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The Targeted Therapy Continuum

Tissue Biomarkers in Oncology Clinical Development The Digital Advantage Christopher Ung VP Strategic Business & Operations, Oncology TMD – A Quintiles Laboratory. The Targeted Therapy Continuum. Non-Targeted. Targeted (Somewhat). Personalized Med. (bcr/abl) (c-kit) (PDGFR) Gleevec.

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The Targeted Therapy Continuum

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  1. Tissue Biomarkers in Oncology Clinical Development The Digital AdvantageChristopher UngVP Strategic Business & Operations, OncologyTMD – A Quintiles Laboratory

  2. The Targeted Therapy Continuum Non-Targeted Targeted (Somewhat) Personalized Med. (bcr/abl) (c-kit) (PDGFR) Gleevec (HER2) (pHer2) (pHer3) Tykerb (KRAS) Vectibix Erbitux (EGFR) Erbitux Iressa (HER2) Herceptin Chemotherapies 1998 2002 2003 2008 2008 Time Consuming Clinical Endpoints (TTP, OS) “More is better” (MTD Approach) No target population Earlier decisions based on Biological Endpoints Efficacy without Toxicity (Biologically Effective Dose) Targeted Population Biomarker-Driven Single or Combination Therapy Treat Based on Histology Treat Based on “some” Biomarkers Treat Based on Molecular Profile

  3. Predictive Biomarkers for Response To Lapatinib Post-Treatment Pre-Treatment Arm A Biomarker Analysis • Observations of Predictive Biomarkers: • Most patients in Cohort A (HER2 overexpressing) had high p-HER2 • However, co-expression of p-HER2 AND p-HER3 predicted for response to lapatinib • High IGF-1R expression does not appear to play a role in drug resistance, nor does PTEN deficiency Johnston, et al. (2008). Phase II Study of Predictive Biomarker Profiles for Response Targeting Human HER-2 in Advanced Inflammatory Breast Cancer With Lapatinib Monotherapy. JCO 26(7): 1066-72.

  4. Quintiles – Solid Tumor Oncology Services CAP GLP/GCP CLIA Biomarker Driven Spans Discovery through Clinical Development for Oncology Science Differentiator 4

  5. Our Biomarker Tool Set FFPE Tissue Tissue Microarray (TMA) Xenografts Frozen Tissue Fluorescent in situ hybridization (FISH) Chromogenic in situ hybridization (CISH) Immunohistochemistry (IHC) Immunofluorescence (IF) Digital Pathology & Image Analysis Real-Time PCR (Mutation Analysis & Gene Expression) 5

  6. Biomarkers for Oncology Drug Development: An Example Biomarkers to Analyze “Activation” Status of PI3K Pathway • PI3KCA mutation, PI3KCA amplification • PTEN expression by IHC (advantages over sequencing) Other Biomarkers • KRAS and/or BRAF mutation (depending on tumor type) • EGFR, HER2, c-Met amplification (depending on tumor type) • IGF-1R, p-EGFR, p-HER2, p-HER3 Biomarkers for PD/Target Modulation • p-S6, p-4EBP1, p-mTOR, Cleaved Caspase 3, Ki67

  7. Broken Slides Lost Slides Expensive to ship Images are hard to transmit Outsourcing to independent labs is tricky especially with data integration The Challenges of IHC Hard to move tissue in and out of China Turnaround time and cost can be high if testing is “over-centralized” IHC is subjective Interpretation between pathologists can be inconsistent Non-numerical biomarker representation is difficult to use

  8. Quintiles Labs Global Coverage Edinburgh Scotland QWES Chicago Beijing China Tokyo Japan Atlanta United States Mumbai India Singapore Sao Paulo Brazil Support Services Pretoria South Africa Owned Facility Anatomic Pathology Affiliated Facility Buenos Aires, Argentina Regional Labs Allow for Rapid TAT and Lower Shipping Costs

  9. Tissue Biomarker Assay Development Model • Proof or Robustness. Full development & validation at TMD. • SOPs in place • Teams trained at TMD • Both platform and technology are reviewed • Performance qualification at global labs • TMD inspects global labs • Extensive use of digital pathology platform to maintain quality and consistency Develop Centrally, Perform Globally 9

  10. IHC Assay Validation with Image Analysis Stroma ZR75-1 LNCap DU145 MCF-7 T47D MWM PC3 Tumor T47D (Wild-type PTEN) No tumor PTEN staining, high stromal cell staining PTEN Actin Stroma Du145 (1 Wild-type Allele, 1 Mutant Allele) Tumor Moderate tumor PTEN staining, high stromal cell staining PC3 (PTEN Homozygous Deletion) 10 Numerical Data May Enable Further Resolution in Analyses

  11. Multi-site Integration in a Global Environment Multisite Integration in a Global Environment Pete Tearle Sep 15. 7:00 pm – 9:00 pm Atlanta Room

  12. Quintiles Digital Pathology Applications for Drug Development • Image Analysis & Technology Transfer for Image Analysis Algorithms • Collaboration & education – Digital Pathology conferencing • Global review of tumor presence prior to genotyping of solid tumors • Simultaneous biomarker review of patient data • Tissue Micro Array and Cell Micro Array analysis • Digital Slide Scanning 12

  13. www.quintiles.com/centrallab www.quintiles.com/centrallab

  14. Quintiles Global Oncology Laboratories • CAP, CLIA, GLP, GCP Laboratories • Anatomic Pathology Services • Basic anatomic pathology (accessioning, microtomy, processing, H&E) • Immunohistochemistry (common signaling pathways), • HER2 FISH , EGFR FISH • Mutation analysis (Real-Time PCR) • High resolution scanning of images (Aperio ScanScope) • Tissue MicroArray prep, staining and reporting • Biorepository • Experienced Quintiles histotechnologists • Dual platform – DAKO + Ventana 15

  15. Leveraging Digital Pathology for the Development of Targeted Therapies • Invest in a standardized system for global deployment • Use the platform to increase collaboration and learning, internally and with key constituents • Engage the benefits of archiving, secure back up, image management and image retrieval • Use tools such as TMA Lab and image analysis algorithms to create assay development value • Obtain input for additional creativity and solutions • Stay strong in the vision

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