There's a lot of news out there about the FDA's 6 to 0 vote today recommending that Avastin not gain full approval for treating women with metastatic breast cancer. This case has been watched closely by both drug companies and cancer patient advocate groups. The final decision for withdrawing full approval rests with the FDA Commissioner, Margaret Hamberg. According to one news source, that decision will be rendered later this summer.
I've followed this issue closely. I'm not going to comment on the accelerated approval process granted by the FDA which allowed on label use of this drug sooner than later. With some fear of upsetting people who sided against the FDA, based on what I've read and after careful consideration, the FDA panel is making a sound recommendation.
I base this on the assumption, which I believe to be true, that the NCCN (National Comprehensive Cancer Network) Compendium will continue to list Avastin as a treatment option for breast cancer. This compendium is used by many insurance companies and Medicare to determine which treatments will be reimbursed. The panel's recommendation and ultimate decision to remove the breast cancer approval will not prevent doctors from prescribing Avastin to their breast cancer patients. In addition, Avastin is a serious drug with potentially deadly side-effects (internal bleeding). Unfortunately for patients, Genentech, and our hope for a cure, Avastin showed only marginal benefit in two recent studies. There are many, myself included, that for some people Avastin is the answer and our medical community is hard at work to find the bio-markers which show which patients have the greatest chance of success without endangering women who will not benefit.
Today's recommendation is a win for patients, doctors, and the FDA. Patients will continue to have access to this treatment regimen, insurance companies will continue to pay for the treatment, doctors will still be able to prescribe it to patients who they believe it will benefits, and the FDA is protecting the American people against unnecessary risks.
In closing, I credit my medical team who had the foresight to treat me with Avastin (in off-label use for head & neck cancer) with significantly prolonging my life although I can't prove that it was the Avastin that did the trick. I wish the two recent Avastin breast cancer studies on which the FDA panel based their recommendation had shown great benefit for breast cancer patients, but they didn't.
Lastly, I apologize to anyone I may offend for having sided with the FDA on this one. It is not about the money, it is not about death panels, it is not about Obama care; it is about the science.
Take care.
Wednesday, June 29, 2011
Friday, June 24, 2011
What a H&N Cancer Patient doesn't want to have...
A sore throat. For most people, me included, a sore throat was (past tense) just that and nothing more. We all get them. That was then; now it dredges up a lot of bad memories and negative possibilities. I've been feeling a bit under the weather for about two weeks with frequent migraines, more than the usual fatigue and loss of appetite, and a SORE THROAT. I went to the doctors today for my annual physical (it's actually been a few years). They swabbed my throat and it came back positive for type A strep. I began a 10 day regimen of an antibiotic. In researching this on the Internet, it appears that this is a pretty common illness and that whatever contagion I may have will be gone within 24 hours of beginning my medication. For now, the best cure is a little extra rest.
I can't not wonder how I got this. I realize this is a stretch with possibly scant medical backing. For me, I believe it to be a somewhat compromised immune system from my cancer and all my cancer treatments and a potential side effect of the stress and close people contact associated with traveling (that trip to ASCO 2011 in Chicago two weeks ago). I've mentioned in the past that travelling is a challenge for me, this is one of a number of those challenges... real or imagined.
Take care everyone.
Ed
I can't not wonder how I got this. I realize this is a stretch with possibly scant medical backing. For me, I believe it to be a somewhat compromised immune system from my cancer and all my cancer treatments and a potential side effect of the stress and close people contact associated with traveling (that trip to ASCO 2011 in Chicago two weeks ago). I've mentioned in the past that travelling is a challenge for me, this is one of a number of those challenges... real or imagined.
Take care everyone.
Ed
Tuesday, June 14, 2011
Targeted Cancer Therapies - A Peek Behind the Curtain
Lions, and Tigers and Bears! Oh my! It took Dorothy courage to look behind the curtain in the city of Oz. She found the Wizard.
I recently took a peek behind the curtain. For me, more so than courage, it was curiosity and a desire to make a personal contribution which prompted me to attend the June 2011 American Society of Clinical Oncology (ASCO) conference, Patients Pathways Progress. This is the premier annual oncology conference in the world. It attracted 30,000 oncology professionals. There were hundreds of sessions ranging from the kickoff of a large keynote address to meetings with individual researchers who were peer-selected to display their ground breaking research.
I expected to find a few presentations on the biology of cancer and how our growing knowledge of genetic science would lead to targeted cancer therapies. As with Dorothy in The Wizard of Oz, what I found behind the curtain surprised me. Unlike Dorothy, I found a set of true wizards comprised of oncologists, molecular biologists, epidemiologists, and statisticians who were willing to share their latest breakthroughs in the hopes of collectively and collaboratively finding cures to cancers.
Out of the dozens of presentations in which I participated, my personal favorite was the one delivered by Apostolia M. Tsimberidou, MD, PhD, titled Personalized Medicine in a Phase I Clinical Trials Program: The M. D. Anderson Cancer Center Initiative. The hypothesis of her study is, “Genetics and molecular analyses of patients’ cancers will identify biomarkers for targeted therapies that will improve clinical outcomes.” A phase I non-randomized trial within M. D. Anderson’s Investigational Cancer Therapeutics department was begun in 2007. The trial used tissue from patients referred for treatment to this trial to identify genetic mutations. If a genetic mutation was found and a drug regimen was available that targeted that specific mutation, the patient was enrolled in this phase I trial. Of the 1,144 patients whose tissue sample was analyzed for molecular aberrations, 40.2% were identified with one or more cancer-suspected genetic defects. This patient set was then placed on either a “Matched Therapy” or a “Therapy without Matching” regimen. Here’s the bottom line. The “matched therapy” group showed a 27% positive response rate whereas the “therapy without matching” group showed a 5% positive response rate. The conclusion, based on rigorous statistical methods, was that the matched therapy group faired far better than the non-matched group. By my way of thinking, more than 5 times better. The studies long term goals were twofold. First, over the next five year they hope to develop the capability to test all of M. D. Anderson’s 30,000 new patients a year for any genetic/molecular aberration in order to assign targeted therapy. Second, to perform research that proves efficacy so that the tests are reimbursed and become the standard of care.
This one presentation was one of hundreds during this five day conference focused on genetics and targeted therapies. This is what elevates my hope for a cure. Although targeted therapies are a relatively nascent science, the acceleration of discovery is shifting into high gear. As Dorothy said to Toto upon her arrival in Oz, “We’re not in Kansas anymore.”
I recently took a peek behind the curtain. For me, more so than courage, it was curiosity and a desire to make a personal contribution which prompted me to attend the June 2011 American Society of Clinical Oncology (ASCO) conference, Patients Pathways Progress. This is the premier annual oncology conference in the world. It attracted 30,000 oncology professionals. There were hundreds of sessions ranging from the kickoff of a large keynote address to meetings with individual researchers who were peer-selected to display their ground breaking research.
I expected to find a few presentations on the biology of cancer and how our growing knowledge of genetic science would lead to targeted cancer therapies. As with Dorothy in The Wizard of Oz, what I found behind the curtain surprised me. Unlike Dorothy, I found a set of true wizards comprised of oncologists, molecular biologists, epidemiologists, and statisticians who were willing to share their latest breakthroughs in the hopes of collectively and collaboratively finding cures to cancers.
Out of the dozens of presentations in which I participated, my personal favorite was the one delivered by Apostolia M. Tsimberidou, MD, PhD, titled Personalized Medicine in a Phase I Clinical Trials Program: The M. D. Anderson Cancer Center Initiative. The hypothesis of her study is, “Genetics and molecular analyses of patients’ cancers will identify biomarkers for targeted therapies that will improve clinical outcomes.” A phase I non-randomized trial within M. D. Anderson’s Investigational Cancer Therapeutics department was begun in 2007. The trial used tissue from patients referred for treatment to this trial to identify genetic mutations. If a genetic mutation was found and a drug regimen was available that targeted that specific mutation, the patient was enrolled in this phase I trial. Of the 1,144 patients whose tissue sample was analyzed for molecular aberrations, 40.2% were identified with one or more cancer-suspected genetic defects. This patient set was then placed on either a “Matched Therapy” or a “Therapy without Matching” regimen. Here’s the bottom line. The “matched therapy” group showed a 27% positive response rate whereas the “therapy without matching” group showed a 5% positive response rate. The conclusion, based on rigorous statistical methods, was that the matched therapy group faired far better than the non-matched group. By my way of thinking, more than 5 times better. The studies long term goals were twofold. First, over the next five year they hope to develop the capability to test all of M. D. Anderson’s 30,000 new patients a year for any genetic/molecular aberration in order to assign targeted therapy. Second, to perform research that proves efficacy so that the tests are reimbursed and become the standard of care.
This one presentation was one of hundreds during this five day conference focused on genetics and targeted therapies. This is what elevates my hope for a cure. Although targeted therapies are a relatively nascent science, the acceleration of discovery is shifting into high gear. As Dorothy said to Toto upon her arrival in Oz, “We’re not in Kansas anymore.”
Monday, June 6, 2011
"Major Shift in War on Cancer"
This is the headline of an article in today's (June 6 2011) Wall Street Journal regarding the 2011 ASCO (American Society of Clinical Oncologist) conference currently being held in Chicago at the McCormick Place conference center. There are about 25,000 attendees. Although traveling is a challenge for me, I am here as a patient research advocate volunteer and am honored and somewhat humbled to be one of those in attendance.
The WSJ article goes on to say, and I quote...
"New research is signaling a major shift in how cancer drugs are developed and patients are treated—offering the promise of personalized therapies that reach patients faster and are more effective than other medicines.
At the heart of the change: an emerging ability for researchers to use genetic information to match drugs to the biological drivers of tumors in individuals."
Here are some of the highlights from my perspective based on people I met, presentations attended, and the overall conference materials:
The WSJ article goes on to say, and I quote...
"New research is signaling a major shift in how cancer drugs are developed and patients are treated—offering the promise of personalized therapies that reach patients faster and are more effective than other medicines.
At the heart of the change: an emerging ability for researchers to use genetic information to match drugs to the biological drivers of tumors in individuals."
Here are some of the highlights from my perspective based on people I met, presentations attended, and the overall conference materials:
- About 30% of the several hundred large presentations are on a deeper understanding of the genetics within many different cancers... head & neck, lung, ovarian, breast, melanoma, etc. In sessions I attended there is a focus on finding combinations of mutant genes which lead to cancer (or a prediction of cancer) versus a prior focus of finding one single gene mutation. Finding these gene combinations is akin to finding a needle in a haystack, but large teams of medical doctors, molecular biologists, and other researchers across cancer institutions and international boundaries are attacking focused research and making progress.
- I spent an afternoon meeting with drug company representatives. The larger companies like GSK, Abbot Laboratories, Genentech, Pfizer, etc have 1,000 square foot plus exhibition spaces. Most of them have a subset space for discussions on current research staffed by highly knowledgeable researchers and molecular biologists. This resource allocation confirmed for me the conference’s focus on finding cures through deeper genetic understanding.
- About 20% of the exhibition space was dedicated to companies specializing is what appeared to be the most current technologies and biology's available for genetic mutation detection. The cost of testing is falling rapidly. There are three primary testing techniques. Single gene testing costs begin at about one hundred dollars while testing an individual’s entire genome is about ten thousand dollars. Elapse time for gene testing from patient consent to results has been shortened, but is still a 3 to 4 week process.
- Researchers are beginning to test genetic defects across cancer types. This is the paradigm shift I wrote about in my prior blog entry. It is too early to know what fruit this will bear.
- Multi drug cocktails are resulting in evidence-based patient benefits.
- Genetic testing is still part art and part science. Testing methods and processes are being refined and as these refinements are put into practice better data will lead to quicker and more accurate results.
- Genetic mutations are complex. There are missing gene pieces and gene mismatches. Some gene mutations promote tumor grow while other gene mutations affect genes which, when working properly, inhibit tumor growth. The downstream effect of promotion and inhibiting have very different biological effects that can affect many (up to about 100) cell processes. This is one of the factors that make finding a cure, even after finding a mutation, so complex.
It is hard to summarize this annual gathering of the world’s leading oncologists. My takeaway is a true sense of breakthroughs, progress, and an excitement from the participants about winning the war on cancer. For some patients it will come too late; for others it will mean the difference between life and death.
Take care everyone.
Friday, May 20, 2011
A Paradigm Shift in How Cancer is Evaluated and Treated
We all know there are many different cancers (lung, breast, ovarian, etc.). We have also heard that within similar cancers there are cancer subtypes. If one goes to a cancer website (e.g., the American Cancer Society at http://www.cancer.org/), it is generally organized by cancer type. Same with medical institutions... lymphomas, lung, bone, breast, etc.
There is a lot of buzz right now for a recent Pfizer drug, Crizotinib, in the fight against lung cancer. Pfizer has isolated a genetic mutation in a human gene known as ALK. It is estimated that 3 to 5% of those with lung cancer have this genetic mutation. Although that's not a large percentage, it's estimated to be 7,000 to 10,000 new cases of lung cancer (out of 220,000) in the U.S. per year. Crizotinib targets this genetic mutation leaving healthy cells alone. In an early trial with 82 patients there was measurable tumor shrinkage in 90% of patients after two months. This compares to an expected response rate closer to 10%. This genetic mutation was identified in 2007. Pfizer is requesting an accelerated approval from the FDA and expects it to be granted this year. The drug, if successful, could be FDA approved by as early as 2012. This would reduce the time of drug development from 8 to 10 years to five years. My hat is off to Pfizer and all those who participated in this discovery and development.
Now for the paradigm shift. What other cancers have this ALK mutation? Head and Neck cancer, Breast cancer, Liver cancer, Ovarian cancer, and the list goes on. An assay for the detection of this ALK mutation is a few hundred dollars. As an early step in a patient's cancer assessment process, would it not make sense to test for an ALK mutation? And, in cases where there is an ALK mutation, would it not make sense to give the patient a choice as to joining a clinical trial for the use of Crizotinib? This would mean crossing organizational boundaries within established medical institutions. Within the best medical institutions, this will not be a roadblock.
For more information, Google Crizotinib. It has been written up in the Wall Street Journal, USA Today, various oncology-oriented publications and by Pfizer. This is truly an exciting development in the war on cancer.
Take car everyone.
There is a lot of buzz right now for a recent Pfizer drug, Crizotinib, in the fight against lung cancer. Pfizer has isolated a genetic mutation in a human gene known as ALK. It is estimated that 3 to 5% of those with lung cancer have this genetic mutation. Although that's not a large percentage, it's estimated to be 7,000 to 10,000 new cases of lung cancer (out of 220,000) in the U.S. per year. Crizotinib targets this genetic mutation leaving healthy cells alone. In an early trial with 82 patients there was measurable tumor shrinkage in 90% of patients after two months. This compares to an expected response rate closer to 10%. This genetic mutation was identified in 2007. Pfizer is requesting an accelerated approval from the FDA and expects it to be granted this year. The drug, if successful, could be FDA approved by as early as 2012. This would reduce the time of drug development from 8 to 10 years to five years. My hat is off to Pfizer and all those who participated in this discovery and development.
Now for the paradigm shift. What other cancers have this ALK mutation? Head and Neck cancer, Breast cancer, Liver cancer, Ovarian cancer, and the list goes on. An assay for the detection of this ALK mutation is a few hundred dollars. As an early step in a patient's cancer assessment process, would it not make sense to test for an ALK mutation? And, in cases where there is an ALK mutation, would it not make sense to give the patient a choice as to joining a clinical trial for the use of Crizotinib? This would mean crossing organizational boundaries within established medical institutions. Within the best medical institutions, this will not be a roadblock.
For more information, Google Crizotinib. It has been written up in the Wall Street Journal, USA Today, various oncology-oriented publications and by Pfizer. This is truly an exciting development in the war on cancer.
Take car everyone.
Friday, April 1, 2011
Genetically Informed Medicine
I wish I was smart, astute, or quick enough to have developed the above phase, "genetically informed medicine." It captures part of the essence of my current medically-oriented research obsession. The article in which I read this was titled, The "Me Decade" of Cancer (see Reference #1). It's a play on the baby boomer "me" generation and covers the topics of personalized medicine and genetics. The phase used in the article was by Harold Varmus, Director of the National Cancer Institute (NCI).
There is a quiet revolution taking place in the world of genetically focused cancer treatment.
Take care everyone.
References
==========
Ref #1 - The "Me Decade" of Cancer
http://www.the-scientist.com/article/display/58059/
Ref #2 - The Clearity Foundation
http://www.clearityfoundation.org/clearity-overview.aspx
Ref #3 - Cancer Commons
http://www.cancercommons.org/
Ref #4 - The Molecular Biology of Head & Neck Cancer
http://www.medscape.com/viewarticle/735920
Once again, I'd like to encourage a dialogue with those that find this information useful. It is easy to post a comment. Below is an image of a world map with pin points of recent blog visitors. Although many readers live in the US, this blog has gained a truly global following... India, Australia, Singapore, Egypt, Greece, Switzerland, Nigeria, and many other foreign lands.
There is a quiet revolution taking place in the world of genetically focused cancer treatment.
- For those with Ovarian cancer, a non-profit, The Clearity Foundation, will help women create a molecular model of their tumor and based on the specific genetics of that tumor, they will recommend treatment options (see reference #2).
- For those with Melanoma, another group, CancerCommons, has created a molecular model of melanoma and is offering treatment guidance based on one's genetic code (see reference #3).
- There is even a molecular model for head and neck cancer (see reference #4). This too offers insight into potential genetic-driven treatment options.
Take care everyone.
References
==========
Ref #1 - The "Me Decade" of Cancer
http://www.the-scientist.com/article/display/58059/
Ref #2 - The Clearity Foundation
http://www.clearityfoundation.org/clearity-overview.aspx
Ref #3 - Cancer Commons
http://www.cancercommons.org/
Ref #4 - The Molecular Biology of Head & Neck Cancer
http://www.medscape.com/viewarticle/735920
Once again, I'd like to encourage a dialogue with those that find this information useful. It is easy to post a comment. Below is an image of a world map with pin points of recent blog visitors. Although many readers live in the US, this blog has gained a truly global following... India, Australia, Singapore, Egypt, Greece, Switzerland, Nigeria, and many other foreign lands.
You can double click on the map image to enlarge it.
.
.
Tuesday, March 22, 2011
An “Ah-Ha” Moment for the Oncology Community
This is my third attempt at writing this complex blog entry. The first two attempts were too cumbersome and convoluted; they did however help me crystallize my viewpoint.
Here’s the hypothesis…
Given relatively recent advances in genetic testing, the human genome project, the cancer genome project, and human cell molecular modeling, individual results from clinical cancer trials are being sorely underutilized.
Personally, I’m closest to head and neck cancer as I follow news stories on it daily. However, my hypothesis applies to all clinical cancer trials. I will use a head and neck clinical cancer trial as an example in support of this hypothesis.
There are a set of head and neck oncologists who believe that patients with recurrent head and neck squamous cell carcinoma who do not respond to platinum-based chemotherapy have run out of treatment options and in turn have a very poor prognosis. See link in Reference #1 at the bottom of this blog entry. The article is about a paper presented at the 2010 ASCO (American Society of Clinical Oncologists) meeting and it backs up this assertion of a poor patient prognosis.
There have been early phase clinical head and neck cancer trials which on the surface have shown promising, but inconclusive results. See link in Reference #2 at the bottom of this blog entry to clinical trial NCT00442507 at www.clinicaltrials.gov. This was a phase II trial using a combination of Tarceva and Avastin that included 48 patients beginning in March 2007 and ending in January 2009. The results of that trial were printed in an article on www.cancerconnect.com (see Reference #3). On the surface the results of the clinical trial are positive, but lukewarm… Article headline, “Combination of Avastin® and Tarceva® Shows Promise in Head and Neck Cancer.” If you read the article it goes on to say, “Seven patients experienced a complete or partial disappearance of detectable cancer.”
Here’s the quandary. A group of oncologists at last year’s preeminent oncology event, ASCO, reported that the prognosis for recurrent head and neck cancer patients who failed platinum-based chemotherapy was poor. Yet, we have a study which completed in January 2009 where seven patients which fit the profile of this poor prognosis group experienced a complete or partial disappearance of detectable cancer. To my eyes, this is a major disconnect in viewpoints.
If, and this is a big “if,” one was able to use recently developed genetic testing to have pre-picked just those seven patients for this trial, the article headline would have read, “HEAD & NECK CANCER CURED IN SOME PATIENTS,” it would not be “Shows Promising Results.”
If I were part of the oncology community, this would be an “Ah-Ha” moment for me. What can we learn from those seven patients that will allow us to effectively use these targeted chemotherapies to save lives efficiently? I don’t know if the oncologists running this clinical trial have thought about exploring this path of reasoning. If my hypothesis is correct, they haven’t. In this example, I hope I'm wrong.
To test this hypothesis, I’m going to try and contact the oncologists for this clinical trial to understand where the results from this trial have led. Please remember, this is just one example. In a more strategic sense, what can we learn from all the other individual successes in all the other clinical cancer trials that have been recently completed or are in progress? My hypothesis says that the individual successes are being underutilized. More on this story as further facts are known.
Take care everyone.
References
==========
Ref #1 – 2010 ASCO Presentation article
http://www.medpagetoday.com/HematologyOncology/OtherCancers/25227
Ref #2 – Clinical Trial
http://clinicaltrials.gov/ct2/show/NCT00442507?term=head+neck+tarceva+avastin&rank=7
Ref #3 – Clinical Trial results article
http://news.cancerconnect.com/combination-of-avastin-and-tarceva-shows-promise-in-head-and-neck-cancer/
Post Script
==========
I struggled with this blog entry. Another appropriate title would be, "Reverse engineering a cure for cancer."
.
Here’s the hypothesis…
Given relatively recent advances in genetic testing, the human genome project, the cancer genome project, and human cell molecular modeling, individual results from clinical cancer trials are being sorely underutilized.
Personally, I’m closest to head and neck cancer as I follow news stories on it daily. However, my hypothesis applies to all clinical cancer trials. I will use a head and neck clinical cancer trial as an example in support of this hypothesis.
There are a set of head and neck oncologists who believe that patients with recurrent head and neck squamous cell carcinoma who do not respond to platinum-based chemotherapy have run out of treatment options and in turn have a very poor prognosis. See link in Reference #1 at the bottom of this blog entry. The article is about a paper presented at the 2010 ASCO (American Society of Clinical Oncologists) meeting and it backs up this assertion of a poor patient prognosis.
There have been early phase clinical head and neck cancer trials which on the surface have shown promising, but inconclusive results. See link in Reference #2 at the bottom of this blog entry to clinical trial NCT00442507 at www.clinicaltrials.gov. This was a phase II trial using a combination of Tarceva and Avastin that included 48 patients beginning in March 2007 and ending in January 2009. The results of that trial were printed in an article on www.cancerconnect.com (see Reference #3). On the surface the results of the clinical trial are positive, but lukewarm… Article headline, “Combination of Avastin® and Tarceva® Shows Promise in Head and Neck Cancer.” If you read the article it goes on to say, “Seven patients experienced a complete or partial disappearance of detectable cancer.”
Here’s the quandary. A group of oncologists at last year’s preeminent oncology event, ASCO, reported that the prognosis for recurrent head and neck cancer patients who failed platinum-based chemotherapy was poor. Yet, we have a study which completed in January 2009 where seven patients which fit the profile of this poor prognosis group experienced a complete or partial disappearance of detectable cancer. To my eyes, this is a major disconnect in viewpoints.
If, and this is a big “if,” one was able to use recently developed genetic testing to have pre-picked just those seven patients for this trial, the article headline would have read, “HEAD & NECK CANCER CURED IN SOME PATIENTS,” it would not be “Shows Promising Results.”
If I were part of the oncology community, this would be an “Ah-Ha” moment for me. What can we learn from those seven patients that will allow us to effectively use these targeted chemotherapies to save lives efficiently? I don’t know if the oncologists running this clinical trial have thought about exploring this path of reasoning. If my hypothesis is correct, they haven’t. In this example, I hope I'm wrong.
To test this hypothesis, I’m going to try and contact the oncologists for this clinical trial to understand where the results from this trial have led. Please remember, this is just one example. In a more strategic sense, what can we learn from all the other individual successes in all the other clinical cancer trials that have been recently completed or are in progress? My hypothesis says that the individual successes are being underutilized. More on this story as further facts are known.
Take care everyone.
References
==========
Ref #1 – 2010 ASCO Presentation article
http://www.medpagetoday.com/HematologyOncology/OtherCancers/25227
Ref #2 – Clinical Trial
http://clinicaltrials.gov/ct2/show/NCT00442507?term=head+neck+tarceva+avastin&rank=7
Ref #3 – Clinical Trial results article
http://news.cancerconnect.com/combination-of-avastin-and-tarceva-shows-promise-in-head-and-neck-cancer/
Post Script
==========
I struggled with this blog entry. Another appropriate title would be, "Reverse engineering a cure for cancer."
.
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