Podcast
Questions and Answers
What do measured expression levels in gene analysis reflect?
What do measured expression levels in gene analysis reflect?
- The patient's overall health
- The activity level of genes in tumour cells (correct)
- The size of the tumour
- The amount of treatment required
How do assays predict the likelihood of cancer recurrence?
How do assays predict the likelihood of cancer recurrence?
- By evaluating family medical history
- By comparing expression levels to established patterns (correct)
- Through imaging techniques
- By analyzing blood pressure variations
Which treatment change might occur with a high risk of recurrence indicated by the assay?
Which treatment change might occur with a high risk of recurrence indicated by the assay?
- Changing from tamoxifen to an alternative treatment (correct)
- Lowering the dosage of current medication
- Delaying treatment for further evaluation
- Switching to a chemotherapy regimen
What was a significant advancement achieved through the development of these assays?
What was a significant advancement achieved through the development of these assays?
Which biomarker panel is specifically useful for predicting metastasis risk?
Which biomarker panel is specifically useful for predicting metastasis risk?
What advantage have biomarker panels provided in cancer therapy?
What advantage have biomarker panels provided in cancer therapy?
How might the use of MammaPrint impact treatment plans for patients?
How might the use of MammaPrint impact treatment plans for patients?
What is one benefit of using biomarker panels for diagnosis?
What is one benefit of using biomarker panels for diagnosis?
What is a significant factor contributing to the poor response of cancer patients to existing drugs?
What is a significant factor contributing to the poor response of cancer patients to existing drugs?
In the context of oncology, what percentage of patients experience substantial improvement in health and survival?
In the context of oncology, what percentage of patients experience substantial improvement in health and survival?
What type of heterogeneity refers to differences found within a single tumor?
What type of heterogeneity refers to differences found within a single tumor?
What is considered a crucial consideration when treating near end-of-life cancer patients?
What is considered a crucial consideration when treating near end-of-life cancer patients?
Why is it not feasible to use every available drug on cancer patients?
Why is it not feasible to use every available drug on cancer patients?
What percentage of patients die from treatment-related complications?
What percentage of patients die from treatment-related complications?
What is a vital element that influences tumor behavior and response to therapies?
What is a vital element that influences tumor behavior and response to therapies?
What classification do differences between tumors in different patients fall under?
What classification do differences between tumors in different patients fall under?
What role do predictive biomarkers play in treatment?
What role do predictive biomarkers play in treatment?
Which statement about prognostic biomarkers is true?
Which statement about prognostic biomarkers is true?
How does a prognostic biomarker influence treatment decisions?
How does a prognostic biomarker influence treatment decisions?
What is a key feature of Next Generation Sequencing (NGS)?
What is a key feature of Next Generation Sequencing (NGS)?
What is a potential consequence of a predictive biomarker's absence?
What is a potential consequence of a predictive biomarker's absence?
What is the main function of companion diagnostics in relation to biomarkers?
What is the main function of companion diagnostics in relation to biomarkers?
How has NGS improved cancer subtype identification?
How has NGS improved cancer subtype identification?
What is one benefit of integrating NGS with transcription profiling?
What is one benefit of integrating NGS with transcription profiling?
How can understanding the mechanisms of gene X impact cancer treatment?
How can understanding the mechanisms of gene X impact cancer treatment?
What characteristic is essential for prognostic biomarkers in clinical settings?
What characteristic is essential for prognostic biomarkers in clinical settings?
What does NGS help identify in patients with heterogeneity within diseases?
What does NGS help identify in patients with heterogeneity within diseases?
Why is it important to assess the presence of biomarkers before administering certain treatments?
Why is it important to assess the presence of biomarkers before administering certain treatments?
Which statement is true regarding the prognostic power of NGS identified subtypes?
Which statement is true regarding the prognostic power of NGS identified subtypes?
How does NGS improve treatment decisions for clinicians?
How does NGS improve treatment decisions for clinicians?
Why is detailed prognostic information from NGS important?
Why is detailed prognostic information from NGS important?
What percentage of ER+ breast cancer patients are estimated to respond to anti-oestrogen or endocrine therapy?
What percentage of ER+ breast cancer patients are estimated to respond to anti-oestrogen or endocrine therapy?
What significant change did the application of NGS to cancer panels in 2012 indicate?
What significant change did the application of NGS to cancer panels in 2012 indicate?
Why is ER- status particularly useful in clinical decision-making regarding endocrine therapy?
Why is ER- status particularly useful in clinical decision-making regarding endocrine therapy?
What is implied by the statement that ER+ status is a reasonable biomarker for endocrine therapy?
What is implied by the statement that ER+ status is a reasonable biomarker for endocrine therapy?
What distinguishes a predictive biomarker from a prognostic biomarker?
What distinguishes a predictive biomarker from a prognostic biomarker?
What is a major limitation observed in stratifying patients by ER status?
What is a major limitation observed in stratifying patients by ER status?
What clinical implication arises from the necessity of additional biomarkers for ER+ patients?
What clinical implication arises from the necessity of additional biomarkers for ER+ patients?
How do cumulative survival rates compare between ER+ and ER- patients based on the content provided?
How do cumulative survival rates compare between ER+ and ER- patients based on the content provided?
What alternative therapies should be considered for ER- patients?
What alternative therapies should be considered for ER- patients?
What does a steep decline in the Kaplan-Meier plot for a subgroup indicate?
What does a steep decline in the Kaplan-Meier plot for a subgroup indicate?
What is the significance of a log-rank P-value of 1.2 × 10⁻¹⁴ in the context of the study?
What is the significance of a log-rank P-value of 1.2 × 10⁻¹⁴ in the context of the study?
What role does the analysis of additional genes play in the study of breast cancer?
What role does the analysis of additional genes play in the study of breast cancer?
What does a gradual decline in the Kaplan-Meier plot represent for a subgroup such as IntClust 4?
What does a gradual decline in the Kaplan-Meier plot represent for a subgroup such as IntClust 4?
What information does the legend on the Kaplan-Meier plot provide?
What information does the legend on the Kaplan-Meier plot provide?
How are subgroups in the Kaplan-Meier plot identified?
How are subgroups in the Kaplan-Meier plot identified?
What is the primary conclusion about patients in IntClust 7 based on the plot?
What is the primary conclusion about patients in IntClust 7 based on the plot?
What is the main objective of identifying oncogenic drivers and disease modifiers?
What is the main objective of identifying oncogenic drivers and disease modifiers?
Flashcards
Inter-tumour heterogeneity
Inter-tumour heterogeneity
Variations in the characteristics of a tumor across different individuals or cancer types.
Intra-tumour heterogeneity
Intra-tumour heterogeneity
Differences in the characteristics of a tumor within the same individual.
Tumor Microenvironment
Tumor Microenvironment
The surrounding environment of a tumor, including blood vessels, immune cells, and extracellular matrix, which can influence tumor growth and response to treatment.
Tumour Heterogeneity
Tumour Heterogeneity
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Epithelial Characteristics
Epithelial Characteristics
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Personalized Therapy
Personalized Therapy
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Oncology Challenges
Oncology Challenges
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Treatment Considerations
Treatment Considerations
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Predictive Biomarker
Predictive Biomarker
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Prognostic Biomarker
Prognostic Biomarker
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ER status as a predictive biomarker
ER status as a predictive biomarker
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Response to Endocrine Therapy in ER+ Patients
Response to Endocrine Therapy in ER+ Patients
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Response to Endocrine Therapy in ER- Patients
Response to Endocrine Therapy in ER- Patients
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ER status as a treatment decision tool
ER status as a treatment decision tool
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Limitations of ER status as a predictor
Limitations of ER status as a predictor
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Survival advantage in ER+ patients
Survival advantage in ER+ patients
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Gene X
Gene X
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Metastatic Potential
Metastatic Potential
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Biomarkers
Biomarkers
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Companion Diagnostics
Companion Diagnostics
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Disease Subtype with a Prognostic Biomarker
Disease Subtype with a Prognostic Biomarker
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Treatment X (Effective Only with Biomarker Present)
Treatment X (Effective Only with Biomarker Present)
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Gene Expression Analysis
Gene Expression Analysis
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Patient Stratification
Patient Stratification
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Recurrence Risk
Recurrence Risk
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Biomarker Panel
Biomarker Panel
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Overtreatment
Overtreatment
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Personalized Treatment
Personalized Treatment
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MammaPrint
MammaPrint
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Oncotype DX
Oncotype DX
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What is the main benefit of Next Generation Sequencing (NGS) in terms of genomic profiling?
What is the main benefit of Next Generation Sequencing (NGS) in terms of genomic profiling?
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How does NGS contribute to understanding disease mechanisms?
How does NGS contribute to understanding disease mechanisms?
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How has NGS impacted cancer subtyping?
How has NGS impacted cancer subtyping?
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What is the advantage of combining NGS with transcription profiling?
What is the advantage of combining NGS with transcription profiling?
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How does NGS contribute to identifying high-risk patients?
How does NGS contribute to identifying high-risk patients?
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How does NGS impact treatment decisions?
How does NGS impact treatment decisions?
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How does NGS help in understanding prognosis?
How does NGS help in understanding prognosis?
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How does NGS help in tailoring treatment plans?
How does NGS help in tailoring treatment plans?
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Kaplan-Meier Plot
Kaplan-Meier Plot
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Integrative Clusters (IntClust)
Integrative Clusters (IntClust)
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Log-rank Test
Log-rank Test
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Oncogenic Drivers
Oncogenic Drivers
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Disease Modifiers
Disease Modifiers
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Reclassifying Disease Subtypes
Reclassifying Disease Subtypes
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Understanding the Molecular Mechanism
Understanding the Molecular Mechanism
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Study Notes
Measuring and Modeling Heterogeneity in Breast Cancer
- Oncology is a challenging field with approximately 7% of patients dying from treatment itself.
- Many patients don't respond well to existing drugs due to cancer's complexity and variability.
- Quality of life vs. treatment is a frequent consideration, especially for those nearing the end of life.
- Intra-tumour heterogeneity (diversity within a single tumour) results from clonal expansion and evolving mutated cells.
- This creates pockets of active cells, competitive within the tumour, promoting a diverse environment.
- Inter-tumour heterogeneity are differences between tumors in different patients or types of cancer. Tumor behavior is influenced by its origin
- Tumours are genetically and phenotypically diverse, varying significantly within a single tumor.
- Treatments don't always work for all tumour cells or all tumours.
- It's hard to predict tumour response to treatment and long-term prognosis accurately.
- Cancer cells adapt to treatments and improve survival rates through mutations.
- Cancer is multifaceted, not one disease, but hundreds composed of different diseases.
Tumour Heterogeneity
- Tumour heterogeneity refers to differences between one tumour and the next through inter-tumour (differences between tumors in different patients or types of cancer) and intra-tumour (differences within a single tumour) heterogeneity
- Understanding tumour heterogeneity is fundamental to developing more effective cancer treatments and understanding why one treatment doesn't work for everyone.
- Tumours originate in different body tissues each originating from different cells and tissue of origin
- Tumours display extensive genetic and phenotypic heterogeneity, exhibiting considerable variation in cellular activity and appearance.
Tumour Microenvironment (TME)
- The surrounding environment of a tumour critically affects its growth and response to therapy.
- The TME comprises various components, including the tumour epithelium, stroma (supportive tissue), fibroblasts, endothelium, neuro-endocrine cells, and immune cells.
- These components interact in complex ways, influencing processes such as cell proliferation, cell death, and immune response.
- Increased interstitial pressure, leaky vessels, and disorganized blood vessels can restrict access of immune cells to the tumour.
- Collagen deposition in tumours can act as barriers to drug penetration.
- Tumours contain cancer stem cells which make up a small percentage of the tumour mass but are highly malignant and difficult to treat
- These cells are responsible for tumour recurrence and drug resistance
Classification and Stratification of Breast Cancer
- Breast cancer is heterogeneous, meaning it consists of different cells with varying characteristics that affect treatment response.
- Stratification involves categorizing breast cancer into subtypes based on these characteristics, allowing customized treatment plans.
- Histological subtypes categorize tumours based on their microscopic appearance (e.g., DCIS, IDC).
- Molecular subtypes categorize tumours based on genetic and protein profiles with subtypes like ER-positive, HER2-positive, and triple-negative.
- Understanding subtype and grade aids in treatment selection.
Biomarkers in Breast Cancer Treatment
- Biomarkers are measurable indicators of disease (e.g., protein or gene)
- Some are prognostic (predicting course of disease or likelihood of recurrence) while others are predictive (indicating likelihood of response to treatment, e.g., HER2 status).
- Classic biomarkers (e.g., receptor status) provide a basic understanding of aggressiveness and response to treatment.
- Molecular biomarkers (e.g., gene expression profiling) offer more precise classification and individualized treatment, leading to a better prognosis.
- Several molecular tests predict recurrence, and treatment options based on molecular classification are now more common.
New Technologies (Next Generation Sequencing, NGS)
- NGS provides comprehensive genomic profiling, enabling analysis of entire genomes
- Identification of important mutations crucial for understanding disease mechanisms
- NGS with transcription profiling provides a comprehensive understanding of the disease, leading to more accurate prognosis and treatment approaches to enhance outcomes
- Gene expression patterns provide insights into the mechanisms of tumour behaviours
- Large datasets have shown that survival curves converge, signifying a need for better prediction methods
- Next generation sequencing technologies (e.g., oncotypeDX, MammaPrint) offer individualised assessments of recurrence risk and treatment effectiveness when analysing gene expression
- Limitations still exist, like biological issues, availability of tumour tissue, and lab reproducibility.
Breast Cancer Models
- Cell lines are transformed cells that can be grown in culture, exhibiting features of various breast cancer subtypes.
- Xenografts involve transplanting human cancer cells into mice and are used to investigate tumour growth, metastasis and responses to treatment in an animal model.
- Genetically engineered mouse models (GEMs) are mice genetically modified to develop a specific aspect of breast cancer, enabling more detailed study.
- Each method offers unique advantages and disadvantages, with a balance required for robust studies.
- Integrated approaches examining multiple model types are often essential.
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