1. Cancer Care Engineering Colorectal Cancer Gabriela Chiorean, M.D. May 27, 2011

2. Rationale Perform OMICs of healthy, polyps, cancer Perform OMICs of healthy, polyps, cancer Compare OMICs between cancer, polyps and healthy: develop new screening and risk assessment tools Compare OMICs between cancer, polyps and healthy: develop new screening and risk assessment tools Analyse changes in OMICs with treatment and correlate with response/toxicity: predictive markers Analyse changes in OMICs with treatment and correlate with response/toxicity: predictive markers

3. Schema IUCRO-0221 CCE in CRC SAMPLESSAMPLES Blood (Serum) 7 mL red top Metabolomics, vit D Blood (Plasma) 21 mL purple top Genomics, lipidomics, glycoproteomics N=810 Stratification: -Healthy (n=270) -Polyps (n=270) -Cancer (n=270) stg 1/2 stg 3 stg 4 metastatic Fresh Tissue 10 mg polyp or 50 mg cancer / 50 mg normal tissue SHIPDRYICESHIPDRYICE 8-hr fasting Paraffin-Embedded Tissue MSI, methylation, KRAS, BRAF, p53

4. Samples Collection Healthy Controls Screening Colonoscopy – GI Clinic Label specimens Healthy if no polyps/tumor Blood Questionnaires N= 5 6/2009 N=74 5/2010 N=109 5/2011

5. Samples Collection Adenomatous Polyps Screening Colonoscopy – GI Clinic Label specimens Polyp Polyps identified Tissue procurement/Research specialist -Polyp cut in ½ -Place in tube with no preservative -Freeze at -70 o C Blood Questionnaires N= 3 6/2009 N= 65 5/2010 N= 96 5/2011

6. Samples Collection Cancer Surgery Tissue: tumor, normal mucosa Blood Questionnaires ChemotherapyFollow-up Every 3 months Up to 24 months N= 8 6/2009 N= 34 5/2010 N= 55 5/2011

7. Sample Acquisition 4/2009-5/2011 Cancer total No prior chemo Prior chemo n=55 n=26 n=29 Stage 1 n=6 n=6 0 Stage 2 n=3 n=2 n=1 Stage 3 n=17 n=10 n=7 Stage 4 n=29 n=8 n=21