Uncharted - our attempt to change the future of cancer for patients.
Operation Warp Speed for Cancer
Cancer patients are overwhelmed, suffering needlessly, and dying sooner because they’re powerless to engage in their own care in ways that will improve their outcomes. What matters? What doesn’t? What information can I trust? How do I decide?
The science is hard to access and make sense of. There is too much information everywhere and most of it can't help patients with the problems in front of them.
We empower patients to improve their outcomes by giving them access to the right scientific information and opportunities to make change quickly. The material in this course is specifically selected to educate patients for that mission only. Lots of exciting science is left out purposefully because it can’t affect care decisions today or in the near future.
When I (Dr. Christopher Gregg) was diagnosed with Stage IV cancer, I looked at the massive scientific literature in the cancer field, reading thousands of papers, and asked my brilliant colleagues, "what can make difference for me right now?".
Here’s the story.
The Cancer Patient Masterclass is the result of that journey.
The Cancer Patient Masterclass.
We empower patients and families by providing them hope through a deep, scientific understanding of their disease, proven methods to improve their quality of life, and actions to improve their outcome.
We help oncologists inform and educate their patients to become active partners in their own care.
We support new cancer trials, therapies, and research to move cancer — even advanced cancer — from a terminal diagnosis in the next 3 years.
We understand the science. We understand what it will take. We know it’s possible.
Transcript:
Hi, my name's Chris.
I'm a cancer patient, diagnosed with a stage four terminal disease, but this story doesn't end how you think it might.
That's me. I have a terrible bald cone head because I have a rare form of male breast cancer and I'm undergoing aggressive chemotherapy.
So I look like Dr. Evil, but I'm not evil.
That's my wife, Denise. She is a tireless optimist and supporter.
That's my son Ethan. He shaved his head to support his dad, and that's my daughter cadence. She's the humorist in the family.
And that's Penny.
I'm a scientist. I did my PhD with Sam Weiss at the University of Calgary and stem cell biology, and then I moved to Harvard to do a postdoc in genomics and neuroscience.
10 years ago, I started my own lab with a tenure track faculty position at the University of Utah, and we studied gene regulation in the brain and how it affects behavior and disease. We discovered new controls over how our genes are expressed. I told people why they have sex.
We discovered that artificial intelligence fundamentally changes and vastly improves our understanding of behavior.
We found how elephants prevent cancer from forming in their bodies, and we discovered hidden genetic elements in the human genome that are linked to hibernation.
All of this was so exciting and my career was on an amazing upward trajectory.
We got a number of different awards, which was incredibly exciting. And then I was diagnosed with cancer.
This completely upended my world and it completely reshaped my life. And now I'm focused on a new mission, which is to help patients. When I was initially diagnosed, my doctor said the next big revolution in care is not likely to be a magic drug that is curative, but instead a smarter way of using existing drugs. And I took that information to heart and I started reading hundreds if not thousands of papers that were focused on. I was looking for papers that were focused on ways to use existing drugs in a much smarter way.
And I found my way to a paper published by Dr. Bob Gaby in 2007, and Dr. Gaton B is a mathematician, and he proposed a very clever way of using existing drugs in improved care pathways that could be curative. This was so incredibly influential and exciting for me.
Four months later, I, I organized the symposium at the Huntsman Cancer Institute and invited Bob and a small group of leading thinkers in the field to discuss how we could cure cancer today. Not in 10 years, not in 20 years, but today, right now, that conference was incredibly transformative for my care personally and how I treated my cancer with my oncologist.
And it opened up an entirely new opportunity to improve cancer care. I think going forward, many people have weighed in on the ideas that I'm gonna talk about here. They're incredibly talented and they are at the front of a revolution in cancer care.
We are now in a position to launch operation warp speed to cure cancer.
One of the things that I realized early on in my discussions with these folks is that no single drug, new or old will ever cure cancer. Our current drugs are very good actually in many cases.
The fundamental problem is that our cancer care pathways are terrible. They're a death sentence, and that death sentence is enforced by the standard of care and the insurance system. And it leaves us essentially with two choices going forward.
On the one hand, we can stay in this old world where we just focus on making drugs in that world. We don't cure cancer and we continue to let people die, or we can enter a new world where we cure cancer and we shift the focus from just generating new drugs to creating care pathways that are curative in current standard of care, we give people continuous treatment with the maximum tolerated dose. And this always leads to drug resistance. We start with the drug that's the least toxic, and we keep the patient on that drug chronically.
And initially they may have a good response or a stable response, but then they progress and the disease develops resistance to that drug and we allow it to grow back. And then we switch to a new drug and we keep the patient chronically on that drug until they progress and the disease develops resistance, and then we switch to another drug and we keep them on that chronically until the disease develops resistance and it grows again, and then another drug until we're out of drugs and there's no bullets left in the gun, and that leads ultimately to the death of the patient. This is a terrible care pathway.
We're not using our drugs effectively, but that pathway is forced upon us in part by the insurance company. You cannot switch drugs until you show progression, and then they'll allow you to switch to a new drug and reimburse you for it, and then you can't go back. And when you've u when you've used up all of the drugs that are available, you're done.
This care pathway always fails because the approach fundamentally fails to recognize that cancer is an evolutionary process. It is evolution in action. And that means that we can learn from ecology and evolution. Important lessons about how to build care pathways that are curative.
A single tumor has billions of cells, and we know that large populations are so incredibly phenotypically and genetically diverse that they're almost always resistant to extinction. You only get a chance at a cure when the population is small and fragmented and multiple different modes of attack destabilize the population leading to extinction in nature or a cure in cancer.
So this means we need a totally new care pathway. Instead of continuously treating with the maximum dose until the disease develops resistance to each drug, we precisely sequence the drugs in a way that prevents resistance and drives the cancer to extinction.
So we start with drug A, but instead of waiting for progression, we switch when the disease has reached the naira with the treat with that treatment. And then we go to drug B, which has a new mechanism of action. And then we go to drug C, which has yet another mechanism of action. And we're gradually picking off more and more and more cancer cells.
And we never let the disease get off the ground. Even though the patient has reached n e d, no evidence of disease, we know there's cancer cells in their body and we keep adding more and more drugs and we keep treating instead of stopping treatment and letting the disease grow back or staying on the same treatment until the disease develops resistance and grows back.
Notice that in this care pathway, the patient has never progressed on any of the medicines that have been used. So if the disease returns in the future and it's not a curative pathway for whatever reason for that patient, those bullets are nonetheless still in the gun.
And we can return to those drugs and still get some effective treatment in the future. And we can introduce many other drugs that we might not typically use in that disease because there's so many different phenotypes of cells that we can gradually pick them off using a variety of different biological mechanisms and targets.
This is a much smarter approach to cancer treatment that has the chance to give each patient a cure. Now that approach focuses on the tumor and frankly, most of cancer research and care focuses on the tumor. What about the patient? A smarter approach?
A smarter care pathway introduces pr, precise drug sequencing, diet and behavioral components to prevent resistance, drive cancer to extinction, and increase the quality of life for the patient. So in this pathway, we've got our sequence of drugs and we switch before resistance and we never let the disease get off of a mat.
And over time, it ultimately goes to extinction, but at the same time, we increase the quality of life for the patient and the health of the patient. And we do that by precisely managing their mental health and their metabolic health.
And this builds, builds an integrative care pathway that is very powerful. And while that's fundamentally the right approach, different patients are nonetheless different. And we need to discover and deliver care pathways that work best for particular patients.
Patients can differ for lots of reasons, their age, their personality, their life goals and health.
Their treatment response is different side effects and the comorbid conditions they carry into their care.
Cancer diagnosis, their dietary habits and metabolic traits are different. Their mental and behavioral health is different. Their treatment compliance and fundamental understanding of their care is different, and that influences their ability to adhere to a care pathway And their social support difference, which is one of the biggest predictors of outcomes. Fundamentally, we have a real problem.
There's no map to navigate cancer care for different pathway, different patients, and build the right pathways. Without a map, we're navigating blindly and locked into a path pathway of reactive care rather than precise predictive care.
In reactive care, problems arise and we try to fix them in predictive care, we have the map and we can see what's coming for the patient and we can avoid it and make changes before problems arise.
But how do we uncover the map for cancer care pathways? The technology doesn't exist. The data doesn't exist. The conceptual framework doesn't even really exist.
It turns out that the ultimate precision medicine platform was developed a very long time ago. By evolution, the human nervous system is evolution solution to precision medicine and personalized medicine.
Every organ and tissue in the body is innovated by the peripheral nervous system at the cellular level, monitoring, endocrine changes, metabolic changes, inflammation changes and physical changes. And that information is communicated to the brain to influence expression, emotion, homeostasis, and behavior.
Fundamentally, behavior is the expression of our underlying biology. The problem that we've had in the past is that there's never been an effective and trusted way to understand behavior.
It seems infinitely variable, individual, complex and dynamic.
But we have some fundamental new insights that change. This. AI in mice in our lab has revealed that natural behavior is built from modules. Machine learning finds these modules, they're the building blocks of behavior, and it analyzes the expression, frequency, timing, and sequential order of these modules. We found that genes and underlying health control the expression of specific modules, development effects, modules.
And these can be used to understand disease processes, detect disease processes, and predict outcomes.
So modules are the building blocks of complex behavioral phenotypes. You can think of them as the genes of behavior. They're reproducible behavioral sequences that range from one second to hundreds of seconds in duration and modules are controlled by underlying biology and health. They're fundamentally linked to the health of the organism. And this AI now turns behavior analysis into an objective, sensitive and precise platform.
And now it can be used for diagnosing, monitoring, and predicting health and disease and patient needs.
While we had these insights, we had no capability to build them out for humans by chance, I met Jeff Barson, who has deep expertise in artificial intelligence and consumer technologies for enterprise scale solutions in humans.
He'd worked for years with the company Higher View, the world's leading company for doing job interviews and using artificial intelligence to analyze job interviews from facial speech and vocal patterns that enable the prediction of who should fit best into which jobs and which organizations. Remarkably, the job interview setting is very similar to the doctor patient interview setting.
There was a huge opportunity that we could see together to build now new technologies that enable precision medicine for people.
And so we founded Storyline a few years ago. Storyline uses artificial intelligence to discover and deliver precision care pathways for everyone. It finds biologically valid human phenotypes and biomarkers. It provides low cost treatment and care delivery. It enables continuous learning and improvement for the development of adaptive care pathways.
It provides superhuman diagnostic and predictive accuracy to make the best decisions for a given patient. And it's scalable for millions of patients worldwide. So storyline is a platform technology. It's for the discovery and delivery of care pathways using behavioral ai. I like to say that storyline is to neuroscience and behavior with genome sequencing is to genetics.
And in many ways we have built an architected storyline and modeled it on the successes of Illumina that enabled the Genome Medicine Revolution. Storyline enables an entirely new data space for discovery and value creation. While the genome sequence that you're born with is the same genome sequence that you die with and doesn't change.
Behavioral data is dynamic and patient behavior. Sentiment and expression reflect what the patient is going through now and is predictive of what they're about to go through. We can map trajectories for patients in entirely new ways. This is incredibly powerful, and we're able to capture entirely new classes of data that have never been captured before. How do we capture that data? It's captured through a smartphone. We can deliver clinical assessments to patients and they perform those assessments on their smartphone. The smartphone videotapes, their responses and their facial speech and vocal patterns are moved up into the cloud into a secure storage environment. So here's an example of patients getting an on-demand clinical interview from their home through their smartphone and they're doing a neurological assessment.
Just look directly into the camera and follow along with me. Puff out your cheeks, raise your eyebrows twice, stick out your tongue all the way and smile. A big smile. It's a personal and fun experience and it's precise.
Those videos are now in the cloud. And then we launch the world's leading behavioral ai AI pipeline. That pipeline extracts over 20,000 different facial speech and vocal measures from a smartphone.
From the face. We do, we track pupil dilation, eye movements, head movements, blood flow patterns across the face, power and eye coloration, microexpressions, blinking rates, and more from speech.
We get information about how the, how the individual articulates their illness and how they feel, their personality traits, sentence structure, speech pattern, education level, their vocabulary utterances and their sentiment. It's not just what you say but how you say it. And for that reason, we also analyze the audio. And from the audio and these vocal patterns, we uncover vocal micro tremors changes to pitch tone and harmonics, pronunciation, and other features.
This makes behavior analysis objective, sensitive and precise. It's we're getting 1 million times the data that would come from EHR records or questionnaires.
Here's a video of me and storylines, tracking hundreds of points across my face to measure my expressions and responses and look, it captures my hands and finger movements, all part of that full expression experience. We can do standardized or novel neurological assessments and behavioral assessments all remotely from the patient's home.
This is me in my living room doing a standard neurological assessment touching my nose.
And you'll see me try to stand on one foot with my eyes closed, Not so good. Now, from that data, we can capture extraordinary measures, micro expressions of facial patterns that we could never see before, and we capture these in 3d. So here is a video recording and those aren't sensory devices placed on the face.
That's the AI reconstructing facial microexpressions in three dimensions. Even though the video itself is 2D and on the, on the in the graph, the micro expression that the person expresses in each frame of the video is reduced down to a single data point. In multidimensional space discovery isn't enough to move at warp speed.
We need to integrate the research and discovery ecosystem with the clinical care delivery system.
So AI Care Pathway bio and biomarker discovery on the storyline platform is seamlessly integrated with telehealth. And that means we can instantly deliver these models of care to millions of people globally.
And that also enables us to develop adaptive care pathways that predict patient trajectories so that care decisions can be modified and modulated according to the needs of the patient. This will enable us to provide precision medicine for everyone.
Storyline works in this new space that isn't met by the existing technologies that we're working with now. Our platform and approach has opened up some extraordinary new opportunities.
The Cancer Stories Project in collaboration with the Huntsman Cancer Institute is discovering biomarkers and the best care pathways for each patient. Our initial focus is on lung cancer, breast cancer, and colon cancer.
The behavioral stories for Health project in collaboration with her Gene is the first and largest AI behavioral genetics project in history. 500,000 people will get storyline, behavioral AI profiling along with whole genome sequencing.
Uncharted is delivering and explaining the best cancer care pathways to patients and doctors everywhere. And Project Lantern is making precision medicine available to everyone.
We're focused in collaboration with Seek Haven on bringing these technologies to help improve the care of homeless people and people with addiction problems. This is an incredibly exciting time because we're charting the pathway to a cure for each patient.
I've been in remission for almost two years using a cancer care pathway that's built on extinction therapy principles integrated with metabolic and mental health care programs. It's time to bring these precision care pathway capabilities to everyone.
The cure for cancer lies at the intersection between drugs, data and care pathways. One in two women and one in three men will get cancer in their lifetimes. This is an epidemic, but we can solve this right now.
There will be winners and losers in this new world of artificial intelligence and precision care pathways.
But operation warp speed for cancer is going to happen. Some people will continue to focus on just generating new medicines, and others will join us in this new world of creating and delivering precision care pathways that are curative.
Thank you so much for listening to our story. I'm incredibly grateful and I look forward to talking with you more.
Thank you.
