Oncotype DX® Breast Cancer
Assay Clinical Data Review
Post-SABCS 2011 Update
2
Agenda
• SABCS 2011 Meeting Overview
• Clinical Validation of the Oncotype DX® Breast Cancer Assay for
DCIS Patients
– ECOG 5194 Podium Presentation
• New Data for Patients with Invasive Breast Cancer
–
–
–
–
Oncotype DX reveals underlying biology in the neoadjuvant setting
Traditional clinical pathologic measures cannot predict the Recurrence Score®
Assay quality assurance is critical
Oncotype DX Changes Treatment Decision in Node Negative and Node Positive
Breast Cancer
• Advances in New Technology: Next Generation Sequencing
• Closing Remarks
3
SABCS 2011 Meeting Overview
• Understanding and treating the underlying
biology
– Quantifying recurrence risk in DCIS
– New therapeutic regimens in ER-positive breast
cancer
– Combination antibody therapy for HER-2 positive
disease
– Continual advances in basic research and technology
Clinical Validation of the
Oncotype DX® Breast Cancer
Assay for DCIS Patients
A QUANTITATIVE MULTIGENE RT-PCR ASSAY FOR
PREDICTING RECURRENCE RISK AFTER SURGICAL
EXCISION ALONE WITHOUT IRRADIATION FOR DUCTAL
CARCINOMA IN SITU (DCIS): A PROSPECTIVE VALIDATION
STUDY OF THE DCIS SCORE FROM ECOG E5194
Solin LJ, Gray R, Baehner FL, Butler S, Badve S, Yoshizawa C,
Shak S, Hughes L, Sledge G, Davidson N, Perez EA, Ingle J,
Sparano J, Wood W
Eastern Cooperative Oncology Group (ECOG)
North Central Cancer Treatment Group (NCCTG)
Genomic Health, Inc (GHI)
2011 San Antonio Breast Cancer Symposium
Solin LJ et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-6.
PRESPECIFIED STUDY OBJECTIVES
Primary:
To determine whether there is a significant
association between the DCIS Score and the risk of
an ipsilateral breast event (IBE)
Secondary:
To determine whether the DCIS Score provides
value beyond standard clinical and pathologic factors
Conditional (if DCIS Score validated):
To evaluate the Recurrence Score as a predictor
of risk of an ipsilateral breast event (IBE)
Solin LJ et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-6.
7
DCIS SCORE: 10-YEAR IPSILATERAL BREAST
EVENTS (IBE) BY RISK GROUP
ANY IBE
Solin LJ et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-6.
INVASIVE IBE
8
DCIS SCORE: 10-YEAR RISK OF AN
IPSILATERAL BREAST EVENT (IBE)
ANY IBE
Solin LJ et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-6.
INVASIVE IBE
9
SUMMARY: DCIS SCORE
1. Present study validates the DCIS Score as a predictor of
an ipsilateral breast event (IBE) and invasive IBE
2. DCIS Score quantifies 10-year risk of IBE
- Continuous variable or 3 risk groups
3. DCIS Score provides independent information on IBE risk
beyond clinical and pathologic variables
- Including tamoxifen, grade, and negative margin width
- Identifies underlying tumor biology
4. DCIS Score provides a new clinical tool to guide treatment
selection for patients with newly diagnosed DCIS
Solin LJ et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-6.
Oncotype DX® Reveals
Underlying Biology in the
Neoadjuvant Setting
11
Previous Studies Evaluating the Recurrence
Score as a Predictor of Neoadjuvant
Chemotherapy Response
1Gianni
Neoadjuvant
Anthracyline-Taxane Treatment1
(N=89)
Neoadjuvant
Docetaxel Treatment2
(N=72)
P=0.005
P=0.0079
L, et al. J Clin Oncol. 2005. 2Chang JC, et al. Breast Cancer Res Treat. 2008.
Ixabepilone and Cyclophosphamide as
Neoadjuvant Therapy in HER2-Negative
Breast Cancer with Exploratory
Oncotype DX® Assessments: A Sarah
Cannon Research Institute Phase II Trial
Yardley DA,1,2 Peacock NW,1,2 Hendricks C,3 Huh SY,4
Ketchum S,5 Chao C,6 Yoshizawa C,6 Burris HA,1,2
Hainsworth JD1,2
1Sarah
Cannon Research Institute, Nashville, TN; 2Tennessee Oncology, PLLC, Nashville, TN; 3Center for Cancer
and Blood Disorders, Bethesda, MD; 4Providence Medical Group, Terre Haute, IN; 5Mercy Hospital, Portland, ME;
6Genomic Health, Inc.®, Redwood City, CA
Yardley DA et al, San Antonio Breast Cancer Symposium 2011; Abstract P5-13-09.
13
Study Objectives
• To correlate the baseline Oncotype DX® Recurrence Score® with
– pCR rate to neoadjuvant ixabepilone/cyclophosphamide
– Clinical response rate to neoadjuvant
ixabepilone/cyclophosphamide
• To compare Recurrence Score results determined at baseline to
those determined after completion of neoadjuvant
ixabepilone/cyclophosphamide
Yardley DA et al, San Antonio Breast Cancer Symposium 2011; Abstract P5-13-09.
Clinical Characteristics and Neoadjuvant
Treatment Results in Patients with Baseline
Recurrence Score® Results
Characteristic (N=138)
Number of Patients
Median age, years (range)
51 (30-79)
ER+ 75 (54%)
Hormone receptor status
PR+ 61 (44%)
ER-/PR- 62 (45%)
Low (<18) 20 (14%)
Baseline Oncotype DX Recurrence
Score
Intermediate (18-30) 23 (17%)
High (≥31) 95 (69%)
Completed 6 cycles of neoadjuvant
chemotherapy
112
Definitive surgery performed
108
Clinical response to neoadjuvant
treatment (N=112)
Pathologic Complete Response
(N=108)
CR 30 (27%)
CR + PR 70 (63%)
19 (18%)
Yardley DA et al, San Antonio Breast Cancer Symposium 2011; Abstract P5-13-09.
14
15
Correlation of Pathologic Complete Responses and
Baseline Recurrence Score® Results
Baseline Recurrence Score (N=108)
Baseline RS Group
Proportion (%) with pCR
Low
(RS<18)
Intermediate
(RS 18-30)
High
(RS≥31)
0/19 (0%)
0/17 (0%)
19/72 (26%)
Mantel-Haenszel Chi-square p=0.002
Logistic Regression of Continuous RS
Variable
Continuous RS
Odds Ratio
95% CI
P-value
57.9
(9.5,583)
<0.001
•
There were NO pCRs in tumors with either “Low” or “Intermediate” baseline Recurrence
Scores (RS≤30).
•
A high Oncotype DX® Recurrence Score, analyzed either by RS group or as a
continuous variable, was strongly associated with a pCR to neoadjuvant chemotherapy.
Yardley DA et al, San Antonio Breast Cancer Symposium 2011; Abstract P5-13-09.
16
Paired Baseline and Post-treatment
Recurrence Score® Results
o
o
ER+ by IHC (n=44)
ER- by IHC (n=28)
Spearman correlation
Overall: 0.82 (95% CI 0.72-0.88)
ER+: 0.60 (95% CI 0.37-0.76)
ER-: 0.55 (95% CI 0.21-0.76)
Lin’s concordance: correlation
Overall: 0.76
ER+: 0.72
ER-: 0.44
N=72 samples
•
•
•
Paired baseline and post-treatment Recurrence Scores demonstrated concordance.
ER negative tumors demonstrated higher Recurrence Scores at baseline and after neoadjuvant
chemotherapy.
13 of 40 tumors (33%) with a high RS at baseline had residual tumor with low or intermediate RS after
neoadjuvant chemotherapy. No tumors with initial low or intermediate RS had high risk RS after neoadjuvant
chemotherapy.
Yardley DA et al, San Antonio Breast Cancer Symposium 2011; Abstract P5-13-09.
17
Summary and Conclusions
•
Baseline Oncotype DX® Recurrence Score ® Results were highly predictive of the
likelihood of achieving a pCR with neoadjuvant ixabepilone/cyclophosphamide.
•
All pCRs occurred in patients with baseline high risk Recurrence Scores (≥31).
•
There was high concordance (Spearman coefficient = 0.82) and agreement (Lin’s
concordance correlation = 0.76) in Recurrence Scores determined at baseline and
after neoadjuvant chemotherapy, suggesting that most tumors retain the same
molecular characteristics.
•
Further follow-up is necessary to confirm that Oncotype DX Recurrence Scores
correlate with survival endpoints in addition to pCR rate.
•
Oncotype DX Recurrence Scores may provide important prognostic information in
patients who are candidates for neoadjuvant chemotherapy. Identification of patients
unlikely to achieve pCR with current regimens may be useful in the design of future
clinical trials.
Yardley DA et al, San Antonio Breast Cancer Symposium 2011; Abstract P5-13-09.
Traditional Clinical Pathologic
Measures Cannot Predict the
Recurrence Score®
Prospective Comparison of Risk
Assessment Tools in Early Breast
Cancer (Recurrence Score®, uPA/PAI-1,
Central Grade, and Luminal Subtypes):
Final Correlation Analysis from the
Phase III WSG planB Trial
Gluz O,1,2 Kreipe HH,³ Degenhardt T,1 Christgen M,³ Kates R,1
Liedtke C, 1,4 Shak S,5 Clemens M,6 Markmann S,7 Uleer C,8
Augustin D,9 Thomssen C,10 Nitz U,1,2 and Harbeck N 1,11
on behalf of the planB investigators
1West
German Study Group, Moenchengladbach, Germany; 2Bethesda Hospital, Moenchengladbach, Germany;
³Institut of Pathology, Medical College, Hanover, Germany; 4University Hospital Muenster, Muenster, Germany; 5
Genomic Health, Redwood City, CA.; 6Hospital Mutterhaus, Trier, Germany; 7University Hospital Suedstadt,
Rostock, Germany; 8Gynecological Practice, Hildesheim, Germany; 9Hospital Deggendorf, Deggendorf, Germany;
10University Halle, Halle, Germany; 11 Breast Center, University of Cologne, Cologne, Germany
Gluz O et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-3.
20
Plan B Trial Design
HER2-negative Primary Breast Cancer
HR•
•
•
•
pT1-4
free margins
pN+
pN0 high risk
•
•
•
•
•
pT>2cm
G2-3
uPA/PAI-1↑
HRage <35 years
HR+
R
E
C
U
R
R
E
N
C
E
S
C
O
R
E
0-3 LN and
RS>11
or ≥ 4 LN
0-3 LN and
RS<11
R
A
N
D
O
M
I
Z
A
T
I
O
N
T75C600 x 6*
E90C600x4 Doc100 x4*
Endocrine therapy*
* Endocrine therapy and RT according to national guidelines
Gluz O et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-3.
21
Patient Characteristics
Recurrence Score® Central tumor bank
population
population
n=2549*
n=3033
Age
< 50
> 50
Median
33%
67%
56 years
33%
67%
56 years
Nodal status
pN0
pN1
pN2/3
62%
33%
5%
62%
33%
5%
Tumor size
< 20 mm
> 20 mm
55%
45%
55%
45%
Central
grade
G1
G2
G3
5%
63%
32%
5%
57%
39%
*Baseline data not available for two patients
Gluz O et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-3.
22
Risk Distribution by Recurrence
Score®
Gluz O et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-3.
23
Recurrence Score ® by Ki-67
Plan B Cut-offs
high risk
high risk
(>25)
(>25)
intermediate
intermediate
risk (12-25)
risk (12-25)
low risk
low risk
(0-11)
(0-11)
9%
32%
11%
41%
67%
55%
68%
48%
24%
13%
22%
11%
Ki-67 <14
Ki-67 14
Gluz O et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-3..
Ki-67 <20
Ki-67 20
24
Recurrence Score ® by Ki-67
Standard Cut-offs
high risk
high risk
(≥31)
(≥31)
intermediate
intermediate
risk (18-30)
risk (18-30)
low risk
low risk
(<18)
(<18)
3%
19%
3%
26%
36%
43%
38%
44%
61%
38%
59%
30%
Ki-67 <14
Ki-67 14
Gluz O et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-3..
Ki-67 <20
Ki-67 20
25
Recurrence Score® by Central Grade
Plan B Cut-offs
high risk
(>25)
intermediate
risk (12-25)
low risk
(0-11)
Concordance is
limited
• If the RS is high it is
quite likely that
central grade is high.
• However, the
converse is not true.
4%
12%
43%
72%
67%
46%
24%
21%
11%
1
2
Central grade
Gluz O et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-3..
3
26
Recurrence Score® by Central Grade
Standard Cut-offs
high risk
(≥31)
intermediate
risk (18-30)
low risk
(<18)
Concordance is
limited
• If the RS is high it is
quite likely that
central grade is high.
• However, the
converse is not true.
5%
30%
37%
39%
39%
63%
56%
31%
1
2
Central grade
Gluz O et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-3..
3
27
Conclusions
• Large phase III prospective study comparing two CT regimens. Data
presented: correlation between RS and uPA/PAI-1, central grade,
and Ki-67in patients with HR+, N+/- early stage breast cancer at
baseline.
• RS data available in large cohort of 2,549 patients.
• This study demonstrated only a moderate correlation between RS
and Ki-67 and RS and central grade. Weak concordance was
observed between RS and uPA/PAI-1.
As previously demonstrated in multiple studies, Oncotype DX® provides an
individualized RS result that cannot be predicted by traditional
clinicopathologic measures.
Gluz O et al, San Antonio Breast Cancer Symposium 2011; Abstract S4-3.
Assay Quality Assurance is
Critical
Consistency and Control in Clinical
Assay Technology over Time: The
Oncotype DX® Recurrence Score® and
Assessment of Single Gene
Expression Levels
Baehner FL,1,2 Butler S,1 Anderson J,1 Ballard J,1
Tan V,1 Tharayanil A,1 Shak S1
1Genomic
Health, Inc., Redwood City, CA; 2University of California,
San Francisco, San Francisco, CA
Baehner FL et al, San Antonio Breast Cancer Symposium 2011; Abstract P1-07-11.
30
Background
• The American Society of Clinical Oncology® and College of
American Pathology® have highlighted the importance of
consistency and control in clinical assay technology.1-2
• The Genomic Health clinical laboratory quality assurance and
quality control programs and biannual proficiency testing ensures
consistency and reproducibility for the RS and quantitative single
gene results for ER, PR, and HER2.
1Wolff
A et al, J Clin Oncol 2007. 2Hammonds E et al, J Clin Oncol 2010.
Baehner FL et al, San Antonio Breast Cancer Symposium 2011; Abstract P1-07-11.
31
Methods
• All tumors successfully analyzed in the Genomic Health laboratory
from January 1, 2005 to March 31, 2011 were included.
• Descriptive statistics for the Recurrence Score® value, the average
reference gene expression level, and expression levels for
quantitative single genes ER, PR and HER2 were calculated for
each calendar year.
- Single gene reporting (ER, PR, HER2) began in 2008.
• The associations by year between HER2 and GRB7, ER and HER2,
and ER and PR expression levels were characterized using
scatterplots and correlation statistics.
• Subgroup analyses were conducted by histological tumor type, core
biopsy versus excision, and whether micro-dissection was done.
Baehner FL et al, San Antonio Breast Cancer Symposium 2011; Abstract P1-07-11.
32
Recurrence Score® Distribution
Over Time
• RS distribution is
consistent over time.
• The average and
median RSs are 19.5
and 17, respectively.
• Approximately 50% of
cases have a RS
between 12 and 24.
Baehner FL et al, San Antonio Breast Cancer Symposium 2011; Abstract P1-07-11.
33
Reference Gene Distributions
Reference Gene Average
Reference Gene Distribution by Year
31
30
29
28
27
26
2005
•
•
2006
2007
2008
2009
2010
2011
The distribution of the average non-normalized level of expression for the five reference genes
remained consistent over time, with non-systematic variation in the median value within
approximately 0.5 units.
The middle 50% of cases were within one unit, indicating consistently low variation in reference
gene expression levels.
Baehner FL et al, San Antonio Breast Cancer Symposium 2011; Abstract P1-07-11.
34
ER Quantitative Gene Distributions
ER Quantitative Distribution by Year
13
12
ER
11
10
9
8
7
2008
2009
2010
2011
• The distribution of quantitative ER and PR expression was consistent over time.
Baehner FL et al, San Antonio Breast Cancer Symposium 2011; Abstract P1-07-11.
35
HER2 Quantitative Gene
Distributions
HER2 Quantitative Distribution by Year
11
HER2
10
9
8
7
2008
% HER2 positive:
•
•
2.2%
2009
1.9%
2010
1.5%
2011
1.2%
The distribution of quantitative HER2 expression was consistent over time, with a wide range of
HER2 expression noted.
The majority of cases show HER2 expression levels consistent with HER2 normal status.
Baehner FL et al, San Antonio Breast Cancer Symposium 2011; Abstract P1-07-11.
36
HER2 and GRB7 Quantitative Gene
Distributions
•
Year
Pearson Correlation,
Regression Slope
2008
0.80, 0.76
•
2009
0.79, 0.75
2010
0.77, 0.74
2011
0.77, 0.74
HER2 and GRB7 gene expression are
highly correlated
High degree of similarity over time in
the distributions of HER2 and GRB7
Baehner FL et al, San Antonio Breast Cancer Symposium 2011; Abstract P1-07-11.
37
Conclusions
• This study evaluated consistency of RS and single gene expression
levels for ER, PR, and HER2 over a 6 year period (2005 to 2011) in
207,691 patient cases.
• Multiple quality control and quality assurance processes have
resulted in consistent performance of the Oncotype DX® Breast
Cancer Assay.
• A high degree of consistency and no systematic change in
expression level for reference genes, RS, ER, PR, or HER2 was
observed.
37
Baehner FL et al, San Antonio Breast Cancer
Symposium
2011; Abstract P1-07-11.
Oncotype DX® Changes
Treatment Decision in Node
Negative and Node Positive
Breast Cancer
Impact of the Recurrence Score® on Adjuvant
Decision-Making in ER-positive Early Breast
Cancer - Results of a Large Prospective
Multicentre Decision Impact Study in Nodenegative and Node-positive Disease
Rezai M,1 Eiermann W,2 Kümmel S,3 Kühne T,4 Warm
M,5 Friedrichs K,6 Schneeweiss A,7 Markmann S,8
Eggemann H,9 Hilfrich J,10 Jackisch C,11 Witzel I,12
Eidtmann H,13 Kaufmann M,14 Blohmer J15
1 Luisenkrankenhaus,
Düsseldorf, 2Rotkreuzkrankenhaus, München, 3Kliniken Essen
Mitte, Essen, 4Klinikum, Esslingen, 5Krankenhaus Holweide, Köln, 6Mammazentrum,
Hamburg, 7Nationales Tumorcentrum, Universität Heidelberg,, 8Universitätsklinikum,
Rostock , 9Universitätsklinikum, Magdeburg ,10Eilenriedeklinik, Hannover, 11Klinikum,
Offenbach, 12Universitätsklinikum, Hamburg , 13Universitätsklinikum, Kiel
14Universitätsklinikum, Frankfurt, 15Sankt Gertrauden-Krankenhaus, Berlin
Rezai M et al, San Antonio Breast Cancer Symposium 2011; Abstract P2-12-26.
40
Changes in Treatment Recommendations
Based on the Oncotype DX® Results
Patients
N
Overall Change Rate
Pre- to Post-Oncotype DX
CHT to
HT
HT to
CHT
Other
All evaluable
366
121
33.1% (95% CI 28.3 – 38.1)
79
21.6%
39
10.7%
3
0.8%
Node-negative
244
74
30.3% (95% CI 24.6 – 36.5)
45
18.4%
28
11.5%
1+
0.4%
Node-positive
122
47
38.5% (95% CI 29.9 – 47.8)
34
27.9%
11
9.0%
2*
1.6%
95% confidence intervals calculated using Clopper-Pearson method
+Observation to CHT *Observation to HT, CT to CHT
Rezai M et al, San Antonio Breast Cancer Symposium 2011; Abstract P2-12-26.
Australian Decision Impact Study: The
impact of Oncotype DX® Recurrence
Score® (RS) on Adjuvant Treatment
Decisions in Hormone Receptor
Positive (HR+), Node-negative (N0) and
Node-positive (N+) Early Stage Breast
Cancer (ESBC) in the Multidisciplinary
Clinic (MDC)
de Boer RH,1 Baker C,2 Speakman D,3 and Mann GB4
1Royal
Melbourne Hospital, Melbourne, Victoria, Australia; 2Austin Hospital, Melbourne, Victoria,
Australia; 3Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia; 4Royal Melbourne and
Royal Women’s Hospital, Melbourne, Victoria, Australia
de Boer RH et al, San Antonio Breast Cancer Symposium 2011; Abstract P4-09-18.
42
Changes in Treatment Recommendations
Based on the Oncotype DX® Results
Patients
N
Overall Change Rate
CHT to
Pre- to Post-Oncotype DX
HT
HT to
CHT
All evaluable
151
36
24%
24
15.9%
12
7.9%
Node-negative
101
23
22.8%
12
11.9%
11
10.9%
Node-positive
51
13
26%
12
24%
1
2%
de Boer RH et al, San Antonio Breast Cancer Symposium  2011; Abstract P4-09-18.
43
Conclusions
• There were multiple decision impact studies presented at
SABCS in both node-positive and node-negative
patients.1-3
• Changes in treatment decisions ranged from 23.8% to
33.1%.
• These results are consistent with previous studies
performed worldwide showing that the RS changes
treatment decisions approximately a third of the time.4
M et al, San Antonio Breast Cancer Symposium 2011; 2de Boer RH et al, San Antonio Breast Cancer Symposium 2011; 3Holt S et al,
San Antonio Breast Cancer Symposium 2011; 4 Hornberger J et al, St Gallen International Breast Cancer Conference 2011
1Rezai
Advances in New Technology:
Next Generation Sequencing
Breast Cancer Recurrence Risk
Probed by Whole Transcriptome
Next Generation Sequencing in
136 Patients
Baker J,1 Liu ML,1 Crager M,1 Stephans J,1 Pho
M,1 Jeong J,1 Scott A,1 Ambannavar R,1 Morlan
J,1 Pelham R,1 Qu K,1 Mena R,2 Esteban J,2 Collin
F,1 and Sinicropi D1
1Genomic
Health, Inc.®, Redwood City, CA; 2Providence Saint Joseph Medical
Center, Burbank, CA
Baker J et al, San Antonio Breast Cancer Symposium 2011; Abstract PD-03-09.
46
Summary and Conclusions
• Genomic Health reported on the technical performance of whole
transcriptome next generation sequencing compared to the 21-gene
RT-PCR Oncotype DX® Breast Cancer Assay.
• Whole transcriptome RNA-Seq identified more than 1800 new
coding, intronic, and intergenic transcripts that were strongly
associated with breast cancer recurrence risk.
• This technology has sensitivity and selectivity comparable to RTPCR, can provide a vast increase in the number of interrogated
transcripts, can reveal new biological relationships, and has
excellent performance suitable for the discovery of RNA biomarkers.
Baker J et al, San Antonio Breast Cancer Symposium 2011; Abstract PD-03-09.
47
Closing Remarks
• These studies support the importance of understanding
cancer biology to advance the treatment of breast cancer
patients.
• Oncotype DX® is the first clinically validated commercial
genomic assay quantifying the risk for local recurrence in
DCIS patients.
• Data from a large phase III prospective study confirms
that the Recurrence Score® cannot be predicted by
clinical and pathological variables.
• A growing body of evidence suggests that the
Recurrence Score may help guide neoadjuvant
treatment decisions.
48
Closing Remarks
• Genomic Health’s quality assurance and quality control
programs ensure consistency and reproducibility for the
Recurrence Score® and quantitative single gene results
for ER, PR, and HER2.
• Multiple decision impact studies demonstrate that the
Recurrence Score changes treatment decisions in node
negative and node positive breast cancer.
• Genomic Health is committed to performing cutting edge
research to better serve the oncology community
(physicians and patients).
Thank You