1. Show of hands, how many people know someone whose life has been impacted by cancer? Just about all of us.

2. Cancer 1.6M new cases 600K deaths 12.7M new cases 7.6M deaths
#2 leading cause of death – close to surpassing heart disease. Far and away #1 leading cause of death before the age of 75. Major public health crisis.
12.7M new cases
7.6M deaths

3. Cancer is a disease of DNA mutations
The same inherent errors are responsible for all evolution… giving organisms a fitness advantage over their peers… also helps our cells gain a fitness advantage over their peers… ultimately causing death.

4. 100’s of different gene mutations cause cancer
Frequency
ALK
What we’ve come to learn over the last 20 years, is that cancer arises from mutations in hundreds of different genes and each of these gene mutations leads to different dependencies and vulnerabilities – some of which can be targeted.
We call this the long tail. One strategy is to understand the causal mutation, and then to develop a drug that uniquely targets that mutaiton
Mutated cancer genes

5. Matthew Aug 2011: Diagnosed with stage IV lung cancer
Sept 2, 2011: Critical condition - collapsed lungs, respiratory failure, pulmonary embolism
“I was dying”
Sept 10, 2011: ALK test, first dose of crizotinib (Pfizer)
Sept 21, 2011: discharged, no signs of cancer
May 2012: cancer relapsed, ceritinib (Novartis)
June 2012: Quick, dramatic improvements
January 2013: cancer progressed again, new chemotherapy regimen
September 2013: PhD student, Cleveland Clinic studying cancer mutations

6. Matthew June 2014: Got married, still on chemotherapy
July 2015: New clinical trial, back in remission
“Unlike most people my age, I am not planning things too far into the future. I usually only look about three to six months ahead,” he says. “I have learned to really ‘stop to smell the roses’, as cliché as that sounds. I have found it is so important to take things day by day and appreciate all the little things in life.”
crizotinib
20 months
ceritinib
28 months ?

7. Dozens of new precision medicines coming
Frequency
NTRK1-3
MAP2K1
MAPK1
Investigational Drugs
Approved Drugs
ROS1
Approval for firsrt indication – always are others.
28 investigational opportunities – if we assume half make it to market, that’s 14 new indications – if we assume $500M, that’s $7B in annual revenue. If we assume 3 years to enroll patients, and that could be halved. That’s $10B in new revenue.
Mutated cancer genes

8. Catch-22 X X X $$ Reimbursement Genetic Testing
Precision Medicine Trials
precision oncology catch-22:
Patients need tumor sequencing to determine eligibility for drug trials
&
Pharma companies needs sequenced cancer patients to complete drug trials
But,
Payers require clinical utility demonstration before they will reimburse tumor sequencing
So,
Most patients are never sequenced and never know eligibility for trials
And
Pharma trials take years to enroll, delaying time to market

9. Strata Trial Sequence 100,000 cancer patients & match to trials
We set out to solve this problem with the most ambitious precision oncology initiative in history
Providing no-cost tumor sequencing to 100,000 cancer patients - value of $ M
Sequence 100,000 cancer patients & match to trials
Accelerate 10 new drug approvals in 5 years

10. Precision oncology network
DNA sequencing
Big data
Precision oncology network
Latest in DNA sequencing – not 1 genome in 10 years, but hundreds of cancer genomes every day, cost effectively, in a startup company
Big data – would require reading trillions of bases of DNA, sifting through data to identify cancer causing mutations and matching patients to trials – automatically
New kind of network, uniting dozens of pharmaceutical companies, healthcare insititions and physicians in a common cause – helping patients match to drugs that will actually work for their disease

13. 100 million wells / chip
100 bases / well / 3 hour run
= 10 billion bases / run
1 cancer genome = 3 billion bases
One 3X cancer genome / run
- OR -
Target 100 informative genes only
= 100,000 bases
With barcoding & multiplexing
100 1,000X cancer genomes / run

14. Alignment & Variant Calling
100 – 200 patient samples / day
10 – 20 billion bases / day
25 – 50,000 patient samples / year
2 – 4 trillion bases / year
1,000+ trial matches / year

15. Regional hospital Cancer Centers Strata Oncology Cancer patient
Pharma trials
Cancer Centers
Strata Oncology
Tumor
sample
Cancer patient

16. We believe in the promise of precision oncology – that by precisely targeting the genetic errors in an individual patient’s cancer we can dramatically improve outcomes.
Our mission is to substantially broaden access to the latest advances in precision oncology and we by doing so we can accelerate new drug approvals and better patient outcomes.
Specifically – we plan to give 100,000 advanced cancer patients the opportunity to match to a precision medicine clinical trial
And we plan to speed the approval and availiblity of 10 new cancer medicines in the next 5 years.
DNA sequencing + Big data + Precision oncology network = Broadened access + Better outcomes