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MS. ABUTALEB: Good morning and welcome to Washington Post Live. I’m Yasmeen Abutaleb, a health policy reporter here at The Post. Today we have a segment of our Chasing Cancer Series, and my first guest is Eric Lefkofsky. He’s a tech entrepreneur and a co-founder of Groupon, among other companies. He’s also the founder and CEO of Tempus, a provider of technology-enabled precision medicine solutions. Eric, welcome to Washington Post Live. Thanks so much for joining us today.

MR. LEFKOFSKY: Thank you. Thanks for having me.

MS. ABUTALEB: So, I think we want to start with your story, which is I think pretty inspiring about how you came to found and lead Tempus. Your wife was diagnosed with breast cancer in 2015, and it was her journey that led you to found this company and to be really passionate about this area. So, can you tell us that story of why and how you founded this company?

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MR. LEFKOFSKY: Yeah, so I mean, you know, in my case it was personal. About seven years ago my wife was diagnosed with breast cancer, and I was just perplexed at how little data was a part of her care. And I ended up thinking there has to be a different way, a better way. And so, we got fixated at the time--you know, back then this was seven years ago--genomic tests were becoming more pervasive. And yet, it was hard for doctors to figure out how to incorporate this new data modality into their--into their practice.

And so, we set out originally to make genomic tests smarter by actually connecting them to clinical data for those patients and allowing the physician to kind of recontextualize the sequencing result in the context of that patient. So, in other words, if we’re sequencing a patient and we find a mutation, we didn’t want to recommend a drug that the patient had already taken in a prior line of therapy failed. We didn’t want to recommend a clinical trial that they weren’t eligible for because they would fail some inclusion or exclusion criteria of the trial. We didn’t want to fail to note adverse events that were material to their care. So, we set out to make these tests more personal and more connected where the molecular data and the clinical data were presented together to the physician.

And by making genomic tests smarter in cancer, we actually kind of stumbled into a platform to bring the power and promise of AI to healthcare I think more broadly by making all diagnostics intelligent, by building a platform that allows us to do that same thing, not just in cancer but in cardiology, in neurology, in immunology, and other disease areas. But in my case, you know, it was personal. I watched her being treated and thought there just has to be a way to bring more technology and more data to the point of care so physicians can make data-driven decisions.

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MS. ABUTALEB: And what, exactly, does Tempus offer patients? Can we start by explaining the tests that you provide?

MR. LEFKOFSKY: Yeah, so in cancer Tempus provides a fairly broad set of sequencing assays called next-generation sequencing assays to the market, where we’re doing what’s called solid tumor profiling. So, we’re sequencing patients, the tissue from their tumor and trying to figure out both at a somatic level--so what’s going on, which genes are driving that tumor, might be driving that tumor’s growth. And then we also do germline profiling. So, we’re looking at the patient’s normal state. And then we’re also doing cell-free DNA or liquid biopsy analysis. So, we might also look at their blood and what circulating tumor cells are floating around in their blood. And then we also do whole exome profiling clinically. So, we do--so instead of just doing a panel, like in our case we typically would sequence 648 genes that are typically known to drive cancer, we also do whole exome profiling and whole genome profiling. So, we look more broadly.

And then, we’re working on a series of new assays and new solutions that span looking at recurrence and resistance monitoring and minimal residual disease detection, and things of that nature. So, we have a pretty broad portfolio in cancer, sequencing patients, trying to figure out what’s driving their tumor or if their tumor is not responding to a chemotherapy, which resistance mechanisms are kicking in that are causing issues, and then how can we ultimately find potential targeted therapies or clinical trials or combinatorial therapies that the physician might consider in evaluating the next step.

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MS. ABUTALEB: In the last several years, last decade it’s become much easier for people to understand some of their genetic makeup. Does Tempus have any plans to offer direct-to consumer genetic testing, or is that something that you’re thinking about or working on?

MR. LEFKOFSKY: So, at this stage, you know, it’s kind of you look at it disease area by disease area. You know, cancer’s incredibly complex. The heterogenicity of these tumors, the--how these--how these tumors evolve over time, the number of potential treatment options that exist between surgery and chemotherapy and radiotherapy and immunotherapy and targeted therapy, we tend to believe that, at least for the next, I don’t know, 5 or 10 or 20 years, most solutions can and should and will go through their primary physician, which typically could be an oncologist or radiologist or a surgeon or a pathologist. And so, most of our solutions are physician-facing.

You know, you could imagine a world far into the future where with FDA approval companies like ours are communicating more often with patients. But I tend to think--and if you look at our core technology platform--the part of the journey that we’re in right now is assembling the necessary datasets that allow you to build really intricate and elegant machine learning and AI solutions that assist physicians in doing their job to help them make data-driven decisions. And I tend to think that’s where the biggest impact in healthcare is going to come from on the--on the physician side.

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MS. ABUTALEB: So, you also partner with medical centers and community healthcare systems to organize and aggregate clinical data. Can you explain to us how that works, exactly?

MR. LEFKOFSKY: Yeah, so we--in our case, we have relationships with hundreds of hospital systems across the country, you know, over 200 direct connections to hospital systems across the country. I think at the end of Q2 it was roughly 800 hospitals that were connected, sending data to Tempus regularly. That number grows materially, or at least it has grown materially in the past every quarter. And so, we have a very broad network of hospitals that we’re connected to where they’re sending us data for the patients that we’re sequencing or for the patients that they want us to analyze that might be a fit for, for example, a clinical trial. We bring that data in.

We’re typically structuring that data so we can figure out who these patients are, what drugs they’ve taken, how they responded, are they a fit for a particular therapy or trial. And then we’re going to--and then we deidentify that data, and we’re holding onto and retaining a deidentified data in the aggregate. So, we have millions of patients-worth of deidentified data that we hold onto that kind of powers our overall technology platform and helps us look at real-world insights across this deidentified patient population that are therapeutically relevant.

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MS. ABUTALEB: So, you mentioned earlier when you were talking about your wife’s journey and how you founded the company, Tempus has this huge molecular and clinical library. So how does that library help doctors and patients figure out how they might be able to use personalized medicine for the particular cancer someone might be dealing with?

MR. LEFKOFSKY: Yeah, I think the--in many ways--I mean, the first and probably the most important is it’s critical to look at real-world evidence at scale, and in particular look at can I find patients that are similar to my patient, and can I--and can I see their particular therapeutic journey and how they responded? Because ultimately, the challenge you have with clinical trials and often with approval of therapies is that the studies we run tend to be relatively small. So, we might look at a population of 200 patients or 400 patients or 600 patients that would ultimately--in the phase three study that led to this drug being approved.

And the challenge you have is, you know, there’s roughly 200 subtypes of cancer, and there’s--you know, in our case, like, if you look at our panel, it’s 648 genes. So, imagine you’re looking at 648 genes just on the genomic side across 200 subtypes of cancer, and even within that, all kinds of phenotypic characteristics that are relevant like this patient has diabetes or they have a heart condition or they are old or are they’re young or they’re on this particular medication or they had this adverse event a year ago. So, you need to kind of look at a lot of those characteristics which aren’t going to be represented in any small population of patients.

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And so, what ends up happening is there’s a giant disconnect between the universe of patients that were in the trial and the much larger universe of patients that are out in the real world. And so, physicians have to navigate that, and our technology at least gives them a window into what’s happening again at a deidentified level, but at least a window into what’s happening across the spectrum with patients so that at least they can kind of have some insight into what might occur with this patient and that they can take that into consideration as they think about what to do next.

MS. ABUTALEB: And how, exactly, do patients access this library or this ability to treat their cancer so specifically? What is the cost or the range for this kind of treatment, and are your services typically covered by insurance?

MR. LEFKOFSKY: Yeah, so again, the solutions that we make available we make available today to physicians. So, the way a patient would take advantage of some of Tempus’ technology is they would go to their doctor and say, you know, have you ordered next-generation sequencing for me, or is my cancer eligible for that kind of profiling, and then their oncologist in this case might order a Tempus test, and then they would be the beneficiary of that kind of information that their physician could consider.

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The way our tests are ordered is they’re ordered like any other laboratory test that a physician orders. There’s typically a medical necessity to order the test. We’re the lab running the test. We would bill insurance and get paid or not get paid, depending on how insurance covers these tests. But typically, there’s kind of minimal to no recourse to patients or to providers, as companies like ours bear the risk of not getting paid. So, it’s--you know, it tends to be for most patients just a very good thing without any recourse.

MS. ABUTALEB: And how can this--if you’ve got this huge library, a ton of data, how can it be used for other diseases and viruses, like COVID-19 for instance, where we’re still trying to learn and figure out a lot, and the disease affects people so differently?

MR. LEFKOFSKY: I think COVID’s a really good example of if you look at the kind of problems that Tempus is attempting to solve--right?--collecting vast amounts of data in real time, building the pipes that allow us to bring data out of this often siloed and fractured system, bringing it into a place like Tempus, structure it, harmonize it, make sense of it, and then ultimately derive insights from the data and then be able to put it back into the healthcare system where it’s so needed, you know, that core platform and architecture that we build in cancer that didn’t exist in COVID is I think one of the reasons we had such a difficult time at the start of the pandemic getting control of what was going on.

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You know, there was all this kind of confusion over whether hydroxychloroquine was advantageous, or Remdesivir, or you know, whatever it is, an IL-6 inhibitor. And a lot of that information could have been resolved very quickly if somebody like Tempus existed at scale in infectious disease, where we could have seen these patients who were COVID-positive; we could have looked at what therapies were being given in the real world; aggregated that data--again, on a deidentified basis--so, not specific to any one person but specific to all--just the general population, are people or are they not responding in the real world when they take this particular drug? If we would have had those pipes in place and that kind of a platform to structure and garner insight from that data, we could have, I think, likely answered some of those questions in weeks or a month or two, instead of how long it took us to finally get a handle on whether or not these things added value.

And ultimately, through studies that were run prospectively, we concluded that hydroxychloroquine didn't work. And you still need to run those studies. I mean, those studies, there's still a place for both retrospective and prospective studies to be run to validate the real-world data in a controlled environment. But getting insights from the data quick also has a place and, in this case, I think would have saved, you know, tens of thousands of patients who ultimately probably had the wrong therapy because we didn't have that system in place.

MS. ABUTALEB: It's so interesting, because you mentioned, you know, they could have aggregated the data and helped concluded that hydroxychloroquine didn't work. I think we all know that took a little bit too long last year; it took a couple of months.

So, when it comes to--and this is not exactly what this is, but there are some articles, and you talked about how Tempus could help accelerate or transform drug discovery. So, how exactly would that work?

MR. LEFKOFSKY: Yeah, our job is to basically bring the power and promise of artificial intelligence to diagnostics. We think diagnostics is the place where you can kind of connect ecosystem and collect vast amounts of data.

Some of that data is going to be used to help navigate a patient to the right therapeutic, and that's what we're principally in the business of doing, but some of that data can also be used for biomarker discovery, for investigative research, for novel exploration of new therapeutics, and we kind of view our job as making sure that the data we generate is broadly available to anyone and everyone who can possibly use it to advance a drug, to advance research, to figure out a way to get medications into the clinic that save people's lives.

And so, we fundamentally believe that our job is not just to help route patients to the right therapeutic, but to aggregate the kind of datasets that can actually advance the next level of therapeutics across anybody and everybody who has that capability: every biotech company, every pharma company, we want to universally make our data available if it can help them advance that cause.

MS. ABUTALEB: So, I want to ask you, because I can tell through the course of this conversation, you bring a very sort of tech mindset to health care, which can be kind of slow when--you know, it's a very difficult industry to break into.

So, you're an entrepreneur. Tempus is a departure from some of your other ventures, like commerce, logistics, and marketing. So, how are you measuring Tempus' success? Are you trying to build it to become the biggest and most successful of your businesses, or do you have a different goal here?

MR. LEFKOFSKY: You know, I think we’re somewhat fortunate that, you know, we can stay focused on the core mission at hand, which is helping patients live longer and healthier lives. And if we’re successful at that core mission, the company will also thrive and do incredibly well. So, we have the luxury, it’s one of the few businesses where if you just want to stay kind of singularly focused on the altruistic nature of what we do, that also happens to be what’s singularly in the best interest of the capitalistic nature of what we do. And so, we’re super fortunate.

I think, for us, it’s--I know at least for me I’ve never been a part of a business that had the potential to be this transformative really on every vector, and so, I’m kind of heads-down focused on doing everything I possibly can to make sure that Tempus lives up to its full potential, and that’s my main focus.

MS. ABUTALEB: And one thing I want to ask you is, we’ve seen a lot of tech companies come into healthcare with sort of mixed success. We’ve seen Apple and Amazon and Google have healthcare endeavors. Some have succeeded; some have not. How do you think this kind of participation from tech companies could help accelerate some healthcare technology, and what could the possible outcomes be for cancer treatment, and what’s the key to success for someone with a tech mindset or a tech company to come into healthcare? Because as you know, it’s not that simple.

MR. LEFKOFSKY: Yeah, it’s not that simple. There’s no question. Healthcare is very complicated. But I think that the walls of the dam have broken. That’s just at this point, I think, kind of over.

I just can’t imagine any scenario where technology and AI don’t permeate many, many, if not every aspect of healthcare. And I think it’s in large part because there have been all these background technologies that have been built up over the last decade: low-cost cloud computing, all kinds of advancements in imaging technologies, like optical character recognition and natural language processing, literally a revolution in the cost of generating molecular data, and a scale and cost that none of us thought was even imaginable 15 or 20 years ago. And so, when you combine all that, what it means is we can for the first time ever assemble vast amounts of data and that are very high quality and relatively low cost.

And as a result, you can build solutions that, like, peer inside the medical record and allow you to structure it, harmonize it, make sense of it, see what’s happening. And so, you can build those datasets that are needed to understand, like, what’s happening to these patients. Up until very recently, that was impossible. And now that you can do that, I think there will be a generation of companies, of which Tempus is currently, you know, a leader, that bring those solutions to market. And I think, you know, in the aggregate those businesses will be super transformative.

And I think you’ll see--you’ll see folks like Google and Microsoft and Amazon and Apple and others that will be able to take advantage of some of the work companies like we do and bring all of their capabilities to bear, and that’s when you’re going to see, I think, this thing just explode in terms of really us being able to eradicate and/or manage a series of life-threatening diseases in ways that seemed like unimaginable a few decades ago. And so, I would not be surprised at all if, you know, 30 or 40 or 50 years from now, you know, we don’t have--we don’t lose 600,000 people a year to cancer, we lose 60,000. And when you talk about a 90 percent reduction in mortality rate, cancer will feel like a rare--like a rare disorder. It won’t feel like what it is today, which is the second-largest killer I think of people in the United States. It’s right up there with stroke.

MS. ABUTALEB: Well, we’re unfortunately out of time this morning for this segment. But, Eric Lefkofsky, thank you so much for joining us. It was a fascinating conversation.

MR. LEFKOFSKY: Thanks for having me.

MS. ABUTALEB: Please stay with us. After this sponsor segment, we will be back with pioneering oncologist and Pulitzer Prize-winning author Siddhartha Mukherjee.

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MS. MESERVE: Precision medicine has revolutionized many aspects of healthcare, including the treatment of cancer. Joining me to discuss is Dr. Akila Viswanathan. She is professor and director of Johns Hopkins Radiation Oncology and Molecular Radiation Sciences. Great to have you with us. Let me ask you first, how is precision medicine used in the treatment of cancer?

MS. VISWANATHAN: Let me first say thank you so much for the invitation today. It’s wonderful to be here and to have the opportunity to speak to the audience.

Precision medicine is used in many different ways. First of all, we have to clarify that precision medicine is many things. It’s biological therapy where we’re targeting specific genes or specific features that are unique to the tumor. It’s also technologic therapy, where we may use imaging like MRI or PET scans or CT scans to determine where the cancer’s located, and then we use radiation to direct treatment using high-end technology to focus on the exact location of where the cancer is. So, precision medicine is a very broad spectrum of cancer treatment, and patients may need various forms of precision medicine in order to receive appropriate treatment.

MS. MESERVE: What is proton beam therapy, and how does that factor in?

MS. VISWANATHAN: Proton beam therapy is one of the technologic types of treatments that I was referring to. It means that we’re using the charged particle that is very effective at breaking up the DNA of the cancer cell that it hits or that it is targeting. And so, it means that it’s very effective. But it also has a very unique property, that it doesn’t pass through tissue; it stops at the edge of the tumor. So, we can prescribe proton therapy to literally the edge of the tumor and target that and essentially, you know, hit the tumor directly; whereas, photon therapy will have some of the radiation dose go past the tumor, some of it go to the sides of the tumor, so you treat a broader area with what’s called low dose. The dose to the tumor itself is the same, but it’s much more precise, and there’s less normal tissue treated with proton beam therapy.

MS. MESERVE: So, is precision medicine actually having an impact on cancer outcomes?

MS. VISWANATHAN: Absolutely. We’ve seen in both the biological and the technological fronts incredible advances. So, we, you know, have for many, many years had biological therapy. For example, HER2 was discovered and is used to create and treat breast cancer patients with Herceptin.

In radiation, we’ve seen incredible advances with the integration of imaging into our radiation modalities. For example, in our proton center in Washington, D.C., at Sibley Memorial Hospital, which is part of the Sidney Kimmel Comprehensive Cancer Center, we’re able to use a new technology that was just released call real-time gating. That allows us to watch the tumor as it moves and to turn the proton beam on just when the tumor’s in the center of where we want to radiate. So, we can turn the beam on and off in a way that allows us to spare the normal tissue to the millimeter level to avoid the normal tissues.

MS. MESERVE: Cancer can be a complicated disease. As you’ve described it, there are many aspects to precision treatment. So how do you put together an individualized treatment plan?

MS. VISWANATHAN: We start with our world-class experts. We have physicians that are at the top of their game looking at every single aspect of patients’ needs when they come in the door. So, you know, they amalgamate and interpret all of the data. They look very closely at the patient. They talk to them about their needs and wishes. And then they formulate together with their family a plan that meets their goals. You know, if the goal is to eradicate the disease, what are the treatment approaches that may get the patient to that state?

And so, we implement precision therapy as part of a multidisciplinary team--surgeons, medical oncologists, radiation oncologists coming together and deciding which way we can implement proton beam therapy, targeted biological therapy, precision robotics surgery, in order to give the best outcome possible.

MS. MESERVE: Look to the future with me, if you would. What do you see as the big challenges and the big opportunities when it comes to precision medicine and cancer care?

MS. VISWANATHAN: You know, our fields are evolving so quickly that we need to keep up. And keeping up means new research. We need to take the best biological therapy, the things that are just coming out, and combine it with the latest in our proton therapy--the real time gating, the pencil-beam scanning technology that spares the normal tissues--these technologies coming together and being given in a very safe and effective manner. That’s really what we need to push for the future. You know, giving these treatments together generally spares side effects. So, for kids, for example, they’re able to get effective treatment for say a brain tumor that spares them the neurocognitive or intellectual side effects that might occur. But we need to know the sequencing and the best combination regimens to make sure that we optimize all aspects of patients’ outcomes.

MS. MESERVE: Thank you, Dr. Akila Viswanathan, director and professor at Johns Hopkins Radiation Oncology and Molecular Radiation Sciences. And now back to The Washington Post.

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MS. ABUTALEB: Welcome back. For those of you just joining us, I’m Yasmeen Abutaleb, a health policy reporter with The Washington Post. My next guest is Dr. Siddhartha Mukherjee. He is a pioneering oncologist and a Pulitzer Prize-winning author. Thank you so much for joining us, and welcome back.

MR. MUKHERJEE: Well, thank you very much.

MS. ABUTALEB: So, I want to start by asking you about precision medicine. It’s a term that gained a lot of steam during the Obama White House years. It’s a term we’ve all heard. But I don’t know that many people understand it. So, can you just help us understand what, exactly, it is, and what it means in terms of cancer care?

MR. MUKHERJEE: Well, precision medicine is a word that it’s a little bit like the blind people and the elephant: You know, some people feel the tail, some people feel the trunk, some people feel the sides, and they have their own definitions of what the elephant is.

In a very broad sense, precision medicine means finding the right therapy for the right person at the right time, and that’s a very broad definition. And of course, it can be interpreted in different ways. The important thing is that precision medicine is about, as I said, finding--you know, treating each individual disease, including each individual cancer, as if it was its own disease and trying to understand what we could do for that particular disease that would be helpful to extend the lives and the health of an individual case.

MS. ABUTALEB: Sorry, there’s sirens in my background. Just ignore that.

How has precision medicine come of age in the last few years, and in particular how has it been used to treat cancer?

MR. MUKHERJEE: Well, so, you know, as I said, I’ve written before about this. I am--I have some sobriety about precision medicine, and my sobriety is--I’ll tell you exactly what my sobriety is.

In the 1990s and early 2000s, when we sequenced cancer genomes and human genomes, we--I think some of us optimists had thought that out of the genome, just by the genetic sequence, and perhaps by understanding the expression of genes in cancer cells, that we would--sort of the therapies would fall out of it. In other words, there would be a kind of, you know--you know, cancer is X, the therapy is Y, and so forth. That has worked for some cancers, spectacularly for cancers such as some breast cancers. I heard a conversation about HER2 and Herceptin. It has worked for some leukemias such as chronic myelogenous leukemia, some lung cancers. But the--so that’s the optimistic part of it.

The sobriety in this is that for most cancers, the genetic sequence of the cancer and our understanding of, you know, what the cancer expresses in terms of its proteins has not led, thus far, to a panoply, as it were, of medicines that we can use for that particular cancer that would solve the problem. And that’s been a very sobering message, because we had thought that that would be the case.

In the disease that I treat, which is a precancerous syndrome called myelodysplastic syndrome or--and also acute myelogenous leukemia, you know, I can send sequencing and I can--you know, I get lots of sequencing data back. The data from the sequencing from the genome and from the understanding of the cancer--what the cancer expresses marginally--and this is very important--only marginally affects what I use as treatment for the--for that cancer. I’m still using drugs that were used in the 1970s and 1980s to treat a cancer in 2021. Now, that’s not true for breast cancer. That’s not true for some kinds of lung cancer. So, there is a very vast degree of heterogeneity in our ability to go from information that the cancer provides to the specific drugs that the cancer can respond to.

One last point is that I’m particularly interested in prevention precision therapeutics. So, in other words, can we use all the various mechanisms that we have now--scans, blood tests, et cetera, et cetera--to prevent cancers in their earliest stages or to catch cancer in their earliest stages and thereby use precision medicine? It’s almost always the case that in advanced cancers we’ve been not so lucky in doing the kind of precision medicine that we had hoped to do. But in early cancers, we really get a lot of effect, and the real hope is to find these early cancers using a variety of mechanisms and eradicate them so that we can really bring the power of precision medicine. So, precision medicine is really tied with--is the detection of early cancers as much as we can get them.

MS. ABUTALEB: So, I understand your sobriety around this and that it doesn’t obviously work across the spectrum. But can you think of a particular case or instance where you did see it have a positive impact in someone’s course of care, or it was effective in the course of treatment?

MR. MUKHERJEE: I can think of dozens of such cases. It’s not just one. And you know, but some of them come from earlier eras.

I mean, right now a woman with breast cancer undergoes a barrage of tests, genetic and otherwise, to localize the cancer, to find out how big the cancer is, and then also to find out what the genes that are expressed in the cancer. Is it dependent on hormones such as estrogen and progesterone? It is dependent on a particular genetic mutation called HER2? Now, that’s woman life, if she has an ER, or estrogen receptor, PR, progesterone receptor, HER2+ cancer has been totally transformed since the 1950s,

'60s, '70s and '80s. She now can enjoy a healthy life of, I would suspect, you know, 10 more years, maybe even 15 more years and potentially be cured of her cancer, which is a huge advancement.

The mortality, the absolute mortality from breast cancer has been dropping by about 1 percent per year in the United States. And you could say 1 percent is not such a big deal, but over 25 years that amounts to about 25-odd percent. Now, that is a transformative story. A woman with breast cancer coming into a clinic in 1990 would meet a very, very different idea of her prognosis than a woman coming in in 2021. That’s the, I would say, the optimistic story.

A man or a woman with pancreatic cancer, advanced pancreatic cancer will not meet that story. A man or woman with, you know, advanced acute myelogenous leukemia--a disease that we’ve been working on very extensively--will not meet that criteria. So, there is really a spectrum, as it were, in which some cancers have advanced in genetic and precision medicine ways very dramatically and other cancers have proved to be very sobering experiences.

MS. ABUTALEB: So, I think you’ve really helped us understand the different factors at play in determining whether precision medicine might be helpful in someone’s course of care. We did have a lot of viewers who wrote in asking if there’s an age cutoff for precision medicine. So, could you help us understand whether age is a factor in this?

MR. MUKHERJEE: No, it isn’t, really. I mean, you know, obviously if some part of precision medicine involves a bone marrow transplant--so, in other words, we sequence the genes of a person who has leukemia or some other such disease and we find that their chances of relapsing are very high and that they, you know, need a bone marrow transplant, then age is a cutoff because that procedure is really sort of crossing the Rubicon. And so, in those cases, age is a cutoff.

But for most other patients, these new therapies are very well tolerated. You know, the classic example, perhaps the most striking example of precision medicine might be the use of the drug Imatinib or Gleevec for chronic myelogenous leukemia. It really has changed the universe of that disease, and we’re using that drug in all age groups. It seems to be relatively harmless and can be used across really multiple age groups.

MS. ABUTALEB: You wrote a piece in 2018 where you asked if we could expand our idea of what personalized medicine could mean. Could you talk a little bit about that? How do you see a more holistic view of cancer care being brought to life, and who would play a role in that?

MR. MUKHERJEE: Yeah, I think--I think that the idea of precision medicine being, you know, just what I call mutant hunting is--it narrows the definition too much. And by mutant hunting I mean, you know, go to a cancer, find what mutations it has, and try to use those mutations to find the drugs that it will respond to. I think that is far too narrow a definition of precision medicine.

Precision medicine very broadly could involve precision detection--in other words, finding out what cancer you have and where you have long before it can be visually seen in the body. And there are many companies, laboratories that are doing that work. Precision medicine could involve being very directed in terms of surgical and radiation therapy so that you don’t damage collateral tissue and you know exactly what kind of radiation or surgical therapy to use. And of course, it could mean, you know, matching a mutation or its profile to the particular cancer.

One project that we’ve done, which is kind of an interesting project, is along with several other groups, including Hans Clevers’ group in The Netherlands, we’ve been able to harvest the--an individual cancer from an individual person’s body and grow that cancer as what’s called an organoid, little--tiny little hundred, 200, 300-cell tissues, I’d love to show you a picture at some point of time--and then, you know, deploy or test in a test tube. Thousands of drugs that are FDA-approved on those--on your individual cancer. That is also precision medicine. It is not genomic precision medicine. It is not, you know, prevention precision medicine. But it’s a kind of, I would say, in some ways a low-tech precision medicine which depends on saying I don’t know but I’ll empirically test an individual cancer against thousands of drugs.

So--and we get very unusual results, and we’ve treated some patients with it with some success. I would say with more than some success, with real success. So, I think, as I said before, precision medicine, I think we use the term way too narrowly and then bash the term. But I think that, you know, as I said in that 2018 piece, we should widen the idea of what precision medicine is because we are learning things about cancer that we didn’t know before.

MS. ABUTALEB: So, I want to shift the conversation a little bit in the last few minutes we have. The mRNA vaccines have been a huge success in the fight against COVID, and more broadly just as a medical technology it’s raised a lot of excitement about how this mRNA technology could be used in other diseases. One of the ones that’s been mentioned is how this mRNA technology could be used in cancer care. So, could you explain to us how that could hypothetically work and how optimistic you are about this making some advancements in cancer care?

MR. MUKHERJEE: Well, one of the major areas of cancer care is immunotherapy, and we’re still trying to understand how immunotherapy works, what its range is and possibilities are.

Now, immunotherapy, of course, involves inciting the immune system against anything, and in the case of cancer it would be inciting the immune system against cancer. Now, it’s important to realize that the mRNA vaccines allow us to find a completely new way of inciting or exciting the immune system against cancer. So, you can imagine taking a cancer cell, finding out what’s unique about it, what unique proteins it expresses, and then just like, you know, you have a vaccine against COVID which would incite your immune system against COVID, a virus, you could imagine such a similar thing with cancer. You could imagine inciting an immune response against the cancer and thereby directing immunotherapy against cancer.

Now, this could be done at a cancer-by-cancer level, which would be highly dependent on precision medicine. In other words, you’d have to take the individual cancer and find out what was unique about it, and then use the mRNA to incite an immune response against it. Or it could be done as a preventative. So, you know, there are now several vaccines against potential virally induced cancers such as human papilloma virus or such as Epstein--we haven’t got a vaccine yet there, but for cancer-related viruses such as Epstein-Barr Virus.

So, it opens a new frontier of being able to deliver mRNAs into a cancer--sorry, into a human body such that you could elicit an immune response against cancer. One of the things that our laboratory’s working on is something different, which is to say can you use the similar mRNA technology to change the genetics of a human body such that you can now attack the cancer not only in an immunological sense but to make a difference using the mRNA to make a difference between the normal cell and the cancer cell. So, there are really a variety of mechanisms--mostly immunological but some non-immunological--by which we can use these mRNA technologies to advance cancer care.

MS. ABUTALEB: So, I think we have just a couple minutes left, and I want to ask a question that will hopefully leave us on a hopeful note, which is do you think that mRNA vaccines could help cure cancer or act in a way that the HPV vaccine does, and do you think that we’re inching towards a future where there could be more vaccines to help prevent or cure various forms of cancer?

MR. MUKHERJEE: It depends on what you mean by the word “vaccine.” You know, there are two kinds of vaccines. There are sort of what I would say preventative vaccines. HPV would be one of them. And I think absolutely we will see new vaccines emerge, hopefully new vaccines against HPV, which is already quite successful, but potentially vaccines against other virally induced cancers such as EBV and others.

There’s another kind of vaccine which is when you have a disease, and you incite the immune system against the cancer, and it acts as a kind of preventive for the spread or growth of cancer. That’s a therapeutic vaccine. And there I see an enormous amount of potential in these mRNA vaccines, because we can make them quickly, we can make them safely, we know that they induce a strong immune response. But again, that will depend on our capacity to find unique things about the cancer just like we found unique things about COVID that you could incite the immune system against and thereby prevent and treat a cancer. Now, this is a therapeutic vaccine, so it may have to be designed on a person-to-person basis.

But mRNA is a very versatile technology. It’s really information that’s been encoded in a piece of a molecule. So, I’m very optimistic about the idea that these mRNA vaccines therapeutically as well as prophylactically will really change the universe of cancer.

MS. ABUTALEB: Well, we’re out of time, so we’re going to have to leave it there. But, Dr. Mukherjee, thank you so much for joining us today and for a fascinating conversation.

MR. MUKHERJEE: Thank you very much.

MS. ABUTALEB: And thank you for watching. To see what interviews we have coming up, head over to WashingtonPostLive.com to find out and register. As always, thanks for watching. I’m Yasmeen Abutaleb.

[End recorded session.]

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