
  there.
• 6:24
  There's
• 6:25
  ways
• 6:25
  where
• 6:25
  you can
• 6:25
  test.
• 6:27
  let's
• 6:27
  start
• 6:27
  big
• 6:27
  picture
• 6:27
  first.
• 6:28
  So
• 6:28
  there's
• 6:28
  a lot of,
• 6:29
  tumor
• 6:30
  biopsy
• 6:30
  tests
• 6:30
  out
• 6:31
  there.
• 6:31
  And those
• 6:31
  a lot
• 6:31
  of blood
• 6:32
  tests
• 6:32
  out there.
• 6:33
  And
• 6:34
  you know
• 6:34
  I think
• 6:35
  the blood
• 6:35
  tests
• 6:35
  have
• 6:35
  really
• 6:35
  come on
• 6:36
  in
• 6:36
  the past
• 6:36
  couple
• 6:36
  of years
• 6:37
  where
• 6:37
  we can
• 6:37
  take your
• 6:38
  blood
• 6:38
  and ....
• 6:39
  your tumor.
• 6:40
  What are the
• 6:40
  big
• 6:40
  differences
• 6:41
  and
• 6:41
  advantages
• 6:42
  and
• 6:42
  disadvantages
• 6:43
  to
• 6:43
  taking a
• 6:44
  biopsy
• 6:45
  tissue
• 6:46
  and doing
• 6:46
  the
• 6:46
  sequencing
• 6:47
  of the
• 6:47
  tumor
• 6:47
  versus
• 6:48
  a blood
• 6:48
  sample of
• 6:49
  the patient,
• 6:49
  and
• 6:50
  trying
• 6:50
  to do
• 6:51
  the
• 6:51
  sequencing
• 6:51
  of
• 6:51
  the tumor.
• 6:52
  this
• 6:53
  whole
• 6:53
  expansion
• 6:54
  of,
• 6:55
  technology
• 6:56
  and
• 6:56
  science
• 6:56
  and
• 6:56
  everything,
• 6:56
  we have
• 6:57
  these two
• 6:57
  major
• 6:57
  groups,
• 6:57
  like you
• 6:58
  said,
• 6:58
  you take,
• 6:59
  a piece
• 7:00
  of tissue
• 7:01
  and we
• 7:01
  call it
• 7:01
  a
• 7:01
  snapshot.
• 7:03
  So
• 7:03
  when you
• 7:03
  take
• 7:03
  a biopsy,
• 7:04
  there's
• 7:05
  just a
• 7:05
  snapshot.
• 7:06
  It's like
• 7:06
  taking
• 7:06
  a
• 7:06
  picture.
• 7:07
  You're
• 7:07
  capturing
• 7:08
  what
• 7:08
  you took out
• 7:10
  and
• 7:10
  that's
• 7:10
  it.
• 7:11
  You're
• 7:11
  not
• 7:11
  getting
• 7:11
  anything
• 7:12
  that's
• 7:12
  surrounding
• 7:13
  nothing
• 7:13
  that
• 7:13
  may be
• 7:13
  circulating
• 7:14
  the blood.
• 7:14
  If
• 7:14
  there's
• 7:15
  metastatic
• 7:15
  sites,
• 7:16
  you're
• 7:16
  not
• 7:16
  capturing
• 7:17
  that.
• 7:17
  You're
• 7:17
  solely
• 7:17
  capturing
• 7:18
  that
• 7:19
  portion
• 7:19
  of tumor
• 7:20
  that
• 7:20
  you took out.
• 7:21
  And
• 7:21
  that is
• 7:21
  really
• 7:22
  advantageous
• 7:22
  for
• 7:23
  multiple
• 7:23
  reasons,
• 7:24
  is
• 7:24
  that
• 7:25
  you are
• 7:25
  getting
• 7:25
  that full
• 7:26
  picture.
• 7:26
  You're
• 7:27
  able to
• 7:27
  send that
• 7:28
  for
• 7:28
  sequencing.
• 7:29
  And
• 7:29
  tissue
• 7:30
  biopsies
• 7:30
  right now
• 7:31
  are
• 7:32
  highly
• 7:32
  more
• 7:32
  sensitive
• 7:33
  since
• 7:33
  it's,
• 7:35
  tissue
• 7:35
  that
• 7:35
  you can
• 7:35
  take and
• 7:36
  fully
• 7:37
  look at,
• 7:38
  you're
• 7:39
  able to
• 7:39
  determine
• 7:40
  the DNA,
• 7:40
  the RNA
• 7:41
  and the
• 7:41
  protein,
• 7:41
  what's
• 7:42
  going on
• 7:42
  inside
• 7:42
  the cells
• 7:43
  and on
• 7:44
  the cell
• 7:44
  surface.
• 7:45
  And
• 7:45
  so it's
• 7:46
  a
• 7:46
  snapshot
• 7:46
  where
• 7:47
  you're
• 7:47
  able to
• 7:47
  capture
• 7:48
  heterogeneity
• 7:49
  and
• 7:49
  everything
• 7:49
  like
• 7:49
  that.
• 7:50
  Now in
• 7:51
  contrast
• 7:52
  liquid
• 7:53
  biopsies
• 7:54
  are
• 7:54
  very advantageous
• 7:55
  because
• 7:56
  if a
• 7:56
  patient
• 7:57
  does have
• 7:57
  metastatic
• 7:58
  sites,
• 7:59
  essentially
• 7:59
  when you
• 7:59
  take a
• 8:00
  blood
• 8:00
  draw,
• 8:01
  you're
• 8:01
  taking
• 8:01
  a hodgepodge.
• 8:02
  If you're
• 8:03
  having,
• 8:04
  metastatic
• 8:04
  sites
• 8:05
  that are
• 8:05
  essentially
• 8:05
  shedding
• 8:06
  tumor
• 8:07
  into the
• 8:07
  body,
• 8:08
  into the
• 8:09
  blood,
• 8:09
  you're
• 8:10
  able to
• 8:10
  take a
• 8:10
  draw,
• 8:11
  all of that.
• 8:11
  So
• 8:12
  I think
• 8:12
  of doing
• 8:13
  a
• 8:13
  recording
• 8:14
  versus
• 8:14
  taking
• 8:14
  a snapshot.
• 8:15
  So
• 8:16
  your chances
• 8:16
  are that
• 8:16
  you're
• 8:17
  going
• 8:17
  to
• 8:17
  capture
• 8:18
  cancer
• 8:18
  information
• 8:19
  from
• 8:19
  multiple
• 8:20
  metastatic
• 8:20
  sites.
• 8:22
  And
• 8:22
  really
• 8:23
  one of
• 8:23
  the
• 8:23
  pros of
• 8:23
  doing
• 8:24
  this
• 8:24
  is that
• 8:25
  it's less
• 8:25
  invasive.
• 8:26
  No one wants
• 8:27
  to have
• 8:27
  a biopsy.
• 8:28
  And
• 8:28
  sometimes
• 8:28
  most of
• 8:28
  the time
• 8:29
  they
• 8:29
  can't
• 8:29
  have an
• 8:30
  additional
• 8:30
  biopsy.
• 8:31
  So that's
• 8:31
  where
• 8:32
  liquid
• 8:32
  testing
• 8:32
  really
• 8:33
  comes in.
• 8:33
  As a pro,
• 8:35
  however,
• 8:36
  there's a
• 8:36
  sensitivity
• 8:37
  issue
• 8:38
  when you're
• 8:38
  able
• 8:39
  to take
• 8:39
  that
• 8:39
  snapshot
• 8:40
  or that
• 8:40
  picture
• 8:41
  and do a
• 8:41
  tissue
• 8:41
  biopsy,
• 8:42
  the material is
• 8:43
  right
• 8:44
  there.
• 8:44
  You can
• 8:44
  see the
• 8:45
  tumor
• 8:45
  material,
• 8:45
  you know
• 8:46
  you have it
• 8:46
  and
• 8:47
  that can be
• 8:47
  analyzed.
• 8:48
  Whereas
• 8:49
  not all
• 8:50
  tumors
• 8:50
  shed and
• 8:51
  or mean
• 8:52
  that they
• 8:52
  spread.
• 8:53
  And
• 8:53
  you can
• 8:53
  capture it
• 8:54
  in the blood.
• 8:55
  And so
• 8:55
  it's a
• 8:55
  little
• 8:55
  harder
• 8:56
  in
• 8:56
  sensitivity
• 8:57
  to
• 8:57
  be
• 8:57
  able to
• 8:57
  do that.
• 8:58
  But
• 8:58
  in the
• 8:59
  absence
• 8:59
  of
• 8:59
  tissue,
• 9:00
  at least
• 9:00
  you have
• 9:00
  a backup
• 9:01
  which
• 9:01
  we use
• 9:02
  with
• 9:02
  liquid
• 9:02
  biopsies.
• 9:03
  And
• 9:03
  when we
• 9:03
  talk
• 9:03
  about
• 9:04
  sensitivity,
• 9:04
  what does that
• 9:05
  mean
• 9:05
  practically?
• 9:06
  Does
• 9:06
  that mean
• 9:06
  we're
• 9:06
  more
• 9:06
  likely to
• 9:07
  catch
• 9:07
  something?
• 9:07
  We're
• 9:08
  more
• 9:08
  likely to
• 9:08
  miss
• 9:08
  something
• 9:09
  that's there.
• 9:10
  What does that
• 9:11
  mean in
• 9:11
  kind of
• 9:11
  layman's
• 9:12
  terms.
• 9:12
  Yeah.
• 9:13
  So
• 9:13
  sensitivity
• 9:14
  is just
• 9:14
  what
• 9:14
  you said
• 9:15
  is that
• 9:15
  we're
• 9:15
  able to
• 9:16
  be highly
• 9:16
  sensitive
• 9:17
  in
• 9:17
  tissue,
• 9:18
  meaning
• 9:18
  that it's
• 9:19
  the
• 9:19
  tissue is
• 9:19
  actually
• 9:20
  there.
• 9:20
  You see
• 9:20
  the tumor.
• 9:21
  You've
• 9:21
  captured
• 9:22
  it versus
• 9:23
  in a
• 9:23
  liquid
• 9:23
  biopsy,
• 9:24
  there's
• 9:25
  less
• 9:25
  sensitivity
• 9:25
  in
• 9:26
  the fact
• 9:26
  that you
• 9:26
  can't
• 9:27
  always
• 9:27
  detect it
• 9:28
  because
• 9:28
  again,
• 9:28
  it's a
• 9:29
  hodgepodge.
• 9:29
  There's
• 9:29
  a lot of
• 9:30
  other
• 9:30
  things
• 9:30
  in that
• 9:31
  blood
• 9:31
  specimen
• 9:32
  outside
• 9:32
  of tumor.
• 9:33
  And so
• 9:33
  you're
• 9:34
  looking
• 9:34
  at your
• 9:34
  blood
• 9:34
  cells,
• 9:35
  your
• 9:35
  white
• 9:35
  blood
• 9:36
  cells,
• 9:38
  and
• 9:38
  everything else
• 9:38
  that can be
• 9:39
  found in
• 9:39
  blood.
• 9:40
  So
• 9:40
  you have to sift
• 9:41
  through
• 9:41
  things
• 9:41
  more.
• 9:42
  So
• 9:42
  if you have
• 9:43
  to sift
• 9:43
  through
• 9:43
  things
• 9:44
  more,
• 9:44
  your
• 9:44
  sensitivity
• 9:45
  kind of
• 9:45
  goes
• 9:45
  down.
• 9:46
  Whereas
• 9:46
  in tissue
• 9:47
  the tumor
• 9:48
  is
• 9:48
  blatantly
• 9:48
  right
• 9:49
  there.
• 9:49
  You can
• 9:49
  assess
• 9:50
  it.
• 9:51
  And
• 9:51
  I think
• 9:51
  one of
• 9:51
  the
• 9:51
  things
• 9:52
  that
• 9:52
  we're
• 9:52
  going
• 9:52
  to
• 9:52
  discuss
• 9:53
  in one
• 9:53
  of the
• 9:53
  later
• 9:54
  sessions
• 9:54
  about our
• 9:54
  circulating
• 9:55
  biomarkers
• 9:56
  is that,
• 9:57
  like
• 9:58
  peaches
• 9:58
  mentioned,
• 9:58
  not
• 9:59
  all cancers
• 10:00
  let their
• 10:01
  DNA float
• 10:01
  in the
• 10:02
  blood.
• 10:02
  And uveal
• 10:03
  melanoma
• 10:03
  is one of
• 10:04
  the ones
• 10:04
  where
• 10:04
  we know
• 10:05
  from
• 10:05
  really
• 10:05
  good data
• 10:06
  and
• 10:06
  really
• 10:06
  good
• 10:06
  studies
• 10:07
  that
• 10:08
  you're
• 10:08
  less
• 10:08
  likely
• 10:08
  to find
• 10:09
  uveal
• 10:10
  melanoma
• 10:10
  DNA
• 10:11
  in the
• 10:11
  blood of
• 10:12
  in
• 10:12
  patients
• 10:13
  with UVA
• 10:13
  melanoma
• 10:14
  than
• 10:14
  you are
• 10:14
  other
• 10:14
  types
• 10:15
  of
• 10:15
  cancer,
• 10:15
  like
• 10:15
  cutaneous
• 10:16
  melanoma
• 10:17
  or breast
• 10:17
  cancer.
• 10:18
  And so
• 10:19
  these
• 10:19
  liquid,
• 10:20
  biopsies
• 10:21
  can be
• 10:21
  easier.
• 10:22
  They can give
• 10:23
  you a
• 10:23
  more
• 10:23
  holistic
• 10:24
  picture
• 10:24
  because
• 10:24
  you're
• 10:24
  looking
• 10:25
  at
• 10:25
  everything
• 10:25
  versus
• 10:26
  just
• 10:26
  one spot,
• 10:27
  but
• 10:27
  you are
• 10:27
  more
• 10:28
  likely to
• 10:28
  miss
• 10:29
  stuff
• 10:29
  that's
• 10:29
  there
• 10:30
  because
• 10:30
  of that.
• 10:31
  And the
• 10:32
  other
• 10:32
  thing,
• 10:32
  just
• 10:32
  taking
• 10:33
  a step
• 10:33
  back,
• 10:33
  you know,
• 10:34
  here when
• 10:35
  we're
• 10:35
  talking
• 10:35
  about
• 10:36
  that
• 10:36
  liquid
• 10:37
  biopsy,
• 10:38
  we're
• 10:38
  talking
• 10:39
  about
• 10:39
  that
• 10:39
  fishing
• 10:39
  expedition
• 10:40
  where
• 10:40
  we're
• 10:40
  doing
• 10:41
  sequencing
• 10:41
  to say
• 10:42
  we want
• 10:42
  to
• 10:42
  sequence
• 10:43
  everything
• 10:43
  in the tumor
• 10:44
  and
• 10:44
  figure out
• 10:45
  what is
• 10:47
  what
• 10:47
  changes.
• 10:48
  There's
• 10:48
  a tumor.
• 10:48
  Have our
• 10:49
  conversation
• 10:50
  in about
• 10:50
  an hour
• 10:50
  or two
• 10:51
  where
• 10:51
  we're
• 10:51
  looking
• 10:51
  at
• 10:52
  circulating
• 10:52
  DNA is
• 10:53
  really
• 10:53
  more of a
• 10:54
  focused
• 10:54
  panel
• 10:55
  that
• 10:55
  we're
• 10:55
  using
• 10:56
  to guide
• 10:56
  and
• 10:57
  measure,
• 10:57
  not to
• 10:58
  really
• 10:58
  understand
• 10:58
  the biology.
• 10:59
  So
• 10:59
  they are
• 10:59
  a little
• 11:00
  different
• 11:00
  tests,
• 11:01
  that's
• 11:01
  important
• 11:02
  in
• 11:02
  regards
• 11:02
  to the
• 11:03
  likelihood
• 11:04
  of
• 11:04
  finding
• 11:04
  something
• 11:04
  or not.
• 11:05
  Because
• 11:05
  with
• 11:05
  liquid
• 11:06
  biopsies,
• 11:07
  the more things
• 11:08
  you look
• 11:08
  at
• 11:09
  and with
• 11:10
  tumor
• 11:10
  testing
• 11:11
  we want
• 11:11
  to look
• 11:11
  at
• 11:12
  everything
• 11:12
  for this
• 11:13
  discussion,
• 11:14
  the more likely
• 11:14
  you
• 11:14
  are to
• 11:15
  miss
• 11:15
  stuff
• 11:16
  where
• 11:16
  if you
• 11:16
  look at
• 11:17
  one
• 11:17
  thing,
• 11:17
  you're
• 11:17
  more
• 11:17
  likely
• 11:18
  to find
• 11:18
  that one
• 11:18
  thing.
• 11:19
  talking
• 11:19
  about
• 11:19
  the,
• 11:20
  tumor
• 11:20
  biopsies,
• 11:21
  you know,
• 11:21
  you're
• 11:22
  less
• 11:22
  likely
• 11:22
  to miss
• 11:23
  any changes
• 11:24
  that are
• 11:24
  there.
• 11:25
  There are
• 11:26
  different
• 11:26
  types.
• 11:26
  There's
• 11:27
  targeted
• 11:27
  panels.
• 11:28
  I think
• 11:28
  some are
• 11:29
  do
• 11:29
  a couple
• 11:29
  hundred
• 11:30
  genes.
• 11:30
  There's
• 11:30
  some
• 11:31
  that,
• 11:32
  sequenced
• 11:32
  the
• 11:32
  entire
• 11:33
  genome.
• 11:34
  There's
• 11:34
  some that
• 11:34
  sequence
• 11:35
  both DNA
• 11:36
  and RNA.
• 11:37
  Can
• 11:37
  you kind
• 11:37
  of
• 11:38
  discuss
• 11:38
  the
• 11:38
  differences
• 11:38
  of
• 11:39
  the panels
• 11:39
  and the
• 11:39
  advantages
• 11:40
  to the
• 11:40
  different
• 11:41
  methods
• 11:41
  that are
• 11:42
  out
• 11:42
  there?
• 11:43
  doing DNA
• 11:44
  and RNA
• 11:45
  assessment
• 11:45
  is as
• 11:46
  you can
• 11:46
  imagine,
• 11:47
  we have
• 11:47
  a lot
• 11:47
  of 23,000
• 11:48
  plus
• 11:49
  genes
• 11:49
  in our
• 11:49
  body,
• 11:49
  lots and
• 11:50
  lots of
• 11:50
  genes
• 11:51
  to
• 11:52
  be able
• 11:52
  to look
• 11:52
  at all
• 11:53
  of those.
• 11:53
  The
• 11:54
  technology
• 11:54
  has advanced
• 11:55
  quite
• 11:55
  a bit
• 11:56
  and so,
• 11:57
  so that
• 11:57
  it's
• 11:58
  somewhat
• 11:58
  cost
• 11:58
  efficient
• 11:59
  for us
• 11:59
  to be
• 11:59
  able to
• 11:59
  do this.
• 12:00
  Now
• 12:01
  when we
• 12:01
  look at,
• 12:02
  ihc
• 12:03
  or
• 12:03
  basically
• 12:04
  proteins,
• 12:04
  what's on
• 12:05
  the cell
• 12:05
  surface
• 12:06
  of your
• 12:07
  tumors,
• 12:08
  that's
• 12:08
  very
• 12:08
  advantageous
• 12:09
  for us.
• 12:09
  But
• 12:10
  that's
• 12:10
  one
• 12:10
  kind of
• 12:10
  test we
• 12:11
  call
• 12:11
  that,
• 12:12
  you know,
• 12:12
  surface
• 12:12
  and ihc
• 12:13
  a surface
• 12:14
  test.
• 12:14
  So
• 12:14
  tells us
• 12:14
  what's on
• 12:15
  the
• 12:15
  actual
• 12:15
  outside
• 12:16
  of it.
• 12:16
  Can it
• 12:17
  be
• 12:17
  targeted.
• 12:18
  There's
• 12:18
  a lot of
• 12:18
  your PDL
• 12:19
  ones or,
• 12:19
  and
• 12:20
  other,
• 12:21
  proteins.
• 12:22
  And so
• 12:22
  a lot
• 12:23
  of your
• 12:23
  local
• 12:23
  labs and
• 12:24
  requests
• 12:25
  and
• 12:25
  whatnot,
• 12:25
  they'll
• 12:25
  do those
• 12:26
  in-house.
• 12:26
  They can
• 12:26
  typically do that,
• 12:28
  but
• 12:28
  they don't
• 12:28
  have the
• 12:28
  technology
• 12:29
  to to do
• 12:30
  full
• 12:31
  exome
• 12:32
  or genome
• 12:32
  sequencing.
• 12:34
  And that
• 12:34
  comes to
• 12:35
  a lot
• 12:35
  of your
• 12:35
  commercial
• 12:36
  labs
• 12:36
  that many of
• 12:36
  you
• 12:37
  may be
• 12:37
  familiar
• 12:37
  with.
• 12:38
  So when
• 12:39
  we're
• 12:39
  talking
• 12:39
  about
• 12:39
  whole
• 12:40
  exome
• 12:40
  sequencing,
• 12:41
  we're
• 12:41
  basically
• 12:42
  looking
• 12:42
  or
• 12:43
  looking
• 12:43
  at at
• 12:44
  analyzing
• 12:45
  DNA
• 12:46
  and RNA
• 12:47
  that
• 12:47
  are,
• 12:49
  basically
• 12:50
  with
• 12:50
  whole
• 12:50
  genome
• 12:51
  sequencing.
• 12:51
  I'll just
• 12:52
  start
• 12:52
  there.
• 12:52
  That's a
• 12:52
  bigger
• 12:53
  picture.
• 12:53
  Yeah,
• 12:54
  it's it's
• 12:54
  a lot
• 12:54
  harder
• 12:55
  to do
• 12:55
  because
• 12:55
  you're
• 12:55
  looking
• 12:55
  at
• 12:56
  everything,
• 12:56
  everything
• 12:56
  that's
• 12:57
  going
• 12:57
  to be
• 12:57
  made
• 12:57
  or not
• 12:58
  be made.
• 12:58
  Whereas
• 12:58
  whole
• 12:59
  exome
• 12:59
  sequencing,
• 12:59
  it's
• 13:00
  a lot
• 13:00
  more
• 13:00
  targeted.
• 13:01
  So
• 13:01
  a lot of
• 13:02
  your DNA
• 13:02
  is what
• 13:03
  we call
• 13:03
  junk DNA.
• 13:04
  Yeah,
• 13:04
  it's
• 13:04
  there and
• 13:05
  there's
• 13:05
  nothing.
• 13:06
  And so
• 13:07
  genomic
• 13:08
  whole
• 13:08
  genome is
• 13:09
  you
• 13:09
  sequence
• 13:09
  everything,
• 13:10
  including
• 13:10
  the junk
• 13:11
  where
• 13:11
  a whole
• 13:12
  exome is
• 13:12
  saying,
• 13:13
  we're
• 13:13
  just
• 13:13
  going
• 13:13
  to
• 13:13
  sequence
• 13:14
  the stuff
• 13:14
  that
• 13:14
  we know
• 13:15
  actually
• 13:15
  has a
• 13:15
  biological
• 13:16
  purpose.
• 13:16
  Exactly.
• 13:17
  Yeah.
• 13:17
  And
• 13:18
  that's
• 13:18
  the
• 13:18
  difference.
• 13:18
  And
• 13:18
  it really
• 13:19
  and the
• 13:19
  importance
• 13:19
  of that
• 13:19
  goes back
• 13:20
  to what
• 13:20
  we
• 13:20
  discussed
• 13:20
  before.
• 13:21
  The more
• 13:21
  things
• 13:22
  you look
• 13:22
  at,
• 13:22
  the harder
• 13:23
  it is
• 13:23
  to know
• 13:23
  what's
• 13:23
  there.
• 13:24
  And so
• 13:25
  trying
• 13:25
  to
• 13:25
  focus on
• 13:26
  the non
• 13:26
  junk
• 13:27
  we think
• 13:27
  is
• 13:28
  advantageous.
• 13:28
  Exactly.
• 13:29
  And you
• 13:30
  know,
• 13:30
  again
• 13:31
  with
• 13:31
  hotspot
• 13:31
  panel.
• 13:32
  So I
• 13:32
  you know
• 13:33
  we always
• 13:33
  say ten
• 13:35
  years ago
• 13:35
  there were
• 13:36
  maybe 50
• 13:36
  or 100
• 13:37
  genes
• 13:37
  that were
• 13:38
  actually
• 13:38
  relevant
• 13:39
  in cancer
• 13:39
  that we
• 13:39
  needed to
• 13:40
  know
• 13:40
  about.
• 13:41
  Then
• 13:41
  it was
• 13:41
  300
• 13:42
  genes.
• 13:43
  So when
• 13:43
  we started,
• 13:44
  we
• 13:44
  call them
• 13:44
  hotspot
• 13:44
  panels,
• 13:45
  where
• 13:45
  we just
• 13:45
  look at
• 13:46
  those
• 13:46
  100 genes
• 13:47
  or those
• 13:47
  300
• 13:47
  genes,
• 13:48
  because
• 13:48
  those are
• 13:48
  the ones
• 13:48
  most
• 13:49
  valuable
• 13:49
  in
• 13:49
  knowing
• 13:50
  about.
• 13:51
  But we're
• 13:51
  seeing
• 13:51
  is that
• 13:52
  that
• 13:52
  number
• 13:53
  keeps
• 13:53
  increasing.
• 13:55
  Now
• 13:55
  it's up
• 13:55
  to 700
• 13:56
  and
• 13:56
  something
• 13:57
  genes
• 13:58
  that are
• 13:58
  relevant
• 13:58
  in
• 13:59
  cancer.
• 14:00
  And so
• 14:00
  we've
• 14:01
  moved out
• 14:01
  of this
• 14:02
  thought
• 14:03
  process
• 14:03
  of just
• 14:03
  doing
• 14:04
  what's
• 14:04
  currently
• 14:05
  relevant
• 14:05
  in cancer
• 14:06
  and
• 14:06
  expanding
• 14:07
  that
• 14:08
  by
• 14:08
  looking
• 14:08
  at whole
• 14:08
  exome,
• 14:09
  looking
• 14:09
  at
• 14:09
  everything
• 14:10
  essentially
• 14:11
  here,
• 14:11
  a lot of
• 14:11
  people
• 14:12
  say,
• 14:12
  well,
• 14:12
  that's
• 14:12
  a lot.
• 14:13
  Why would you be doing
• 14:14
  that?
• 14:14
  It's not
• 14:14
  even relevant
• 14:15
  right
• 14:15
  now.
• 14:16
  But then
• 14:16
  I can
• 14:17
  argue
• 14:18
  this gene
• 14:18
  wasn't
• 14:19
  relevant,
• 14:19
  you know,
• 14:19
  six
• 14:20
  months ago.
• 14:20
  And now
• 14:21
  it is.
• 14:21
  And so
• 14:22
  the
• 14:22
  advantage,
• 14:23
  the advantage
• 14:23
  of
• 14:23
  basically
• 14:24
  doing
• 14:24
  whole
• 14:24
  exome
• 14:25
  sequencing,
• 14:25
  not
• 14:25
  looking
• 14:26
  at just
• 14:26
  700
• 14:27
  genes,
• 14:27
  but
• 14:28
  looking
• 14:28
  at 20,000
• 14:30
  genes,
• 14:31
  is that
• 14:31
  when you
• 14:32
  do that,
• 14:32
  you're
• 14:32
  basically
• 14:33
  getting
• 14:33
  that
• 14:33
  whole
• 14:34
  molecular
• 14:34
  blueprint
• 14:35
  of your
• 14:35
  tumor
• 14:36
  right
• 14:36
  now.
• 14:37
  And so if
• 14:38
  there is
• 14:38
  something
• 14:39
  that may
• 14:39
  be
• 14:39
  changed
• 14:40
  in
• 14:40
  the tumor,
• 14:40
  if
• 14:41
  there's a
• 14:41
  clinical
• 14:41
  trial
• 14:42
  or
• 14:42
  therapy
• 14:43
  that may be
• 14:43
  upcoming,
• 14:44
  you don't have
• 14:45
  to retest
• 14:46
  for that
• 14:46
  tumor.
• 14:46
  You already know
• 14:47
  that that
• 14:48
  tumor
• 14:48
  harbors
• 14:48
  that
• 14:48
  alteration.
• 14:50
  And so we
• 14:50
  always
• 14:50
  say that
• 14:51
  every
• 14:51
  gene is
• 14:52
  going
• 14:52
  to be
• 14:52
  a cancer
• 14:52
  gene
• 14:53
  at some point.
• 14:54
  So
• 14:54
  why don't
• 14:54
  we test
• 14:55
  for it
• 14:55
  now?
• 14:55
  Why don't
• 14:56
  we get
• 14:56
  that full
• 14:56
  picture
• 14:58
  of all
• 14:58
  the
• 14:58
  genes and
• 14:59
  their
• 14:59
  status?
• 15:00
  And then
• 15:00
  if you do
• 15:00
  another
• 15:01
  biopsy,
• 15:01
  you can also
• 15:02
  see how
• 15:02
  it
• 15:02
  changes
• 15:03
  later on.
• 15:03
  But
• 15:04
  at least
• 15:04
  you get
• 15:04
  a
• 15:04
  snapshot
• 15:05
  snapshot
• 15:06
  of what's
• 15:06
  happening
• 15:07
  and
• 15:07
  not just
• 15:07
  a limited
• 15:08
  view of
• 15:08
  those
• 15:09
  hundred
• 15:09
  or 300
• 15:10
  genes,
• 15:10
  but
• 15:10
  everything
• 15:11
  that's
• 15:11
  going on.
• 15:12
  So that's
• 15:12
  a
• 15:12
  difference
• 15:12
  between
• 15:13
  a hotspot
• 15:14
  just
• 15:14
  looking
• 15:14
  at
• 15:14
  a couple
• 15:15
  hundred
• 15:15
  genes
• 15:16
  versus
• 15:16
  full
• 15:16
  exome
• 15:17
  sequencing,
• 15:17
  when you're
• 15:17
  looking
• 15:18
  at
• 15:18
  hundreds
• 15:19
  of genes
• 15:20
  at a
• 15:20
  time.
• 15:21
  And
• 15:21
  I think
• 15:21
  what
• 15:21
  you said
• 15:22
  is
• 15:22
  important,
• 15:22
  you know,
• 15:23
  in
• 15:23
  the future,
• 15:24
  everything,
• 15:24
  every gene
• 15:25
  will
• 15:25
  probably
• 15:25
  be
• 15:26
  a cancer
• 15:26
  gene.
• 15:26
  You know,
• 15:27
  doctor,
• 15:28
  may me
• 15:28
  who's
• 15:29
  over
• 15:29
  there
• 15:29
  and
• 15:29
  doctor
• 15:29
  McKean
• 15:30
  will be
• 15:30
  talking,
• 15:31
  soon
• 15:31
  about
• 15:31
  clinical
• 15:32
  trials.
• 15:32
  And we're
• 15:33
  seeing
• 15:33
  clinical
• 15:33
  trials
• 15:34
  come in
• 15:34
  with
• 15:35
  different
• 15:35
  ways of
• 15:36
  targeting
• 15:37
  vast
• 15:38
  number of
• 15:39
  mutations,
• 15:40
  that
• 15:40
  are
• 15:41
  coming in
• 15:41
  the pipeline
• 15:42
  that will be
• 15:42
  available
• 15:42
  both now
• 15:43
  and in 2
• 15:44
  or
• 15:44
  3 years.
• 15:44
  And so
• 15:45
  having
• 15:45
  that
• 15:45
  information
• 15:46
  is
• 15:46
  hugely important.
• 15:47
  So
• 15:47
  I always
• 15:48
  tell
• 15:48
  people
• 15:48
  if you're
• 15:48
  going
• 15:49
  to do
• 15:49
  genetic
• 15:50
  testing
• 15:50
  on
• 15:50
  the tumor,
• 15:51
  like I've
• 15:52
  already
• 15:52
  said,
• 15:52
  that's a
• 15:52
  fishing
• 15:53
  expedition.
• 15:53
  So I tell
• 15:54
  people
• 15:54
  if you're
• 15:54
  going
• 15:54
  to fish,
• 15:55
  fish
• 15:56
  don't
• 15:56
  half way
• 15:57
  fish,
• 15:57
  right.
• 15:58
  If you're
• 15:58
  going
• 15:58
  to do it,
• 15:58
  do it.
• 15:59
  And so
• 16:00
  it's
• 16:00
  really
• 16:00
  important
• 16:01
  if you're
• 16:01
  going
• 16:01
  to do
• 16:02
  these tests
• 16:02
  that you
• 16:02
  do these
• 16:03
  full
• 16:03
  panels,
• 16:04
  because
• 16:04
  most of
• 16:05
  the time
• 16:05
  you're
• 16:05
  not
• 16:06
  going to
• 16:06
  find
• 16:06
  anything
• 16:06
  that
• 16:07
  will affect
• 16:08
  how
• 16:08
  your cancer
• 16:08
  is
• 16:09
  treated
• 16:09
  or how
• 16:09
  your family
• 16:10
  member's
• 16:10
  cancer is
• 16:10
  treated.
• 16:11
  But
• 16:11
  you could
• 16:12
  and
• 16:12
  we've all
• 16:12
  found
• 16:13
  something
• 16:13
  that has
• 16:13
  changed
• 16:14
  the
• 16:14
  management
• 16:14
  and
• 16:14
  benefited
• 16:15
  the patients.
• 16:16
  And
• 16:16
  you also
• 16:17
  raise a
• 16:17
  good point
• 16:17
  if you're
• 16:18
  gonna get
• 16:19
  NGS
• 16:20
  testing.
• 16:21
  I feel like
• 16:21
  there's
• 16:22
  a lot
• 16:22
  of jargon
• 16:22
  in the field
• 16:23
  right
• 16:23
  now.
• 16:24
  NGS is
• 16:25
  used as
• 16:25
  a huge
• 16:26
  umbrella
• 16:26
  term
• 16:26
  for what
• 16:27
  we were
• 16:27
  talking
• 16:27
  about,
• 16:28
  about
• 16:28
  whole
• 16:28
  exome
• 16:29
  sequencing
• 16:29
  and
• 16:29
  whatnot.
• 16:30
  And so
• 16:30
  it's
• 16:30
  important
• 16:31
  I always
• 16:31
  advocate
• 16:32
  people
• 16:32
  to know
• 16:33
  what
• 16:34
  they're
• 16:34
  looking
• 16:34
  for
• 16:35
  and
• 16:35
  having
• 16:35
  those
• 16:35
  conversations
• 16:36
  with your
• 16:37
  oncologist
• 16:38
  as
• 16:38
  they're
• 16:38
  able to
• 16:38
  tell you
• 16:39
  what
• 16:40
  tests
• 16:41
  they'll
• 16:41
  be
• 16:41
  sending for
• 16:43
  and what
• 16:43
  that test
• 16:43
  is
• 16:44
  actually
• 16:44
  going
• 16:45
  to
• 16:45
  give you
• 16:45
  the
• 16:45
  results
• 16:46
  for.
• 16:46
  You can ask them
• 16:47
  how many
• 16:47
  genes
• 16:47
  are
• 16:47
  tested
• 16:48
  in my panel,
• 16:49
  and
• 16:49
  if they say
• 16:50
  100, 200,
• 16:51
  you
• 16:51
  kind of
• 16:52
  know it's
• 16:52
  a hotspot
• 16:53
  and maybe
• 16:53
  you can
• 16:53
  advocate
• 16:54
  for
• 16:54
  something
• 16:55
  larger.
• 16:55
  But
• 16:55
  of course
• 16:56
  it's
• 16:56
  always up
• 16:56
  to you
• 16:57
  and
• 16:57
  the oncologist,
• 16:58
  but just
• 16:58
  knowing
• 16:58
  kind of
• 16:59
  what
• 16:59
  you're
• 16:59
  looking for
• 17:00
  and that
• 17:01
  there are
• 17:01
  differences
• 17:02
  in these
• 17:02
  tests,
• 17:02
  I think
• 17:03
  are
• 17:03
  really
• 17:03
  important
• 17:03
  in your
• 17:04
  own
• 17:04
  journey.
• 17:05
  And and
• 17:06
  going
• 17:06
  there,
• 17:06
  speaking
• 17:07
  to that
• 17:07
  as well,
• 17:07
  you know,
• 17:08
  these
• 17:08
  platforms,
• 17:09
  this next
• 17:10
  generation
• 17:10
  sequencing
• 17:11
  or NGS
• 17:11
  testing
• 17:12
  is not
• 17:13
  cheap.
• 17:13
  Most of
• 17:14
  the time.
• 17:14
  Insurance
• 17:15
  covers
• 17:15
  it.
• 17:15
  And so
• 17:16
  insurance
• 17:16
  is
• 17:16
  paying a
• 17:17
  hefty price.
• 17:18
  But
• 17:18
  if you're
• 17:18
  going to
• 17:19
  have your
• 17:20
  insurance
• 17:20
  pay
• 17:21
  thousands
• 17:21
  of
• 17:21
  dollars
• 17:22
  for the
• 17:22
  test,
• 17:23
  pay
• 17:23
  thousands
• 17:23
  of
• 17:23
  dollars
• 17:24
  for the
• 17:24
  complete
• 17:24
  test
• 17:25
  is what I
• 17:25
  always
• 17:25
  say.
• 17:25
  Make sure
• 17:26
  you're
• 17:26
  getting
• 17:26
  all the
• 17:27
  information
• 17:27
  if you're
• 17:27
  going
• 17:28
  to pay
• 17:28
  for it.
• 17:29
  And
• 17:29
  thankfully,
• 17:30
  within
• 17:30
  the past
• 17:31
  couple
• 17:31
  of years,
• 17:31
  most of
• 17:31
  these
• 17:32
  panels
• 17:32
  have
• 17:32
  become
• 17:33
  very
• 17:33
  comprehensive.
• 17:34
  Pretty
• 17:34
  much
• 17:35
  complete
• 17:35
  genome
• 17:36
  or
• 17:36
  complete
• 17:37
  non junk
• 17:37
  genome.
• 17:39
  still are
• 17:39
  some very
• 17:40
  focused
• 17:40
  panels
• 17:40
  out
• 17:41
  there.
• 17:41
  And so
• 17:41
  just
• 17:41
  making
• 17:42
  sure you
• 17:42
  send the
• 17:42
  most
• 17:43
  broad one
• 17:44
  you can
• 17:44
  find is
• 17:45
  important.
• 17:46
  So that's
• 17:46
  kind of
• 17:47
  a big
• 17:47
  overview
• 17:47
  of the
• 17:48
  different
• 17:48
  tests.
• 17:48
  What
• 17:49
  questions
• 17:49
  do
• 17:49
  you guys
• 17:50
  have
• 17:50
  before
• 17:50
  we start
• 17:50
  talking
• 17:51
  about
• 17:51
  uveal
• 17:52
  melanoma
• 17:52
  genetics
• 17:53
  and how
• 17:53
  this is
• 17:53
  impacting
• 17:54
  treatment?
• 17:55
  in the
• 17:56
  next
• 17:56
  part.
• 18:01
  the
• 18:01
  question
• 18:01
  was
• 18:01
  have we
• 18:02
  heard of
• 18:02
  the
• 18:02
  gallery,
• 18:03
  tests
• 18:03
  that are
• 18:04
  supposed
• 18:04
  to detect
• 18:05
  cancer?
• 18:06
  And do
• 18:06
  we think
• 18:06
  it could
• 18:07
  pick up
• 18:07
  melanoma
• 18:08
  or uveal
• 18:09
  melanoma?
• 18:09
  So that's
• 18:10
  a great
• 18:11
  question.
• 18:11
  And
• 18:11
  the gallery
• 18:12
  test is a
• 18:12
  little
• 18:13
  different.
• 18:13
  So
• 18:14
  most of the time
• 18:15
  when
• 18:15
  we're
• 18:16
  when
• 18:16
  we're
• 18:16
  talking
• 18:17
  about
• 18:17
  these
• 18:17
  genetic
• 18:18
  tests
• 18:18
  and these
• 18:19
  liquid
• 18:19
  biopsies
• 18:20
  that
• 18:20
  we're
• 18:20
  discussing,
• 18:21
  we're
• 18:22
  looking to
• 18:22
  say
• 18:23
  are there
• 18:24
  changes
• 18:24
  in the DNA.
• 18:25
  So
• 18:25
  has the
• 18:25
  DNA
• 18:26
  changed?
• 18:27
  Its
• 18:27
  sequence
• 18:27
  has
• 18:27
  gotten
• 18:28
  shorter,
• 18:28
  gotten
• 18:28
  longer.
• 18:30
  This
• 18:30
  gallery
• 18:30
  test
• 18:31
  actually
• 18:31
  looks at
• 18:32
  the
• 18:32
  methylation.
• 18:33
  So on
• 18:33
  your DNA
• 18:34
  you have
• 18:34
  these
• 18:34
  little
• 18:35
  methyl
• 18:35
  groups.
• 18:36
  And then
• 18:37
  there's a
• 18:37
  different
• 18:37
  pattern
• 18:38
  of how
• 18:38
  those
• 18:39
  groups
• 18:39
  can be
• 18:39
  on there.
• 18:40
  And
• 18:40
  so that
• 18:40
  really
• 18:41
  looks
• 18:41
  at this
• 18:41
  methylation
• 18:42
  pattern.
• 18:42
  And then
• 18:43
  can
• 18:43
  predict
• 18:43
  cancer
• 18:45
  in the
• 18:45
  current
• 18:45
  version
• 18:46
  of the test
• 18:47
  you know
• 18:47
  they can
• 18:47
  detect
• 18:48
  all cancers.
• 18:49
  And these
• 18:49
  were
• 18:49
  validated
• 18:50
  on very
• 18:51
  big trials
• 18:52
  I don't know
• 18:53
  off
• 18:53
  the top
• 18:53
  of my head
• 18:54
  if uveal
• 18:55
  melanoma,
• 18:56
  how
• 18:56
  well that
• 18:57
  was
• 18:57
  represented
• 18:58
  in those
• 18:58
  trials
• 19:00
  usually
• 19:00
  rare
• 19:01
  cancers
• 19:01
  like this
• 19:02
  are not
• 19:02
  that well
• 19:03
  represented.
• 19:03
  And so
• 19:04
  the tests
• 19:04
  are not
• 19:04
  as good
• 19:06
  for rare
• 19:07
  tumor
• 19:07
  such as
• 19:07
  uveal
• 19:08
  melanoma
• 19:08
  as
• 19:08
  they are.
• 19:09
  And more
• 19:09
  common
• 19:09
  cancers
• 19:10
  like
• 19:10
  lung,
• 19:11
  breast,
• 19:11
  prostate,
• 19:12
  etc..
• 19:13
  The other
• 19:13
  thing
• 19:13
  about
• 19:14
  those
• 19:14
  tests is
• 19:15
  they're
• 19:16
  still new
• 19:16
  and we're
• 19:16
  still
• 19:16
  learning,
• 19:17
  you know,
• 19:17
  in the
• 19:18
  current
• 19:18
  version
• 19:18
  of the test,
• 19:19
  if
• 19:19
  it comes back
• 19:20
  saying
• 19:21
  that you
• 19:21
  have
• 19:21
  cancer in
• 19:22
  your
• 19:22
  blood
• 19:23
  for,
• 19:24
  let's
• 19:24
  say, for
• 19:24
  example,
• 19:25
  breast
• 19:25
  cancer,
• 19:26
  there's a
• 19:26
  44%
• 19:27
  chance
• 19:27
  that you
• 19:27
  actually
• 19:28
  don't.
• 19:29
  That is a
• 19:29
  false
• 19:29
  positive.
• 19:30
  And so
• 19:31
  I think
• 19:32
  the is
• 19:33
  advancing
• 19:33
  the newer
• 19:34
  versions
• 19:34
  of that
• 19:34
  test
• 19:35
  are in trial.
• 19:36
  So
• 19:36
  I think
• 19:36
  they will
• 19:36
  get
• 19:37
  better
• 19:37
  with
• 19:37
  time.
• 19:38
  Right now
• 19:38
  I'd be hesitant
• 19:39
  to you
• 19:40
  put
• 19:40
  too much
• 19:40
  weight
• 19:41
  on it
• 19:41
  for uveal
• 19:42
  melanoma.
• 19:42
  Just
• 19:42
  because I
• 19:43
  don't
• 19:44
  know if
• 19:44
  it was
• 19:44
  adequately
• 19:45
  represented
• 19:46
  and how
• 19:46
  the test
• 19:46
  was
• 19:46
  developed.
• 19:47
  And
• 19:47
  a test
• 19:48
  is only
• 19:48
  as good
• 19:48
  as
• 19:49
  how
• 19:49
  well you
• 19:49
  trained
• 19:49
  it.
• 19:51
  Yeah,
• 19:51
  I don't
• 19:52
  know
• 19:52
  if you
• 19:52
  have any
• 19:52
  thoughts
• 19:52
  on that.
• 19:53
  I think
• 19:53
  it's
• 19:53
  exciting.
• 19:54
  It's
• 19:55
  again,
• 19:55
  that
• 19:55
  whole
• 19:56
  expansion
• 19:56
  of liquid
• 19:57
  biopsies
• 19:58
  and it's
• 19:58
  the
• 19:58
  new kid
• 19:59
  on the
• 19:59
  block
• 19:59
  essentially
• 20:00
  in
• 20:00
  testing,
• 20:01
  again,
• 20:02
  the data
• 20:02
  is going
• 20:03
  to take
• 20:03
  a little
• 20:03
  while
• 20:04
  to catch
• 20:04
  up.
• 20:04
  So I'm
• 20:05
  always a
• 20:05
  strong
• 20:05
  advocate
• 20:06
  like the
• 20:06
  Nccn
• 20:07
  guidelines.
• 20:07
  And
• 20:08
  if you
• 20:08
  have
• 20:08
  tissue,
• 20:09
  that's
• 20:09
  what you
• 20:10
  want to
• 20:10
  send.
• 20:10
  But
• 20:10
  with all
• 20:11
  these
• 20:11
  additional
• 20:11
  tools
• 20:12
  with
• 20:12
  liquid,
• 20:12
  it's it's
• 20:13
  getting
• 20:13
  more and
• 20:13
  more
• 20:13
  exciting,
• 20:14
  especially
• 20:15
  with,
• 20:15
  you know,
• 20:15
  early
• 20:16
  detection
• 20:17
  and
• 20:17
  being able
• 20:18
  to
• 20:18
  determine
• 20:19
  if it's
• 20:19
  there's
• 20:20
  likely to
• 20:20
  be
• 20:20
  recurrence
• 20:21
  and
• 20:21
  everything.
• 20:21
  So we're
• 20:22
  in a
• 20:22
  really
• 20:23
  neat time
• 20:24
  of of
• 20:25
  science
• 20:25
  and
• 20:25
  advancements.
• 20:27
  So
• 20:27
  the question
• 20:28
  was for
• 20:28
  people
• 20:28
  who are
• 20:28
  like five
• 20:29
  years out
• 20:29
  are there
• 20:30
  any research
• 20:30
  looking
• 20:31
  at liquid
• 20:31
  biopsies
• 20:32
  to try
• 20:32
  to
• 20:32
  understand
• 20:33
  what's
• 20:33
  going on
• 20:33
  in the
• 20:34
  genetics
• 20:34
  of
• 20:34
  the tumor?
• 20:35
  And from
• 20:36
  my
• 20:36
  understanding,
• 20:37
  there's
• 20:37
  nothing
• 20:37
  in that
• 20:38
  particular
• 20:39
  area.
• 20:40
  Now.
• 20:40
  There's
• 20:41
  a lot
• 20:41
  of work
• 20:42
  on trying
• 20:42
  to
• 20:42
  develop
• 20:43
  blood
• 20:43
  based
• 20:44
  biomarkers
• 20:44
  so
• 20:45
  that can
• 20:45
  be
• 20:45
  circulating
• 20:46
  tumor
• 20:46
  cells,
• 20:46
  circulating
• 20:47
  hybrid
• 20:47
  cells,
• 20:48
  circulating
• 20:48
  DNA.
• 20:49
  And I
• 20:50
  believe
• 20:50
  our
• 20:50
  we have a panel
• 20:51
  on that
• 20:51
  later
• 20:52
  this afternoon.
• 20:53
  Those are
• 20:53
  more
• 20:54
  focused
• 20:54
  panels
• 20:55
  or
• 20:55
  focused
• 20:55
  tests
• 20:55
  really
• 20:56
  trying
• 20:56
  to ask
• 20:57
  the question
• 20:57
  of can
• 20:58
  we
• 20:58
  detect
• 20:59
  the
• 20:59
  cancer
• 21:00
  in the blood
• 21:00
  so we can
• 21:01
  follow
• 21:01
  and
• 21:02
  monitor
• 21:02
  it to
• 21:02
  predict
• 21:03
  recurrence
• 21:04
  or
• 21:04
  response?
• 21:05
  that
• 21:06
  is it's a
• 21:06
  similar
• 21:07
  technology,
• 21:08
  but it's
• 21:08
  a different
• 21:08
  application
• 21:09
  of it
• 21:09
  than
• 21:10
  saying
• 21:11
  we're
• 21:11
  going
• 21:11
  to try
• 21:11
  to
• 21:11
  sequence
• 21:12
  the
• 21:12
  entire
• 21:13
  tumor, to
• 21:13
  try to
• 21:14
  understand
• 21:14
  what's
• 21:14
  driving
• 21:15
  the tumor
• 21:15
  and
• 21:15
  how
• 21:15
  we can
• 21:16
  treat it.
• 21:17
  And
• 21:17
  a lot
• 21:17
  of that
• 21:17
  goes back
• 21:18
  to
• 21:18
  how big
• 21:19
  of a scope
• 21:19
  you look
• 21:20
  at.
• 21:20
  You know,
• 21:20
  to
• 21:20
  really do
• 21:21
  the full
• 21:21
  sequencing,
• 21:22
  you need
• 21:22
  a good amount of DNA.
• 21:24
  So
• 21:24
  I don't know
• 21:25
  if
• 21:25
  there
• 21:26
  ever
• 21:26
  will be
• 21:26
  a situation
• 21:27
  where
• 21:27
  someone
• 21:28
  has no
• 21:29
  disease
• 21:29
  on
• 21:29
  their scan,
• 21:30
  and
• 21:31
  we're
• 21:31
  able
• 21:31
  to do
• 21:31
  a somatic
• 21:32
  tumor
• 21:33
  test like
• 21:33
  Peter's
• 21:34
  is
• 21:34
  talking
• 21:34
  about,
• 21:34
  where
• 21:35
  we can
• 21:35
  get all
• 21:35
  that
• 21:35
  information
• 21:36
  just
• 21:37
  because
• 21:37
  if we
• 21:37
  if it's
• 21:38
  not on
• 21:38
  scans,
• 21:38
  there's
• 21:39
  probably
• 21:39
  not going
• 21:39
  to be
• 21:39
  enough
• 21:40
  DNA
• 21:40
  available
• 21:41
  to
• 21:42
  actually
• 21:42
  run the
• 21:42
  test.
• 21:45
  Yeah,
• 21:45
  absolutely.
• 21:45
  that's
• 21:47
  very
• 21:47
  important
• 21:48
  and we
• 21:48
  take it
• 21:48
  very
• 21:48
  seriously
• 21:49
  as a
• 21:49
  scientific
• 21:50
  community,
• 21:51
  is that
• 21:51
  there are
• 21:52
  a lot of
• 21:52
  different
• 21:52
  changes
• 21:53
  that
• 21:53
  can happen
• 21:54
  in your
• 21:54
  DNA, RNA,
• 21:55
  protein.
• 21:55
  There
• 21:56
  actually
• 21:56
  aren't
• 21:56
  going to
• 21:56
  go on
• 21:57
  to have
• 21:58
  a
• 21:58
  functional
• 21:59
  effect.
• 21:59
  They're
• 21:59
  not
• 22:00
  going to
• 22:00
  cause
• 22:00
  cancer.
• 22:01
  And
• 22:01
  maybe
• 22:01
  we just
• 22:01
  don't
• 22:02
  know
• 22:02
  enough
• 22:02
  about
• 22:03
  that
• 22:03
  alteration
• 22:04
  right
• 22:04
  now.
• 22:05
  And so
• 22:05
  there is
• 22:06
  a
• 22:06
  classification
• 22:08
  of how
• 22:08
  we,
• 22:09
  provide
• 22:10
  a title,
• 22:11
  basically
• 22:11
  label
• 22:12
  if it's
• 22:12
  going to
• 22:12
  be
• 22:12
  cancerous
• 22:13
  or not,
• 22:13
  if it's
• 22:14
  going to
• 22:15
  contribute
• 22:15
  to cancer
• 22:15
  or not.
• 22:16
  And so
• 22:18
  you don't
• 22:18
  want
• 22:18
  to talk
• 22:18
  about,
• 22:19
  oh,
• 22:19
  we sequenced
• 22:19
  22,000
• 22:20
  genes.
• 22:20
  All this
• 22:21
  information
• 22:21
  that
• 22:21
  would be
• 22:21
  in an
• 22:22
  encyclopedia,
• 22:23
  essentially
• 22:24
  way too
• 22:24
  much
• 22:24
  information.
• 22:25
  So
• 22:26
  I can speak
• 22:27
  to cares
• 22:27
  at least.
• 22:27
  And a
• 22:28
  lot of
• 22:28
  this
• 22:28
  happens
• 22:29
  in the
• 22:29
  background
• 22:29
  with
• 22:29
  much of
• 22:30
  the
• 22:30
  bioinformatics,
• 22:31
  is we
• 22:31
  look at
• 22:32
  the
• 22:32
  mutations
• 22:33
  we see
• 22:33
  about the
• 22:33
  relevance
• 22:34
  in that
• 22:35
  specific
• 22:35
  tumor
• 22:36
  type,
• 22:36
  the
• 22:36
  relevance
• 22:37
  of that,
• 22:38
  mutation
• 22:39
  in other
• 22:39
  tumors.
• 22:40
  Does it
• 22:41
  play a
• 22:41
  role in,
• 22:42
  in the
• 22:42
  cell
• 22:42
  growth
• 22:43
  or in,
• 22:46
  in
• 22:46
  basically,
• 22:47
  is it
• 22:47
  function
• 22:47
  altered
• 22:48
  enough to
• 22:48
  cause
• 22:49
  cancer?
• 22:49
  And so we
• 22:50
  will
• 22:50
  classify
• 22:51
  them,
• 22:51
  we'll
• 22:51
  say, hey,
• 22:52
  this is a
• 22:52
  pathogenic
• 22:53
  mutation.
• 22:53
  This is
• 22:53
  something
• 22:54
  that's
• 22:54
  going to
• 22:54
  contribute
• 22:55
  to it
• 22:55
  or it's a
• 22:56
  likely
• 22:57
  pathogenic
• 22:57
  meaning
• 22:58
  we
• 22:58
  see that
• 22:58
  it has
• 23:00
  contributes
• 23:00
  to cancer
• 23:01
  in in
• 23:01
  lung
• 23:02
  cancer,
• 23:02
  but not
• 23:02
  so much in uveal
• 23:04
  but
• 23:04
  it's good
• 23:04
  for you
• 23:04
  to be
• 23:05
  aware
• 23:05
  of it.
• 23:06
  And
• 23:06
  then
• 23:06
  we have
• 23:06
  other ones
• 23:07
  where
• 23:07
  there's
• 23:07
  mutations
• 23:08
  that
• 23:08
  we know
• 23:09
  nothing's
• 23:09
  going to
• 23:10
  happen
• 23:10
  with that
• 23:10
  gene.
• 23:11
  Essentially
• 23:12
  you have
• 23:12
  that
• 23:12
  information
• 23:13
  there
• 23:13
  in case
• 23:14
  it does
• 23:14
  become
• 23:14
  relevant
• 23:15
  in
• 23:15
  the future.
• 23:16
  You could
• 23:16
  always
• 23:17
  give
• 23:17
  a call
• 23:17
  and get
• 23:17
  the information,
• 23:18
  but
• 23:19
  we know
• 23:19
  that it's
• 23:20
  nothing
• 23:20
  that you
• 23:20
  really
• 23:21
  need
• 23:21
  to pay
• 23:21
  attention
• 23:21
  to
• 23:22
  right now
• 23:22
  because
• 23:22
  it's
• 23:23
  just,
• 23:24
  you know,
• 23:24
  a word
• 23:27
  that's
• 23:27
  basically
• 23:28
  misspelled,
• 23:28
  but it's
• 23:29
  not
• 23:29
  caught.
• 23:29
  You can still
• 23:30
  understand
• 23:30
  the
• 23:30
  sentence.
• 23:31
  It's how
• 23:31
  I think
• 23:32
  about it.
• 23:33
  so but
• 23:33
  it is
• 23:34
  very
• 23:34
  important
• 23:34
  because
• 23:35
  you don't
• 23:35
  want
• 23:36
  anyone
• 23:36
  to be
• 23:37
  looking
• 23:37
  at a
• 23:37
  report
• 23:38
  and see
• 23:38
  all these
• 23:38
  mutations
• 23:39
  and
• 23:39
  get scared
• 23:40
  when
• 23:40
  they're
• 23:40
  actually
• 23:41
  not doing
• 23:41
  anything
• 23:42
  in the body.
• 23:43
  And so
• 23:43
  we do
• 23:43
  make sure
• 23:44
  to do
• 23:44
  that and
• 23:45
  classify
• 23:45
  these mutations
• 23:46
  so that
• 23:46
  we know
• 23:47
  that
• 23:47
  the ones
• 23:47
  that are
• 23:47
  relevant
• 23:48
  are
• 23:48
  actually
• 23:49
  the ones
• 23:49
  that are
• 23:49
  going to
• 23:49
  be
• 23:49
  provided
• 23:50
  to the
• 23:50
  clinician.
• 23:52
  point,
• 23:52
  Doctor
• 23:52
  Mamie.
• 23:53
  So,
• 23:53
  you know,
• 23:53
  when
• 23:53
  we're
• 23:54
  interpreting
• 23:54
  this
• 23:54
  data,
• 23:55
  there's
• 23:55
  a lot of
• 23:56
  questions
• 23:56
  we have to ask.
• 23:57
  I think
• 23:57
  the first question
• 23:58
  we have
• 23:58
  to ask
• 23:59
  is,
• 24:00
  does
• 24:00
  the change
• 24:01
  actually
• 24:01
  affect
• 24:02
  that
• 24:02
  protein
• 24:03
  which
• 24:04
  peaches
• 24:04
  discussed.
• 24:05
  And then
• 24:05
  there's
• 24:05
  a second
• 24:06
  question
• 24:06
  of does
• 24:07
  that
• 24:07
  matter to
• 24:08
  this tumor.
• 24:09
  And that
• 24:10
  one's
• 24:10
  sometimes
• 24:11
  a harder
• 24:11
  question
• 24:11
  to answer.
• 24:13
  But
• 24:13
  you know,
• 24:14
  like
• 24:14
  Doctor
• 24:14
  alluded
• 24:15
  to, we
• 24:15
  do have
• 24:16
  what
• 24:16
  we call
• 24:16
  driver
• 24:17
  mutations,
• 24:18
  which are
• 24:18
  mutations
• 24:18
  that
• 24:19
  we know
• 24:19
  are
• 24:19
  driving
• 24:19
  the cancer.
• 24:20
  And then
• 24:21
  we have
• 24:21
  what
• 24:22
  we call,
• 24:22
  standby
• 24:23
  or
• 24:23
  bystander
• 24:24
  mutations,
• 24:24
  which
• 24:25
  happen
• 24:26
  in the cancer
• 24:27
  but
• 24:27
  probably
• 24:27
  aren't
• 24:27
  driving
• 24:28
  it.
• 24:28
  And those
• 24:29
  can be
• 24:30
  sometimes
• 24:30
  near
• 24:30
  impossible
• 24:32
  to
• 24:32
  differentiate.
• 24:34
  one of
• 24:35
  the
• 24:35
  things
• 24:35
  you can
• 24:35
  look at
• 24:36
  is
• 24:36
  the percentage
• 24:37
  within
• 24:37
  the tumor.
• 24:38
  So
• 24:38
  anytime
• 24:38
  you get
• 24:38
  these
• 24:39
  reports,
• 24:39
  you'll
• 24:39
  get a percent
• 24:40
  that says
• 24:41
  this
• 24:41
  change
• 24:41
  is in
• 24:42
  this percent.
• 24:43
  And
• 24:43
  sometimes
• 24:44
  we will
• 24:44
  see, you
• 24:45
  know,
• 24:45
  people
• 24:46
  being
• 24:47
  treated
• 24:47
  with
• 24:47
  drugs
• 24:47
  where
• 24:48
  some
• 24:48
  mutations
• 24:49
  have
• 24:49
  4,050% in
• 24:50
  the tumor,
• 24:51
  they find
• 24:52
  one
• 24:52
  mutation
• 24:52
  that's 1
• 24:53
  to 2%
• 24:53
  in the tumor.
• 24:54
  And we'll
• 24:55
  say, oh,
• 24:55
  we should
• 24:56
  try to
• 24:56
  treat
• 24:56
  that.
• 24:57
  Probably
• 24:57
  not a
• 24:57
  good
• 24:58
  treatment
• 24:58
  option
• 24:59
  if it's
• 25:00
  only
• 25:00
  in that
• 25:01
  few
• 25:01
  percentage
• 25:01
  of the tumor,
• 25:02
  because
• 25:02
  you're
• 25:02
  not
• 25:02
  actually
• 25:03
  covering
• 25:03
  at all.
• 25:03
  So
• 25:04
  you do have
• 25:05
  to
• 25:05
  interpret
• 25:05
  these
• 25:05
  reports
• 25:06
  in these
• 25:06
  changes,
• 25:07
  because
• 25:07
  sometimes
• 25:07
  with a
• 25:07
  grain
• 25:08
  of salt,
• 25:08
  by asking
• 25:09
  the questions,
• 25:10
  does that
• 25:10
  change
• 25:11
  actually
• 25:11
  affect
• 25:11
  biology.
• 25:12
  And does
• 25:13
  that
• 25:13
  biology
• 25:13
  actually
• 25:14
  drive
• 25:14
  this
• 25:14
  tumor?
• 25:15
  because
• 25:16
  sometimes
• 25:16
  you
• 25:16
  can get
• 25:17
  a little
• 25:18
  lost in
• 25:18
  the weeds
• 25:18
  in these
• 25:19
  reports
• 25:20
  if you don't
• 25:20
  look at
• 25:20
  those
• 25:21
  or
• 25:21
  don't ask
• 25:22
  those
• 25:22
  questions.
• 25:24
  let's
• 25:24
  talk
• 25:25
  about,
• 25:25
  what
• 25:26
  do we
• 25:26
  expect to
• 25:26
  find in
• 25:28
  in kind
• 25:29
  of a
• 25:29
  testing
• 25:30
  of
• 25:30
  a uveal
• 25:31
  melanoma.
• 25:31
  So
• 25:32
  as most of
• 25:33
  us know,
• 25:34
  most
• 25:34
  uveal
• 25:35
  melanomas
• 25:35
  are
• 25:36
  driven
• 25:37
  by one of
• 25:38
  two
• 25:38
  mutations,
• 25:39
  either
• 25:39
  a mutation
• 25:39
  in gnaQ
• 25:40
  or gna11.
• 25:42
  And so
• 25:43
  when
• 25:43
  we send
• 25:43
  these
• 25:43
  reports,
• 25:44
  we 96%
• 25:45
  of the
• 25:46
  time find
• 25:46
  a mutation
• 25:47
  in one of
• 25:47
  these two
• 25:48
  proteins.
• 25:49
  Those are
• 25:50
  proteins
• 25:50
  as in
• 25:51
  right now
• 25:52
  where
• 25:52
  we can't
• 25:52
  actually
• 25:53
  target
• 25:53
  there's
• 25:53
  no drugs
• 25:54
  that can
• 25:54
  actually
• 25:55
  turn that
• 25:55
  on
• 25:55
  or off.
• 25:56
  There's
• 25:56
  a lot of
• 25:57
  work
• 25:58
  going
• 25:58
  on in
• 25:58
  the
• 25:58
  scientific
• 25:59
  community
• 26:00
  trying to
• 26:00
  figure out
• 26:00
  how
• 26:00
  we can
• 26:01
  do that,
• 26:02
  but just
• 26:02
  the type
• 26:03
  of
• 26:03
  protein
• 26:03
  that
• 26:04
  these
• 26:05
  mutations
• 26:05
  are
• 26:06
  actually
• 26:07
  makes it
• 26:07
  really
• 26:07
  difficult
• 26:08
  to block.
• 26:08
  There's
• 26:09
  different
• 26:09
  types
• 26:09
  of
• 26:09
  proteins
• 26:10
  out
• 26:10
  there.
• 26:10
  Some
• 26:10
  are very
• 26:11
  easy to
• 26:11
  turn off
• 26:12
  and turn
• 26:12
  on.
• 26:13
  This particular
• 26:14
  type is
• 26:14
  a little
• 26:14
  bit more
• 26:15
  difficult.
• 26:15
  So it's
• 26:15
  been a
• 26:16
  little
• 26:16
  harder.
• 26:16
  then
• 26:16
  a lot of
• 26:17
  the other,
• 26:18
  we see,
• 26:19
  or the
• 26:19
  other
• 26:19
  most
• 26:19
  common
• 26:20
  mutation
• 26:20
  we see
• 26:20
  in uveal
• 26:21
  melanoma
• 26:21
  is BAP 1
• 26:23
  which
• 26:23
  again is
• 26:23
  very
• 26:24
  hard.
• 26:25
  necessarily
• 26:26
  a
• 26:26
  therapeutic
• 26:27
  option.
• 26:27
  So
• 26:28
  a lot of times
• 26:29
  when
• 26:29
  we do
• 26:29
  this type
• 26:30
  of
• 26:30
  testing
• 26:31
  in
• 26:32
  patients
• 26:32
  with
• 26:32
  uveal
• 26:32
  melanoma
• 26:33
  where
• 26:33
  their cancer
• 26:34
  has
• 26:34
  spread,
• 26:34
  we see
• 26:35
  a mutation
• 26:36
  in one of
• 26:36
  those
• 26:36
  two, Gina
• 26:37
  Q or Gina
• 26:38
  Levin,
• 26:39
  maybe
• 26:40
  with a
• 26:40
  mutation
• 26:40
  in BAP 1
• 26:41
  or a
• 26:41
  couple
• 26:42
  other,
• 26:44
  So
• 26:44
  most of
• 26:45
  the time,
• 26:45
  the fishing
• 26:46
  expedition
• 26:46
  of doing
• 26:47
  this
• 26:47
  testing
• 26:48
  doesn't
• 26:48
  necessarily
• 26:49
  change
• 26:49
  your
• 26:49
  treatment
• 26:50
  option,
• 26:51
  but it's
• 26:51
  really
• 26:52
  when
• 26:52
  we find
• 26:52
  something
• 26:53
  unexpected,
• 26:53
  because
• 26:54
  one
• 26:54
  of the
• 26:54
  big
• 26:55
  shifts
• 26:55
  that
• 26:55
  we see
• 26:56
  right now
• 26:57
  in
• 26:57
  the oncology
• 26:58
  community
• 26:58
  as a
• 26:59
  whole is
• 27:00
  redefining
• 27:01
  cancer,
• 27:01
  not
• 27:02
  based on
• 27:02
  where
• 27:02
  it came,
• 27:03
  but
• 27:03
  from the
• 27:03
  genetic
• 27:04
  mutations.
• 27:05
  You know,
• 27:05
  100
• 27:06
  years ago
• 27:06
  when we
• 27:07
  started
• 27:07
  treating
• 27:07
  cancer,
• 27:08
  the only way
• 27:08
  to
• 27:08
  kind of
• 27:09
  lump
• 27:09
  cancer
• 27:09
  into
• 27:10
  groups
• 27:10
  is to
• 27:10
  say,
• 27:10
  this is where
• 27:11
  it came
• 27:11
  from.
• 27:12
  That's
• 27:12
  why we
• 27:12
  call
• 27:12
  breast
• 27:12
  cancer,
• 27:13
  breast
• 27:13
  cancer
• 27:13
  and
• 27:13
  prostate
• 27:14
  cancer,
• 27:14
  prostate
• 27:15
  cancer.
• 27:16
  But we're
• 27:16
  learning
• 27:16
  now
• 27:17
  that the
• 27:17
  molecular
• 27:18
  signatures
• 27:19
  for some
• 27:20
  cases
• 27:20
  are
• 27:21
  actually
• 27:21
  more
• 27:21
  important
• 27:22
  than
• 27:22
  where
• 27:22
  it came
• 27:23
  from.
• 27:23
  So
• 27:24
  I have had
• 27:24
  patients
• 27:24
  with
• 27:25
  uveal
• 27:25
  melanoma
• 27:26
  that's
• 27:26
  had
• 27:26
  molecular
• 27:27
  signatures
• 27:28
  more
• 27:28
  consistent
• 27:28
  with
• 27:29
  types
• 27:29
  of colon
• 27:30
  cancer
• 27:30
  that can
• 27:30
  respond
• 27:31
  to a mean
• 27:31
  therapy,
• 27:32
  and that
• 27:33
  will change
• 27:33
  what
• 27:33
  we do.
• 27:34
  And
• 27:34
  so most
• 27:35
  of
• 27:35
  the time
• 27:35
  when
• 27:35
  we're
• 27:35
  doing
• 27:36
  this
• 27:36
  testing,
• 27:36
  we're
• 27:36
  not going
• 27:37
  to find
• 27:37
  something.
• 27:38
  But
• 27:38
  if we
• 27:38
  find
• 27:39
  a mutation
• 27:39
  or
• 27:39
  a protein
• 27:41
  that is
• 27:41
  more
• 27:42
  similar
• 27:42
  to
• 27:42
  another
• 27:42
  cancer,
• 27:43
  that can
• 27:44
  actually
• 27:44
  change
• 27:45
  how we
• 27:45
  treat the
• 27:45
  patient
• 27:46
  and
• 27:46
  benefit
• 27:46
  the patient.
• 27:47
  So, like
• 27:48
  I said,
• 27:49
  it's a
• 27:49
  fishing
• 27:49
  expedition.
• 27:50
  Most of
• 27:50
  the time
• 27:50
  you're
• 27:50
  going to
• 27:50
  come up
• 27:51
  negative,
• 27:51
  but
• 27:52
  it can
• 27:52
  actually
• 27:53
  change,
• 27:54
  what
• 27:54
  what we do
• 27:55
  and
• 27:55
  how your cancer
• 27:56
  is
• 27:56
  treated.
• 27:56
  I feel like
• 27:57
  with
• 27:57
  the more
• 27:57
  information
• 27:58
  we get
• 27:59
  from
• 27:59
  all of
• 27:59
  these
• 27:59
  tests,
• 28:00
  we're
• 28:00
  going to
• 28:00
  learn
• 28:01
  more
• 28:01
  about the
• 28:01
  cancer
• 28:02
  itself.
• 28:03
  And so
• 28:03
  we know,
• 28:04
  you know,
• 28:04
  gnac and
• 28:05
  all
• 28:06
  the other
• 28:06
  ones,
• 28:06
  which ones
• 28:07
  are
• 28:07
  prevalent.
• 28:07
  We can't act
• 28:08
  on them
• 28:08
  yet.
• 28:08
  There's
• 28:09
  clinical
• 28:09
  trials,
• 28:10
  but we're
• 28:10
  learning
• 28:11
  about
• 28:12
  what
• 28:12
  shouldn't
• 28:12
  be there,
• 28:13
  what's
• 28:13
  commonly
• 28:14
  not
• 28:14
  there.
• 28:14
  And all
• 28:15
  these
• 28:15
  signatures
• 28:15
  that
• 28:16
  we can
• 28:16
  potentially
• 28:16
  develop
• 28:17
  in the
• 28:17
  future
• 28:18
  to
• 28:18
  identify
• 28:18
  these or
• 28:19
  maybe
• 28:19
  find
• 28:19
  future
• 28:20
  targets.
• 28:20
  So
• 28:21
  that's
• 28:21
  a whole
• 28:21
  other
• 28:21
  research
• 28:22
  side
• 28:22
  of it.
• 28:22
  But,
• 28:23
  you know,
• 28:23
  the more
• 28:24
  we test,
• 28:24
  the more
• 28:24
  we know.
• 28:25
  And
• 28:25
  hopefully
• 28:25
  you can
• 28:26
  advance
• 28:26
  it in
• 28:26
  the
• 28:26
  future.
• 28:29
  I think
• 28:29
  the other
• 28:30
  side
• 28:30
  benefit
• 28:31
  I'll talk
• 28:31
  about
• 28:31
  is most
• 28:32
  of the,
• 28:33
  tumor
• 28:33
  testing
• 28:34
  platforms
• 28:34
  that are out there
• 28:35
  right now
• 28:36
  will
• 28:36
  actually
• 28:36
  give you
• 28:37
  your HLA
• 28:37
  type,
• 28:38
  which is not the type
• 28:40
  which
• 28:40
  is not
• 28:41
  the
• 28:42
  cancer
• 28:42
  per say.
• 28:42
  It's more
• 28:43
  you HLA
• 28:44
  type is
• 28:44
  what
• 28:45
  I tell
• 28:45
  people
• 28:45
  is your
• 28:46
  blood
• 28:46
  type,
• 28:47
  but
• 28:47
  it's not
• 28:47
  the blood
• 28:47
  type
• 28:48
  we use
• 28:48
  for blood
• 28:48
  donation.
• 28:49
  It's a
• 28:49
  blood
• 28:49
  type
• 28:50
  we use
• 28:50
  for organ
• 28:50
  transplant.
• 28:51
  And for
• 28:52
  most
• 28:52
  tumors
• 28:53
  it's not
• 28:53
  that
• 28:53
  relevant
• 28:54
  for uveal
• 28:54
  melanoma,
• 28:55
  it's
• 28:55
  highly
• 28:55
  relevant.
• 28:56
  We know
• 28:57
  tebentafusp
• 28:57
  for
• 28:58
  Kimmtrac
• 28:58
  is only
• 28:59
  effective
• 29:00
  and
• 29:00
  approved
• 29:01
  for
• 29:01
  people
• 29:01
  who have
• 29:02
  a certain
• 29:02
  blood
• 29:02
  type
• 29:03
  HLA 8
• 29:04
  A02 O 1.
• 29:05
  And
• 29:05
  we know
• 29:06
  that
• 29:06
  there's
• 29:06
  clinical
• 29:06
  trials
• 29:07
  such as
• 29:07
  the
• 29:08
  ideaya
• 29:08
  clinical
• 29:09
  trial
• 29:09
  that's
• 29:09
  available
• 29:10
  right now
• 29:10
  for
• 29:10
  people
• 29:11
  who don't
• 29:11
  have that
• 29:12
  blood
• 29:12
  type.
• 29:13
  So it
• 29:14
  it is
• 29:14
  advantageous
• 29:15
  to get
• 29:15
  this
• 29:15
  testing
• 29:16
  because
• 29:16
  you're
• 29:16
  getting
• 29:17
  that
• 29:17
  information
• 29:17
  as well.
• 29:18
  And
• 29:19
  you can
• 29:19
  really
• 29:19
  get
• 29:19
  kind of
• 29:20
  both of
• 29:21
  those
• 29:21
  and
• 29:21
  questions
• 29:22
  answered
• 29:22
  in
• 29:23
  one test,
• 29:23
  which is
• 29:23
  great.
• 29:24
  Where
• 29:25
  historically
• 29:25
  they were
• 29:25
  separate
• 29:26
  tests.
• 29:31
  Any other
• 29:32
  questions?
• 29:32
  No.
• 29:34
  Anything else
• 29:34
  you want
• 29:35
  to add
• 29:35
  or
• 29:35
  discuss?
• 29:36
  Peaches,
• 29:36
  I know
• 29:37
  the talk
• 29:37
  has been
• 29:37
  pretty
• 29:38
  informal
• 29:38
  since
• 29:38
  we didn't
• 29:38
  have
• 29:38
  slides.
• 29:39
  Yeah,
• 29:39
  yeah.
• 29:39
  just
• 29:40
  I always
• 29:40
  advocate
• 29:41
  for
• 29:41
  asking,
• 29:42
  having
• 29:42
  the
• 29:42
  conversations
• 29:43
  with your
• 29:43
  clinicians.
• 29:44
  I know,
• 29:44
  Doctor
• 29:44
  moser
• 29:44
  you're
• 29:45
  fantastic
• 29:45
  with
• 29:46
  taking
• 29:46
  time
• 29:46
  with your patients.
• 29:47
  And I
• 29:47
  know,
• 29:48
  you know,
• 29:48
  sometimes
• 29:49
  that's
• 29:49
  a little
• 29:50
  hard
• 29:50
  to get
• 29:50
  from
• 29:50
  clinicians.
• 29:51
  So,
• 29:51
  you know,
• 29:52
  advocating
• 29:52
  for
• 29:52
  yourself,
• 29:53
  asking
• 29:53
  those
• 29:54
  questions
• 29:54
  about,
• 29:55
  again,
• 29:55
  somatic
• 29:56
  testing
• 29:56
  can mean
• 29:56
  a lot
• 29:57
  of things
• 29:58
  to a
• 29:58
  lot of
• 29:58
  different
• 29:59
  companies.
• 30:00
  So take
• 30:00
  the time
• 30:01
  with the
• 30:01
  clinician
• 30:02
  who
• 30:02
  should know
• 30:02
  essentially
• 30:03
  what
• 30:03
  you're
• 30:03
  looking
• 30:03
  for to
• 30:04
  get the
• 30:04
  right
• 30:04
  test.
• 30:06
  Right.
• 30:07
  So,
• 30:07
  Doctor
• 30:08
  Moser,
• 30:08
  peaches,
• 30:09
  I have
• 30:09
  a question
• 30:10
  for you
• 30:10
  guys.
• 30:11
  at least
• 30:11
  are
• 30:11
  familiar
• 30:12
  with the
• 30:12
  Castle
• 30:12
  Biosciences
• 30:13
  report
• 30:14
  that
• 30:14
  comes in.
• 30:15
  we can
• 30:15
  see
• 30:15
  lots of
• 30:16
  different
• 30:16
  things.
• 30:17
  I know
• 30:17
  I've
• 30:17
  looked at
• 30:18
  one of
• 30:18
  my caris
• 30:18
  reports.
• 30:19
  with
• 30:19
  Doctor
• 30:19
  Moser in
• 30:20
  an appointment,
• 30:20
  but I'm
• 30:21
  curious,
• 30:21
  do
• 30:21
  you guys
• 30:22
  have any
• 30:22
  tools at
• 30:23
  caris
• 30:23
  Life
• 30:23
  Sciences?
• 30:25
  you guys
• 30:25
  have any
• 30:25
  tools for
• 30:26
  helping
• 30:26
  patients
• 30:26
  to,
• 30:27
  understand
• 30:27
  and
• 30:27
  interpret
• 30:28
  their
• 30:28
  report
• 30:28
  aside
• 30:29
  from
• 30:29
  obviously
• 30:29
  talking
• 30:29
  to their
• 30:30
  oncologist?
• 30:32
  It's a
• 30:32
  great
• 30:32
  question.
• 30:33
  So,
• 30:35
  we do
• 30:35
  we have a
• 30:35
  whole
• 30:36
  patient
• 30:36
  navigation.
• 30:37
  Okay.
• 30:38
  Essentially
• 30:38
  that will
• 30:38
  help.
• 30:39
  I like
• 30:40
  to work
• 30:41
  closely
• 30:41
  with
• 30:41
  my oncologist
• 30:42
  so
• 30:43
  that if
• 30:43
  they have
• 30:44
  questions,
• 30:45
  I can be
• 30:45
  that
• 30:46
  resource.
• 30:47
  in my
• 30:47
  role,
• 30:48
  technically
• 30:48
  not
• 30:48
  allowed
• 30:48
  to speak
• 30:49
  to
• 30:49
  patients
• 30:50
  in that
• 30:50
  capacity.
• 30:51
  Yeah.
• 30:51
  but so
• 30:52
  we do
• 30:53
  really
• 30:53
  good.
• 30:54
  we offer
• 30:54
  a lot of
• 30:55
  education
• 30:55
  things.
• 30:55
  So we
• 30:56
  work
• 30:56
  with RN's
• 30:57
  and the
• 30:57
  whole
• 30:57
  clinical
• 30:58
  staff,
• 30:58
  if they
• 30:58
  want to
• 30:59
  learn
• 30:59
  how to
• 30:59
  interpret
• 31:00
  the reports
• 31:01
  as well,
• 31:01
  just said
• 31:02
  a basic
• 31:02
  level.
• 31:03
  Yeah.
• 31:03
  so that
• 31:04
  they can
• 31:04
  at least.
• 31:04
  What is the
• 31:05
  green box
• 31:05
  mean?
• 31:05
  What is
• 31:06
  a red
• 31:06
  box?
• 31:06
  You know,
• 31:07
  where
• 31:07
  am I
• 31:07
  looking
• 31:08
  on this
• 31:08
  report?
• 31:08
  Yeah.
• 31:09
  because
• 31:09
  I think
• 31:10
  it's
• 31:10
  valuable
• 31:10
  a lot of
• 31:10
  the time
• 31:11
  they're
• 31:11
  spending
• 31:12
  time with
• 31:12
  the
• 31:12
  patient
• 31:12
  as well,
• 31:13
  answering
• 31:13
  these
• 31:13
  questions.
• 31:14
  so
• 31:16
  I would
• 31:16
  say a
• 31:17
  lot of
• 31:18
  companies
• 31:18
  do have
• 31:19
  some sort
• 31:19
  of
• 31:19
  patient
• 31:20
  navigation
• 31:20
  team that
• 31:21
  can
• 31:21
  help them
• 31:21
  walk
• 31:22
  through
• 31:22
  those
• 31:22
  reports.
• 31:23
  but we
• 31:23
  leave it
• 31:24
  to the
• 31:24
  clinician
• 31:24
  most
• 31:25
  of the time
• 31:25
  because
• 31:26
  you don't
• 31:26
  want
• 31:26
  anything
• 31:26
  to kind
• 31:27
  of get
• 31:27
  misinterpreted.
• 31:28
  You know,
• 31:28
  for sure.
• 31:29
  That
• 31:29
  totally
• 31:29
  makes
• 31:30
  sense.
• 31:31
  question,
• 31:32
  kind of
• 31:32
  just
• 31:32
  regarding
• 31:32
  what
• 31:32
  you guys
• 31:33
  do on
• 31:33
  your end,
• 31:34
  obviously,
• 31:35
  biopsy
• 31:35
  testing,
• 31:36
  rare
• 31:36
  diseases.
• 31:37
  We know
• 31:37
  from
• 31:38
  many of us
• 31:39
  who
• 31:39
  have had
• 31:39
  castle
• 31:39
  testing,
• 31:40
  and
• 31:40
  I think
• 31:40
  I know
• 31:40
  I've
• 31:41
  seen this
• 31:41
  on my
• 31:41
  Kara's
• 31:42
  tests.
• 31:42
  We get,
• 31:43
  you know,
• 31:43
  an
• 31:43
  explanation
• 31:44
  of
• 31:44
  benefits
• 31:44
  and your
• 31:45
  insurance
• 31:45
  comes
• 31:45
  back
• 31:45
  and says,
• 31:46
  this
• 31:46
  is an
• 31:46
  experimental test
• 31:47
  and
• 31:47
  we don't
• 31:48
  cover it.
• 31:49
  what does
• 31:49
  caris do
• 31:50
  for
• 31:50
  patients
• 31:50
  as far
• 31:50
  as a
• 31:51
  financial
• 31:51
  standpoint
• 31:51
  to help
• 31:52
  them
• 31:53
  figure
• 31:53
  that out?
• 31:54
  Yeah.
• 31:54
  And and
• 31:54
  that's
• 31:55
  it.
• 31:55
  The two
• 31:55
  most
• 31:56
  common
• 31:56
  questions
• 31:56
  I get.
• 31:57
  yeah,
• 31:58
  that's an
• 31:58
  excellent
• 31:58
  question.
• 31:59
  So again,
• 31:59
  we have
• 32:00
  an entire
• 32:01
  patient
• 32:01
  team that
• 32:02
  will do
• 32:02
  that.
• 32:02
  One thing
• 32:03
  I can
• 32:03
  advocate
• 32:04
  with
• 32:04
  caris is
• 32:04
  I know
• 32:05
  the test
• 32:05
  is
• 32:05
  expensive,
• 32:06
  just like
• 32:06
  most
• 32:07
  tests.
• 32:07
  It really
• 32:08
  depends
• 32:08
  on
• 32:08
  insurance
• 32:09
  and where
• 32:09
  you're at
• 32:09
  with your
• 32:10
  deductible
• 32:10
  as well.
• 32:11
  That
• 32:11
  plays a
• 32:11
  huge part
• 32:12
  versus
• 32:12
  getting
• 32:13
  the test
• 32:13
  in the
• 32:13
  beginning
• 32:14
  of
• 32:14
  the year
• 32:14
  versus
• 32:14
  the end
• 32:14
  of the
• 32:15
  year.
• 32:15
  All of
• 32:15
  those
• 32:15
  logistics,
• 32:16
  which
• 32:16
  I've
• 32:17
  recently
• 32:17
  learned,
• 32:19
  but we do
• 32:20
  I do
• 32:20
  pride
• 32:21
  myself in
• 32:21
  the
• 32:21
  patient
• 32:22
  navigator
• 32:22
  team that
• 32:22
  we have.
• 32:23
  They
• 32:23
  essentially
• 32:24
  we don't
• 32:24
  direct
• 32:24
  dealer.
• 32:25
  I don't
• 32:27
  balance
• 32:27
  Bill.
• 32:27
  Thank you.
• 32:28
  And so
• 32:28
  the patient
• 32:29
  isn't
• 32:29
  going
• 32:29
  to
• 32:30
  receive
• 32:30
  a bill
• 32:30
  like
• 32:31
  that.
• 32:31
  Okay.
• 32:33
  we've
• 32:33
  had it
• 32:34
  maybe
• 32:34
  happen
• 32:34
  by mistake
• 32:35
  once you
• 32:35
  contact
• 32:36
  us
• 32:36
  immediately
• 32:36
  and we're
• 32:37
  going to
• 32:37
  work to
• 32:37
  to figure
• 32:38
  that out.
• 32:39
  We also know
• 32:39
  that some
• 32:40
  have to
• 32:40
  do
• 32:40
  self-pay.
• 32:41
  And so
• 32:42
  how do we
• 32:42
  work with
• 32:42
  that.
• 32:43
  So
• 32:43
  basically.
• 32:45
  We.
• 32:46
  Even if
• 32:46
  there
• 32:47
  were
• 32:47
  a bill
• 32:47
  and maybe
• 32:48
  a couple
• 32:48
  hundred
• 32:49
  dollars,
• 32:50
  there's
• 32:50
  still
• 32:50
  a program
• 32:51
  for that.
• 32:51
  Okay.
• 32:52
  So we're
• 32:52
  not
• 32:52
  going to
• 32:52
  dig into
• 32:53
  finances.
• 32:54
  We
• 32:54
  don't do
• 32:54
  any
• 32:54
  of that
• 32:55
  in the
• 32:55
  background,
• 32:55
  which
• 32:56
  I know
• 32:56
  some some
• 32:57
  companies
• 32:57
  unfortunately.
• 32:58
  You know,
• 32:59
  I just
• 32:59
  I think
• 32:59
  it's
• 32:59
  important
• 33:00
  to point
• 33:00
  out,
• 33:00
  especially
• 33:01
  for
• 33:01
  those of
• 33:01
  us who
• 33:02
  are
• 33:02
  dealing
• 33:02
  with,
• 33:03
  who are
• 33:04
  dealing
• 33:04
  with,
• 33:04
  you know,
• 33:05
  the
• 33:05
  financial
• 33:05
  aspect
• 33:06
  of things
• 33:06
  and just
• 33:06
  the
• 33:07
  confusion
• 33:07
  and the
• 33:07
  insurance
• 33:08
  battles
• 33:08
  and
• 33:09
  just all
• 33:09
  of the
• 33:09
  things
• 33:10
  that can
• 33:10
  come into
• 33:10
  our
• 33:11
  diagnosis,
• 33:11
  it's
• 33:12
  important
• 33:12
  to
• 33:12
  recognize
• 33:12
  we do have
• 33:13
  companies
• 33:13
  who are doing
• 33:14
  these tests
• 33:15
  who
• 33:15
  understand
• 33:15
  that
• 33:16
  and
• 33:16
  who are
• 33:16
  making it
• 33:17
  as much
• 33:17
  of a
• 33:17
  priority
• 33:18
  as
• 33:18
  possible
• 33:19
  for
• 33:19
  patients
• 33:20
  to not be
• 33:20
  financially
• 33:21
  burdened
• 33:21
  by having
• 33:22
  this test
• 33:22
  done.
• 33:23
  And
• 33:23
  I guess
• 33:24
  my
• 33:24
  you
• 33:24
  guys can
• 33:25
  correct me
• 33:25
  if
• 33:25
  I'm wrong,
• 33:26
  but my
• 33:26
  understanding
• 33:26
  of it
• 33:27
  is that
• 33:27
  these
• 33:27
  companies
• 33:28
  want
• 33:29
  they want
• 33:29
  to do
• 33:30
  the research,
• 33:30
  they want
• 33:30
  to see
• 33:31
  what's
• 33:31
  happening.
• 33:32
  And and
• 33:32
  it's
• 33:33
  worth
• 33:33
  it's
• 33:33
  worth
• 33:34
  doing
• 33:34
  the
• 33:34
  tests,
• 33:35
  and it's
• 33:35
  worth
• 33:35
  seeing
• 33:36
  the results
• 33:36
  from as
• 33:37
  many
• 33:37
  patients
• 33:37
  as possible
• 33:38
  to get
• 33:38
  that
• 33:38
  information.
• 33:39
  Like, I,
• 33:40
  I don't
• 33:40
  know,
• 33:40
  I guess
• 33:41
  for me,
• 33:41
  as
• 33:41
  a patient,
• 33:41
  it
• 33:41
  kind of
• 33:42
  feels
• 33:42
  like the
• 33:42
  information
• 33:43
  feels
• 33:43
  more
• 33:44
  valuable
• 33:45
  than the
• 33:46
  cash flow.
• 33:47
  If
• 33:47
  that makes
• 33:47
  some
• 33:48
  level of
• 33:48
  sense.
• 33:49
  Like
• 33:49
  I know
• 33:49
  the cash
• 33:50
  flow is
• 33:50
  important,
• 33:50
  the company
• 33:51
  has to
• 33:51
  continue.
• 33:51
  But,
• 33:52
  I just
• 33:52
  appreciate
• 33:53
  that that
• 33:53
  caris
• 33:54
  Castle
• 33:54
  like
• 33:54
  that,
• 33:55
  they make
• 33:55
  a priority
• 33:55
  of trying
• 33:56
  not to
• 33:56
  put that
• 33:56
  burden
• 33:56
  on
• 33:57
  patients.
• 33:57
  Yeah.
• 33:57
  And
• 33:58
  both of
• 33:58
  the
• 33:58
  companies,
• 33:59
  I mean,
• 33:59
  we work
• 33:59
  closely
• 33:59
  with
• 33:59
  Castle
• 34:00
  two.
• 34:00
  They're
• 34:00
  great is
• 34:01
  how much
• 34:02
  more can
• 34:03
  we learn
• 34:03
  about this
• 34:04
  so that
• 34:05
  we can
• 34:05
  have
• 34:06
  advancements?
• 34:06
  It's a
• 34:07
  question.
• 34:08
  Yeah.
• 34:08
  So
• 34:08
  translational.
• 34:09
  So
• 34:09
  that's
• 34:09
  the whole
• 34:10
  goal.
• 34:10
  Yeah.
• 34:10
  Is that
• 34:11
  we learn
• 34:12
  all of
• 34:12
  this
• 34:12
  information.
• 34:13
  Find
• 34:13
  this.
• 34:13
  So
• 34:14
  I would even
• 34:15
  say that
• 34:15
  the
• 34:16
  the drugs
• 34:17
  that we
• 34:17
  have now
• 34:17
  for these
• 34:18
  specific
• 34:18
  markers
• 34:19
  like the
• 34:19
  HLA or
• 34:22
  you
• 34:22
  know, PDL
• 34:22
  ones and
• 34:23
  stuff
• 34:23
  that all
• 34:23
  came from
• 34:24
  learning
• 34:25
  about it
• 34:26
  first.
• 34:26
  So that
• 34:26
  being
• 34:27
  in the experiment
• 34:27
  and
• 34:27
  now you
• 34:28
  went
• 34:28
  through
• 34:28
  the
• 34:29
  clinical
• 34:29
  trials
• 34:30
  to now
• 34:30
  be a drug
• 34:31
  that's
• 34:31
  available.
• 34:31
  So it all
• 34:32
  begins
• 34:32
  with
• 34:32
  research
• 34:32
  and with
• 34:33
  caris
• 34:34
  We're
• 34:34
  twofold.
• 34:35
  So first
• 34:35
  and
• 34:35
  foremost
• 34:36
  it's
• 34:36
  about
• 34:36
  getting
• 34:37
  those
• 34:37
  reports
• 34:37
  to our
• 34:37
  clinician
• 34:38
  to help
• 34:38
  with
• 34:38
  treatment.
• 34:39
  But
• 34:40
  our second
• 34:40
  branch is
• 34:41
  research.
• 34:42
  So how do
• 34:42
  we use
• 34:42
  this not
• 34:43
  to sell
• 34:43
  the information
• 34:44
  but to
• 34:44
  learn about it
• 34:46
  and then
• 34:46
  partner
• 34:46
  to figure
• 34:47
  out like,
• 34:47
  hey,
• 34:47
  these
• 34:48
  these
• 34:48
  genes are
• 34:49
  coming up
• 34:49
  a lot
• 34:49
  in this
• 34:50
  cancer
• 34:51
  based
• 34:51
  off of
• 34:51
  how they
• 34:51
  work.
• 34:52
  Can
• 34:52
  a drug
• 34:52
  be
• 34:53
  developed
• 34:53
  to then,
• 34:54
  you know,
• 34:54
  go into
• 34:55
  trials
• 34:56
  for use?
• 34:57
  So
• 34:57
  just to
• 34:58
  recap
• 34:58
  that
• 34:58
  question,
• 34:59
  for
• 34:59
  those of
• 34:59
  you
• 34:59
  who
• 34:59
  didn't
• 34:59
  hear the
• 34:59
  question,
• 35:01
  just does
• 35:01
  the kind
• 35:02
  of the
• 35:02
  more
• 35:02
  testing
• 35:03
  that
• 35:03
  happens
• 35:03
  make it
• 35:04
  so that
• 35:04
  the drug
• 35:05
  becomes
• 35:06
  approved
• 35:06
  as
• 35:06
  something
• 35:07
  that
• 35:07
  is no
• 35:07
  longer
• 35:07
  experimental
• 35:08
  by
• 35:08
  insurance?
• 35:09
  Anyway,
• 35:10
  kind
• 35:11
  of to
• 35:11
  go along.
• 35:11
  I'll
• 35:11
  go ahead.
• 35:12
  I want to
• 35:12
  I'll
• 35:12
  answer
• 35:13
  that too.
• 35:13
  So you're
• 35:13
  absolutely
• 35:14
  right.
• 35:14
  Right.
• 35:14
  If
• 35:14
  we find
• 35:15
  that
• 35:15
  something's
• 35:15
  there
• 35:16
  on doing
• 35:16
  these
• 35:16
  tests,
• 35:17
  that
• 35:17
  drives
• 35:17
  the
• 35:17
  development
• 35:18
  of ways
• 35:18
  to try to
• 35:19
  target
• 35:19
  it.
• 35:20
  And so by
• 35:20
  doing
• 35:21
  more
• 35:21
  tests,
• 35:21
  we might
• 35:22
  better
• 35:22
  understand
• 35:22
  it.
• 35:23
  I think
• 35:23
  the other
• 35:24
  thing,
• 35:24
  too, is,
• 35:27
  tests
• 35:27
  are done,
• 35:28
  the companies
• 35:28
  can share
• 35:29
  the data
• 35:30
  kind of
• 35:30
  anonymously
• 35:31
  in
• 35:32
  aggregate.
• 35:32
  So
• 35:32
  they'll
• 35:33
  say, here
• 35:33
  is
• 35:33
  the data
• 35:34
  of,
• 35:35
  you know,
• 35:35
  so many
• 35:35
  patients
• 35:36
  with this
• 35:36
  that's
• 35:36
  done.
• 35:37
  And
• 35:38
  we are
• 35:38
  starting
• 35:38
  to do
• 35:39
  that.
• 35:39
  And
• 35:39
  through
• 35:39
  academic
• 35:40
  partnerships,
• 35:41
  you know,
• 35:41
  I've been
• 35:42
  involved
• 35:42
  with this
• 35:42
  with
• 35:42
  Caris
• 35:43
  and other
• 35:43
  companies.
• 35:44
  We're
• 35:44
  going
• 35:44
  back and
• 35:45
  saying,
• 35:45
  okay,
• 35:45
  so you do
• 35:46
  all the RNA
• 35:47
  and
• 35:47
  that's
• 35:47
  not part
• 35:47
  of the report,
• 35:48
  but
• 35:48
  can
• 35:49
  we try
• 35:49
  to
• 35:49
  analyze
• 35:50
  that to
• 35:50
  better
• 35:50
  understand
• 35:51
  the tumor
• 35:51
  biology?
• 35:52
  So both,
• 35:53
  you know,
• 35:54
  getting
• 35:54
  the test
• 35:54
  done
• 35:55
  helps
• 35:55
  potentially
• 35:56
  drive
• 35:56
  new
• 35:56
  therapies
• 35:57
  by
• 35:57
  finding
• 35:57
  stuff
• 35:58
  to
• 35:58
  target.
• 35:59
  But
• 35:59
  we also
• 35:59
  are also
• 36:00
  exploring
• 36:01
  that
• 36:01
  in an
• 36:01
  anonymized
• 36:02
  way
• 36:03
  or non
• 36:03
  patient
• 36:04
  specific
• 36:04
  way to
• 36:05
  try to
• 36:05
  understand
• 36:06
  the biology
• 36:07
  so we can
• 36:07
  better
• 36:07
  treat it
• 36:08
  in that
• 36:08
  way too.
• 36:08
  Yeah.
• 36:09
  Awesome.
• 36:10
  Do
• 36:10
  we have
• 36:10
  any other
• 36:10
  questions
• 36:11
  from the
• 36:11
  audience?
• 36:14
  Doctor
• 36:14
  Mimi
• 36:15
  yeah, I
• 36:15
  was
• 36:16
  going.
• 36:16
  To
• 36:16
  just turn
• 36:16
  just my point
• 36:18
  that,
• 36:18
  you know,
• 36:19
  when we
• 36:20
  collect
• 36:20
  these,
• 36:21
  ngs
• 36:22
  or DNA
• 36:23
  sequencing
• 36:24
  or RNA
• 36:24
  sequencing
• 36:25
  data,
• 36:26
  we can
• 36:26
  pair it
• 36:27
  with
• 36:28
  the outcomes
• 36:29
  that have
• 36:29
  happened
• 36:29
  in a
• 36:30
  patient's
• 36:31
  mutations
• 36:32
  and how
• 36:33
  they did
• 36:33
  with
• 36:33
  certain
• 36:34
  treatment
• 36:34
  and
• 36:34
  what kind
• 36:35
  of side
• 36:35
  effects
• 36:36
  they had.
• 36:37
  And
• 36:37
  hopefully
• 36:38
  that
• 36:38
  could
• 36:38
  drive
• 36:39
  clinical
• 36:39
  trials
• 36:40
  and
• 36:40
  research
• 36:40
  to
• 36:40
  predict
• 36:42
  responses
• 36:43
  or
• 36:43
  predict
• 36:44
  toxicity
• 36:45
  in
• 36:45
  patients.
• 36:45
  So,
• 36:46
  you know,
• 36:47
  if we can
• 36:47
  say that,
• 36:48
  hey,
• 36:48
  there's a
• 36:49
  marker Z
• 36:50
  in this
• 36:51
  patient's,
• 36:52
  tumor
• 36:53
  and that
• 36:53
  predicts
• 36:54
  for
• 36:54
  toxicity,
• 36:55
  but
• 36:55
  it doesn't
• 36:56
  predict
• 36:56
  for a
• 36:56
  response,
• 36:57
  then
• 36:57
  we can
• 36:58
  potentially
• 36:59
  avoid
• 36:59
  those
• 36:59
  therapies.
• 37:00
  Right.
• 37:01
  And
• 37:01
  and so
• 37:03
  that will
• 37:03
  only come
• 37:04
  if
• 37:04
  we have
• 37:05
  paired
• 37:06
  data,
• 37:06
  paired
• 37:07
  data from
• 37:08
  the patient
• 37:09
  and
• 37:09
  from our
• 37:10
  industry
• 37:10
  partners,
• 37:11
  caris
• 37:11
  compass
• 37:11
  and
• 37:12
  all of them,
• 37:13
  and
• 37:13
  kind of
• 37:14
  putting
• 37:14
  that
• 37:14
  together
• 37:15
  in an
• 37:15
  anonymous
• 37:16
  way.
• 37:16
  So we're
• 37:16
  not
• 37:17
  really,
• 37:17
  you know,
• 37:18
  sort of
• 37:19
  the red
• 37:20
  tape
• 37:20
  to buy
• 37:20
  a lot of
• 37:21
  the
• 37:21
  things
• 37:21
  that
• 37:21
  happens
• 37:22
  in this
• 37:22
  kind of
• 37:22
  research.
• 37:24
  Thank
• 37:25
  you so
• 37:25
  much,
• 37:25
  Doctor
• 37:26
  I think
• 37:27
  one of
• 37:27
  the
• 37:28
  things
• 37:28
  that
• 37:28
  I take
• 37:28
  away from
• 37:29
  this is,
• 37:29
  is these
• 37:30
  kinds
• 37:30
  of tests
• 37:30
  help
• 37:31
  eliminate
• 37:31
  trial
• 37:31
  and
• 37:31
  error,
• 37:32
  like,
• 37:32
  right
• 37:32
  now,
• 37:33
  I remember
• 37:33
  when,
• 37:34
  when
• 37:34
  Doctor
• 37:34
  Moser
• 37:35
  came out
• 37:35
  to, like,
• 37:36
  with
• 37:36
  Meredith
• 37:36
  McKeen
• 37:37
  in
• 37:37
  Nashville,
• 37:38
  one of the
• 37:38
  things
• 37:38
  that we
• 37:39
  talked
• 37:39
  about
• 37:39
  at the
• 37:39
  very
• 37:39
  beginning
• 37:40
  of
• 37:40
  some of
• 37:40
  those
• 37:40
  sessions,
• 37:41
  we were
• 37:41
  talking
• 37:41
  about,
• 37:41
  you know,
• 37:42
  navigating
• 37:42
  clinical
• 37:43
  trials.
• 37:43
  We were
• 37:44
  talking
• 37:44
  about the
• 37:44
  new FDA
• 37:45
  approval
• 37:45
  of
• 37:46
  aspect.
• 37:46
  Kimmtrac.
• 37:47
  I guess
• 37:48
  that's
• 37:48
  the same
• 37:48
  thing,
• 37:48
  in case
• 37:49
  you
• 37:49
  didn't
• 37:49
  know.
• 37:51
  but
• 37:51
  one of
• 37:52
  the
• 37:52
  things
• 37:52
  that
• 37:52
  doctor
• 37:52
  from
• 37:53
  doctor
• 37:53
  McKean
• 37:53
  and
• 37:53
  Doctor
• 37:54
  Moser
• 37:54
  both
• 37:54
  touched on
• 37:55
  is that
• 37:56
  at that
• 37:56
  time,
• 37:57
  you know,
• 37:57
  two years
• 37:57
  ago, most
• 37:58
  uveal
• 37:59
  melanoma
• 37:59
  oncologists
• 38:00
  were kind
• 38:00
  of like
• 38:00
  flying
• 38:01
  by the
• 38:01
  seat of
• 38:01
  their
• 38:01
  pants.
• 38:02
  It was
• 38:02
  guesswork.
• 38:03
  We're
• 38:03
  getting
• 38:03
  closer
• 38:04
  and
• 38:04
  closer
• 38:04
  to having
• 38:05
  less
• 38:05
  guesswork
• 38:06
  for
• 38:06
  certain
• 38:07
  parts
• 38:07
  of the
• 38:08
  demographic
• 38:08
  of
• 38:08
  patients.
• 38:09
  And
• 38:09
  the more
• 38:09
  of these
• 38:10
  kinds
• 38:10
  of tests
• 38:10
  that happen,
• 38:11
  the more
• 38:12
  that
• 38:12
  guesswork
• 38:12
  goes
• 38:12
  away.
• 38:13
  And it's
• 38:13
  no longer
• 38:13
  trial
• 38:14
  and
• 38:14
  error.
• 38:14
  Quite
• 38:14
  as scary
• 38:15
  feeling
• 38:16
  as it,
• 38:16
  you know,
• 38:17
  was five,
• 38:17
  ten years
• 38:18
  ago.
• 38:20
  Okay.
• 38:21
  Any other
• 38:21
  questions?
• 38:22
  Comments?
• 38:24
  let's
• 38:24
  give a
• 38:25
  round of
• 38:25
  applause
• 38:25
  to Doctor
• 38:26
  Ulrich
• 38:26
  and
• 38:26
  Doctor
• 38:27
  Mosher,
• 38:27
  and,
• 38:28
  we'll
• 38:28
  bring
• 38:28
  them back
• 38:29
  up
• 38:29
  a little
• 38:29
  later.