“We design our drug panel so that it is comprehensive enough that we would be able to find at least one exceptional drug in the majority of cases.” – Payel Chatterjee, SEngine
Payel Chatterjee, Chief Scientist, SEngine Precision Medicine, led a discussion on the role of organoids in guiding cancer treatment decisions. The value proposition of “functional testing” (applying 100 or more drugs to fresh tumor tissue and seeing how the cancer responds) is that this very direct approach can identify unexpected drugs to try, and extraordinary results, for some patients. The drugs in the panel that SEngine tests are unique because they pay attention to the genomics and FDA-approved drugs for that cancer, but also include drugs that have been approved for other cancers to make a very comprehensive list to test. This broader range of drug options leads to surprises every day. The lesson from their experience is that you should never be too biased to the typical treatments because you don’t know if a surprise might come up. Some of their surprises and successes have been in cancers with very difficult prognoses, such as pancreatic and ovarian cancer.
Payel shared several stories, including unexpected and exceptional responses:
- A pancreatic cancer patient with a HER2 amplification had an amazing response. For 1.5 years, they have been scanning her, and they can’t believe it, but there is no evidence of disease.
- A woman who was in hospice with a very late stage of ovarian cancer tried the SEngine organoid test. The test indicated a top candidate of an approved drug that was normally indicated for a blood cancer, but not for her cancer. The doctors were surprised, but tried it, and she experienced an exceptional response. She was able to get out of hospice and travel.
- A very terminally ill cholangiocarcinoma patient had progressed through five lines of treatment, but nothing was working. A SEngine organoid test identified Dasatinib, which was used mostly in leukemias, as a top drug. It had an exceptional response. The patient’s pain and tumor markers were controlled for several months when her life expectancy would’ve been measured in weeks.
- A colon cancer patient’s doctor was struggling to find a therapy after several lines of therapy. SEngine PARIS test identified gemcitabine, which is a common chemotherapy. The patient took it, the tumor was reduced, and the patient lived for nine months, instead of weeks.
- A prostate cancer patient had failed four lines of treatment. SEngine identified 9 drugs with relatively high scores, showing potential. The patient chose Azacitidine because he learned it had fewer side effects.
Organoids maintain the tumor heterogeneity and physiology.
43 drugs can be tested on a full plate, drawn from physician recommendations, the standard of care, the genomic landscape, and FDA-approved drugs, to create a comprehensive targetable list.
In 70% of cases, including patients who have had multiple lines of therapy and have no known druggable biomarkers, SEngine could still identify an actionable candidate therapy, beyond the patient’s genomic report.
Questions for Further Discussion
- Functional testing seems like it offers useful information to guide complex treatment decisions and may uncover unexpected treatment candidates. Do you agree?
- How can we accelerate adoption? What are the barriers to wider use?