PracticeUpdate Oncology February 2019

SABCS 2018 29

differences between the somatic and genomic or the germline mutations. We’ll also have some proteomics done, mRNA and miRNA analysis done. We will have a lot of data coming out from these trials as time goes by. So this trial is really a great oppor- tunity for us to learn a lot about the genetic basis of cancer. And maybe we might have some understanding, or a better under- standing, of the influence of race and ethnicity. Dr. Haffizulla: That is so important to real precision medicine, if you will. Dr. Badve: Absolutely. Dr. Haffizulla: Finally, for our clinicians viewing, how can the data from this study affect their practice? Dr. Badve: That’s a very interesting question and it’s kind of difficult to answer. Partly because when you are doing a population-level data analysis, converting it back to a single patient-level data is a little bit difficult. But of course, the basic understanding is they have to take into consideration, clinicians have to take into consideration, the impact of race and ethnicity. We clearly don’t know how they impact, whether it’s diet, whether it’s lifestyle, whether it’s just having a bad set of genes or whether there are SNPs. There’s all of these open questions, so we really do not know. But the simplest thing is making sure that the patient is aware of the data risk and monitoring them adequately is clearly what’s going to be important. Go to www.practiceupdate.com/c/77345 to watch this interview with Dr. Badve.

Asian populations did surprisingly well and sometimes even better than the white population. This is the first time, in some ways, we have data on Asian populations in a randomized trial, and that’s partly because of the large population that we have in this trial, 7000-plus, allowed us to tease out some of the ethnic differences. There were also some differences between the Hispanic and the non-Hispanic populations, although it’s kind of difficult to say what exactly the differences were because we really don’t know the genetic basis of the patients. This is on self-reported race, so there has to be some caveats in interpretation of the data. Because a lot of patients have mixed race, they may not even know that they are mixed race. So race was not assessed in a genetic basis it was assessed based on self-disclosure and self-identification. Dr. Haffizulla: That’s a very important point. Dr. Badve: So, we really need to understand all the biological bases, but we have clearly some indications that maybe the black pop- ulation needs to be followed up more closely; closely monitored for recurrences and all of those things. And clear emphasis on our understanding the biological basis of the differences as to why black populations do poorly as opposed to the white populations. Dr. Haffizulla: Well, understanding the racial heterogeneity that you touched on is it important for us to tease that out in clinical trials from a genetic basis and not just on a self-reported basis? Dr. Badve: Oh, absolutely. Although, having said that there is some data to suggest that there is a literally good concordance between genetic race and self-reported race, but it’s always nice to have solid data. And one of the things that is happening with the TAILORx is there is going to be a project sponsored by the NCI (National Cancer Institute), which is called The Clinical Trial Sequencing program. This is the next generation of TCGA, The Cancer Genomic Atlas, and as a part of this project they will be sequencing in all the TCGA treatment given for patients enrolled in this trial with and without recurrence. So, we will have genomic DNA analyzed, as well as the tumor DNA analyzed, to find out the

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VOL. 3 • NO. 1 • 2019