Thanks for your interest in the Kasey Altman hackathon to find the best next treatment for this rare cancer patient.
On Thursday, June 3, we launched the Kasey Altman Hackathon with a presentation of her medical history by her oncologist, Dr. Lenny Wexler of Memorial Sloan Kettering Cancer Center.
Here are some highlights from Dr. Wexler’s presentation and the following discussion:
Kasey is a 24 year old woman, diagnosed in October 2020 with stage 4 Fusion-positive (PAX3-FOX01) Alveolar Rhabdomyosarcoma with lymph node and bone involvement
Her tumor cells are positive for B7-H3; negative for NY-ESO-1, Her2, PD-L1, EGFR.
After three cycles (9 weeks) she had an expected prompt and dramatic improvement. Normally this cancer is highly responsive to chemotherapy, but it often recurs.
In early January, she began the first of three cycles of Vinorelbine and Irinotecan.
March 2021 biopsy results: Microsatellite stable (MSS), tumor mutational burden 1.6 (low Tumor Mutational Burden)
MYCN amplification change: 59.1 (increased x20 since Oct. 2020 bx)
TP53 deletion, mutation
In March, she resumed “VAC” and “VC” chemotherapy while having 33 rounds of radiation – proton therapy – to her primary site, hip bones and sites of initial nodal involvement.
On May 17, she began her first of three final planned cycles of another chemo combination (VAI with Ifosfamide replacing Cyclophosphamide), which is gentler on the immune system in anticipation of her eventual consolidation with a personalized vaccine.
Whole exome sequencing and RNA sequencing has been performed by Tempus. Three attempts to do RNA sequencing at Memorial Sloan Kettering failed.
Concern was shared over results of the RNA sequencing report, prompting need to follow-up with Tempus (method?) and MSK (residual tissue available?)
Questions pending include biopsy changes due to genetic evolution or subclonal expansion, why PDX attempts have failed, Dr. Ezra Cohen’s ASCO presentation on UCSD precision immunotherapy trial requested
Expectation – MYCN increase x20 would yield other findings on RNA report
The Target Cancer Foundation’s Jim Palma will be helping with their TRACK program.
Please see the lightly edited transcription of the meeting and the recording below for more details. Action and pending items will be revisited next Thursday.
If you have any questions, please feel free to contact Brad Power at bradfordpower@gmail.com.
Best,
Kasey Altman, Delsee Altman, Lupe Montes, and Brad Power