Doctors Share How They Use DCISionRT in Clinic

  • Presented by: Leona Hamrick, DHSc, PA-C, MSL-BC, Steven Cai, MD, FACS, Lynn Canavan, MD, FACS, Pat Whitworth, MD, FACS

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    Leona Hamrick, DHSc, PA-C, MSL-BC

    Senior Director of Global Medical Affairs, PreludeDx

    0:00 Welcome & Speaker Introductions
    1:30 DCISionRT Validation Data Review

    Pat Whitworth, MD, FACS

    Breast Surgical Oncology Specialist, Director of the Nashville Breast Cancer

    16:56 Core Biopsy Case Studies

    Lynn Canavan, MD, FACS

    Medical Director of Breast Surgical Oncology, Texas Breast Specialists

    28:43 Core Biopsy Case Studies & Practice Comparison

    Steven Cai, MD, FACS

    Director of Surgical Services, Rendr Care, and Clinical Assistant Professor at Mount Sinai Icahn School of Medicine

    42:26 Core-Biopsy Case Studies

    Leader of Breast Cancer Multidisciplinary Team, Comprehensive Breast Care, A Division of Michigan Healthcare Professionals

    Roundtable Discussion:

    55:41 Closing Thoughts
    59:01 Endocrine Therapy
    1:01:45 Ordering DCISionRT when Cancer may be Invasive
    1:05:05 DCISionRT’s Residual Risk Group
    1:05:35 DCISionRT Turnaround Time
  • Presented by: Troy Bremer, PhD, Leona Hamrick, DHSc, PA-C, MSL-BC, Erica Giblin, MD, James Pellicane, MD, Eric Brown, MD, FACS

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    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    0:00 Welcome & Speaker Introductions
    0:59 Identifying Patient Risk with DCISionRT
    6:51 DCISionRT Validation Data Review

    Leona Hamrick, DHSc, PA-C, MSL-BC

    Senior Director, Global Medical Affairs, PreludeDx

    16:25 Comparing Validation Data & Clinical Results

    James Pellicane, MD

    Director of Breast Oncology, Bon Secours Cancer Institute

    20:09 Real-world RRt Case Studies

    Erica Giblin, MD

    Medical Director of Breast Care Services, Breast Surgical Oncologist, Ascension Medical Group

    30:32 Real-world RRt Case Studies

    Eric Brown, MD, FACS

    Leader of Breast Cancer Multidisciplinary Team, Comprehensive Breast Care, A Division of Michigan Healthcare Professionals

    38:18 Real-world RRt Case Studies

    Surgeon Roundtable Discussion:

    45:23 Core Biopsy vs. Surgical Specimen
    48:40 Oncoplastic Considerations
    50:03 DCISionRT Specimen Requirements
    51:10 Insurance and Turnaround Time
    51:56 Radiation Therapy Considerations
    54:39 Integrating DCISionRT in Clinical Workflow
    55:21 Role of Radiation Therapy
  • Presented by: Troy Bremer, PhD, Leona Hamrick, DHSc, PA-C, MSL-BC, Chirag Shah, MD, Fleure Gallant, MD, and Lonika Majithia, MD

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    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    0:00 Welcome & Speaker Introductions

    Leona Hamrick, DHSc, PA-C, MSL-BC

    Senior Director, Global Medical Affairs, PreludeDx

    1:15 Identifying Patient Risk with DCISionRT

    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    8:46 DCISionRT Validation Data Review

    Leona Hamrick, DHSc, PA-C, MSL-BC

    Senior Director, Global Medical Affairs, PreludeDx

    17:32 Comparing Clinical Results with Validation Data

    Chirag Shah, MD

    Co-Director of Comprehensive Breast Program and Director of Clinical Research in the Department of Radiation Oncology at the Cleveland Clinic

    20:26 Real-world RRt Case Studies—High Grade Patients

    Fleure Gallant, MD

    Clinical Director of Radiation Oncology, Maimonides Medical Center. Clinical Assistant Professor, SUNY Downstate Medical Center

    25:32 Real-world RRt Case Studies—Varying HR Status and Age

    Lonika Majithia, MD

    Medical Director of Brachytherapy & Director of Radiation Oncology Educational Program at Inova Schar Cancer Center

    35:00 Real-world RRt Case Studies—Varying HR Status and Age

    Radiation Oncologist Roundtable Discussion:

    42:00 Patient Risk Tolerance
    44:11 RT Modalities
    49:41 Impact of Nuclear Grade
    52:35 Personal Physician Experience with DCISionRT
    54:15 Mastectomies for Patients with RRt
    56:44 Implication of DCISionRT RRt for Multi-Disciplinary Teams
    1:00:10 Surveilling RRt Patients
  • Presented by: Pat Whitworth, MD, FACS, Troy Bremer, PhD and Chirag Shah, MD

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    Pat Whitworth, MD, FACS

    Breast Surgical Oncology Specialist, Director of the Nashville Breast Center

    0:34 Clinical Need–takeaways from DCIS randomized landmark trials, RTOG, NCCN

    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    5:08 Genomic Solution—DCISionRT
    8:56 Who will recur despite BCS+RT?
    9:42 Pathway for residual recurrence risk
    10:52 About Residual Risk Subtype (RRt)

    Chirag Shah, MD

    Co-Director of Comprehensive Breast Program and Director of Clinical Research in the Department of Radiation Oncology at the Cleveland Clinic

    11:15 Validation data of DCISionRT+RRt
    14:20 Stratification for RT benefit and NNT
    18:20 RRt clinpath subpopulations

    Pat Whitworth, MD, FACS

    Breast Surgical Oncology Specialist, Director of the Nashville Breast Center

    19:05 Validation supporting true low risk and RT benefit groups
    20:43 Age and grade Subpopulation analysis
    23:40 Individualized patient care

    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    24:00 Summary:  Supportive evidence
    26:22 Real-world Case Studies

    Panel Q and A Discussion

    33:36 Addressing microcalcifications in study cohort
    34:19 Local Recurrence rate vs metastatic rate in study cohort
    35:06 Margins status and DS in study cohort and treatment implications
    37:33 Hormone Receptor status in study cohort and treatment implications
    41:55 Overcoming nuclear grade subjectivity
    43:36 Management of patients meeting RTOG criteria
    44:52 RT modalities
    45:42 Implementing into clinical practice
    48:15 Specimen type for testing
    49:30 RRt vs Decision Score
    50:25 RRt treatment implications
    50:25 Closing statements from KOLs
  • Presented by: Troy Bremer, PhD and Rachel Rabinovitch, MD, FASTRO

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    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    0:05 Speaker Introduction and Agenda

    Rachel Rabinovitch, MD, FASTRO

    Radiation Oncologist, Professor, Radiation Oncology, University of Colorado

    1:08 Background DCIS Treatment – Radiation Therapy Landmark Trials

    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    10:35 Data Overview and Clinical Evidence
    11:20 DCISionRT Test Report
    12:39 Integration of Biology and Clinicopathologic Factors
    16:50 DCISionRT Demonstrates Consistent RT Prediction
    18:20 DCISionRT Correctly Reclassifies ClinPath in All Validation Cohorts
    22:46 Supportive Evidence DCISionRT

    Rachel Rabinovitch, MD, FASTRO

    Radiation Oncologist, Professor, Radiation Oncology, University of Colorado

    24:15 Clinical Application in Radiation Oncology – My Approach to DCIS

    Panel Q and A Discussion

    38:47 Q&A and Discussion
    38:58 Test’s impact on mastectomy decisions
    40:40 Risk assessment by ClinPath
    42:05 Integrating into tumor board and workflow
    42:58 Test’s impact on boost decisions
    44:55 Test’s impact on margins assessment
    51:19 DCISionRT vs OncotypeDCIS
    52:40 ex-US availability
    53:06 Getting started and specimen requirements
    56:55 Test’s impact regarding endocrine therapy
  • Presented by: Troy Bremer, PhD, Julie Margenthaler, MD, FACS and, Chirag Shah, MD

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    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    1:44 Clinical Application of DCISionRT
    4:40 Clinical Evidence

    Julie Margenthaler, MD, FACS

    Breast Surgeon, Siteman Cancer Center, Washington University School of Medicine St Louis, Missouri

    10:30 Patient Discussion and Clinical Application
    13:43 100 Patient Analysis
    20:40 Case Studies

    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    23:31 DCIS Biosignature Score and Residual Risk Subtype

    Panel Discussion with the Speakers: Multidisciplinary Perspectives – Q/A Discussion

    33:32 Treatment Recommendations for Residual Risk Type
    39:08 Treatment with Endocrine Therapy for patients under 50 years old with a low-risk vs elevated score
    50:54 Additional Ongoing Research – Troy Bremer, PhD
    51:48 Final Thoughts – Julie Margenthaler, MD, FACS and Chirag Shah, MD

    Closing Remarks

    53:13 Closing Remarks from Troy Bremer, PhD
  • Presented by: Troy Bremer, PhD, Pat Whitworth, MD, Chirag Shah, MD, Anne Peled, MD, and Karen Barbosa, DO, FACOS

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    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    0:00 Welcome, Introductions, and Agenda
    2:02 Introduction to DCISionRT
    5:58 DCISionRT Validation Data Review

    Pat Whitworth, MD, FACS

    Breast Surgical Oncology Specialist, Director of the Nashville Breast Center

    10:15 Standard of Care for DCIS
    12:06 DCISionRT Correctly Reclassifies Patient Risk
    14:27 Surgical Perspective on Clinical Impact of DCISionRT

    Chirag Shah, MD

    Director of Clinical Research & Associate Professor in the Department of Radiation Oncology at the Cleveland Clinic

    17:46 DCISionRT Helps to Tailor Individual Radiation Treatment Decisions
    20:06 DCISionRT Minimizes Over & Under Treatment
    22:14 Clinical Implications of DCISionRT for Radiation Oncologists

    Anne Peled, MD

    Co-Director, Sutter CPMC Breast Cancer Program

    23:39 Clinical Application of DCISionRT
    27:40 Oncoplastic Case Studies
    33:16 Clinical Considerations & Benefits of DCISionRT

    Karen Barbosa, DO, FACOS

    Breast Surgeon, Oncoplastic Surgeon, & Medical Director of Tidal Health Delaware Breast Cancer Program

    35:38 Incorporating DCISionRT into a Health System

    Panel Discussion

    38:46 What are the important considerations when utilizing DCISionRT?
    41:26 Ordering DCISionRT on lumpectomies & biopsies
    44:07 How to use DCISionRT in your surgical practice
    47:15 How do surgical margins apply to radiation oncology?
    53:47 Endocrine therapy for DCIS
    56:51 Patient risk tolerance
  • Moderator: Dede Goehler, BSN
    Featured Speakers: Leonard Farber, MD and Beth Dupree, MD, FACS, ABOIM

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    Leonard Farber, MD

    • Radiation Oncologist
    • Sr. Clinical Adviser, PreludeDx
    1:34 Current Standard of DCIS Care
    4:34 Clinicopatholgy Alone Doesn’t Accurately Assess Risk
    6:07 DCISionRT – The Predictive DCIS Test
    10:49 Validation Data Review
    18:33 Clinical Utility of DCISionRT
    20:10 Clinical Utility–Radiation Oncologist Perspective

    Beth DuPree, MD, FACS, ABOIM

    Breast Surgeon

    20:54 Clinical Utility- Surgeon Perspective
    28:48 Case Studies
    41:50 Integrating DCISionRT Into Your Practice

    Q and A with the Panelists

    48:07 How can I integrate DCISionRT with the doctors in my practice?
    51:40 Can DCISionRT be used to help guide endocrine therapy?
    54:52 Is DCISionRT covered by insurance?
  • Presented by: Dan Forche, Fredrik Warnberg, MD, PhD, Troy Bremer, PhD, Pat Whitworth, MD, FACS, Chirag Shah, MD, Frank A. Vicini, MD, FACR, FABS, FASTRO, and Bruce Mann, MBBS, PhD, FRACS

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    Dan Forche

    President & CEO of PreludeDx

    0:00 Speaker Introductions & Agenda

    Fredrik Warnberg, MD, PhD

    Professor in the Dept. of Surgery, University of Gothenburg, Sweden

    2:09 Rationale for DCISionRT Validation in SweDCIS

    Troy Bremer, PhD

    Founder & Chief Scientific Officer of PreludeDx

    4:39 Summary of DCISionRT Randomized SweDCIS Results

    Pat Whitworth, MD, FACS

    Breast Surgical Oncology Specialist, Director of the Nashville Breast Center

    9:33 Clinical Value beyond Clinpath
    9:33 Decision Impact/Clinical Utility Study Results
    15:15 Surgical Perspective on the Clinical Impact of DCISionRT

    Chirag Shah, MD

    Co-Director of the Comprehensive Breast Program, Cleveland Clinic

    16:32 Consistent Prediction of RT Benefit
    16:32 DCISionRT Risk Stratifies RTOG
    20:42 Clinical Implications of DCISionRT for Radiation Oncologists

    Case Studies

    22:00 Case Studies

    Panel Discussion with the Speakers

    39:19 Standard of Care in Sweden – Fredrik Warnberg, MD, PhD
    40:18 Ordering DCISionRT on a Pre-Surgical Biopsy – Pat Whitworth, MD, FACS
    44:11 The Future of DCISionRT – Troy Bremer, PhD
    47:00 Use of Tamoxifen in Patients with DCIS – Bruce Mann, MBBS, PhD,
    FRACS. Chirag Shah, MD. Frank Vicini, MD, FACR, FASTRO, FABS. Pat Whitworth, MD, FACS.
    50:46 Surgical Margins – Chirag Shah, MD & Pat Whitwoth, MD, FACS

    Q and A with the Panelists

    53:27 Are patients with higher residual risk candidates for mastectomy?
    55:40 How is DCISionRT validated for margin status?
    56:04 Is DCISionRT the “gold standard” of care for DCIS?
    57:38 Biologic Drivers in DCISionRT
    1:00:52 What do DCISionRT’s independent studies look like when combined?
    1:02:28 Confidence when using clinicopathology factors to make decisions

    Closing Remarks

    1:04:00 Closing Remarks from Troy Bremer
  • Presented by: David Dabbs, MD, Julie Reiland, MD, FACS, and Anne Peled, MD

    Disclaimer: The following video contains graphic images from actual breast surgery. Viewer discretion is advised.

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    David Dabbs, MD

    PreludeDx Chief of Pathology

    0:00 Speaker Introductions & Agenda
    3:23 The Unmet Clinical Need – Individualized DCIS Treatment
    12:32 DCISionRT – Providing Personalized DCIS Information
    14:03 DCISionRT Overview and Data Highlights
    23:50 The Future of DCISionRT

    Julie Reiland, MD, FACS

    Committee Chair, American Society of Breast Surgeons

    26:07 Oncoplastic Surgery & Related Surgical Techniques
    29:53 Surgical Planning with DCISionRT
    31:37 Surgical Videos (Warning: Graphic)
    45:09 Getting Started with Oncoplastic Surgery
    46:33 Conclusion

    Anne Peled, MD

    Co-Director, Sutter CPMC Breast Cancer Program

    48:53 Clinical Application of DCISionRT
    50:54 Case Studies
    56:46 Clinical Considerations & Conclusion

    Q and A with the Panelists

    48:07 How can I integrate DCISionRT with the doctors in my practice?
    51:40 Can DCISionRT be used to help guide endocrine therapy?
    54:52 Is DCISionRT covered by insurance?
  • Moderator: Dede Goehler, BSN
    Featured Speaker: Leonard Farber, MD

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    Dede Goehler, BSN

    Registered Nurse & PreludeDx Patient Advocate

    0:00 Speaker Introduction

    Leonard Farber, MD

    Radiation Oncologist

    1:54 Speaker Introduction
    2:34 Current Standard of DCIS Care
    3:52 Who Benefits from Radiation Therapy?
    5:50 DCISionRT Overview
    10:31 DCISionRT & OncotypeDx DCIS: A Comparison
    12:09 DCISionRT validation data highlights
    21:47 DCISionRT PREDICT Registry
    22:53 Case Studies
    29:30 Conclusion: A Radiation Oncologist’s Perspective

    Q and A with the Panelists

    32:48 What is the turn-around-time for DCISionRT?
    33:06 Does insurance cover DCISionRT?
    34:44 As a nurse, how can I help integrate DCISionRT into my physician’s practice?
    36:46 What type of tissue specimen can DCISionRT be ordered on?
    39:30 Does DCISionRT account for the benefits of hormone therapy?
  • Presented by: Troy Bremer, Ph.D. and Vincent Reid, MD, FACS

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    Troy Bremer, Ph.D.

    CSO and Founder of PreludeDx

    0:29 Current Standard of DCIS Care
    1:07 Role of Radiation Therapy for DCIS
    3:12 DCISionRT Overview & Test Results Explanation
    5:04 DCISionRT Validation Data Highlights
    16:24 DCISionRT: Consistent RT Prediction
    18:58 DCISionRT Clinical Summary
    20:09 PREDICT Registry Summary
    21:06 Future of DCISionRT

    Vincent Reid, MD, FACS

    Medical Director, Hall-Perrine Cancer Center & Chairman of Surgery, Mercy Medical Center

    22:46 Speaker Introduction
    23:45 Clinical Dilemma for Managing DCIS Patients
    26:45 Case Studies
    33:50 Conclusion: A Surgeon’s Perspective

    Q and A with the Panelists

    36:19 What does a DCISion Score of 3 mean for a patient?
    37:30 Is DCISionRT covered by insurance?
    38:11 How does DCISionRT work in different subtypes of patients?
    40:17 How to incorporate DCISionRT into protocol with tumor boards?
    41:37 Do unexpected recurrences occur in patients tested with DCISionRT?
    42:45 How to best introduce DCISionRT for implementation in a multidisciplinary practice?
    44:36 How does DCISionRT impact mastectomy considerations?
    46:16 How do high DCISion Scores & large lesions impact treatment recommendations?
    47:20 What are benefits of ordering DCISionRT on Pre-Surgical Biopsy Specimen?
    48:23 What is the Turn Around Time?
    48:42 How does DCISionRT help with decision between BCS + RT vs oncoplastic vs mastectomy?
  • Presented by: Troy Bremer, Ph.D. and Kristina Mirabeau-Beale, MD, MPH

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    Troy Bremer, Ph.D.

    CSO and Founder of PreludeDx

    0:00 Speaker Introductions
    1:49 Presentation Agenda
    3:51 Role of Radiation Therapy for DCIS
    7:03 DCISionRT Overview & Test Results Explanation
    9:21 DCISionRT Validation Data Highlight
    20:56 DCISionRT: Consistent RT Prediction
    24:31 DCISionRT Clinical Summary
    25:51 PREDICT Registry Summary
    27:01 Future of DCISionRT
    28:52 Short Q&A

    Kristina Mirabeau-Beale, MD, MPH

    Radiation Oncologist, GenesisCare

    29:48 Clinical Dilemma for Managing DCIS Patients
    31:46 Case Studies
    43:31 Physician Analysis Report
    45:45 Conclusion: Radiation Oncologist’s Perspective

    Q and A with the Panelists

    48:05 Can you order DCISionRT for micro-invasive disease?
    48:38 How does selection bias impact patient referrals to your practice?
    50:35 DCISionRT Insurance Coverage
    52:00 Does DCISionRT address the use of hormone therapy?
    53:14 DCISionRT & NCCN Guidelines
  • Presented by: Christy Kesslering, MD, Troy Bremer, Ph.D. and Jim Pellicane, MD

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    Troy Bremer, Ph.D.

    CSO and Founder of PreludeDx

    2:00 DCISionRT—Background of Assay, Supporting Evidence/Data, Outcomes

    Jim Pellicane, MD

    • Breast Cancer Surgeon
    • Director of Breast Oncology
    • Bon Secours Cancer Institute
    15:50 Introduction
    16:16 Surgeon’s clinical dilemma to assessing risk in DCIS patients
    22:57 Why is ER not a good indicator of risk assessment?
    24:13 Why is patient age is no an independent predictor of risk?
    25:23 What are side effects of RT, especially for younger patients?
    26:20 What are the surgical options and decisions impacted by RT?
    27:11 Case Studies
    36:00 Personal lessons learned
    39:18 What is the impact of hormone therapy on DCISionRT score?

    Christy Kesslering, MD

    • Radiation Oncologist, Breast Cancer Specialist
    • Radiation Oncology Consultants
    • Northwester Medicine Radiation Oncology, Warrenville
    39:55 Introduction
    40:04 Clinical dilemma: Am I seeing all the patients? When do surgeons refer patients to me?
    50:04 Why Tumor Grade and RTOG9804 Classification is not always the best indicator of Risk?
    51:23 Case Studies
    52:15 Clinical Application of DCISionRT testing for DCIS patients
    53:08 Why should DCISionRT be ordered for every patient?
    55:20 How genomic testing can help guide intensification and de-escalation of RT
    56:52 Challenges and solution insights for radiation oncologists to use genomics in DCIS

    Q and A with the Panelists

    59:22 Why is 0.8 that DCISionRT common score? Answered by Christy
    1:00:46 Turn-around-time and Billing. Answered by Dr. Pellicane
    1:01:43 How do you build consensus/buy-in within your medical group/colleagues to implement a DCIS protocol between radiation oncologists and surgeons? Answered by Dr. Pellicane and Dr. Kesslering
    1:03:20 Why order DCISionRT on all my DCIS patients? Answered by Dr. Kesslering
    1:04:28 What are the results and implications of interaction studies between DCISion Score and RT? Answered by Dr. Bremer
    105:59 Conclusion
  • Presented by: Troy Bremer, Ph.D., Chirag Shah, MD and Pat Whitworth, MD, FACS

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    Troy Bremer, Ph.D.

    CSO and Founder of PreludeDx

    0:46 Supportive evidence for DCISionRT
    2:12 DCISionRT overview and test results
    4:30 Validation data highlights
    7:30 RT benefit prediction and NNT data highlight
    8:14 Reclassification data highlight

    Chirag Shah, MD

    • Radiation Oncologist
    • Director of Clinical Research and Associate Professor
    • Department of Radiation Oncology at the Cleveland Clinic
    8:54 Introduction
    9:07 Managing DCIS and RT role in background studies
    12:30 Who needs or doesn’t need RT?
    14:07 Changing treatment recommendations
    15:51 Applying DCISionRT in my practice
    17:11 Cost effectiveness and value
    18:39 Case Studies
    19:56 Conclusion: Radiation oncologist’s perspectives

    Pat Whitworth, MD

    • Breast Surgical Oncology Specialist
    • St. Thomas Health, Ascension
    • Direction of Nashville Breast Center
    21:06 Introduction
    21:24 Impact of genomic testing in clinical practice, pre-op visit
    22:43 Clinical dilemma for DCIS
    24:33 DCIS tools to guide patient management, pros/cons
    26:54 Surgical margins and guidelines
    28:53 Genomic assays for DCIS
    30:58 Identifying patients with RT benefit after BCS
    31:58 Patient Discussion with DCISionRT Test Report
    32:50 Clinical application and case studies
    36:58 Conclusion: Surgeon’s perspectives
    37:41 Decision impact PREDICT Registry

    Q and A with the Panelists

    38:50 How to interpret DCISionRT in context of ET?
    39:48 Case study recommendation with low DCISionRT
    42:10 Role of MSKCC nomogram for DCIS management?
    43:40 DCISionRT protocol in own medical practices?
    45:35 Role of APBI in DCIS?
    46:48 Which patients are indicated for DCISionRT?

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