[Applause] every Monday morning and tumor board
every Monday morning and tumor board
every Monday morning and tumor board doctors who treat cancer get together at
doctors who treat cancer get together at
doctors who treat cancer get together at Baylor clinic to discuss difficult cases
Baylor clinic to discuss difficult cases
Baylor clinic to discuss difficult cases for one particular case a doctor said
for one particular case a doctor said
for one particular case a doctor said you can’t cure it if it doesn’t fit in
you can’t cure it if it doesn’t fit in
you can’t cure it if it doesn’t fit in the box he was referring to the use of
the box he was referring to the use of
the box he was referring to the use of focused radiation therapy in which
focused radiation therapy in which
focused radiation therapy in which higher energy x-rays are directed at a
higher energy x-rays are directed at a
higher energy x-rays are directed at a cancer the problem is if the cancer
cancer the problem is if the cancer
cancer the problem is if the cancer doesn’t fit in the box a box that you
doesn’t fit in the box a box that you
doesn’t fit in the box a box that you can cut out with a surgical scalpel or a
can cut out with a surgical scalpel or a
can cut out with a surgical scalpel or a box that you can destroy with radiation
box that you can destroy with radiation
box that you can destroy with radiation if the cancer spread outside of the box
if the cancer spread outside of the box
if the cancer spread outside of the box to other parts of the body or if it’s
to other parts of the body or if it’s
to other parts of the body or if it’s too close to important structures like
too close to important structures like
too close to important structures like the heart of the brainstem what do you
the heart of the brainstem what do you
the heart of the brainstem what do you do the goal is to cure everyone’s cancer
do the goal is to cure everyone’s cancer
do the goal is to cure everyone’s cancer not just those with cancer small enough
not just those with cancer small enough
not just those with cancer small enough to cut or to destroy with radiation in
to cut or to destroy with radiation in
to cut or to destroy with radiation in this talk I want to show you how to
this talk I want to show you how to
this talk I want to show you how to think of cancer in a box differently not
think of cancer in a box differently not
think of cancer in a box differently not as a box for radiation or surgery that’s
as a box for radiation or surgery that’s
as a box for radiation or surgery that’s too limiting instead I want you to think
too limiting instead I want you to think
too limiting instead I want you to think of cancer in a box as cancer in a
of cancer in a box as cancer in a
of cancer in a box as cancer in a computer by putting cancer in a computer
computer by putting cancer in a computer
computer by putting cancer in a computer I want to use the same computing power
I want to use the same computing power
I want to use the same computing power in your smartphone to treat cancer we do
in your smartphone to treat cancer we do
in your smartphone to treat cancer we do this by taking cancers putting them in a
this by taking cancers putting them in a
this by taking cancers putting them in a sophisticated meat grinder and analyzing
sophisticated meat grinder and analyzing
sophisticated meat grinder and analyzing the data that comes out we call this DNA
the data that comes out we call this DNA
the data that comes out we call this DNA sequencing I’ll show you that 50% of our
sequencing I’ll show you that 50% of our
sequencing I’ll show you that 50% of our progress in cancer medicine over the
progress in cancer medicine over the
progress in cancer medicine over the last 10 years is a result of sequencing
last 10 years is a result of sequencing
last 10 years is a result of sequencing that is digitizing cancers after the
that is digitizing cancers after the
that is digitizing cancers after the human genome project was completed in
human genome project was completed in
human genome project was completed in 2000 the cost of DNA sequencing dropped
2000 the cost of DNA sequencing dropped
2000 the cost of DNA sequencing dropped as quickly as Moore’s law which is
as quickly as Moore’s law which is
as quickly as Moore’s law which is responsible for bringing better and
responsible for bringing better and
responsible for bringing better and faster smartphones every two years in
faster smartphones every two years in
faster smartphones every two years in 2007 with the technical breakthrough
2007 with the technical breakthrough
2007 with the technical breakthrough called next-generation sequencing the
called next-generation sequencing the
called next-generation sequencing the cost of DNA sequencing dropped even
cost of DNA sequencing dropped even
cost of DNA sequencing dropped even faster than Moore’s law coincidentally
faster than Moore’s law coincidentally
faster than Moore’s law coincidentally 2007 is also the year that we started
2007 is also the year that we started
2007 is also the year that we started seeing this slide in the investor pitch
seeing this slide in the investor pitch
seeing this slide in the investor pitch decks of every Silicon Valley biotech
decks of every Silicon Valley biotech
decks of every Silicon Valley biotech startup answer researchers were quick to
startup answer researchers were quick to
startup answer researchers were quick to take advantage of this breakthrough by
take advantage of this breakthrough by
take advantage of this breakthrough by sequencing a patient’s cancer and a
sequencing a patient’s cancer and a
sequencing a patient’s cancer and a patient’s normal tissue you did too
patient’s normal tissue you did too
patient’s normal tissue you did too sequences or to books of about three
sequences or to books of about three
sequences or to books of about three billion letters each and I compared
billion letters each and I compared
billion letters each and I compared these two books we can pull out
these two books we can pull out
these two books we can pull out mutations specific to a patient’s cancer
mutations specific to a patient’s cancer
mutations specific to a patient’s cancer in 2008 cancer patients scientists did
in 2008 cancer patients scientists did
in 2008 cancer patients scientists did exactly this or a patient with leukemia
exactly this or a patient with leukemia
exactly this or a patient with leukemia and they sequenced the world’s first
and they sequenced the world’s first
and they sequenced the world’s first cancer genome 2013 over 3,000 cancer
cancer genome 2013 over 3,000 cancer
cancer genome 2013 over 3,000 cancer genomes have been sequenced through the
genomes have been sequenced through the
genomes have been sequenced through the Cancer Genome Atlas 2017 the Cancer
Cancer Genome Atlas 2017 the Cancer
Cancer Genome Atlas 2017 the Cancer Genome Atlas or TCGA was wrapping up at
Genome Atlas or TCGA was wrapping up at
Genome Atlas or TCGA was wrapping up at that time 11,000 patients have their
that time 11,000 patients have their
that time 11,000 patients have their cancer sequenced or presenting 33 cancer
cancer sequenced or presenting 33 cancer
cancer sequenced or presenting 33 cancer types all in all five hundred thousand
types all in all five hundred thousand
types all in all five hundred thousand DVDs have been produced it’s at least a
DVDs have been produced it’s at least a
DVDs have been produced it’s at least a few hours of Netflix content question is
few hours of Netflix content question is
few hours of Netflix content question is what do you do with all this data and
what do you do with all this data and
what do you do with all this data and the technological and computing
the technological and computing
the technological and computing pipelines for generating more at this
pipelines for generating more at this
pipelines for generating more at this data we are talking about cancer so the
data we are talking about cancer so the
data we are talking about cancer so the answer is that we use this data to save
answer is that we use this data to save
answer is that we use this data to save lives when I first started medical
lives when I first started medical
lives when I first started medical school this article Jeanette Campbell
school this article Jeanette Campbell
school this article Jeanette Campbell came out in the New York Times he
came out in the New York Times he
came out in the New York Times he described the story of Lukas Wortman who
described the story of Lukas Wortman who
described the story of Lukas Wortman who was a medical student just like me he
was a medical student just like me he
was a medical student just like me he wanted to be a hematologist oncologist
wanted to be a hematologist oncologist
wanted to be a hematologist oncologist or a doctor who treats cancers to the
or a doctor who treats cancers to the
or a doctor who treats cancers to the blood he himself was diagnosed with
blood he himself was diagnosed with
blood he himself was diagnosed with leukemia at age 25 initially he received
leukemia at age 25 initially he received
leukemia at age 25 initially he received chemotherapy and his the command went
chemotherapy and his the command went
chemotherapy and his the command went away but then it came back and after
away but then it came back and after
away but then it came back and after that his chances of surviving leukemia
that his chances of surviving leukemia
that his chances of surviving leukemia were under 5% so his doctors took an
were under 5% so his doctors took an
were under 5% so his doctors took an experimental approach it put his cancer
experimental approach it put his cancer
experimental approach it put his cancer in a box it put a needle in his bone
in a box it put a needle in his bone
in a box it put a needle in his bone marrow took out some of his leukemia put
marrow took out some of his leukemia put
marrow took out some of his leukemia put it into a meat grinder that at
it into a meat grinder that at
it into a meat grinder that at Washington University we call the genome
Washington University we call the genome
Washington University we call the genome Institute and analyzed the data that
Institute and analyzed the data that
Institute and analyzed the data that came out what they found was very
came out what they found was very
came out what they found was very similar to this in which every color
similar to this in which every color
similar to this in which every color represents a different strain or clone
represents a different strain or clone
represents a different strain or clone of leukemia with the different set of
of leukemia with the different set of
of leukemia with the different set of mutations unlike traditional tests
mutations unlike traditional tests
mutations unlike traditional tests sequencing captured the full complexity
sequencing captured the full complexity
sequencing captured the full complexity of leukemia a disease that isn’t static
of leukemia a disease that isn’t static
of leukemia a disease that isn’t static but balls with time and isn’t uniform
but balls with time and isn’t uniform
but balls with time and isn’t uniform pose if many layers or clothes and what
pose if many layers or clothes and what
pose if many layers or clothes and what sequencing found was that these leukemia
sequencing found was that these leukemia
sequencing found was that these leukemia clones shared an overactive gene thus
clones shared an overactive gene thus
clones shared an overactive gene thus overactive gene could be treated with a
overactive gene could be treated with a
overactive gene could be treated with a kidney cancer drug Luca started
kidney cancer drug Luca started
kidney cancer drug Luca started receiving this kidney cancer drug which
receiving this kidney cancer drug which
receiving this kidney cancer drug which he never would have received without DNA
he never would have received without DNA
he never would have received without DNA sequencing and his leukemia went away
sequencing and his leukemia went away
sequencing and his leukemia went away he’s now a professor at the medical
he’s now a professor at the medical
he’s now a professor at the medical school I attended and his ability to
school I attended and his ability to
school I attended and his ability to defy the odds and rid his body of
defy the odds and rid his body of
defy the odds and rid his body of leukemia was a direct result of
leukemia was a direct result of
leukemia was a direct result of sequencing so by putting cancer in a box
sequencing so by putting cancer in a box
sequencing so by putting cancer in a box by putting cancer in a computer we can
by putting cancer in a computer we can
by putting cancer in a computer we can search for better therapies to give our
search for better therapies to give our
search for better therapies to give our patients in the last few years
patients in the last few years
patients in the last few years sequencing has become so fundamental to
sequencing has become so fundamental to
sequencing has become so fundamental to cancer research in cancer medicine the
cancer research in cancer medicine the
cancer research in cancer medicine the top hospitals like MD Anderson and deep
top hospitals like MD Anderson and deep
top hospitals like MD Anderson and deep pocket institutions that you normally
pocket institutions that you normally
pocket institutions that you normally don’t associate with medicine like
don’t associate with medicine like
don’t associate with medicine like federal government and Google have been
federal government and Google have been
federal government and Google have been pouring billions of dollars into
pouring billions of dollars into
pouring billions of dollars into sequencing everyone’s cancers and now
sequencing everyone’s cancers and now
sequencing everyone’s cancers and now that we can sequence cancers and
that we can sequence cancers and
that we can sequence cancers and identify cancer mutations we’re having
identify cancer mutations we’re having
identify cancer mutations we’re having to invent new types of clinical trials
to invent new types of clinical trials
to invent new types of clinical trials instead of a clinical trial for patients
instead of a clinical trial for patients
instead of a clinical trial for patients with lung cancer we can run a trial or
with lung cancer we can run a trial or
with lung cancer we can run a trial or patients with lung cancer breast cancer
patients with lung cancer breast cancer
patients with lung cancer breast cancer colon cancer it doesn’t really matter
colon cancer it doesn’t really matter
colon cancer it doesn’t really matter what kind of cancer they have as long as
what kind of cancer they have as long as
what kind of cancer they have as long as their cancer it has a specific mutation
their cancer it has a specific mutation
their cancer it has a specific mutation they can receive a trial drug using this
they can receive a trial drug using this
they can receive a trial drug using this new type of trial design a basket trial
new type of trial design a basket trial
new type of trial design a basket trial so how has this new drug development
so how has this new drug development
so how has this new drug development strategy panned out increasingly we see
strategy panned out increasingly we see
strategy panned out increasingly we see results like this in which all the
results like this in which all the
results like this in which all the vertical bars beneath the horizontal
vertical bars beneath the horizontal
vertical bars beneath the horizontal line represent the cancer that shrink in
line represent the cancer that shrink in
line represent the cancer that shrink in response to an experimental drug all the
response to an experimental drug all the
response to an experimental drug all the different colors represent different
different colors represent different
different colors represent different types of cancer pancreatic cancer colon
types of cancer pancreatic cancer colon
types of cancer pancreatic cancer colon cancer and you can see that it doesn’t
cancer and you can see that it doesn’t
cancer and you can see that it doesn’t really matter where the cancer
really matter where the cancer
really matter where the cancer originated in the body as long as it has
originated in the body as long as it has
originated in the body as long as it has a specific mutation there’s a good
a specific mutation there’s a good
a specific mutation there’s a good chance this experimental drug will work
chance this experimental drug will work
chance this experimental drug will work or that patient this graph in particular
or that patient this graph in particular
or that patient this graph in particular represents cancers with microsatellite
represents cancers with microsatellite
represents cancers with microsatellite instability a class of mutations that
instability a class of mutations that
instability a class of mutations that renders the cancer susceptible to
renders the cancer susceptible to
renders the cancer susceptible to immunotherapy in 2017 the fda-approved
immunotherapy in 2017 the fda-approved
immunotherapy in 2017 the fda-approved immunotherapy for solid tumors with
immunotherapy for solid tumors with
immunotherapy for solid tumors with microsatellite instability the first
microsatellite instability the first
microsatellite instability the first example
example
example of a truck approval or a cancerous
of a truck approval or a cancerous
of a truck approval or a cancerous mutation not for where it originated the
mutation not for where it originated the
mutation not for where it originated the body at the end of medical school I had
body at the end of medical school I had
body at the end of medical school I had a classmate who wasn’t feeling very well
a classmate who wasn’t feeling very well
a classmate who wasn’t feeling very well he had a lot of reasons for not feeling
he had a lot of reasons for not feeling
he had a lot of reasons for not feeling very well he was on a surgery rotation
very well he was on a surgery rotation
very well he was on a surgery rotation so it’s what we talked it up to until
so it’s what we talked it up to until
so it’s what we talked it up to until you went to the doctor’s office and they
you went to the doctor’s office and they
you went to the doctor’s office and they found that he had a rare type of
found that he had a rare type of
found that he had a rare type of pancreatic cancer the same type of
pancreatic cancer the same type of
pancreatic cancer the same type of pancreatic cancer that Steve Jobs passed
pancreatic cancer that Steve Jobs passed
pancreatic cancer that Steve Jobs passed away from when they sequenced his tumor
away from when they sequenced his tumor
away from when they sequenced his tumor they found that his cancer had
they found that his cancer had
they found that his cancer had microsatellite instability and he
microsatellite instability and he
microsatellite instability and he received this immunotherapy if his
received this immunotherapy if his
received this immunotherapy if his facebook photos from his recent wedding
facebook photos from his recent wedding
facebook photos from his recent wedding are to be believed he’s doing quite well
are to be believed he’s doing quite well
are to be believed he’s doing quite well again the ability to defy the odds
again the ability to defy the odds
again the ability to defy the odds through sequencing to identify the best
through sequencing to identify the best
through sequencing to identify the best therapy for our patients one final
therapy for our patients one final
therapy for our patients one final example of putting cancer in a box
example of putting cancer in a box
example of putting cancer in a box starts as many stories started with
starts as many stories started with
starts as many stories started with someone getting pregnant pregnant mom
someone getting pregnant pregnant mom
someone getting pregnant pregnant mom she can look for how her baby is doing
she can look for how her baby is doing
she can look for how her baby is doing by getting a blood test when she gets a
by getting a blood test when she gets a
by getting a blood test when she gets a blood test how did the DNA and her blood
blood test how did the DNA and her blood
blood test how did the DNA and her blood comes from her and part of the DNA comes
comes from her and part of the DNA comes
comes from her and part of the DNA comes from a baby it’s actually a very common
from a baby it’s actually a very common
from a baby it’s actually a very common non-invasive prenatal testing I wouldn’t
non-invasive prenatal testing I wouldn’t
non-invasive prenatal testing I wouldn’t know that’s very common because I’ve
know that’s very common because I’ve
know that’s very common because I’ve never been pregnant hundreds of
never been pregnant hundreds of
never been pregnant hundreds of thousands of women get these blood tests
thousands of women get these blood tests
thousands of women get these blood tests every year and very rarely these tests
every year and very rarely these tests
every year and very rarely these tests identify cancer in a pregnant woman like
identify cancer in a pregnant woman like
identify cancer in a pregnant woman like babies when we have a cancer are the DNA
babies when we have a cancer are the DNA
babies when we have a cancer are the DNA and our blood comes from us and part of
and our blood comes from us and part of
and our blood comes from us and part of the DNA comes from the cancer we can
the DNA comes from the cancer we can
the DNA comes from the cancer we can look for these little pieces of DNA not
look for these little pieces of DNA not
look for these little pieces of DNA not just in pregnant women but in everyone
just in pregnant women but in everyone
just in pregnant women but in everyone again we take blood from a patient put
again we take blood from a patient put
again we take blood from a patient put it into a sophisticated juicer and
it into a sophisticated juicer and
it into a sophisticated juicer and analyze the date that comes out and by
analyze the date that comes out and by
analyze the date that comes out and by doing so we can find cancerous early
doing so we can find cancerous early
doing so we can find cancerous early monitor cancers in a non-invasive way
monitor cancers in a non-invasive way
monitor cancers in a non-invasive way and identify the best therapies for our
and identify the best therapies for our
and identify the best therapies for our cancer patients at the end of the day I
cancer patients at the end of the day I
cancer patients at the end of the day I agree with the doctor who said you can’t
agree with the doctor who said you can’t
agree with the doctor who said you can’t care it if it doesn’t
but I shouldn’t lend us as doctors or as
but I shouldn’t lend us as doctors or as patients if the cancer doesn’t fit in a
patients if the cancer doesn’t fit in a
patients if the cancer doesn’t fit in a traditional box a box in which you can
traditional box a box in which you can
traditional box a box in which you can only cure cancer its small if it’s
only cure cancer its small if it’s
only cure cancer its small if it’s early-stage then we can call cancer it’s
early-stage then we can call cancer it’s
early-stage then we can call cancer it’s in a different type of box by creating
in a different type of box by creating
in a different type of box by creating boxes by combining computing power with
boxes by combining computing power with
boxes by combining computing power with methods for probing and manipulating the
methods for probing and manipulating the
methods for probing and manipulating the rich biology within cancers we can
rich biology within cancers we can
rich biology within cancers we can create new tools to control this
create new tools to control this
create new tools to control this devastating disease
”
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