Steve Abbott:
Well, hello everyone, and welcome to episode 14 of our Medical Minute Podcast series from our new dedicated studio in our new offices in beautiful downtown Norwood. We had a great time with Tim Schroeder on the previous three episodes talking about clinical trials. So if you haven't had a chance to look at those, please go back and see those. I mean, as someone who's been in the CRO space for years, I can't even tell you how much I learned. A lot. And so Tim was full of information, and as Jill would attest, clinical trials hold just unlimited promise for the future for cancer care. So please give those a look when you get a chance.
Steve Abbott:
Anyway, so for the next two episodes, we're going to talk about, and I never know exactly how to use the term, but precision oncology, precision medicine, molecular medicine, whatever we want to call it. But anyway, it's that. So it represents a kind of revolutionary step forward in early detection, and so I think maybe what I'll do at this point is maybe Jill can... What is the right term? I mean, do any of those work? Are they synonymous or...
Jill Hunt, CNP:
All of them work, and all of them are right, and you also will hear terms like personalized medicine. Essentially, what all of those terms collectively mean is it's a personalized approach to someone's individual tumor and cancer. It's not putting everybody in little compartments and blankets treating a disease.
Steve Abbott:
Got it. Yep. That makes perfect sense. Okay. So I don't know if people will remember or not. Hopefully, they watched episode 10, where I kicked off my journey as a human pin cushion. That will continue over the next couple of episodes. But in that episode, Jill took my blood for something called a Guardant360, which is a liquid biopsy. And at the time, we explained it, but Jill, if you could just do five, 10 seconds, 15 seconds maybe on what a liquid biopsy is. Why it's maybe not better than a tissue biopsy, but how it differs and why that's good for people going forward as well.
Jill Hunt, CNP:
Okay. So a liquid biopsy is a way to measure what's called a cell-free circulating tumor DNA that's in the bloodstream. The tumors themselves shed little pieces of themselves during different parts of cell division. And when that happens, parts of that can circulate through the bloodstream, and through some pretty amazing advances in science, they've been able to extract that from the blood and test it specifically for certain mutations that are specific to your cancer.
Jill Hunt, CNP:
The way that that differs, obviously from a standard tissue biopsy. In a standard tissue biopsy, you are going into the tumor itself and removing a chunk of that tissue and then sending the traditional method to the pathologist, and they're reading and doing the stains and different testing on the tumor. And why the advances have been made and why this is such a great addition to cancer care is that number one, it gives you a great method of surveillance while patients are going through treatment.
Jill Hunt, CNP:
It gives you a way to detect when things are starting to change early. It is also for patients who might not be a candidate for a tissue biopsy. Sometimes lung cancer patients are diagnosed by not necessarily a tissue diagnosis, but because they've had fluid removed from their lung and they've picked up the cancer cells and diagnosed it, but not actually had a tissue. If the patients are older, they're on blood thinners, they have multiple other issues that would not be a great candidate for them to be sedated for a biopsy or the biopsy itself is a risk for complications, then this offers another way of looking for some of those mutations that offer treatment options.
Steve Abbott:
Yeah. And I remember that's what stuck with me when you went through it, the first time as someone that's had several of these and been around the space for a while. But what really resonated with me was when you said that they go in and they get the tissue, but what they're really looking for within the tissue is also what's excreted, kind of excreted into the blood by way of cancer cells DNA. So they can find the same thing in the blood.
Steve Abbott:
And that was something I really had never heard it explained that way before, which I thought was really helpful. So anyway, so now maybe we'll get into the result that we actually got back on mine.
Jill Hunt, CNP:
Yes.
Steve Abbott:
Which was different than the two before. So maybe if you want to cover what I got in the previous two results and what we're seeing now.
Jill Hunt, CNP:
Okay.
Steve Abbott:
Okay.
Jill Hunt, CNP:
Perfect. So there are multiple different liquid biopsies. The one that we sent on Steve, as he had previously mentioned, was a Guardant360. The nice thing about the report that comes from Guardant is that not only do you get your most recent results, but they also graph out your previous results. And so I know at a glance quickly exactly when you had your previous testing done, what those results were, and then what the changes are.
Jill Hunt, CNP:
So going on his most recent report, I can tell you that on June 10th of 2020, Steve had a Guardant360 drawn, and at that point, there were no detected alterations, at that point. The test was then again drawn on November 19th of 2020, and again, at that point, we had no detected alterations. When we rechecked, and we drew, when I had the pleasure of drawing your blood, on December 22nd with a very nice needle, we, at that point, did pick up a 0.2% alteration. And the nice thing about the report is that not only does it give you the specific quantitative measurement, but then it also gives you what mutation or alteration was picked up.
Jill Hunt, CNP:
And so on Steve's, we were able to pick up a TP53 V216L variation. And although when you are looking at those results, there is not a specific treatment that is associated with that alteration. But what it does tell us, and it's funny because I think the first couple test results that you got, you had told me that the report was only four pages long. This most recent one is 12. So it gives you a lot more information once you start picking up those alterations. And that TP53 variation can be found in multiple different types of cancer. It's not specific to just the prostate.
Steve Abbott:
Okay.
Jill Hunt, CNP:
Okay.
Steve Abbott:
Okay. All right. So then, let's just say that I am a patient of Cincinnati Cancer Advisors, which I am, and I'm also an employee of Cincinnati Cancer Advisors.
Jill Hunt, CNP:
Are you?
Steve Abbott:
Well, some might say. So anyway, so this report comes back, you guys see it. First of all, you know it's different than before. Secondly, it's got something that's clinically significant, if not huge, but something clinically significant. So what do Cincinnati Cancer Advisors advise that I do at this point?
Jill Hunt, CNP:
So as we had talked about before, when we were actually talking about drawing this on the episode that we drew it, this is another data point. And so we had your serial PSAs up until that point, and that was enough to raise the question of hey, we need to get a little better look and see if we've got anything else that can point us in the direction of what's going on here.
Jill Hunt, CNP:
The Guardant360 was part one of that. And what this is telling us is that we definitely see a correlation in the fact that your PSA is rising, and now we're also getting a measurable alteration on the cell-free tumor DNA. Okay?
Steve Abbott:
Okay.
Jill Hunt, CNP:
So they match what that tells us. And then the other thing that we had talked about in episode 10 was to update your PSMA Scan because we had done that also previously, it identified some lymph nodes that were problematic, and you had had some targeted radiation therapy to treat those very early on.
Steve Abbott:
Yep.
Jill Hunt, CNP:
So now we're in the process of gathering all of the data and essentially establishing a new baseline for exactly what your disease is doing. And so the next step will be to get that PSMA Scan, and as we had talked, you are going to get to make that lovely trek back up to Ann Arbor, Michigan, and all of their beautiful weather.
Steve Abbott:
I have to go see it in the summertime. I don't know. I only get to go there in winter, it seems.
Jill Hunt, CNP:
Yeah. I'm thinking in the summertime, I could think of better places to go. No slam on Ann Arbor. No slam on Michigan. I just, it's a little cold up there.
Steve Abbott:
Well, at least the LSU people will love you for that comment for whatever that's worth anyway. Okay. So to kind of sum up then, so these types of tests are... I don't know. I don't want to overstate the case, but really, almost invaluable in terms of finding things early.
Jill Hunt, CNP:
Right.
Steve Abbott:
Right. Because it's not that invasive to get a blood test, and so...
Jill Hunt, CNP:
And you pretty much get blood tests drawn just about every time that you visit your oncologist.
Steve Abbott:
Exactly.
Jill Hunt, CNP:
The other piece that I did want to specifically speak to and you had asked, what would Cincinnati Cancer Advisors do? The other piece that I did kind of leave out is the fact that we have been in close contact with your entire treatment team.
Steve Abbott:
Yep.
Jill Hunt, CNP:
So your treating radiation oncologist, when you had the elevated PSAs, they called and were like, "Okay, what are we going to do with this situation?" And they already had an idea and we all just kind of collaborated on what your best next steps were. So I don't want to paint a picture that we ordered and sent you off and that we... It was a collaborative approach with the entire treatment team, and your treating oncologist was the spearhead for all of it.
Steve Abbott:
Okay. Yeah. And as I've told you before, you've heard me say it before, but that's one of the things I love about what we do is it's not... The catchphrase I've used before is it's not a visit. It's a relationship, and so that's kind of the way we treat it. So, okay. So then I'm going to head on up to Ann Arbor, Michigan, and get this test done. And then next week, we'll have those results back, and then we can cover those, and we'll go for there.
Steve Abbott:
So thanks, everybody, for tuning in. We're really enjoying doing this. It's an important service. So please like, and share, and please subscribe to our YouTube channel because we'll have a whole lot of interesting content to come. And I'm biased, but I would say life-saving content to come. So anyway, thanks to everybody and we'll see you next week.