00:00:06.620 --> 00:00:13.630
- Zuri Skrivins is patient number 10
in a bold experiment to stop cancer.

00:00:13.630 --> 00:00:16.660
- You know, the whole thing for
me has been a roller coaster.

00:00:16.660 --> 00:00:19.770
I had a baby and there was so much joy.

00:00:19.770 --> 00:00:25.200
And then 10 months later I had breast
cancer, and everything changed.

00:00:25.200 --> 00:00:31.840
- At 33, Zuri had a mastectomy followed
by standard breast cancer treatments.

00:00:31.840 --> 00:00:35.800
Nine months later, her cancer was back.

00:00:35.800 --> 00:00:39.350
It had spread to her liver and lymph nodes.

00:00:39.350 --> 00:00:43.010
Stage 4 -- incurable cancer.

00:00:43.010 --> 00:00:45.170
- You know, when someone
tells you that it's spread

00:00:45.170 --> 00:00:50.290
your head goes to the worst place possible.

00:00:50.290 --> 00:00:52.800
And I really thought that was it for me.

00:00:52.800 --> 00:00:58.230
- Then Zuri was prescribed a
medication commonly used for diabetes,

00:00:58.230 --> 00:01:01.510
and her cancer disappeared.

00:01:01.510 --> 00:01:03.730
That was over three years ago.

00:01:03.730 --> 00:01:05.630
- That's it.

00:01:05.630 --> 00:01:07.750
Surreal.

00:01:07.750 --> 00:01:09.320
Not even real at all.

00:01:12.470 --> 00:01:14.360
It still shocks me.

00:01:14.360 --> 00:01:18.930
Even though I've had three scans over
the course of two and a half years,

00:01:18.930 --> 00:01:22.630
I'm still a bit surprised.

00:01:22.630 --> 00:01:26.490
- Zuri is a beacon of
hope for cancer patients,

00:01:26.490 --> 00:01:31.440
a super responder in a revolutionary
new approach to cracking cancer.

00:01:36.475 --> 00:01:41.940
For stage 4 cancer patients,
hope can be very hard to find.

00:01:41.940 --> 00:01:48.590
But some people are finding it here,
in a highly experimental clinical trial

00:01:48.590 --> 00:01:52.410
at the BC Cancer Agency in Vancouver.

00:01:52.410 --> 00:01:57.210
As a geneticist I'm particularly
intrigued, since the study

00:01:57.210 --> 00:02:02.890
unleashes the power of genomic
research to fight cancer.

00:02:02.890 --> 00:02:03.872
- Hi.

00:02:03.872 --> 00:02:06.420
Dr. Laskin, good to meet you.

00:02:06.420 --> 00:02:10.110
- Dr. Janessa Laskin is
the co-founder of POG,

00:02:10.110 --> 00:02:13.710
the Personalized
Oncogenomics Clinical Trial.

00:02:13.710 --> 00:02:16.050
- Personal oncogenomics.

00:02:16.050 --> 00:02:21.730
It's a very big term, but
what exactly does it refer to?

00:02:21.730 --> 00:02:25.140
- Well, it refers to a program that
we're running at the BC Cancer Agency

00:02:25.140 --> 00:02:29.370
where we're taking people's
actual individual cancers

00:02:29.370 --> 00:02:31.980
and we're doing DNA and RNA analysis.

00:02:31.980 --> 00:02:35.490
We're trying to find
what's driving that cancer,

00:02:35.490 --> 00:02:39.210
and can we identify a
drug that will block that

00:02:39.210 --> 00:02:43.860
cancer driver in each
individual, specific person.

00:02:43.860 --> 00:02:50.950
- When the POG team analyzed Zuri Skrivin's
cancer, they discovered something unusual.

00:02:50.950 --> 00:02:55.990
- She had this growth factor
that was very, very, very high.

00:02:55.990 --> 00:03:00.550
And when we looked in the
literature, that growth factor

00:03:00.550 --> 00:03:03.340
can be blocked by a diabetic medication.

00:03:03.340 --> 00:03:04.236
- Wow.

00:03:04.236 --> 00:03:05.075
- Yeah.

00:03:05.075 --> 00:03:05.574
- Thank you.

00:03:05.574 --> 00:03:08.770
- And pick up your socks, please.

00:03:08.770 --> 00:03:12.250
- It sounds bizarre that Zuri
was prescribed a diabetes

00:03:12.250 --> 00:03:17.170
drug for her cancer, along with a
course of standard hormone therapy.

00:03:17.170 --> 00:03:21.190
But after just four
months, no sign of cancer.

00:03:21.190 --> 00:03:22.720
- I feel very lucky.

00:03:22.720 --> 00:03:24.530
It's taken some getting used to.

00:03:24.530 --> 00:03:27.710
Everything's a little bit more beautiful.

00:03:27.710 --> 00:03:33.580
- Zuri's breathtaking recovery illustrates
a radical new way of treating cancers.

00:03:33.580 --> 00:03:36.890
Not according to where
they originate in the body,

00:03:36.890 --> 00:03:40.840
but rather as a disease
of genetic mutations.

00:03:40.840 --> 00:03:44.470
- I think what POG is going
to show us is that there

00:03:44.470 --> 00:03:49.420
are abnormalities on a genomic level
that run across all these cancer types.

00:03:49.420 --> 00:03:52.930
So it's possible at some point we
might not say "You have a lung cancer."

00:03:52.930 --> 00:03:58.840
We might say, "You have an EGFR,
BRAF, RAS-mediated malignancy,"

00:03:58.840 --> 00:04:01.580
but that won't roll off
the tongue very easily.

00:04:01.580 --> 00:04:04.960
But in some senses, we're
recategorizing cancers.

00:04:04.960 --> 00:04:11.080
- When POG launched in 2012, there were
only 30 cancer patients in the trial.

00:04:11.080 --> 00:04:15.220
But initial results were so
promising that two years later,

00:04:15.220 --> 00:04:20.560
they expanded to take in 300
people with incurable cancer.

00:04:20.560 --> 00:04:27.420
Trish Keating became patient number
130, and made medical history.

00:04:27.420 --> 00:04:28.280
- Good morning.

00:04:28.280 --> 00:04:29.442
- Good morning.

00:04:29.442 --> 00:04:30.150
What's your name?

00:04:31.263 --> 00:04:32.060
Oh, nice.

00:04:32.060 --> 00:04:37.520
- Trish had already endured five years
of painful and exhausting treatments

00:04:37.520 --> 00:04:39.290
for colorectal cancer.

00:04:39.290 --> 00:04:41.090
- 149.6.

00:04:41.090 --> 00:04:46.160
- She was considered palliative
when she entered the POG trial.

00:04:46.160 --> 00:04:48.740
- And see there's a spot up
here in her neck that's glowing,

00:04:48.740 --> 00:04:50.156
that's consistent with her cancer.

00:04:52.320 --> 00:04:54.330
She was in pretty bad shape.

00:04:54.330 --> 00:04:57.810
Her PET scan really had lit
up like a Christmas tree.

00:04:57.810 --> 00:05:02.010
Multiple lymph nodes were lighting
up all throughout her body.

00:05:02.010 --> 00:05:06.400
- By sequencing, or mapping,
Trish's entire genome,

00:05:06.400 --> 00:05:12.720
the POG team identified a specific protein
that they believed was driving her cancer.

00:05:12.720 --> 00:05:18.660
And that protein could be blocked by a
common medication for high blood pressure.

00:05:18.660 --> 00:05:23.100
- I will fully admit that I was
quite skeptical that it would work.

00:05:23.100 --> 00:05:27.420
- Despite his doubts, Dr. Howard
Lim put Trish on the drug.

00:05:27.420 --> 00:05:30.570
The results were astonishing.

00:05:30.570 --> 00:05:36.930
- This next scan shows Trish's
response to treatment after four weeks.

00:05:36.930 --> 00:05:40.200
I had to double check that this
was actually Trish's PET scan,

00:05:40.200 --> 00:05:44.820
because I couldn't believe that
everything had disappeared.

00:05:44.820 --> 00:05:48.240
I actually went down to the
radiologist to confirm everything,

00:05:48.240 --> 00:05:49.763
because I just couldn't believe it.

00:05:49.763 --> 00:05:53.190
Then I just called Trish
to give her the good news.

00:05:53.190 --> 00:05:56.590
- You know, hey, I am a miracle.

00:05:56.590 --> 00:05:58.880
I mean I don't mean that
personally I'm a miracle,

00:05:58.880 --> 00:06:02.590
I just think that the fact that
I'm still alive is a miracle.

00:06:02.590 --> 00:06:06.490
- Trish's astounding
remission is truly a wonder.

00:06:06.490 --> 00:06:09.620
She's one of a small
group of super responders

00:06:09.620 --> 00:06:17.280
out of the almost 750 people enrolled
in the POG trial by the end of 2016.

00:06:17.280 --> 00:06:22.320
- There are now 40 or 50 or 60 of
these incredibly remarkable responses

00:06:22.320 --> 00:06:23.880
that have occurred.

00:06:23.880 --> 00:06:28.560
- Dr. Marco Marra is one of the
world's leading genome scientists

00:06:28.560 --> 00:06:33.090
and co-founder of the POG trial.

00:06:33.090 --> 00:06:35.888
- So this is the brain
of the whole enterprise.

00:06:35.888 --> 00:06:37.112
- It's amazing.

00:06:37.112 --> 00:06:40.190
So you know they used
to have supercomputers,

00:06:40.190 --> 00:06:44.195
but this is way beyond the
supercomputer of the past.

00:06:44.195 --> 00:06:48.650
They say that the genome is
the equivalent of 1,000 volumes

00:06:48.650 --> 00:06:50.660
of the complete works of Shakespeare.

00:06:50.660 --> 00:06:52.580
That's how much information is there.

00:06:52.580 --> 00:06:58.550
And you guys are now sequencing tumors
and healthy bodies and compare...

00:06:58.550 --> 00:07:01.910
it's a staggering amount of
computer power that you need.

00:07:01.910 --> 00:07:02.950
- It is.

00:07:02.950 --> 00:07:05.690
It's a game of significant numbers.

00:07:05.690 --> 00:07:08.870
But thanks to technology and
the evolution of the technology,

00:07:08.870 --> 00:07:13.250
we now have machines that are
capable of reading out all the DNA

00:07:13.250 --> 00:07:19.320
sequence not only of tumor DNA, but of
normal DNA, for a few thousand dollars.

00:07:19.320 --> 00:07:22.250
And so this presents new opportunity.

00:07:22.250 --> 00:07:26.230
- To find the genetic mutation
causing a patient's cancer,

00:07:26.230 --> 00:07:29.390
the POG trial compares their normal DNA--

00:07:29.390 --> 00:07:32.510
which is each cell's complete
set of instructions--

00:07:32.510 --> 00:07:34.370
with their tumor's DNA.

00:07:34.370 --> 00:07:37.752
That enables personalized
diagnosis and treatment.

00:07:40.410 --> 00:07:46.320
- We're talking about the entire genome
read out over a rapid enough timeframe

00:07:46.320 --> 00:07:49.230
to have an impact on treatment planning.

00:07:49.230 --> 00:07:53.910
We know that in cancers, bits
of the genome are broken.

00:07:53.910 --> 00:07:55.650
The concept really was,

00:07:55.650 --> 00:07:58.030
if we know what bits of
the genome were broken

00:07:58.030 --> 00:08:02.940
would we be able to take that into
account on an individual basis,

00:08:02.940 --> 00:08:07.880
person by person, to help inform
treatment decision-making?

00:08:10.380 --> 00:08:17.680
- So we've got tomatoes, crazy tomatoes,
and some artichokes growing in there.

00:08:17.680 --> 00:08:18.990
This is amaranth.

00:08:18.990 --> 00:08:23.230
Beets I juice a lot of,
kale I juice a lot of.

00:08:23.230 --> 00:08:28.660
- Patient number 542, Katya Mycyk,
is not a typical POG subject.

00:08:28.660 --> 00:08:31.630
She's put a lot of faith
in alternative medicine

00:08:31.630 --> 00:08:37.809
since being diagnosed with breast
cancer more than six years ago.

00:08:37.809 --> 00:08:43.130
- My protocol consists of a
lot of medicinal mushrooms.

00:08:43.130 --> 00:08:45.610
I'm on CBD oil.

00:08:45.610 --> 00:08:49.150
I do all my juicing, do about 3
and 1/2 liters of juicing a day.

00:08:51.220 --> 00:08:55.120
- When the cancer spread to her
bones, Katya turrned to POG,

00:08:55.120 --> 00:08:58.900
hoping the Personalized
Oncogenomics Clinical Trial

00:08:58.900 --> 00:09:02.110
can find a treatment tailored to her.

00:09:02.110 --> 00:09:06.630
First, the POG team needs
a fresh cancer sample.

00:09:06.630 --> 00:09:07.824
- So how are things going?

00:09:07.824 --> 00:09:08.710
- Good.

00:09:08.710 --> 00:09:10.899
- So today, Katya is getting a biopsy.

00:09:10.899 --> 00:09:12.190
- Did you get any chemotherapy?

00:09:12.190 --> 00:09:13.500
- I've never had chemotherapy,

00:09:13.500 --> 00:09:16.160
and I've only had a tiny
bit of hormone therapy.

00:09:16.160 --> 00:09:16.750
- OK.

00:09:16.750 --> 00:09:18.215
And right now, you're on...?

00:09:18.215 --> 00:09:18.715
- Nothing.

00:09:18.715 --> 00:09:18.970
- Nothing.

00:09:18.970 --> 00:09:19.470
OK.

00:09:20.890 --> 00:09:25.630
- Despite feeling squeamish,
Katya takes a rare opportunity.

00:09:25.630 --> 00:09:30.840
- Dr. Hamilton, will I actually be
able to see the tumor at some point?

00:09:30.840 --> 00:09:33.070
- Sorry, I thought you
didn't want to see it.

00:09:33.070 --> 00:09:33.900
- Now I do.

00:09:33.900 --> 00:09:35.390
- Now you've changed your mind?

00:09:35.390 --> 00:09:35.890
- I have.

00:09:35.890 --> 00:09:37.119
Welcome to my life.

00:09:37.119 --> 00:09:38.410
It's just always been abstract.

00:09:38.410 --> 00:09:41.980
I would kind of like to see what this is.

00:09:45.000 --> 00:09:47.490
That was really intense for me, actually.

00:09:47.490 --> 00:09:50.785
It was so surreal to have
somebody carving into my chest.

00:09:50.785 --> 00:09:51.940
So where's the tumor?

00:09:51.940 --> 00:09:53.300
- It's right in there.

00:09:53.300 --> 00:09:54.800
- I thought they were black.

00:09:54.800 --> 00:09:55.800
- No.

00:09:55.800 --> 00:09:59.430
- It was very cool to see
my cancer, for one thing.

00:09:59.430 --> 00:10:02.276
I always thought it would
be black, and it was white.

00:10:02.276 --> 00:10:03.210
- Flip it over.

00:10:03.210 --> 00:10:03.710
Eww!

00:10:03.710 --> 00:10:04.835
- That's just a bit of fat.

00:10:04.835 --> 00:10:08.460
The tumor sort of goes through
this skin on the dermis there.

00:10:08.460 --> 00:10:11.112
- Well it's all about
facing everything, right?

00:10:11.112 --> 00:10:13.070
You spend your life with
your head in the sand,

00:10:13.070 --> 00:10:16.474
and at some point you have to look at stuff.

00:10:16.474 --> 00:10:17.640
It was, it was a big moment.

00:10:22.399 --> 00:10:23.190
- Don't get up yet.

00:10:27.070 --> 00:10:30.357
- Her tumor is sectioned
to begin the analysis.

00:10:30.357 --> 00:10:32.440
- If you take half, I take
half, would that be...?

00:10:32.440 --> 00:10:33.060
- You want half?

00:10:33.060 --> 00:10:33.290
OK.

00:10:33.290 --> 00:10:33.840
- Is that OK?

00:10:33.840 --> 00:10:34.340
- Yep.

00:10:36.100 --> 00:10:39.760
- It will be many weeks
before Katya gets her results.

00:10:39.760 --> 00:10:41.950
Sequencing may help her.

00:10:41.950 --> 00:10:47.140
It will certainly add to POG's growing
body of knowledge about the genomic origins

00:10:47.140 --> 00:10:49.390
and treatment of cancer.

00:10:49.390 --> 00:10:51.350
- The sequencing test that we do,

00:10:51.350 --> 00:10:55.690
we can actually identify the
driver of these tumor cells.

00:10:55.690 --> 00:11:00.040
- The level of analysis through
the POG computer is mind-boggling.

00:11:00.040 --> 00:11:04.750
- We can get about a trillion bases
of sequence off of this thing.

00:11:04.750 --> 00:11:08.350
And we read it out with those boxes.

00:11:08.350 --> 00:11:14.060
It's basically just a really nice microscope
lens and a pretty fancy digital camera.

00:11:14.060 --> 00:11:16.890
- A very fancy digital camera.

00:11:16.890 --> 00:11:23.620
Researchers sequence a patient's whole
genome, including roughly 20,000 genes.

00:11:23.620 --> 00:11:27.040
Then they search the mountain
of data for the point,

00:11:27.040 --> 00:11:31.000
or points, where things went haywire.

00:11:31.000 --> 00:11:34.590
- So what we're really looking
for is to be able to hone in

00:11:34.590 --> 00:11:40.440
on the particularly relevant areas where
we could try to target the disease.

00:11:40.440 --> 00:11:42.960
- Once they find a target mutation,

00:11:42.960 --> 00:11:46.140
the hunt for an effective
tool to tackle the cancer

00:11:46.140 --> 00:11:50.280
goes lower tech, but no less fascinating.

00:11:50.280 --> 00:11:53.670
Teams comb through all
available medical literature,

00:11:53.670 --> 00:12:00.630
looking for a drug already known to be
effective against this particular mutation.

00:12:00.630 --> 00:12:05.670
The process takes about three
months, an excruciating wait

00:12:05.670 --> 00:12:09.750
for people who have been
diagnosed with incurable cancer.

00:12:09.750 --> 00:12:11.655
People like Marcy Johnson.

00:12:18.380 --> 00:12:22.760
Marcy Johnson was diagnosed
with stage 4 lung cancer,

00:12:22.760 --> 00:12:28.988
and has been riding a roller coaster
of anxiety and hope for months.

00:12:28.988 --> 00:12:34.200
POG genomic testing found a
drug to target her cancer.

00:12:34.200 --> 00:12:36.915
Today, she'll find out if it's working.

00:12:36.915 --> 00:12:37.790
- Hi, good afternoon.

00:12:37.790 --> 00:12:38.420
How are you doing?

00:12:38.420 --> 00:12:38.855
- Good.

00:12:38.855 --> 00:12:39.170
- All right.

00:12:39.170 --> 00:12:40.919
Come on in, you're here to see Dr. Laskin?

00:12:40.919 --> 00:12:44.180
- It's a huge and
emotional leap joining POG.

00:12:44.180 --> 00:12:48.800
Less than 5% of patients in the
trial have been super responders,

00:12:48.800 --> 00:12:50.944
and there are no guarantees.

00:12:50.944 --> 00:12:53.360
- Wouldn't it be great to be
one of those miracle stories?

00:12:53.360 --> 00:12:56.930
There's something out there
that is going to cure me.

00:12:56.930 --> 00:12:59.090
And if there is, Janessa
is going to find it.

00:12:59.090 --> 00:13:02.000
- POG is new and cutting
edge and very exciting,

00:13:02.000 --> 00:13:05.275
but it's still a very
experimental clinical trial.

00:13:05.275 --> 00:13:09.290
- So your last weigh-in was about
47.9 on the 2nd of December.

00:13:09.290 --> 00:13:10.760
- I signed the waivers.

00:13:10.760 --> 00:13:14.780
Clinical trials, whatever she's got, make
me a Janessa Laskin little guinea pig,

00:13:14.780 --> 00:13:16.130
because I'm just...

00:13:16.130 --> 00:13:17.700
I'm here to fight the battle.

00:13:17.700 --> 00:13:18.450
- 101?

00:13:18.450 --> 00:13:19.454
- 101 pounds.

00:13:19.454 --> 00:13:20.210
OK?

00:13:20.210 --> 00:13:22.150
So a couple pounds less than last time.

00:13:22.150 --> 00:13:22.650
All right?

00:13:22.650 --> 00:13:23.149
OK.

00:13:23.149 --> 00:13:27.830
- For a month now, Marcy has been
taking a chemo drug not normally used

00:13:27.830 --> 00:13:32.000
for her type of lung cancer,
and only available to her

00:13:32.000 --> 00:13:34.250
because she's in the trial.

00:13:34.250 --> 00:13:35.670
- Hey, Marcy.

00:13:35.670 --> 00:13:36.840
Nice to see you.

00:13:36.840 --> 00:13:39.340
- Nice to see you again.

00:13:39.340 --> 00:13:39.920
- OK.

00:13:39.920 --> 00:13:43.430
- Because the cancer
metastasized to Marcy's scalp,

00:13:43.430 --> 00:13:46.640
Dr. Laskin is looking there
to see if it's getting better.

00:13:50.040 --> 00:13:51.726
- That's a huge improvement, yeah.

00:13:51.726 --> 00:13:52.226
Yeah.

00:13:52.226 --> 00:13:52.726
- Yay.

00:13:54.952 --> 00:13:56.285
Those pills are doing something.

00:13:56.285 --> 00:13:58.460
- Those pills are doing something.

00:13:58.460 --> 00:14:02.820
- So that makes me hopeful that they're
also doing something in the rest of my body,

00:14:02.820 --> 00:14:06.330
and especially that little shadow
they keep telling me is on my lung.

00:14:06.330 --> 00:14:08.330
- And honestly, I don't
think it gets any better

00:14:08.330 --> 00:14:11.600
than this, which is that we've
done a test, we've found a drug,

00:14:11.600 --> 00:14:12.860
the drug is helping you.

00:14:12.860 --> 00:14:15.020
That's pretty good.

00:14:15.020 --> 00:14:19.670
- I'm sending you an invitation
to my 65th birthday party in 2020.

00:14:19.670 --> 00:14:22.490
- OK.

00:14:22.490 --> 00:14:26.720
- By 2020, the Personalized
Oncogenomics Trial

00:14:26.720 --> 00:14:32.360
will have grown to include thousands of
subjects looking for their own salvation,

00:14:32.360 --> 00:14:36.650
helping science to crack the cancer code.

00:14:36.650 --> 00:14:40.550
- Without POG, I would be
sitting at home waiting.

00:14:40.550 --> 00:14:43.340
Gee, should I not buy green bananas?

00:14:43.340 --> 00:14:44.570
To me, POG is my hope.

00:14:57.470 --> 00:15:02.210
- As a journalist, I can tell
you that it's extremely rare

00:15:02.210 --> 00:15:06.660
to get access to the inner
workings of a clinical trial.

00:15:06.660 --> 00:15:11.120
But we're invited to sit in on
the weekly meeting of the POG team

00:15:11.120 --> 00:15:15.860
as they work together to crack
cancer, one case at a time.

00:15:15.860 --> 00:15:17.840
- So really, I'm looking for guidance.

00:15:17.840 --> 00:15:22.340
Is there anything to suggest
truly mTOR or MAP kinase pathways?

00:15:22.340 --> 00:15:27.920
- It may not always sound much like English,
but the intense focus is unmistakable.

00:15:27.920 --> 00:15:32.180
- And as mentioned, this is a
rare subtype of ovarian carcinoma.

00:15:32.180 --> 00:15:36.800
In each of these purple balls
you can see concentric circles,

00:15:36.800 --> 00:15:40.100
just like you would in a
tree if you cut it down.

00:15:40.100 --> 00:15:44.750
- Normally, these scientists and
doctors would be working in isolation.

00:15:44.750 --> 00:15:48.410
- So I think BTK should
cover that possibility.

00:15:48.410 --> 00:15:52.070
- But here, oncologists
talk with geneticists,

00:15:52.070 --> 00:15:56.390
while lung cancer experts confer
with breast cancer specialists.

00:15:56.390 --> 00:15:58.460
- And of these, the ones
of potential interest,

00:15:58.460 --> 00:16:03.500
we have NF1 homozygous loss of function
mutation, it's lost one copy of the genome.

00:16:03.500 --> 00:16:06.840
And the remaining copy is mutated.

00:16:06.840 --> 00:16:11.720
- POG's interdisciplinary approach
may be key to cracking cancer.

00:16:11.720 --> 00:16:15.530
- I think we have been
a bit naive in thinking

00:16:15.530 --> 00:16:19.200
that cancer is one disease, that
we could find a cure for cancer.

00:16:19.200 --> 00:16:23.210
And I think that cancer is hundreds
or maybe thousands of diseases.

00:16:23.210 --> 00:16:29.240
And in each individual person, we are
seeing very specific and individual

00:16:29.240 --> 00:16:31.490
coalescence of abnormalities.

00:16:31.490 --> 00:16:35.360
- That's why they all examine
a patient's genomic analysis...

00:16:35.360 --> 00:16:38.330
- I would have thought if
you have loss of both copies,

00:16:38.330 --> 00:16:41.720
it becomes a constitutively active pathway.

00:16:41.720 --> 00:16:43.820
- ...and debate possible interventions.

00:16:46.120 --> 00:16:48.110
At these weekly POG meetings,

00:16:48.110 --> 00:16:50.750
they initially worked with people's photos.

00:16:50.750 --> 00:16:56.390
But it was too upsetting for researchers
not used to direct contact with patients.

00:16:56.390 --> 00:16:59.180
Now they're back to using numbers.

00:16:59.180 --> 00:17:02.370
No big deal for Patient 490.

00:17:02.370 --> 00:17:04.939
Karl Pollak just wants answers.

00:17:09.520 --> 00:17:11.589
- Let's get on with the job.

00:17:11.589 --> 00:17:13.210
I have some living to do.

00:17:13.210 --> 00:17:14.950
The cancer is cramping my style.

00:17:16.859 --> 00:17:21.869
- Two years ago, Karl Pollak
was diagnosed with colon cancer.

00:17:21.869 --> 00:17:25.040
It had reached stage 4.

00:17:25.040 --> 00:17:31.290
- Well yeah, by the time they found it my
liver was completely covered with the crap

00:17:31.290 --> 00:17:35.830
and it was starting to invade my lungs.

00:17:35.830 --> 00:17:40.905
If it were just the colon, they
could probably go snip snip,

00:17:40.905 --> 00:17:43.180
sew it up, and be done with it.

00:17:43.180 --> 00:17:49.170
But let's not carve up Karl too quickly.

00:17:49.170 --> 00:17:51.690
- While he waits for his POG analysis,

00:17:51.690 --> 00:17:56.670
Karl's mind turns to the
possible causes of his cancer.

00:17:56.670 --> 00:18:00.390
- I have a pretty good
idea why I got the cancer,

00:18:00.390 --> 00:18:05.460
because all my life I've been eating lots
of red meat and lots of processed meat.

00:18:05.460 --> 00:18:09.280
And it has sodium nitrate
and stuff like that,

00:18:09.280 --> 00:18:17.160
which in those quantities
is apparently carcinogenic.

00:18:20.980 --> 00:18:27.010
- Maybe Karl can take some comfort in
how complicated we now know cancer to be.

00:18:27.010 --> 00:18:30.450
- So I'll have you up
here, lying on your back.

00:18:30.450 --> 00:18:32.860
- Well when you think about cancer cells

00:18:32.860 --> 00:18:36.640
as being your own body's cells
just growing out of control,

00:18:36.640 --> 00:18:40.930
in some very rare cases
there's one or two triggers.

00:18:40.930 --> 00:18:46.360
Sometimes it's an inherited gene that's
telling the cell wrong information.

00:18:46.360 --> 00:18:50.440
Or sometimes it's a virus, and we
know about virally-triggered cancers.

00:18:50.440 --> 00:18:55.960
But I would say in the vast majority, it's
a complicated relationship of environment

00:18:55.960 --> 00:18:58.220
and inherited genetics

00:18:58.220 --> 00:19:02.060
and some sort of mysterious
combination of those factors.

00:19:02.060 --> 00:19:04.390
So when people ask, "What caused my cancer?"

00:19:04.390 --> 00:19:09.010
I think it's often 10 or 15
or even hundreds of things

00:19:09.010 --> 00:19:11.290
that we can't yet quantify for most cases.

00:19:11.290 --> 00:19:14.740
- You're doing great, Karl, you're
just going to feel the bed move again.

00:19:14.740 --> 00:19:20.800
- While the causes are complex, one
sobering fact is not in dispute.

00:19:20.800 --> 00:19:24.910
If you live in North America,
your chances of developing cancer

00:19:24.910 --> 00:19:28.940
are estimated to be over 40%.

00:19:28.940 --> 00:19:33.698
And while promising, POG won't
find a solution for everyone.

00:19:36.390 --> 00:19:41.070
- So they put me on a pill
that was originally designed

00:19:41.070 --> 00:19:46.670
to lower blood pressure,
which it did marvelously.

00:19:46.670 --> 00:19:50.600
But it did nothing for my cancer.

00:19:50.600 --> 00:19:55.550
- After six weeks, a scan showed
that Karl's treatment wasn't working,

00:19:55.550 --> 00:19:58.870
so he went back on standard chemotherapy.

00:19:58.870 --> 00:20:03.830
- On one level, of course
I'm disappointed, you know.

00:20:03.830 --> 00:20:09.170
I wanted them to wave their magic
wand and make the cancer disappear.

00:20:09.170 --> 00:20:10.480
That didn't work.

00:20:10.480 --> 00:20:12.300
You know, that didn't happen.

00:20:12.300 --> 00:20:16.610
But at the same time, I'm
realistic enough to realize

00:20:16.610 --> 00:20:19.190
that this is an experimental program

00:20:19.190 --> 00:20:23.240
and not everything they try
is going to be successful.

00:20:23.240 --> 00:20:27.947
And I just happen to be one of
the ones that were not successful.

00:20:27.947 --> 00:20:29.780
I still think that they're doing great work.

00:20:31.820 --> 00:20:35.270
- We think something's going
to work, we hope it works.

00:20:35.270 --> 00:20:39.800
And sometimes we're lucky and it
turns out that the theory is sound.

00:20:39.800 --> 00:20:42.790
Sometimes it just doesn't
work out the way we think.

00:20:42.790 --> 00:20:44.657
And I think instead of a "trial and error,"

00:20:44.657 --> 00:20:46.490
I think that's just the process of learning.

00:20:50.680 --> 00:20:55.050
- For Katya Mycyk, coping
with stage 4 breast cancer,

00:20:55.050 --> 00:20:58.860
the last few months have
been an agonizing wait.

00:20:58.860 --> 00:21:03.550
- Waiting for the POG results
is incredibly stressful.

00:21:03.550 --> 00:21:06.850
I had no fingernails left by the end of it.

00:21:06.850 --> 00:21:12.209
You think about it a lot, you go for
long hikes trying not to think about it,

00:21:12.209 --> 00:21:13.500
but you think about it anyways.

00:21:16.490 --> 00:21:21.620
- Today, she will finally get the
results of her genomic analysis.

00:21:21.620 --> 00:21:25.741
- It's a big opportunity and a
lot's on the line and you know it.

00:21:25.741 --> 00:21:26.240
So.

00:21:31.170 --> 00:21:31.910
- Hi there.

00:21:31.910 --> 00:21:32.892
Hi.

00:21:32.892 --> 00:21:33.600
How are you guys?

00:21:33.600 --> 00:21:34.020
- Good.

00:21:34.020 --> 00:21:34.440
- Pretty good.

00:21:34.440 --> 00:21:35.100
- OK?

00:21:35.100 --> 00:21:35.630
- You?

00:21:35.630 --> 00:21:36.500
- OK.

00:21:36.500 --> 00:21:38.810
What's interesting is that you do have...

00:21:38.810 --> 00:21:41.350
Within the tumor, there are 57 mutations.

00:21:41.350 --> 00:21:43.760
This is on the sort of middle-ish end.

00:21:43.760 --> 00:21:49.250
- But none of Katya's mutations can
be targeted with an experimental drug.

00:21:49.250 --> 00:21:52.100
- I think it does support
what we call hormone therapy.

00:21:52.100 --> 00:21:56.660
I think you should strongly consider
being on some form of hormone therapy.

00:21:56.660 --> 00:21:57.320
OK?

00:21:57.320 --> 00:21:58.280
- OK.

00:21:58.280 --> 00:21:59.437
- Questions?

00:21:59.437 --> 00:22:00.687
- No, pretty straight forward.

00:22:00.687 --> 00:22:02.120
- Yeah.

00:22:02.120 --> 00:22:03.500
A little disappointing, but yeah.

00:22:03.500 --> 00:22:04.994
- Disappointed because...?

00:22:04.994 --> 00:22:06.910
- Well, you know, you're
hoping for a miracle.

00:22:06.910 --> 00:22:08.860
Everybody always is.

00:22:08.860 --> 00:22:11.570
- Yeah, I mean the POG
doesn't provide miracles.

00:22:11.570 --> 00:22:14.780
It provides you insights in
what might be driving or not.

00:22:14.780 --> 00:22:18.380
It tells you that there's not
a lot of driving mutations,

00:22:18.380 --> 00:22:20.930
which I think is a better associated outcome

00:22:20.930 --> 00:22:23.150
than having a lot of driving mutations.

00:22:23.150 --> 00:22:26.360
- The information does
help Dr. Chia determine

00:22:26.360 --> 00:22:29.460
what kind of standard
hormone therapy might work.

00:22:29.460 --> 00:22:30.710
- Great, thanks for your time.

00:22:30.710 --> 00:22:32.487
- OK, all right.

00:22:32.487 --> 00:22:33.070
OK, take care.

00:22:35.050 --> 00:22:39.106
- It's just not the cutting edge
answer Katya was hoping to hear.

00:22:39.106 --> 00:22:40.354
- It's OK.

00:22:40.354 --> 00:22:41.940
We've got some options, right?

00:22:43.900 --> 00:22:50.050
- Well, I was pretty crushed to realize
that I didn't have any actionable mutations.

00:22:50.050 --> 00:22:51.795
I'd pinned a lot of hopes on it.

00:22:51.795 --> 00:22:54.554
- Just keep on carrying on with your regime.

00:22:54.554 --> 00:22:55.976
You're doing good.

00:23:01.664 --> 00:23:05.130
- Hi, Marcy Johnson, I have a CT scan.

00:23:05.130 --> 00:23:06.600
Thank you.

00:23:06.600 --> 00:23:10.440
- Patients all know of POG's
more spectacular successes,

00:23:10.440 --> 00:23:15.000
so it's easy to forget that
about 25% of people sequenced

00:23:15.000 --> 00:23:18.120
don't get any experimental
treatment suggestions.

00:23:18.120 --> 00:23:21.630
And those who do don't
always have lasting success.

00:23:21.630 --> 00:23:23.100
- That's pretty good right there.

00:23:23.100 --> 00:23:24.330
OK.

00:23:24.330 --> 00:23:27.510
- Marcy Johnson's been receiving
treatment for several months

00:23:27.510 --> 00:23:31.700
for lung cancer, which has
metastasized to her scalp.

00:23:31.700 --> 00:23:33.030
- One, two, three.

00:23:33.030 --> 00:23:37.960
- The experimental drug she has been
taking has had serious side effects.

00:23:37.960 --> 00:23:41.550
So now, Marcy's on a reduced dose.

00:23:41.550 --> 00:23:46.620
She's meeting with Dr. Janessa Laskin to
see if the medication is still working.

00:23:46.620 --> 00:23:47.460
- Hey.

00:23:47.460 --> 00:23:48.840
- Hello, Janessa!

00:23:48.840 --> 00:23:49.590
- Nice to see you.

00:23:49.590 --> 00:23:50.520
- Nice to see you.

00:23:50.520 --> 00:23:52.050
- I like your hat.

00:23:52.050 --> 00:23:56.760
- It actually has a purpose, it keeps
that scab on the side of my head covered.

00:23:56.760 --> 00:24:00.160
- The only other thing that I have to
tell you about the CT of the brain,

00:24:00.160 --> 00:24:05.790
and it's not a perfect scan, is that
there were a couple of tiny little spots

00:24:05.790 --> 00:24:08.010
that are kind of in the...

00:24:08.010 --> 00:24:11.310
not in the brain itself, but kind
of on the surface of the brain.

00:24:11.310 --> 00:24:14.880
So I can't quite tell what those are yet.

00:24:14.880 --> 00:24:21.030
- The CT scan is showing things
that I wish weren't there.

00:24:21.030 --> 00:24:24.530
It could be going into my
brain, which scares me.

00:24:24.530 --> 00:24:25.030
But...

00:24:29.740 --> 00:24:31.369
I totally went brain fog.

00:24:31.369 --> 00:24:32.307
- It's OK.

00:24:35.590 --> 00:24:38.050
- Marcy is struggling to be hopeful.

00:24:38.050 --> 00:24:41.470
The drug she is on has
left her so debilitated,

00:24:41.470 --> 00:24:44.030
at times she can barely leave her apartment.

00:24:44.030 --> 00:24:45.280
- ...if I hadn't just woke up.

00:24:46.900 --> 00:24:48.880
I've gotten past the denial stage.

00:24:48.880 --> 00:24:52.160
Now I know I do have
cancer and it's stage 4.

00:24:54.870 --> 00:24:57.050
And I go back and forth.

00:24:57.050 --> 00:25:00.070
I still have my days
where I'm just so positive

00:25:00.070 --> 00:25:06.010
and then I have days where
I am not positive at all.

00:25:06.010 --> 00:25:07.690
And so far, it's...

00:25:07.690 --> 00:25:11.425
I mean, it's been a year since my diagnosis.

00:25:11.425 --> 00:25:13.800
And that first oncologist I
talked to gave me six months,

00:25:13.800 --> 00:25:15.640
so I'm already six months ahead.

00:25:20.530 --> 00:25:25.850
- Marcy will get seven more months
before she succumbs to her cancer.

00:25:30.710 --> 00:25:35.390
Sadly, Marcy's story is
still a more typical outcome

00:25:35.390 --> 00:25:39.170
for cancer patients who've reached stage 4.

00:25:39.170 --> 00:25:45.230
So far, personalized oncogenomics
improves outcomes for less than 40%

00:25:45.230 --> 00:25:47.390
of patients who are sequenced.

00:25:47.390 --> 00:25:53.345
That's still a huge number, since everyone
admitted to the study has incurable cancer.

00:25:56.540 --> 00:26:00.170
But cancer is a complicated
beast, and there can even

00:26:00.170 --> 00:26:03.380
be nasty surprises for the super responders.

00:26:05.540 --> 00:26:10.220
Trish Keating was an early and
dramatic POG success story.

00:26:10.220 --> 00:26:15.980
Her cancer disappeared for a year after she
started taking a blood pressure medication.

00:26:15.980 --> 00:26:20.420
But then it grew back in a
delicate spot near her spine.

00:26:20.420 --> 00:26:23.682
- I had surgery to remove that tumor.

00:26:23.682 --> 00:26:25.265
It was like an 8 and 1/2 hour surgery.

00:26:28.298 --> 00:26:30.080
- Trish?

00:26:30.080 --> 00:26:30.580
- Hi.

00:26:30.580 --> 00:26:31.150
- Come on in.

00:26:31.150 --> 00:26:31.650
- Hey.

00:26:31.650 --> 00:26:32.149
- Hi.

00:26:32.149 --> 00:26:34.140
- You can just put the water down there.

00:26:34.140 --> 00:26:39.030
- The POG team is trying to figure
out why Trish's cancer came back.

00:26:39.030 --> 00:26:42.000
That may help them solve
an essential mystery --

00:26:42.000 --> 00:26:44.970
why does cancer change over time?

00:26:44.970 --> 00:26:48.270
- I like to use infectious
disease as an analogy.

00:26:48.270 --> 00:26:52.230
We know how quickly the infectious
disease agents mutate, they change,

00:26:52.230 --> 00:26:53.070
and they become...

00:26:53.070 --> 00:26:54.780
The flu vaccine is a good case in point.

00:26:54.780 --> 00:26:55.810
It changes every year.

00:26:55.810 --> 00:26:57.060
Why does it change every year?

00:26:57.060 --> 00:27:02.430
It changes every year because the
composition of the agents changes.

00:27:02.430 --> 00:27:04.270
Cancer is a similar thing.

00:27:04.270 --> 00:27:10.320
So if cancers evolve, treatments will
have to evolve to meet the cancer.

00:27:10.320 --> 00:27:13.650
- Now, four months after
Trish's back surgery,

00:27:13.650 --> 00:27:16.800
a follow-up scan brings another scare.

00:27:16.800 --> 00:27:20.210
A suspicious shadow.

00:27:20.210 --> 00:27:26.760
So today, she's having a consultation
with her oncologist, Dr. Howard Lim.

00:27:26.760 --> 00:27:30.280
- This CAT scan that we did today,
you're going to have a look at it.

00:27:30.280 --> 00:27:32.520
But in all probability...

00:27:32.520 --> 00:27:34.500
- It's probably your
cancer back in the spine.

00:27:34.500 --> 00:27:37.320
- That's what I was thinking,
I was worried about.

00:27:39.900 --> 00:27:47.310
Why did that drug that they
gave me in POG kill the cancer

00:27:47.310 --> 00:27:50.010
that had metastasized to my lymph nodes?

00:27:50.010 --> 00:27:56.370
Why did it not get that one
that was in my spinal column?

00:27:56.370 --> 00:27:57.950
- We redid the POG analysis,

00:27:57.950 --> 00:27:58.450
and actually

00:27:58.450 --> 00:28:02.250
it looks very similar to
your original POG analysis.

00:28:02.250 --> 00:28:04.170
The only thing is it
does show that the cancer

00:28:04.170 --> 00:28:06.930
is becoming resistant to the
blood pressure medication,

00:28:06.930 --> 00:28:08.905
or at least the one in the spine is.

00:28:08.905 --> 00:28:14.092
- I'm so tired of living this cancer.

00:28:14.092 --> 00:28:14.960
- It's about...

00:28:14.960 --> 00:28:15.960
- I know you say like...

00:28:20.190 --> 00:28:25.170
I feel like I'm on a roller coaster,

00:28:25.170 --> 00:28:26.880
and that's not even...

00:28:26.880 --> 00:28:28.710
like John said it better the other day.

00:28:28.710 --> 00:28:32.340
It's like every three months,

00:28:32.340 --> 00:28:37.800
just pretend that you're
going in front of a jury

00:28:37.800 --> 00:28:41.360
who's going to decide if you
get the death sentence or not.

00:28:41.360 --> 00:28:41.910
- Right.

00:28:41.910 --> 00:28:46.080
Fortunately, though, the remainder
of your PET scan is still very quiet.

00:28:46.080 --> 00:28:48.660
So there's no cancer anywhere else.

00:28:48.660 --> 00:28:51.900
The best way to look at it
is, there are more tests.

00:28:51.900 --> 00:28:54.006
Don't look at it as a death sentence,

00:28:54.006 --> 00:28:57.090
look at it as getting more information

00:28:57.090 --> 00:29:01.050
so that we can help you
live as long as possible,

00:29:01.050 --> 00:29:03.180
the best quality as possible.

00:29:03.180 --> 00:29:04.420
- It's a life sentence.

00:29:04.420 --> 00:29:06.020
- It's a life sentence, exactly.

00:29:06.020 --> 00:29:07.040
- Thanks, dear.

00:29:07.040 --> 00:29:10.444
- It's about maintaining your life.

00:29:10.444 --> 00:29:12.730
- Thanks, Howie.

00:29:12.730 --> 00:29:15.190
- Because the blood pressure medication

00:29:15.190 --> 00:29:18.400
is still blocking the
majority of Trish's cancer,

00:29:18.400 --> 00:29:21.810
Dr. Lim decides to increase the dosage.

00:29:21.810 --> 00:29:25.865
- You've proven a lot of people
wrong and all the stats wrong so far,

00:29:25.865 --> 00:29:27.049
so continue to do that.

00:29:27.049 --> 00:29:28.840
- It's all the meditation I'm doing, Howie.

00:29:28.840 --> 00:29:29.830
- That's perfect.

00:29:29.830 --> 00:29:30.420
- Exceptional person.

00:29:30.420 --> 00:29:30.730
- Yeah.

00:29:30.730 --> 00:29:31.510
- Thanks, dear.

00:29:31.510 --> 00:29:33.280
- OK.

00:29:33.280 --> 00:29:36.370
The participants are really key for POG.

00:29:36.370 --> 00:29:41.150
They're the ones taking the courage to step
forward and have their results analyzed.

00:29:41.150 --> 00:29:41.650
- Thanks.

00:29:41.650 --> 00:29:43.300
Bye, love.

00:29:43.300 --> 00:29:47.680
- Without the participants,
there really wouldn't be a POG.

00:29:47.680 --> 00:29:53.020
- Participant 417 joins
the trial late in 2015.

00:29:53.020 --> 00:29:58.900
And so researchers begin studying
a rare case that is not cancer.

00:29:58.900 --> 00:30:01.260
How far can POG go?

00:30:01.260 --> 00:30:02.980
- I'm just wondering, is it shrinking?

00:30:02.980 --> 00:30:04.390
Is it growing?

00:30:04.390 --> 00:30:07.820
Is it not doing anything, or
will it disappear all the way?

00:30:07.820 --> 00:30:08.955
It's like a mystery!

00:30:14.290 --> 00:30:18.090
Hi, my name is Sagar,
and welcome to my home.

00:30:18.090 --> 00:30:21.800
I'm going to an appointment
at BC Children's Hospital.

00:30:21.800 --> 00:30:25.970
My leg problem is neurofibromatosis,
I had it since I was born.

00:30:25.970 --> 00:30:28.730
I'm going to have a checkup.

00:30:28.730 --> 00:30:33.020
- 12-year-old Sagar Dutt was
born with a genetic disorder

00:30:33.020 --> 00:30:35.900
that causes tumors to form on nerve tissue.

00:30:38.180 --> 00:30:42.881
It's not cancer, but the tumor
in his left leg really hurts.

00:30:42.881 --> 00:30:43.380
- Ow, ow.

00:30:43.380 --> 00:30:44.890
My knee, my knee, my knee.

00:30:44.890 --> 00:30:46.370
Gosh.

00:30:46.370 --> 00:30:49.040
- And POG may be able to help him.

00:30:49.040 --> 00:30:53.510
- Neurofibromatosis is one example
where it almost behaves like a cancer,

00:30:53.510 --> 00:30:55.220
but not quite.

00:30:55.220 --> 00:30:56.960
- Hello, would you like to come through?

00:30:56.960 --> 00:30:58.650
We're ready for you.

00:30:58.650 --> 00:31:02.150
- So Sagar's tumor was
sequenced, and the POG team

00:31:02.150 --> 00:31:05.061
has identified a medication
that looks promising.

00:31:05.061 --> 00:31:07.310
- So what we really want to
make sure is that we do it

00:31:07.310 --> 00:31:11.215
in the safest way possible, which is
why we're starting at a very low dose.

00:31:11.215 --> 00:31:14.810
- But what if I still don't
want to take the risk?

00:31:14.810 --> 00:31:17.360
- POG is not a treatment, it's a test.

00:31:17.360 --> 00:31:21.890
And so at the end of this test you
may or may not end up with treatments,

00:31:21.890 --> 00:31:25.430
but those treatments can be quite toxic.

00:31:25.430 --> 00:31:28.550
And it's critical that
people understand that.

00:31:28.550 --> 00:31:34.300
- Sagar has already taken a skeptical
eye to his proposed drug treatment.

00:31:34.300 --> 00:31:40.180
- I already looked at this and
it's a lot of serious side effects.

00:31:40.180 --> 00:31:44.016
- Sagar is nervous because he's
suffered side effects before.

00:31:44.016 --> 00:31:45.890
- You don't have to make
any decisions today.

00:31:45.890 --> 00:31:48.380
Today we're just letting
you know about everything.

00:31:48.380 --> 00:31:49.010
OK?

00:31:49.010 --> 00:31:50.020
- Yeah, I will think.

00:31:50.020 --> 00:31:50.950
- Yeah, OK.

00:31:52.810 --> 00:31:57.450
- Sagar and his family
agree to try the medication.

00:31:57.450 --> 00:31:59.710
- I'm just wondering, is it shrinking?

00:31:59.710 --> 00:32:00.585
Is it growing?

00:32:00.585 --> 00:32:04.650
Is it not doing anything, or
will it disappear all the way?

00:32:04.650 --> 00:32:07.790
It's like a mystery!

00:32:07.790 --> 00:32:10.370
- It's still unclear if the drug is working,

00:32:10.370 --> 00:32:13.386
but Sagar notices a difference.

00:32:13.386 --> 00:32:17.450
- I have a feeling that it's working.

00:32:17.450 --> 00:32:20.870
Before when I always used to go
swimming, I couldn't do a flip.

00:32:20.870 --> 00:32:26.220
Now since I was taking the blood
pressure pills, I can do a whole flip.

00:32:26.220 --> 00:32:29.630
- Sagar's is an unusual
case that could open up

00:32:29.630 --> 00:32:34.100
a range of treatment
options for other diseases.

00:32:34.100 --> 00:32:39.200
So really, POG is adding another
instrument, another technology,

00:32:39.200 --> 00:32:41.400
like adding a microscope.

00:32:41.400 --> 00:32:44.060
And it's opening up whole new frontiers now.

00:32:44.060 --> 00:32:48.110
You're pioneers in this foreign area.

00:32:48.110 --> 00:32:53.120
- When you can bring minds, smart people
together with different perspectives

00:32:53.120 --> 00:32:56.540
to tackle a problem, then you
see inspiration and creativity

00:32:56.540 --> 00:32:58.400
on a whole new level.

00:32:58.400 --> 00:33:01.730
- It was their desire to push
beyond standard approaches

00:33:01.730 --> 00:33:07.280
to cancer that led Dr. Laskin
and her colleagues to found POG.

00:33:07.280 --> 00:33:13.160
But when she met Jen Strack, Dr. Laskin
wasn't anticipating that this case would

00:33:13.160 --> 00:33:14.870
result in a major breakthrough...

00:33:14.870 --> 00:33:15.770
- Hi, Jen.

00:33:15.770 --> 00:33:17.120
- Hi.

00:33:17.120 --> 00:33:20.900
- ...one that could potentially
transform treatment for hundreds,

00:33:20.900 --> 00:33:23.515
even thousands of cancer patients.

00:33:23.515 --> 00:33:25.850
So tell us about your patient, Jen Strack.

00:33:25.850 --> 00:33:28.322
- Jen's case hits near and dear to me.

00:33:28.322 --> 00:33:29.780
Of course because she's my patient,

00:33:29.780 --> 00:33:34.220
but also because she illuminated
a new area of cancer treatment

00:33:34.220 --> 00:33:38.150
that we are going to take and run with.

00:33:38.150 --> 00:33:41.580
Jen was a lifetime never
smoker, completely healthy.

00:33:41.580 --> 00:33:45.440
So the diagnosis of lung cancer
came as a huge surprise to her.

00:33:45.440 --> 00:33:47.290
OK, and just breathe through your mouth.

00:33:47.290 --> 00:33:49.550
- Well, total shock.

00:33:49.550 --> 00:33:53.430
Like, how did I get lung cancer?

00:33:53.430 --> 00:33:57.640
- Lung cancer is the leading
cause of cancer death worldwide.

00:33:57.640 --> 00:34:01.765
And some studies suggest rates
in non-smokers are rising.

00:34:04.280 --> 00:34:06.170
- So your lungs sound perfectly clear.

00:34:06.170 --> 00:34:11.929
- Shortly after Jen Strack was diagnosed,
her cancer metastasized to both lungs.

00:34:11.929 --> 00:34:17.690
Once her POG analysis was done, doctors
noticed something strikingly different.

00:34:17.690 --> 00:34:20.659
- In the DNA of your cancer-- so
that's the set of instructions

00:34:20.659 --> 00:34:23.870
that are telling a cell how to behave--

00:34:23.870 --> 00:34:27.600
you've got two different genes, or
these are sort of bits of information.

00:34:27.600 --> 00:34:29.600
And these two different
genes usually don't live

00:34:29.600 --> 00:34:31.699
anywhere near each other on the chromosomes.

00:34:31.699 --> 00:34:35.239
But for whatever reason, they've joined
up and they're right next to each other

00:34:35.239 --> 00:34:36.800
and they're fused together.

00:34:36.800 --> 00:34:38.150
So we call that a fusion.

00:34:38.150 --> 00:34:40.889
But your fusion is quite unusual.

00:34:40.889 --> 00:34:45.580
I don't think there's much experience with
seeing these two things stuck together.

00:34:45.580 --> 00:34:51.710
- For Jen, this fusion is an absolutely
critical piece of her cancer puzzle.

00:34:51.710 --> 00:34:56.250
It produces very high levels
of one particular protein.

00:34:56.250 --> 00:34:59.430
And that protein is driving her cancer.

00:34:59.430 --> 00:35:02.150
- Her case came at a really opportune time,

00:35:02.150 --> 00:35:09.170
when enough published reports had come out
that maybe this protein was a good target.

00:35:09.170 --> 00:35:14.660
But no one had yet been able to find a
patient and actually test that hypothesis.

00:35:17.820 --> 00:35:22.430
- So she said, "We think that this
drug that's targeted to that mutation

00:35:22.430 --> 00:35:27.210
should work on you to stop the
tumors from growing and spreading."

00:35:27.210 --> 00:35:30.470
- She remains on treatment
now, more than a year out,

00:35:30.470 --> 00:35:35.660
when really she was in quite a
serious condition when we started.

00:35:35.660 --> 00:35:42.750
- I'm living proof that there's results
that they're getting with their research.

00:35:42.750 --> 00:35:44.480
Those look pretty good.

00:35:44.480 --> 00:35:48.830
- I don't think we've cured Jen.

00:35:48.830 --> 00:35:52.790
I think we have given
Jen time with a tolerable

00:35:52.790 --> 00:35:56.970
treatment and a good quality of life.

00:35:56.970 --> 00:36:00.380
And if we can continue that on
for her and for other people,

00:36:00.380 --> 00:36:01.855
that to me is a huge success.

00:36:06.270 --> 00:36:09.950
- It's a huge success
if you consider that Jen

00:36:09.950 --> 00:36:14.330
is the first POG patient with
this particular mutation.

00:36:14.330 --> 00:36:17.330
Her successful treatment could buy more time

00:36:17.330 --> 00:36:22.880
for future cancer patients
with the same gene fusion.

00:36:22.880 --> 00:36:26.660
- How common is this
new fusion that Jen has?

00:36:26.660 --> 00:36:28.040
Well, we don't know.

00:36:28.040 --> 00:36:34.040
Maybe we can go fishing and find it
in even 1% of all cancer patients.

00:36:34.040 --> 00:36:36.150
That's a game changer.

00:36:36.150 --> 00:36:40.230
- By its fifth anniversary
in 2017, the POG team

00:36:40.230 --> 00:36:43.680
will have admitted more than 800 patients.

00:36:43.680 --> 00:36:46.250
They're aiming for 5,000.

00:36:46.250 --> 00:36:50.340
But Dr. Marco Marra is
projecting far beyond that.

00:36:50.340 --> 00:36:54.780
- If you imagine a scenario maybe five
years from now, 10 years from now,

00:36:54.780 --> 00:36:59.580
what would you do with 100,000
fully-characterized genomes

00:36:59.580 --> 00:37:03.750
complete with outcome information, where
you knew the complete molecular profiles

00:37:03.750 --> 00:37:09.207
and you knew how the cancers had
behaved being treated with agents?

00:37:09.207 --> 00:37:11.790
I think you would actually have
a resource that might actually

00:37:11.790 --> 00:37:14.040
revolutionize how we develop drugs.

00:37:14.040 --> 00:37:18.690
- The hope is that the more the POG
team learns about cancer mutations,

00:37:18.690 --> 00:37:22.380
the easier it will be to
develop new treatments.

00:37:22.380 --> 00:37:26.420
Patient number 10, Zuri
Scrivens, embodies that hope.

00:37:26.420 --> 00:37:32.410
- Without being too macabre, you've had how
many years of good, high-quality life now?

00:37:32.410 --> 00:37:32.910
- Five.

00:37:32.910 --> 00:37:34.940
Yeah, yeah.

00:37:34.940 --> 00:37:39.230
I intend on another 45.

00:37:39.230 --> 00:37:44.850
- Zuri will stay on the life-saving
diabetes drug, coupled with hormone therapy,

00:37:44.850 --> 00:37:47.760
as long as it keeps her
breast cancer at bay.

00:37:47.760 --> 00:37:49.560
- You were a lucky one.

00:37:49.560 --> 00:37:50.190
It worked.

00:37:50.190 --> 00:37:54.060
But it's not kind of a
salvation for everyone.

00:37:54.060 --> 00:37:56.780
It's still very early in the technique.

00:37:56.780 --> 00:37:58.210
- Not yet.

00:37:58.210 --> 00:38:01.590
But the hope is the more patients
you can bring into the program

00:38:01.590 --> 00:38:03.640
and test and compare, the better.

00:38:03.640 --> 00:38:04.140
- Exactly.

00:38:04.140 --> 00:38:08.760
- So I think they're on the right
track, that anything is possible.

00:38:08.760 --> 00:38:12.270
I've shown that anything is
possible, my outcome has.

00:38:12.270 --> 00:38:14.910
- But with new Canadian cancer cases

00:38:14.910 --> 00:38:19.680
expected to increase by
40% over the next 15 years,

00:38:19.680 --> 00:38:23.550
can POG move fast enough to
meet such enormous demand?

00:38:29.160 --> 00:38:35.160
Personalized oncogenomics bought
Jen Strack a year of quality time.

00:38:35.160 --> 00:38:37.510
- What is the type of cancer that you're...?

00:38:37.510 --> 00:38:38.010
- Lung.

00:38:38.010 --> 00:38:38.720
- Lung cancer?

00:38:38.720 --> 00:38:39.690
OK.

00:38:39.690 --> 00:38:43.050
- But the last few weeks
have been difficult.

00:38:43.050 --> 00:38:46.830
- Four weeks ago yesterday,
actually, I had brain surgery,

00:38:46.830 --> 00:38:48.330
and they took out two tumors.

00:38:48.330 --> 00:38:50.440
One was the size of a golf ball.

00:38:50.440 --> 00:38:54.600
- Jen's cancer, which is
driven by a unique gene fusion,

00:38:54.600 --> 00:38:57.120
responded well to POG treatment.

00:38:57.120 --> 00:38:59.790
But now, it has spread.

00:38:59.790 --> 00:39:04.380
Today, she's undergoing immunotherapy,
a cutting-edge treatment

00:39:04.380 --> 00:39:09.550
that boosts her body's immune system
so it can attack cancer cells.

00:39:09.550 --> 00:39:14.410
- The future is all going to be about
individualizing patient's care --

00:39:14.410 --> 00:39:16.890
understanding what's
different about their cancers

00:39:16.890 --> 00:39:21.270
and trying to target those runaway pathways.

00:39:21.270 --> 00:39:24.780
And understanding, also, how
to blend in new treatments

00:39:24.780 --> 00:39:29.230
like immunotherapies into that milieu.

00:39:29.230 --> 00:39:31.470
- The immunotherapy is
one of the things that

00:39:31.470 --> 00:39:35.100
did come up on the POG research
that could possibly work,

00:39:35.100 --> 00:39:37.650
and we're giving it a shot.

00:39:37.650 --> 00:39:40.650
We'll see how that goes,
until they say "That's it,"

00:39:40.650 --> 00:39:43.510
there's nothing they can do.

00:39:43.510 --> 00:39:52.240
- Jen's immunotherapy lasts for six weeks
before her cancer grows more aggressive.

00:39:52.240 --> 00:39:58.420
POG couldn't save her life, but it did
give Jen Strack something priceless.

00:39:58.420 --> 00:40:00.430
More time.

00:40:00.430 --> 00:40:05.950
Dr. Laskin will continue to use
Jen's earlier success to help others

00:40:05.950 --> 00:40:09.330
with similar mutations.

00:40:09.330 --> 00:40:14.200
- You are heroes among heroes
in our battle to conquer cancer.

00:40:14.200 --> 00:40:17.260
- BC's Ride to Conquer Cancer.

00:40:17.260 --> 00:40:20.820
Everyone here has a personal
connection to cancer.

00:40:20.820 --> 00:40:25.930
The fundraiser helped kickstart the
personalized oncogenomics program.

00:40:25.930 --> 00:40:29.320
- My name is Zuri Scrivens, and in 2009

00:40:29.320 --> 00:40:32.320
I embarked on my first
Ride to Conquer Cancer.

00:40:32.320 --> 00:40:36.490
- Who better to send the riders
off than POG patient number 10?

00:40:36.490 --> 00:40:40.690
- Now, three years and
another three scans later,

00:40:40.690 --> 00:40:43.320
no sign of active tumors.

00:40:43.320 --> 00:40:48.500
The research being done behind
lab doors is so important.

00:40:48.500 --> 00:40:51.670
From me and my family to all of you --

00:40:51.670 --> 00:40:53.558
thank you so very much.

00:40:53.558 --> 00:40:55.650
(APPLAUSE)

00:40:55.650 --> 00:40:59.520
- Today, Zuri Scrivens
is POG's poster child.

00:40:59.520 --> 00:41:02.740
Young, active, and healthy.

00:41:02.740 --> 00:41:05.090
- Ready, set, ride!

00:41:07.920 --> 00:41:14.160
- Money raised by the ride goes to the BC
Cancer Foundation, which helps fund POG.

00:41:14.160 --> 00:41:18.480
And the money goes a lot further
now than it did five years ago.

00:41:18.480 --> 00:41:21.420
The price for individual
sequencing has dropped

00:41:21.420 --> 00:41:25.232
from about a quarter of
a million to $20,000.

00:41:25.232 --> 00:41:27.520
- Thank you, stay safe.

00:41:27.520 --> 00:41:31.470
- Only British Columbia residents
can currently participate,

00:41:31.470 --> 00:41:35.370
but the benefits will flow far beyond BC.

00:41:35.370 --> 00:41:39.900
- I don't think that the future is
everyone will get a POG analysis

00:41:39.900 --> 00:41:41.400
in the way that we do it now.

00:41:41.400 --> 00:41:42.790
That's not sustainable.

00:41:42.790 --> 00:41:49.110
But it might be true that in five years,
the standard technology looks more like POG.

00:41:49.110 --> 00:41:50.140
- What do we got here?

00:41:50.140 --> 00:41:53.000
- Today we have some prostate
cancer exome libraries...

00:41:53.000 --> 00:41:57.930
- In the business of studying the dynamics
of cancer, the evolution over time,

00:41:57.930 --> 00:42:00.580
is something that we now
are well-positioned to do.

00:42:00.580 --> 00:42:05.520
We're learning incredibly important things
about cancers that are very fundamental.

00:42:05.520 --> 00:42:08.670
And that information will produce a data set

00:42:08.670 --> 00:42:13.020
that will be absolutely central to new
treatment strategies in the future.

00:42:15.540 --> 00:42:17.790
- After a flare up of her cancer,

00:42:17.790 --> 00:42:22.560
sensational super responder
Trish Keating is back on top.

00:42:22.560 --> 00:42:28.290
The tumor on her spine shrank after her
blood pressure medication was doubled.

00:42:28.290 --> 00:42:32.880
- I firmly believe that it's
moving in the right direction.

00:42:32.880 --> 00:42:36.750
I want them there if I'm diagnosed again.

00:42:36.750 --> 00:42:38.602
Analyzing my next...

00:42:38.602 --> 00:42:39.810
No, it's not going to happen.

00:42:39.810 --> 00:42:41.100
But anyway.

00:42:41.100 --> 00:42:47.790
- But does Dr. Laskin think the POG
trial will ever find a cure for cancer?

00:42:47.790 --> 00:42:49.960
- I like to think of myself as an optimist.

00:42:49.960 --> 00:42:53.260
I think that's how you survive
as a medical oncologist.

00:42:53.260 --> 00:42:57.420
What I hope to see in my career
is making cancer a chronic disease

00:42:57.420 --> 00:42:58.840
with tolerable treatments.

00:42:58.840 --> 00:43:00.258
I think that's realistic.

00:43:05.238 --> 00:43:11.468
(MUSIC PLAYING)