1 00:00:05,053 --> 00:00:05,654 GOOD AFTERNOON EVERYONE, 2 00:00:05,654 --> 00:00:07,756 WELCOME TO THE WEDNESDAY 3 00:00:07,756 --> 00:00:08,957 AFTERNOON LECTURE SERIES. 4 00:00:08,957 --> 00:00:11,960 I AM EMILY CHU, CHIEF 5 00:00:11,960 --> 00:00:13,362 INVESTIGATOR AT NIH INSTITUTE. 6 00:00:13,362 --> 00:00:17,633 ON BEHALF OF NEI AND WSA, I AM 7 00:00:17,633 --> 00:00:19,968 THRILLED TO INTRODUCE OUR WAL 8 00:00:19,968 --> 00:00:26,175 SPEAKER TODAY Dr. BRENDA 9 00:00:26,175 --> 00:00:26,408 GALLIE. 10 00:00:26,408 --> 00:00:28,076 BUT BEFORE I DO, I WANT TO GIVE 11 00:00:28,076 --> 00:00:30,979 YOU A QUICK ANNOUNCEMENT, 12 00:00:30,979 --> 00:00:32,548 HOPEFULLY THE SLIDES WILL GO 13 00:00:32,548 --> 00:00:36,151 BACK TO THE CME CREDIT. 14 00:00:36,151 --> 00:00:39,488 THE CODE IS 57,667, REPEAT THAT 15 00:00:39,488 --> 00:00:41,190 AGAIN, 57,667 AND FOR THOSE OF 16 00:00:41,190 --> 00:00:43,825 YOU WHO ARE WATCHING REMOTELY, 17 00:00:43,825 --> 00:00:45,294 YOU CAN SEND QUESTIONS TO THE 18 00:00:45,294 --> 00:00:47,396 SPEAKER ANY TIME DURING THE 19 00:00:47,396 --> 00:00:49,298 LECTURE AND SIMPLY CLICK ON THE 20 00:00:49,298 --> 00:00:50,732 BUTTON THAT SAYS SEND LIVE 21 00:00:50,732 --> 00:00:53,602 FEEDBACK WHICH IS BELOW THE 22 00:00:53,602 --> 00:00:55,404 VIDEOCAST WINDOW AND TYPE IN 23 00:00:55,404 --> 00:00:58,340 YOUR MESSAGE AND WE WILL RELAY 24 00:00:58,340 --> 00:01:00,142 THAT TO THE SPEAKER AT THE END 25 00:01:00,142 --> 00:01:00,676 OF THE LECTURE. 26 00:01:00,676 --> 00:01:04,980 IT IS A REAL PLEASURE FOR ME TO 27 00:01:04,980 --> 00:01:09,151 INTRODUCE Dr. BRENDA GALLIE. 28 00:01:09,151 --> 00:01:10,452 UNIVERSITY OF TORONTO. 29 00:01:10,452 --> 00:01:14,489 SHE DIRECTS THE RETINOBLASTOMA 30 00:01:14,489 --> 00:01:17,593 PROGRAM FOR CHILDREN CALLED "THE 31 00:01:17,593 --> 00:01:17,893 SICK KIDS". 32 00:01:17,893 --> 00:01:19,928 THE FOCUS ON HER RESEARCH CAREER 33 00:01:19,928 --> 00:01:24,233 HAS BEEN ON RETINOBLASTOMA, 34 00:01:24,233 --> 00:01:27,336 CHILDREN'S EYE CANCER AND 35 00:01:27,336 --> 00:01:30,472 INTERESTED IN TOP PATHOGENESIS 36 00:01:30,472 --> 00:01:32,341 AND IMPACT. 37 00:01:32,341 --> 00:01:36,011 HER LAB IS INVOLVED WITH 38 00:01:36,011 --> 00:01:41,016 IDENTIFYING RG1 WHICH CAN DEPICT 39 00:01:41,016 --> 00:01:46,388 RETINOBLASTOMA AND THE PRECURSOR 40 00:01:46,388 --> 00:01:53,895 CALLED THE RETINOMA. 41 00:01:53,895 --> 00:01:57,232 THEY ALSO SHOW THE KIDS GENE 42 00:01:57,232 --> 00:01:58,834 OVER EXPRESSION CORRESPONDS TO 43 00:01:58,834 --> 00:02:01,670 POOR OUTCOME IN LUNG AND OVARIAN 44 00:02:01,670 --> 00:02:03,739 CANCERS SO IT GOES BEYOND THIS. 45 00:02:03,739 --> 00:02:07,242 ON THE CRITICAL SIDE, Dr. 46 00:02:07,242 --> 00:02:12,047 BALLIE'S TEAM HAS DEVELOPED 47 00:02:12,047 --> 00:02:13,548 HIGHLY DEMONSTRATIVE IMPACT ON 48 00:02:13,548 --> 00:02:15,083 PERSONAL MEDICINE. 49 00:02:15,083 --> 00:02:18,253 SHE FOUND THE GENETIC TEST LAB 50 00:02:18,253 --> 00:02:20,322 CALLED IMPACT GENETICS TO 51 00:02:20,322 --> 00:02:22,858 PROVIDE THE HIGHEST MUTATIONS TO 52 00:02:22,858 --> 00:02:24,893 FAMILIES AROUND THE WORLD WHICH 53 00:02:24,893 --> 00:02:27,095 IMPARTS A INTERNATIONAL TEAM IN 54 00:02:27,095 --> 00:02:36,505 2013 DISCOVERED AND RECOGNIZED 55 00:02:36,505 --> 00:02:37,906 RETINOBLASTOMA WITHOUT THE 56 00:02:37,906 --> 00:02:38,373 MUTATION ITSELF. 57 00:02:38,373 --> 00:02:41,310 SO THIS IS AN IMPORTANT PART OF 58 00:02:41,310 --> 00:02:44,880 HER YEAR WITH DISCOVERY AND HAS 59 00:02:44,880 --> 00:02:49,217 RECEIVED MANY ACCOLADES FROM THE 60 00:02:49,217 --> 00:02:52,254 CANADIAN OPHTHALMOLOGY SOCIETY, 61 00:02:52,254 --> 00:02:55,223 KIDS RESEARCH AND ONTARIO ORDER 62 00:02:55,223 --> 00:02:57,359 OF CANADA FOR DELIVERING 63 00:02:57,359 --> 00:02:59,795 MEDICINE AND IS ONE OF MY 64 00:02:59,795 --> 00:03:00,262 MENTORS. 65 00:03:00,262 --> 00:03:04,232 SHE ACTUALLY GOT ME INTO 66 00:03:04,232 --> 00:03:05,667 OPHTHALMOLOGY WHEN SHE TOLD ME 67 00:03:05,667 --> 00:03:07,636 YOU SHOULD BE DOING THIS INSTEAD 68 00:03:07,636 --> 00:03:10,739 OF SOMETHING ELSE SO HERE I AM, 69 00:03:10,739 --> 00:03:13,608 Dr. BRENDA. 70 00:03:13,608 --> 00:03:16,878 THE TITLE TODAY IS 71 00:03:16,878 --> 00:03:18,847 RETINOBLASTOMA CAN WE REACH 72 00:03:18,847 --> 00:03:22,384 EVERY CHILD AND I HOPE THAT 73 00:03:22,384 --> 00:03:24,353 ANSWER IS YES. 74 00:03:24,353 --> 00:03:25,153 Dr. GALLIE, GOOD TO SEE YOU. 75 00:03:25,153 --> 00:03:26,221 $$TRANSMIT 76 00:03:26,221 --> 00:03:29,024 >> THANK YOU VERY MUCH, EMILY. 77 00:03:29,024 --> 00:03:30,859 EMILY UNDERSTATED HER 78 00:03:30,859 --> 00:03:32,127 CONTRIBUTION TO MY WORK. 79 00:03:32,127 --> 00:03:33,862 SHE HAS HAD TREMENDOUS INFLUENCE 80 00:03:33,862 --> 00:03:34,162 ON ME. 81 00:03:34,162 --> 00:03:36,365 SO THANK YOU FOR INVITING ME 82 00:03:36,365 --> 00:03:37,466 HERE. 83 00:03:37,466 --> 00:03:40,669 I THANK THE NIH DIRECTOR WHO IS 84 00:03:40,669 --> 00:03:42,037 TOO BUSY TODAY AND I UNDERSTAND 85 00:03:42,037 --> 00:03:44,473 THAT BUT I AM REALLY HONORED TO 86 00:03:44,473 --> 00:03:45,674 BE HERE TODAY. 87 00:03:45,674 --> 00:03:47,542 ALL THE SYMBOLS ACROSS THE 88 00:03:47,542 --> 00:03:48,577 BOTTOM ARE CHARITIES THAT 89 00:03:48,577 --> 00:03:49,678 SUPPORTED THE WORK IN DIFFERENT 90 00:03:49,678 --> 00:03:51,380 WAYS AND I THINK THERE ARE 91 00:03:51,380 --> 00:03:53,849 PROBABLY A FEW I HAVE NOT GOTTEN 92 00:03:53,849 --> 00:03:55,550 ON THERE AND THE TOP THREE 93 00:03:55,550 --> 00:03:59,254 INSTITUTIONS I WORK IN, SICK 94 00:03:59,254 --> 00:04:01,022 KIDS, UHN, UNIVERSITY TORONTO 95 00:04:01,022 --> 00:04:04,059 AND IRBC IS A CHARITY YOU WILL 96 00:04:04,059 --> 00:04:05,994 HEAR MUCH MORE ABOUT AND REALLY 97 00:04:05,994 --> 00:04:11,400 PUSHING FORWARD TO REACH EVERY 98 00:04:11,400 --> 00:04:11,767 CHILD. 99 00:04:11,767 --> 00:04:13,468 SOME WISE PERSON TOLD ME I 100 00:04:13,468 --> 00:04:14,403 SHOULD SAY THE FIVE POINTS OF 101 00:04:14,403 --> 00:04:16,138 WHAT YOU ARE GOING TO HEAR AND 102 00:04:16,138 --> 00:04:20,242 WHAT TO LEARN SO WE WILL GO 103 00:04:20,242 --> 00:04:20,909 QUICKLY THROUGH CANCERS AND 104 00:04:20,909 --> 00:04:24,513 GENETIC DISEASE. 105 00:04:24,513 --> 00:04:27,115 LASS OF PROSPECTIVE DATA OVER 30 106 00:04:27,115 --> 00:04:30,385 YEARS FOR RECOGNITION OF SERIOUS 107 00:04:30,385 --> 00:04:33,355 HARM FOR CARE I WAS RESPONSIBLE 108 00:04:33,355 --> 00:04:34,923 GIVING TO PATIENTS. 109 00:04:34,923 --> 00:04:36,925 RETINOBLASTOMA IS STILL THE ONLY 110 00:04:36,925 --> 00:04:38,794 CANCER TO INCLUDE A 111 00:04:38,794 --> 00:04:40,662 PREDISPOSITION IN THIS WORLD 112 00:04:40,662 --> 00:04:42,230 STAGING RISK FACTOR SYSTEM AND 113 00:04:42,230 --> 00:04:46,001 EARLY TERMS OF THESE BABIES NOW 114 00:04:46,001 --> 00:04:50,505 LABELED H1 CARRYING THE GENETIC 115 00:04:50,505 --> 00:04:52,274 PREDISPOPPING OPTIMIZES VISION 116 00:04:52,274 --> 00:04:54,009 AND MINIMIZES THERAPY. 117 00:04:54,009 --> 00:04:56,278 AND SUSTAINED RELEASE OF CHEMO 118 00:04:56,278 --> 00:04:58,246 PLAQUE DELIVERS ONLY TO THE EYE 119 00:04:58,246 --> 00:05:00,615 LEADING TO THE FIRST AND ONLY 120 00:05:00,615 --> 00:05:04,619 CLINICAL TRIAL I HAD TO DO WITH 121 00:05:04,619 --> 00:05:09,458 IT, A PHASE 1 STUDY WITH THREE 122 00:05:09,458 --> 00:05:12,594 CONCEPTS IN CLINICAL TRIALS 123 00:05:12,594 --> 00:05:13,895 THERE, COMPLETE RESPONSE, 124 00:05:13,895 --> 00:05:15,430 CONSEQUENCE SCORE AND PRO PENS 125 00:05:15,430 --> 00:05:16,364 AT THE MATCHING. 126 00:05:16,364 --> 00:05:19,901 AND LOOKING FORWARD TO THE WHOLE 127 00:05:19,901 --> 00:05:22,537 WORLD, THE DATA TO EVALUATE 128 00:05:22,537 --> 00:05:23,972 INTERVENTION AND FULL VIEW OF 129 00:05:23,972 --> 00:05:26,241 LIFE FOR PATIENTS TO BE ABLE TO 130 00:05:26,241 --> 00:05:28,043 SEE THEIR WHOLE LIFE LONG 131 00:05:28,043 --> 00:05:28,743 EVERYWHERE THEY ARE WITH 132 00:05:28,743 --> 00:05:30,245 EVERYTHING THAT HAS HAPPENED TO 133 00:05:30,245 --> 00:05:32,280 THEM WITH RESPECT TO 134 00:05:32,280 --> 00:05:34,249 RETINOBLASTOMA AND PARTICULARLY 135 00:05:34,249 --> 00:05:36,084 LOOKING FOR SUBSEQUENT CANCER. 136 00:05:36,084 --> 00:05:38,520 SO I STARTED IN RETINOBLASTOMA 137 00:05:38,520 --> 00:05:40,555 AND ALL THE FELLOWS I HAD A 138 00:05:40,555 --> 00:05:41,857 WONDERFUL LUNCH WITH KNOW ALL 139 00:05:41,857 --> 00:05:42,224 ABOUT THIS. 140 00:05:42,224 --> 00:05:46,962 I WAS A THIRD YEAR RESIDENT IN 141 00:05:46,962 --> 00:05:48,563 OPHTHALMOLOGY CALLED SICK KIDS 142 00:05:48,563 --> 00:05:50,932 CALLED TO EMERGE WITH A RECENT I 143 00:05:50,932 --> 00:05:54,603 AM GRANT WHO CAME IN WITH A 144 00:05:54,603 --> 00:05:55,871 DIAGNOSIS OF CATARACT AND HAD 145 00:05:55,871 --> 00:05:59,774 RED EYE AND YOU CAN SEE THE 146 00:05:59,774 --> 00:06:02,143 PICTURE ON THE LEFT HAS A TUMOR 147 00:06:02,143 --> 00:06:08,416 IN FRONT OF HIS IR IRIS AND 148 00:06:08,416 --> 00:06:10,018 THAT EYE WAS NUKE UNITED AND 149 00:06:10,018 --> 00:06:12,487 THIS IS THE TUMOR GOING DOWN THE 150 00:06:12,487 --> 00:06:13,922 OPTIC NERVE. 151 00:06:13,922 --> 00:06:17,459 SO WE HAD METASTATIC TUMOR ALL 152 00:06:17,459 --> 00:06:17,893 OVER. 153 00:06:17,893 --> 00:06:21,263 HE WAS TREATED WITH EXTERNAL 154 00:06:21,263 --> 00:06:26,902 BEAM RADIATION AND HORRIBLE 155 00:06:26,902 --> 00:06:27,869 CHEMOTHERAPY BECAUSE IN 1973, 156 00:06:27,869 --> 00:06:30,071 OUR MISSION WAS TO SAVE LIFE AND 157 00:06:30,071 --> 00:06:32,140 HE DIED A YEAR LATER WHEN HE 158 00:06:32,140 --> 00:06:34,276 SHOULD HAVE BEEN DYING 159 00:06:34,276 --> 00:06:36,478 PEACEFULLY AT HOME WITH PROPER 160 00:06:36,478 --> 00:06:37,512 PALLIATION WHICH WOULD HAPPEN 161 00:06:37,512 --> 00:06:38,079 TODAY I THINK. 162 00:06:38,079 --> 00:06:41,116 SO WE BUILT A DATABASE WHICH I 163 00:06:41,116 --> 00:06:45,754 WILL COME BACK TO AND CALLED E 164 00:06:45,754 --> 00:06:48,957 CANCER RD AND EVERY TIME WE SEE 165 00:06:48,957 --> 00:06:51,826 A KID WITH RETINOBLASTOMA WE 166 00:06:51,826 --> 00:06:55,330 ENTER DIRECTLY INTO THIS 167 00:06:55,330 --> 00:06:56,264 DATABASE SO I RETROSPECTIVELY 168 00:06:56,264 --> 00:06:57,866 FOUND HIS REAL CHART WHEN I HAD 169 00:06:57,866 --> 00:06:59,868 TO MOVE OUT OF OUR OFFICES AND 170 00:06:59,868 --> 00:07:02,938 YOU CAN SEE THIS IS A SLIDE, 171 00:07:02,938 --> 00:07:04,472 YOUNG PEOPLE WON'T KNOW WHAT A 172 00:07:04,472 --> 00:07:08,209 SLIDE IS BUT THAT IS A PIECE OF 173 00:07:08,209 --> 00:07:11,246 FILM ON CARDBOARD AND I WROTE 174 00:07:11,246 --> 00:07:14,416 1973 ON IT AND THIS IS THE DATA 175 00:07:14,416 --> 00:07:16,418 ENTERED FROM HIS CHART IN E 176 00:07:16,418 --> 00:07:19,487 CANCER CARE SHOWING YOU THE 177 00:07:19,487 --> 00:07:23,425 YELLOW TRIANGLE MEANS 178 00:07:23,425 --> 00:07:25,460 ENUCLEATION AND THE ORANGE 179 00:07:25,460 --> 00:07:27,629 ROUNDED SQUARE IS EXTERNAL BEAM 180 00:07:27,629 --> 00:07:28,863 RADIATION SO THROUGHOUT I WILL 181 00:07:28,863 --> 00:07:30,799 ASK WHAT WE HAVE DONE WITH THE 182 00:07:30,799 --> 00:07:35,036 EYE AND YOU WILL BE ABLE TO TELL 183 00:07:35,036 --> 00:07:37,872 ME WITH THOSE SYMBOLS. 184 00:07:37,872 --> 00:07:39,874 IN 1973, I WAS INSTRUCTED TO 185 00:07:39,874 --> 00:07:42,410 PRESENT THIS CASE OF 186 00:07:42,410 --> 00:07:43,111 RETINOBLASTOMA TO CITY-WIDE 187 00:07:43,111 --> 00:07:45,180 ROUNDS AND I WENT TO THE 188 00:07:45,180 --> 00:07:51,620 HOSPITAL LIBRARY AND I FOUND A 189 00:07:51,620 --> 00:07:58,360 NEWLY PUBLISHED PAPER FROM AL 190 00:07:58,360 --> 00:08:00,895 KNUDSON SHOWING A MATHEMATICAL 191 00:08:00,895 --> 00:08:03,498 ANALYSIS THAT THIS WAS BILATERAL 192 00:08:03,498 --> 00:08:05,700 CAUSING ONLY ONE EVENT IN 193 00:08:05,700 --> 00:08:09,270 CHILDREN WITH BILATERAL DISEASE 194 00:08:09,270 --> 00:08:11,740 WHERE THE UNILATERAL WAS A MORE 195 00:08:11,740 --> 00:08:12,607 COMPLICATED CURVE. 196 00:08:12,607 --> 00:08:17,178 HE CALLED THIS A TWO-HIT CURVE. 197 00:08:17,178 --> 00:08:18,680 IN REANALYZING HIS OWN DATA WE 198 00:08:18,680 --> 00:08:20,448 THINK THIS IS MORE OF A 199 00:08:20,448 --> 00:08:21,950 THREE-HIT BUT THAT IS A MINOR 200 00:08:21,950 --> 00:08:22,217 POINT. 201 00:08:22,217 --> 00:08:24,686 AND THAT SHOWED TO ME CANCER IS 202 00:08:24,686 --> 00:08:27,255 A GENETIC DISEASE AND NOW WE ALL 203 00:08:27,255 --> 00:08:29,924 KNOW IT CONTROLS CELL DIVISION, 204 00:08:29,924 --> 00:08:33,728 GENOMIC DIVISION, ET CETERA AND 205 00:08:33,728 --> 00:08:36,097 THE RB1 MUTATION, MY WORK 206 00:08:36,097 --> 00:08:38,199 SUBSEQUENTLY CONTRIBUTED TO 207 00:08:38,199 --> 00:08:40,335 DETECTION TO OFFER PRECISE CARE 208 00:08:40,335 --> 00:08:43,238 FOR FAMILIES WITH 209 00:08:43,238 --> 00:08:43,972 RETINOBLASTOMA. 210 00:08:43,972 --> 00:08:46,775 SO GOING BACK STILL INTO HISTORY 211 00:08:46,775 --> 00:08:50,378 TO IMPORTANT THINGS, IN 1969 AND 212 00:08:50,378 --> 00:08:51,413 1982, THE NEW YORK GROUP WHO 213 00:08:51,413 --> 00:08:54,482 WERE THE CENTER OF 214 00:08:54,482 --> 00:08:55,684 RETINOBLASTOMA PATIENT CARE AT 215 00:08:55,684 --> 00:08:58,119 THAT TIME AND THAT IS WHY I DID 216 00:08:58,119 --> 00:08:59,254 MY FELLOWSHIP IN NEW YORK, 217 00:08:59,254 --> 00:09:03,758 BECAUSE I WANTED TO PURSUE 218 00:09:03,758 --> 00:09:04,359 RETINOBLASTOMA. 219 00:09:04,359 --> 00:09:05,860 THEY WROTE IN THOSE PAPERS, 220 00:09:05,860 --> 00:09:09,364 RADIO THERAPY THE MOST VALUABLE 221 00:09:09,364 --> 00:09:09,964 WEAPON AGAINST RETINOBLASTOMA 222 00:09:09,964 --> 00:09:11,866 AND THE MAINSTAY OF TREATMENT 223 00:09:11,866 --> 00:09:13,935 HAS BEEN EXTERNAL BEAM RADIO 224 00:09:13,935 --> 00:09:14,235 THERAPY. 225 00:09:14,235 --> 00:09:16,638 AND THAT WAS QUITE A FEW YEARS, 226 00:09:16,638 --> 00:09:20,975 30 YEARS MORE BEFORE THE 227 00:09:20,975 --> 00:09:23,078 BRILLIANT SCIENTISTS HERE AT NIH 228 00:09:23,078 --> 00:09:25,246 SHOWED THAT THEY NEEDED TO 229 00:09:25,246 --> 00:09:26,614 REALLY LOOK AT DATA. 230 00:09:26,614 --> 00:09:29,084 AND THEY LOOKED AT RETROSPECTIVE 231 00:09:29,084 --> 00:09:33,088 DATA COLLECTED IN BOSTON AND NEW 232 00:09:33,088 --> 00:09:35,190 YORK. 233 00:09:35,190 --> 00:09:37,525 LOTS OF PATIENTS SHOWED THAT 234 00:09:37,525 --> 00:09:41,830 THOSE THAT WERE H1 HAD A 235 00:09:41,830 --> 00:09:42,363 50 PERCENT, GREATER THAN 236 00:09:42,363 --> 00:09:48,403 50 PERCENT RISK OF A SECOND 237 00:09:48,403 --> 00:09:50,472 SUBSEQUENT MALIGNANT NEO PLASM 238 00:09:50,472 --> 00:09:51,740 BY AGE 50. 239 00:09:51,740 --> 00:09:54,776 THAT HAD NOT BEEN RECOGNIZED 240 00:09:54,776 --> 00:09:56,077 BECAUSE NO DATA WAS COLLECTED 241 00:09:56,077 --> 00:09:58,546 FROM THERE TO NOW AND THE SAME 242 00:09:58,546 --> 00:10:02,550 PATIENTS WHO WERE H1 CARRIED THE 243 00:10:02,550 --> 00:10:04,652 MUTATION DIDN'T HAVE EXTERNAL 244 00:10:04,652 --> 00:10:08,323 BEAM RADIATION STILL HAD A HIGH 245 00:10:08,323 --> 00:10:11,259 RISK OF SUBSEQUENT MALIGNANT NEO 246 00:10:11,259 --> 00:10:14,896 PLASMS BUT NOTHING LIKE THE 247 00:10:14,896 --> 00:10:17,031 IMPACT OF RADIATION. 248 00:10:17,031 --> 00:10:23,271 SO JUMPING AHEAD TO 2017, THE 249 00:10:23,271 --> 00:10:24,939 CANCER STAGING BOOK THAT CAME 250 00:10:24,939 --> 00:10:27,075 OUT FOR EVERY CANCER AND THE 251 00:10:27,075 --> 00:10:29,611 ONLY CANCER IN THAT BOOK THAT 252 00:10:29,611 --> 00:10:31,412 MENTIONS GENETICS HAVING A 253 00:10:31,412 --> 00:10:34,349 IMPACT ON PROGNOSIS IS 254 00:10:34,349 --> 00:10:34,716 RETINOBLASTOMA. 255 00:10:34,716 --> 00:10:37,218 AND THIS DATA THAT WENT INTO THE 256 00:10:37,218 --> 00:10:39,854 NEW WAY, THE LEVEL OF DISEASE IN 257 00:10:39,854 --> 00:10:44,993 THE EYE, IS BASED ON DATA I HAD 258 00:10:44,993 --> 00:10:47,796 COLLECTED OVER 2001 TO 2011 AND 259 00:10:47,796 --> 00:10:49,063 ANALYZING THAT DATA SAID THAT 260 00:10:49,063 --> 00:10:53,668 THE PREVIOUS WAYS TO STAGE 261 00:10:53,668 --> 00:10:56,037 CANCER STARTING WITH CELLS FOR 262 00:10:56,037 --> 00:10:57,872 CLASSIFICATION AND THE OTHER 263 00:10:57,872 --> 00:10:58,940 CLASSIFICATIONS WEREN'T AS GOOD 264 00:10:58,940 --> 00:11:02,243 AS LOOKING AT THE DATA THAT CAME 265 00:11:02,243 --> 00:11:08,650 OUT OF HERE AND THAT IS THE 266 00:11:08,650 --> 00:11:10,718 CANCER STAGING TMM. 267 00:11:10,718 --> 00:11:12,353 AND THAT WORK IS SUPPORTED IN 268 00:11:12,353 --> 00:11:16,391 THE CLINICAL SURVEY BY THE I 269 00:11:16,391 --> 00:11:17,458 CANCER FOUNDATION LED BY A 270 00:11:17,458 --> 00:11:21,963 DOCTOR IN NEW YORK WHO IS A 271 00:11:21,963 --> 00:11:24,265 BRILLIANT DEDICATED PERSON TO 272 00:11:24,265 --> 00:11:24,732 WORLD EYE CANCER. 273 00:11:24,732 --> 00:11:29,871 SO THIS IS THE H1 STATUS IN THAT 274 00:11:29,871 --> 00:11:33,341 CHAPTER IN THE 8TH EDITION OF 275 00:11:33,341 --> 00:11:37,812 TNM WHICH IS TNM1 WHICH 276 00:11:37,812 --> 00:11:39,480 REPRESENTS THE H MEANING DON'T 277 00:11:39,480 --> 00:11:43,418 KNOW, NO EVIDENCE OF A 278 00:11:43,418 --> 00:11:47,255 CONSULTATIONAL GENE MUTATION. 279 00:11:47,255 --> 00:11:50,992 H1 MEANS BILATERAL, TRY LATERAL 280 00:11:50,992 --> 00:11:52,160 FAMILY HISTORY OR GENOME 281 00:11:52,160 --> 00:11:54,495 IDENTIFIED WITH THAT PATIENT. 282 00:11:54,495 --> 00:11:57,065 H0 IS APPLIED WHEN YOU KNOW THE 283 00:11:57,065 --> 00:11:58,399 RELEVANT MUTATION AND YOU PROVED 284 00:11:58,399 --> 00:12:00,501 THE BABY IN FRONT OF YOU DOES 285 00:12:00,501 --> 00:12:01,903 NOT CARRY THAT MUTATION. 286 00:12:01,903 --> 00:12:04,973 BUT IF I TESTED A UNILATERAL WHO 287 00:12:04,973 --> 00:12:08,343 MIGHT BE EITHER ONE AS KNUDSEN 288 00:12:08,343 --> 00:12:10,845 SHOWED AND DON'T FIND ANY 289 00:12:10,845 --> 00:12:16,718 MUTATION, WE CALL THAT H1 290 00:12:16,718 --> 00:12:19,053 ASTERISK BECAUSE IT CAN'T GO 291 00:12:19,053 --> 00:12:22,924 BELOW THE 1 PERCENT MOST SAME 292 00:12:22,924 --> 00:12:23,191 DIVISION. 293 00:12:23,191 --> 00:12:25,093 IF THAT WERE LESS THAN 294 00:12:25,093 --> 00:12:26,794 1 PERCENT, THE BABIES IN THE 295 00:12:26,794 --> 00:12:30,164 FUTURE WOULD HAVE BILATERAL 296 00:12:30,164 --> 00:12:31,532 RETINOBLASTOMA BECAUSE THEY 297 00:12:31,532 --> 00:12:33,067 WOULD HAVE BEEN DESCENDED FROM 298 00:12:33,067 --> 00:12:35,904 THE SPERM THAT CARRIED THE 299 00:12:35,904 --> 00:12:37,939 MUTATION SO THAT IS WHY THE 300 00:12:37,939 --> 00:12:40,475 ASTERISK IS ON SOME OF THEM. 301 00:12:40,475 --> 00:12:42,677 SO JUMPING BACK TO NAME HISTORY, 302 00:12:42,677 --> 00:12:44,746 I HAVE CARED FOR NOT THE FIRST, 303 00:12:44,746 --> 00:12:47,448 NOT THE GRANDMOTHER BUT YOU KNOW 304 00:12:47,448 --> 00:12:51,452 THE GRANDMOTHER IN 1949 HAD BOTH 305 00:12:51,452 --> 00:12:53,955 EYES ENUCLEATED AND YOU CAN TELL 306 00:12:53,955 --> 00:12:55,523 THAT BY YELLOW TRIANGLES FOR 307 00:12:55,523 --> 00:12:56,124 HER. 308 00:12:56,124 --> 00:12:59,427 SHE IS ALIVE AND WELL, I TALK TO 309 00:12:59,427 --> 00:13:00,962 HER OFTEN THROUGHOUT HER LIFE. 310 00:13:00,962 --> 00:13:02,230 SHE HAD FOUR CHILDREN. 311 00:13:02,230 --> 00:13:04,299 I DIDN'T CARE FOR THE FIRST ONE 312 00:13:04,299 --> 00:13:06,334 BECAUSE I WAS TOO YOUNG AT THAT 313 00:13:06,334 --> 00:13:10,405 TIME BUT ALL OF THOSE -- THAT 314 00:13:10,405 --> 00:13:13,708 CHILD WAS BILATERALLY 315 00:13:13,708 --> 00:13:14,008 ENUCLEATED. 316 00:13:14,008 --> 00:13:16,377 BUT ALL THE REST OF HER CHILDREN 317 00:13:16,377 --> 00:13:20,448 WERE TREATED BY ME, MANAGING 318 00:13:20,448 --> 00:13:22,016 THEIR RETINOBLASTOMA WITH 319 00:13:22,016 --> 00:13:23,851 EXTERNAL BEAM RADIATION, THE 320 00:13:23,851 --> 00:13:24,953 SQUARE THERE. 321 00:13:24,953 --> 00:13:31,559 AND WE DID THAT BECAUSE WE KNEW 322 00:13:31,559 --> 00:13:33,328 AS ELSEWHERE WAS POINTED OUT IN 323 00:13:33,328 --> 00:13:35,096 PAPERS, WE COULD SAVE VISION AND 324 00:13:35,096 --> 00:13:35,997 SAVE EYES. 325 00:13:35,997 --> 00:13:37,832 WE HAD NO IDEA WHAT WE WERE 326 00:13:37,832 --> 00:13:39,534 DOING TO THEM IN SECOND CANCER 327 00:13:39,534 --> 00:13:41,202 RISKS AND YOU SEE THE 328 00:13:41,202 --> 00:13:43,004 GRANDMOTHER IS ALIVE AND WELL 329 00:13:43,004 --> 00:13:45,440 BUT HER TWO OLDEST CHILDREN HAVE 330 00:13:45,440 --> 00:13:47,175 ALREADY DIED OF THEIR SECOND 331 00:13:47,175 --> 00:13:49,610 CANCERS AND THESE TWO REMAINING 332 00:13:49,610 --> 00:13:52,914 DO NOT HAVE THEIR SECOND CANCER 333 00:13:52,914 --> 00:13:54,582 DIAGNOSED YET AND ARE VERY 334 00:13:54,582 --> 00:13:55,650 CONCERNED ABOUT THAT BECAUSE 335 00:13:55,650 --> 00:13:58,953 HERE IS THE THIRD GENERATION 336 00:13:58,953 --> 00:13:59,187 NOW. 337 00:13:59,187 --> 00:14:02,323 THE FIRST CHILD LOOKING FOR THE 338 00:14:02,323 --> 00:14:04,158 PRECISE H1 MUTATION IN EACH 339 00:14:04,158 --> 00:14:06,127 PREGNANCY, THE FIRST AND THIRD 340 00:14:06,127 --> 00:14:08,963 ARE H0 BECAUSE WE KNOW IT CAN BE 341 00:14:08,963 --> 00:14:11,099 PRECISE, DON'T NEED AN ASTERISK 342 00:14:11,099 --> 00:14:12,834 BUT THE MIDDLE ONE IS H1. 343 00:14:12,834 --> 00:14:15,670 AND NOW YOU CAN SEE BECAUSE WE 344 00:14:15,670 --> 00:14:17,505 KNOW OF THAT CHILD, JUST GOING 345 00:14:17,505 --> 00:14:22,410 BACK TO THE RADIATION RISKS, NOW 346 00:14:22,410 --> 00:14:24,979 IN CANADA, ALL H1 BABIES ARE 347 00:14:24,979 --> 00:14:27,115 DELIVERED AT 36 WEEKS WHICH IS 348 00:14:27,115 --> 00:14:27,448 EARLY TERM. 349 00:14:27,448 --> 00:14:29,217 THAT IS ONLY IN CANADA. 350 00:14:29,217 --> 00:14:30,852 IT IS NOT HAPPENING IN THE 351 00:14:30,852 --> 00:14:33,521 STATES UNLESS A FAMILY THAT WE 352 00:14:33,521 --> 00:14:35,390 HAVE MANAGED AND KNOW ABOUT THIS 353 00:14:35,390 --> 00:14:36,424 DEMAND IT. 354 00:14:36,424 --> 00:14:38,860 AND I KNOW OF ONE DELIVERED IN 355 00:14:38,860 --> 00:14:40,995 BOSTON EARLY BECAUSE THEY SAID 356 00:14:40,995 --> 00:14:42,797 WE MUST HAVE EARLY DELIVERY TO 357 00:14:42,797 --> 00:14:44,132 LOOK AT OUR BABY'S EYES. 358 00:14:44,132 --> 00:14:46,934 AND THIS IS A PICTURE OF A 359 00:14:46,934 --> 00:14:49,570 36-YEAR-OLD, THERE IS THE OPTIC 360 00:14:49,570 --> 00:14:51,205 NERVE RIGHT THERE, THESE ARROWS 361 00:14:51,205 --> 00:14:56,778 POINT TO WHERE THE TUMOR IS 362 00:14:56,778 --> 00:15:02,884 IDENTIFIED BUT LOOKING IT THE 363 00:15:02,884 --> 00:15:03,718 OPTHOMOSCOPE OR CAMERA, YOU 364 00:15:03,718 --> 00:15:06,687 CAN'T SEE IT AT ALL BUT LOOKING 365 00:15:06,687 --> 00:15:08,456 THROUGH THE HTC, YOU CAN SEE 366 00:15:08,456 --> 00:15:11,225 THAT IS WHERE THE RETINOBLASTOMA 367 00:15:11,225 --> 00:15:11,559 EMERGES. 368 00:15:11,559 --> 00:15:12,693 AND THEN WE DON'T KNOW WHERE 369 00:15:12,693 --> 00:15:15,363 THAT IS SO WE FOLLOW THE BLOOD 370 00:15:15,363 --> 00:15:16,931 VESSELS FROM THE NERVE AND SAY 371 00:15:16,931 --> 00:15:19,567 WE THINK IT IS THERE AND PUT IN 372 00:15:19,567 --> 00:15:20,401 A LASER BURN. 373 00:15:20,401 --> 00:15:23,037 AND WE PUT IN ANOTHER OT C 374 00:15:23,037 --> 00:15:24,806 IMMEDIATELY AND NOW YOU CAN SEE 375 00:15:24,806 --> 00:15:26,240 THE TUMOR, THAT LITTLE ROUND 376 00:15:26,240 --> 00:15:28,142 THING THERE AND GOING BACK TO 377 00:15:28,142 --> 00:15:30,445 THE RTE IS SHOWING THE LASER 378 00:15:30,445 --> 00:15:32,013 BURN SO WE HAVE HIT IT 379 00:15:32,013 --> 00:15:32,313 CORRECTLY. 380 00:15:32,313 --> 00:15:34,715 NOW WE SEE THE SPOT ON THE 381 00:15:34,715 --> 00:15:37,118 RETINA AND CAN CONTINUE TREATING 382 00:15:37,118 --> 00:15:40,455 THAT BECAUSE WE CAN SEE IT USING 383 00:15:40,455 --> 00:15:40,788 THE LASER. 384 00:15:40,788 --> 00:15:43,724 AND WE KEEP TREATING IT UNTIL WE 385 00:15:43,724 --> 00:15:49,030 HAVE GOT IT THOROUGHLY EVALUATED 386 00:15:49,030 --> 00:15:49,864 THAT WAY. 387 00:15:49,864 --> 00:15:51,732 THIS IS, THEN ON THIS CHILD, FOR 388 00:15:51,732 --> 00:15:54,836 EXAMPLE, WE DID ALL THAT LASER, 389 00:15:54,836 --> 00:15:56,871 AND THIS IS A LASER TREATED 390 00:15:56,871 --> 00:15:58,940 TUMOR IN HER EYE SOMEWHERE NEAR 391 00:15:58,940 --> 00:16:00,908 THE PERIPHERY BUT WITH A VERY 392 00:16:00,908 --> 00:16:05,179 GOOD OC T SHOWING OUR LASERS 393 00:16:05,179 --> 00:16:05,680 CAUSED A PROBLEM. 394 00:16:05,680 --> 00:16:09,383 THAT IS A VITREOUS SEED. 395 00:16:09,383 --> 00:16:11,319 IT IS A GOOD PICTURE OF ONE 396 00:16:11,319 --> 00:16:13,287 BECAUSE THEY ARE HOLLOW IN THE 397 00:16:13,287 --> 00:16:13,554 CENTER. 398 00:16:13,554 --> 00:16:16,390 ALL THE NUTRITION FOR THAT CLUMP 399 00:16:16,390 --> 00:16:22,997 OF SELLS COMES FROM THE VITREOUS 400 00:16:22,997 --> 00:16:29,337 WHERE THE CELLS DIE AND HAVE 401 00:16:29,337 --> 00:16:31,706 THAT PART THAT YOU CAN SEE. 402 00:16:31,706 --> 00:16:33,174 SO THEN WE NEEDED SOMETHING ELSE 403 00:16:33,174 --> 00:16:36,344 TO DO AND WHAT WE DID WAS THE 404 00:16:36,344 --> 00:16:38,212 CHEMO PLAQUE AND WE WILL SHOW 405 00:16:38,212 --> 00:16:39,814 YOU MORE OF THAT. 406 00:16:39,814 --> 00:16:43,518 THIS IS AFTER THE CHEMOPLAQUE 407 00:16:43,518 --> 00:16:44,352 LATER AND KEPT FOLLOWING THAT 408 00:16:44,352 --> 00:16:48,589 AND THERE HAS BEEN NO RECURRENCE 409 00:16:48,589 --> 00:16:48,923 FURTHER. 410 00:16:48,923 --> 00:16:51,492 SO THE E CANCER DATABASE, I 411 00:16:51,492 --> 00:16:54,829 SHOWED YOU ON MY PATIENT 1 412 00:16:54,829 --> 00:16:57,365 LOADED RETROSPECTIVELY BUT WE 413 00:16:57,365 --> 00:17:00,501 USE THIS ONLY IN THE KIDS, A 414 00:17:00,501 --> 00:17:02,870 BEAUTIFUL PROGRAM MADE BY 415 00:17:02,870 --> 00:17:04,772 DEVELOPERS AT PRINCESS MARGARET 416 00:17:04,772 --> 00:17:08,042 HOSPITAL WHICH WE TALKED ABOUT 417 00:17:08,042 --> 00:17:09,944 OVER LUNCH AND WORK OVER EXACTLY 418 00:17:09,944 --> 00:17:10,144 THIS. 419 00:17:10,144 --> 00:17:12,947 AND THAT IS A PROTECTIVE IN THE 420 00:17:12,947 --> 00:17:15,983 OR EVERY TIME WE SEE A PATIENT 421 00:17:15,983 --> 00:17:18,152 OR IN THE CLINIC, AT THE POINT 422 00:17:18,152 --> 00:17:20,755 OF CARE AND REPOSITORY OF DATA. 423 00:17:20,755 --> 00:17:22,890 SO E CANCER CARE, THE 424 00:17:22,890 --> 00:17:26,527 PROSPECTIVE PART IS FROM 2001 TO 425 00:17:26,527 --> 00:17:28,329 '25, STILL USING IT IN SICK KIDS 426 00:17:28,329 --> 00:17:30,831 BUT IT IS OLD, THE SERVER IS 427 00:17:30,831 --> 00:17:33,134 GOING TO DIE BECAUSE IT IS ON 428 00:17:33,134 --> 00:17:34,435 OLD SOFTWARE AND TECHNOLOGY SO 429 00:17:34,435 --> 00:17:36,270 WE REALLY BACK IT UP REGULARLY 430 00:17:36,270 --> 00:17:38,906 BECAUSE WE DON'T KNOW WHEN IT IS 431 00:17:38,906 --> 00:17:39,974 GOING TO FAIL. 432 00:17:39,974 --> 00:17:42,276 WE THEN ACTUALLY PUT THAT 433 00:17:42,276 --> 00:17:45,213 DATABASE INTO KENYA WHERE THE 434 00:17:45,213 --> 00:17:46,247 OPHTHALMOLOGISTS LOVED IT, USED 435 00:17:46,247 --> 00:17:48,216 IT BUT WOULD PHONE US TO SAY IT 436 00:17:48,216 --> 00:17:50,017 IS NOT WORKING, WE WOULD FIND 437 00:17:50,017 --> 00:17:53,187 OUT THERE WAS A POWER FAILURE, 438 00:17:53,187 --> 00:17:55,456 THE SERVER WASN'T TURNED ON AND 439 00:17:55,456 --> 00:17:58,059 REALIZED WE CAN'T GO GLOBALLY 440 00:17:58,059 --> 00:17:59,760 THAT WAY, CANCER CARE CAN'T DO 441 00:17:59,760 --> 00:18:00,461 THAT. 442 00:18:00,461 --> 00:18:04,432 SO WE BUILT A BRAND-NEW MODEL 443 00:18:04,432 --> 00:18:05,433 CALLED DEPICT HEALTH, FULL VIEW 444 00:18:05,433 --> 00:18:07,935 FOR LIFE AS YOU WILL SEE AND 445 00:18:07,935 --> 00:18:09,770 PROSPECTIVE POINT OF CARE 446 00:18:09,770 --> 00:18:10,238 REPOSITORY OF DATA. 447 00:18:10,238 --> 00:18:12,406 THIS IS THE CHARITY THAT RUNS 448 00:18:12,406 --> 00:18:13,107 THIS. 449 00:18:13,107 --> 00:18:15,276 THE CHARITY PAYS THE UNIVERSITY 450 00:18:15,276 --> 00:18:17,511 HEALTH NETWORK EVERY YEAR FOR 451 00:18:17,511 --> 00:18:19,680 EXCLUSIVE LICENSE TO USE MY 452 00:18:19,680 --> 00:18:22,650 DATABASE THAT IS OWNED BY THE 453 00:18:22,650 --> 00:18:25,152 PRINCESS MARGARET CANCER CENTER. 454 00:18:25,152 --> 00:18:28,522 $$TRANSMIT T H I S IS DEPICT 455 00:18:28,522 --> 00:18:29,490 HEALTH. 456 00:18:29,490 --> 00:18:31,592 WHAT IT LOOKS LIKE, THIS IS A 457 00:18:31,592 --> 00:18:33,194 BEAUTIFUL TOOL TO USE. 458 00:18:33,194 --> 00:18:35,496 I COULD DO A DEMO AFTER IF YOU 459 00:18:35,496 --> 00:18:37,431 WANT BECAUSE WE HAVE NOW GOT 460 00:18:37,431 --> 00:18:38,899 THIS RUNNING LIVE BUT I HAVEN'T 461 00:18:38,899 --> 00:18:40,635 TIME TO DO THAT NOW. 462 00:18:40,635 --> 00:18:42,436 AND ANY TIME YOU POINT TO ANY OF 463 00:18:42,436 --> 00:18:44,305 THESE, IT SHOWS THE DATE, YOU 464 00:18:44,305 --> 00:18:45,373 DOUBLE CLICK AND IT OPENS THE 465 00:18:45,373 --> 00:18:47,008 WHOLE EVENT AND YOU CAN SEE 466 00:18:47,008 --> 00:18:47,308 EVERYTHING. 467 00:18:47,308 --> 00:18:50,711 YOU CAN SEE HERE IS THE STAGING 468 00:18:50,711 --> 00:18:52,913 FOR THIS PARTICULAR CHILD, THE 469 00:18:52,913 --> 00:19:01,489 STAGING OF THE EYE, NO NODES, NO 470 00:19:01,489 --> 00:19:01,956 METATASTISIS. 471 00:19:01,956 --> 00:19:03,424 BUT THE LINES THAT CROSS BOTH 472 00:19:03,424 --> 00:19:05,793 EYES ARE SYSTEMIC SO THE GENETIC 473 00:19:05,793 --> 00:19:07,595 TESTING IS GREEN AND ALL THE 474 00:19:07,595 --> 00:19:11,332 BLUE LINES ARE SYSTEMIC 475 00:19:11,332 --> 00:19:12,300 CHEMOTHERAPY. 476 00:19:12,300 --> 00:19:13,801 THINKS ARE ONLY TO THIS EYE AND 477 00:19:13,801 --> 00:19:18,406 WHAT DID WE DO TO THE LEFT EYE? 478 00:19:18,406 --> 00:19:20,741 WE NUCLEATED YOU SEE RIGHT THERE 479 00:19:20,741 --> 00:19:22,076 AFTER THE CHEMOTHERAPY BECAUSE 480 00:19:22,076 --> 00:19:24,578 IT WAS THREATENING THE OPTIC 481 00:19:24,578 --> 00:19:24,945 NERVE. 482 00:19:24,945 --> 00:19:28,416 SO THEN WE DID MORE CHEMO AND WE 483 00:19:28,416 --> 00:19:29,784 ARE NOT WAITING HERE. 484 00:19:29,784 --> 00:19:32,520 SO I WENT TO A WORLD CONGRESS, 485 00:19:32,520 --> 00:19:36,324 SAT IN HIS.HAVING COFFEE WITH 486 00:19:36,324 --> 00:19:39,760 LYNN MURFREE WHO IS MY COLLEAGUE 487 00:19:39,760 --> 00:19:41,228 IN CHILDREN'S LA AND SAID THAT 488 00:19:41,228 --> 00:19:42,697 LITTLE DEVICE I HAVE BEEN 489 00:19:42,697 --> 00:19:45,099 WORKING ON TO GET DRUG ONLY INTO 490 00:19:45,099 --> 00:19:47,702 THE EYE WITHOUT BEING ABSORBED 491 00:19:47,702 --> 00:19:50,371 INTO SYSTEMIC CIRCULATION HAS 492 00:19:50,371 --> 00:19:52,406 BEEN APPROVED BY THE FDA TO PUT 493 00:19:52,406 --> 00:19:53,007 IN A HUMAN. 494 00:19:53,007 --> 00:19:54,642 AND I SAID I HAVE THE PATIENT 495 00:19:54,642 --> 00:19:55,509 WHO NEEDS IT. 496 00:19:55,509 --> 00:20:00,815 WE WENT BACK TO TORONTO, CHASING 497 00:20:00,815 --> 00:20:05,219 ALL THESE TINY DATA FROM 498 00:20:05,219 --> 00:20:08,889 SURGERY, THE RETINAL DETACHMENT 499 00:20:08,889 --> 00:20:09,790 OBVIOUSLY AFFECTED HIS VISION, 500 00:20:09,790 --> 00:20:12,626 AND YOU HAVE ALL THESE BEAUTIFUL 501 00:20:12,626 --> 00:20:15,529 TOOLS TO UPLOAD TO DEPICT HEALTH 502 00:20:15,529 --> 00:20:17,331 KEY IMAGES THAT SUPPORT THE 503 00:20:17,331 --> 00:20:19,066 STORY FROM THAT EVENT, BUT NOT 504 00:20:19,066 --> 00:20:19,800 ALL THE IMAGES. 505 00:20:19,800 --> 00:20:24,138 AND OH BY THE WAY, ALL THE DATA 506 00:20:24,138 --> 00:20:26,240 IS GOING INTO DEPICT HEALTH, 507 00:20:26,240 --> 00:20:29,410 DEPICT HEALTH IS NOT THE 508 00:20:29,410 --> 00:20:31,612 CUSTODIAN OF THAT DATA BUT A 509 00:20:31,612 --> 00:20:33,481 COMMUNICATION SERVER ACROSS THE 510 00:20:33,481 --> 00:20:35,483 WHOLE CIRCLE OF CARE AND THE 511 00:20:35,483 --> 00:20:39,019 SITE SICK KIDS IS STILL MAIN 512 00:20:39,019 --> 00:20:41,055 CUSTODIAN OF THE DATA. 513 00:20:41,055 --> 00:20:44,625 SO OUR CHOICES FOR THIS CHILD 514 00:20:44,625 --> 00:20:48,529 WERE TO ENUCLEATE HIS LAST EYE 515 00:20:48,529 --> 00:20:52,299 OR DO EBT, HE HAS 20/20 VISION 516 00:20:52,299 --> 00:20:54,468 AND SO WHAT WE DID WAS SPEND A 517 00:20:54,468 --> 00:20:59,206 WEEK WITH HEALTH CANADA GETTING 518 00:20:59,206 --> 00:21:00,875 SPECIAL ACCESS AUTHORIZATION TO 519 00:21:00,875 --> 00:21:03,010 PUT THIS CHEMO PLAQUE IN THIS 520 00:21:03,010 --> 00:21:04,145 CHILD'S EYE, THE FIRST HUMAN IN 521 00:21:04,145 --> 00:21:08,182 THE WORLD TO HAVE A CHEMOPLAQUE. 522 00:21:08,182 --> 00:21:11,285 THIS IS THE CHEMOPLAQUE INVENTED 523 00:21:11,285 --> 00:21:18,426 BY THE IDEAS OF LIN MURPHY AND 524 00:21:18,426 --> 00:21:22,963 RICARDO CLAVELLO NOW IN BRAZIL 525 00:21:22,963 --> 00:21:25,266 AND DAVID CARKEY RUNS THE 526 00:21:25,266 --> 00:21:25,499 COMPANY. 527 00:21:25,499 --> 00:21:29,270 THIS IS IN YELLOW FORM THAT WE 528 00:21:29,270 --> 00:21:30,504 DIFFUSE IN THE EYE AND ALL OF 529 00:21:30,504 --> 00:21:32,907 THE PEOPLE WHO HAD LUNCH WITH ME 530 00:21:32,907 --> 00:21:37,311 COULD FEEL IT IN MY HAND. 531 00:21:37,311 --> 00:21:38,012 SORRY? 532 00:21:38,012 --> 00:21:41,515 ABOUT AS BIG AS YOUR BABY FINGER 533 00:21:41,515 --> 00:21:42,216 NAIL, VERY SMALL. 534 00:21:42,216 --> 00:21:44,485 AND I WILL SHOW YOU. 535 00:21:44,485 --> 00:21:48,456 THIS IS PUTTING THE CRAZY GLUE 536 00:21:48,456 --> 00:21:51,892 AND THE BLUE DYE IN THAT LITTLE 537 00:21:51,892 --> 00:21:54,495 GROOVE RIGHT THERE, MUST NOT PUT 538 00:21:54,495 --> 00:21:56,263 ANY OVER TOP OF THE DRUG OR IT 539 00:21:56,263 --> 00:21:58,732 WON'T DO THE JOB. 540 00:21:58,732 --> 00:22:01,669 SO WE PUT THIS IN AT 70 DAYS 541 00:22:01,669 --> 00:22:03,003 BECAUSE IT DIDN'T SEEM TO BE 542 00:22:03,003 --> 00:22:04,705 CAUSING ANY PROBLEM AT ALL AND 543 00:22:04,705 --> 00:22:06,674 WE LOOKED IN BETWEEN AND THE 544 00:22:06,674 --> 00:22:07,875 TUMORS WERE GETTING SMALLER AND 545 00:22:07,875 --> 00:22:10,177 SMALLER AND WE TOOK IT OUT AND 546 00:22:10,177 --> 00:22:12,379 THE ONLY ACTIVE TUMOR HERE IS 547 00:22:12,379 --> 00:22:14,582 STILL WHERE HIS PRIMARY TUMOR 548 00:22:14,582 --> 00:22:16,050 WAS WITH THE CALCIFICATION AND 549 00:22:16,050 --> 00:22:19,420 ALL THE REST HAD DISAPPEARED 550 00:22:19,420 --> 00:22:20,020 COMPLETELY. 551 00:22:20,020 --> 00:22:22,923 ULTIMATELY WE TOOK OUT THIS 552 00:22:22,923 --> 00:22:24,391 TUMOR WITH ANOTHER NEW PROCEDURE 553 00:22:24,391 --> 00:22:27,361 THAT HAS BEEN PROMOTED AND DONE 554 00:22:27,361 --> 00:22:30,231 WITH MY COLLEAGUE JOHN CHAO IN 555 00:22:30,231 --> 00:22:32,066 CHINA AND THAT IS JUST TO TAKE 556 00:22:32,066 --> 00:22:33,801 OUT THE ACTIVE TUMOR. 557 00:22:33,801 --> 00:22:36,437 WE HAD TROUBLE PUBLISHING THAT 558 00:22:36,437 --> 00:22:39,573 BECAUSE TOP EDITORS FOR 559 00:22:39,573 --> 00:22:41,609 OPHTHALMOLOGY JOURNAL SAID YOU 560 00:22:41,609 --> 00:22:44,245 CAN'T OPEN AN EYE WITH 561 00:22:44,245 --> 00:22:46,847 RETINOBLASTOMA BUT THE DATA 562 00:22:46,847 --> 00:22:48,716 WIDELY PUBLISHED NOW FROM CHILD 563 00:22:48,716 --> 00:22:51,485 AND MANY OTHER COLLABORATORS ON 564 00:22:51,485 --> 00:22:53,354 THE PAPER SHOWED THAT BY TAKING 565 00:22:53,354 --> 00:22:56,123 OUT THE TUMOR THAT FAILED MANY 566 00:22:56,123 --> 00:22:59,426 TREATMENTS AND THEREFORE BECOME 567 00:22:59,426 --> 00:23:00,928 MORE GENOMICLY RESISTANT, THAT 568 00:23:00,928 --> 00:23:02,196 THAT ACTUALLY SAVES LIVES AND 569 00:23:02,196 --> 00:23:02,763 EYES. 570 00:23:02,763 --> 00:23:04,331 IT IS BETTER THAN LEAVING THE 571 00:23:04,331 --> 00:23:08,903 DEN HOME IN MICKLY MUTE TRAITING 572 00:23:08,903 --> 00:23:10,304 PROGRESSIVE TUMOR IN THE EYE 573 00:23:10,304 --> 00:23:11,906 WITHOUT TRYING TO TREAT IT. 574 00:23:11,906 --> 00:23:15,809 SO THIS KID IS NOW FOUR YEARS 575 00:23:15,809 --> 00:23:17,511 OUT WITH 20/40 VISION. 576 00:23:17,511 --> 00:23:19,780 SO HEALTH CANADA SAID YOU CAN 577 00:23:19,780 --> 00:23:21,315 ONLY DO THREE OF THOSE. 578 00:23:21,315 --> 00:23:23,017 TWO OF THEM WERE NOT AS WELL 579 00:23:23,017 --> 00:23:24,285 SELECTED AS HE WAS AND THEN YOU 580 00:23:24,285 --> 00:23:26,453 HAVE TO DO A CLINICAL TRIAL. 581 00:23:26,453 --> 00:23:28,589 I HAD NEVER DONE A CLINICAL 582 00:23:28,589 --> 00:23:31,725 TRIAL IN MY LIFE BEFORE THIS ONE 583 00:23:31,725 --> 00:23:35,362 BUT WITH THE HELP OF THE COMPANY 584 00:23:35,362 --> 00:23:41,001 MANAGING AND BUILDING THE 585 00:23:41,001 --> 00:23:43,771 CHEMOPLAQUES AND CHILDREN'S 586 00:23:43,771 --> 00:23:50,277 STUDY JOINED US AND SO THE 587 00:23:50,277 --> 00:23:52,246 DOCTORS AND MY TEAM JOINED US 588 00:23:52,246 --> 00:23:53,380 FOR THE PHASE 1 STUDY. 589 00:23:53,380 --> 00:23:57,217 THIS IS THE DESIGN, THREE 590 00:23:57,217 --> 00:23:58,953 ESCALATING DOSES. 591 00:23:58,953 --> 00:24:01,989 TWO BLACKS, ONE WITH 1.6 AND ONE 592 00:24:01,989 --> 00:24:03,924 WITH .9 AND THE ONE I WILL SHOW 593 00:24:03,924 --> 00:24:05,759 YOU IS THE .9 WHICH I LIKE BEST 594 00:24:05,759 --> 00:24:09,029 OF ALL OF THEM. 595 00:24:09,029 --> 00:24:15,402 AND THEN ESCALATING DOSES THAT 596 00:24:15,402 --> 00:24:16,503 REQUIRE TUBE CHEMOPLAQUES. 597 00:24:16,503 --> 00:24:19,306 THEY STAY IN PLACE FOR SIX WEEKS 598 00:24:19,306 --> 00:24:22,176 AND WE PICKED THAT BECAUSE IN 50 599 00:24:22,176 --> 00:24:23,911 DAYS WITH THE RABBITS THERE WAS 600 00:24:23,911 --> 00:24:25,779 NO DRUG LEFT AND WE PICKED THAT 601 00:24:25,779 --> 00:24:28,315 SO THE PATIENTS WOULD HAVE A 602 00:24:28,315 --> 00:24:31,518 MORE CONSTANT DOSE LEVEL AT SIX 603 00:24:31,518 --> 00:24:31,719 WEEKS. 604 00:24:31,719 --> 00:24:33,454 THEN WE MONITORED THEM WITH 605 00:24:33,454 --> 00:24:40,427 THREE YEARS FOLLOW-UP AND THIS 606 00:24:40,427 --> 00:24:42,062 SHOWS THE CHEMOPLAQUE PUT IN THE 607 00:24:42,062 --> 00:24:45,799 MUSCLES AND IT CAUSES A 608 00:24:45,799 --> 00:24:47,368 FOOTPRINT SCAR SO WE REMEMBER 609 00:24:47,368 --> 00:24:56,343 THE THAT BE AN INTERIOR SCLETOMA 610 00:24:56,343 --> 00:24:56,677 THAN EXTERNAL. 611 00:24:56,677 --> 00:24:58,379 SO THIS IS WHAT I WILL USE MANY 612 00:24:58,379 --> 00:25:00,447 TIMES THROUGHOUT THE REST OF MY 613 00:25:00,447 --> 00:25:03,951 TALK AND THIS WAS ACTUALLY 614 00:25:03,951 --> 00:25:05,619 INVENTED BY AN UNDER GRAD SUMMER 615 00:25:05,619 --> 00:25:08,422 STUDENT WHO LOVED TO EXCEL AND 616 00:25:08,422 --> 00:25:09,690 PRETTY SMART AND SHE BUILT THIS 617 00:25:09,690 --> 00:25:13,961 WAY TO TAKE OUR DATA FROM THE E 618 00:25:13,961 --> 00:25:16,030 CANCER DATABASE AND DISPLAY IT. 619 00:25:16,030 --> 00:25:18,265 THE ONLY DATA HERE IS WHAT IS 620 00:25:18,265 --> 00:25:20,100 THE TREATMENT AND THE DATE IT 621 00:25:20,100 --> 00:25:20,567 WAS DELIVERED. 622 00:25:20,567 --> 00:25:22,803 AND THAT COMES FROM OUR PRO 623 00:25:22,803 --> 00:25:24,405 EXPECT SIEVE DATABASE. 624 00:25:24,405 --> 00:25:26,540 SO THAT DATA GOES INTO THE 625 00:25:26,540 --> 00:25:28,142 SWIMMER PLOT AND THIS IS THE 626 00:25:28,142 --> 00:25:29,677 DOSES OF THE DRUGS SO YOU CAN 627 00:25:29,677 --> 00:25:32,746 SEE THE BLUE DOWN HERE IS THE 628 00:25:32,746 --> 00:25:35,215 6MG, ET CETERA, AND UP TO THE 629 00:25:35,215 --> 00:25:37,084 HIGHER DOSES. 630 00:25:37,084 --> 00:25:39,787 $$TRANSMIT T H E N WE 631 00:25:39,787 --> 00:25:42,189 INVENTED ANOTHER THING BECAUSE 632 00:25:42,189 --> 00:25:44,825 CANS S-R STAGING -- AND TO SAY 633 00:25:44,825 --> 00:25:46,493 YOUR TREATMENT, YOUR THERAPY, 634 00:25:46,493 --> 00:25:48,595 WHATEVER IT IS, IS WORKING, YOU 635 00:25:48,595 --> 00:25:51,131 HAVE TO HAVE SOME MEASUREMENT 636 00:25:51,131 --> 00:25:54,768 THAT IS STANDARD FOR THE CANCER. 637 00:25:54,768 --> 00:25:56,036 FOR RETINOBLASTOMA, IT IS REALLY 638 00:25:56,036 --> 00:25:57,204 HARD BECAUSE OF THE LITTLE 639 00:25:57,204 --> 00:25:58,672 PIECES OF TUMOR ALL OVER THE 640 00:25:58,672 --> 00:26:00,841 PLACE AND HOW CAN YOU KNOW WHAT 641 00:26:00,841 --> 00:26:01,875 TO MEASURE. 642 00:26:01,875 --> 00:26:04,311 SO WE SAID LET'S GET SIMPLE AND 643 00:26:04,311 --> 00:26:09,950 FOLLOW ALONG THE SWIMMER AND 644 00:26:09,950 --> 00:26:13,320 AFTER RESPONSE, THERE IS NO 645 00:26:13,320 --> 00:26:14,922 OTHER CANCER TO THE PATIENT AND 646 00:26:14,922 --> 00:26:17,091 THE EYE AND THAT IS WHAT IS 647 00:26:17,091 --> 00:26:19,059 SHOWED THERE. 648 00:26:19,059 --> 00:26:20,527 DOSE SAME TOXICITY THERE AND NOW 649 00:26:20,527 --> 00:26:22,463 IT IS MORE EXPANDED SO 650 00:26:22,463 --> 00:26:25,399 AUTOMATICALLY PUTS IN THE CRS 651 00:26:25,399 --> 00:26:27,234 AND ALL THOSE EXTRA THINGS SO I 652 00:26:27,234 --> 00:26:29,203 DON'T HAVE TO FILL THEM IN 653 00:26:29,203 --> 00:26:29,737 ANYMORE. 654 00:26:29,737 --> 00:26:30,704 AND THEN WE HAVE THE KEY AND I 655 00:26:30,704 --> 00:26:32,606 WILL SHOW YOU THE DATA BEHIND IT 656 00:26:32,606 --> 00:26:35,609 BUT YOU CAN SEE A LOT OF CRS 657 00:26:35,609 --> 00:26:37,044 HERE, A LOT MORE IN THE SMALLER 658 00:26:37,044 --> 00:26:39,880 OR HIGHER DOSES AND A LOT MORE 659 00:26:39,880 --> 00:26:42,683 DLTS AT THE HIGHER DOSES WHICH 660 00:26:42,683 --> 00:26:47,688 IS WHY WE ARRIVED AT THE 661 00:26:47,688 --> 00:26:52,893 RECOMMEND *EZ PHASE 2 DOSE OF .9 662 00:26:52,893 --> 00:26:55,028 AND 1.2. 663 00:26:55,028 --> 00:26:56,930 SO MERE IS ANOTHER APPROACH TO 664 00:26:56,930 --> 00:26:57,131 THIS. 665 00:26:57,131 --> 00:26:59,666 WE THOUGHT WE WOULD HAVE TO 666 00:26:59,666 --> 00:27:02,269 DESIGN A RANDOMIZED TRIAL TO GET 667 00:27:02,269 --> 00:27:09,343 FDA TO LET US GO FORWARD BUT 668 00:27:09,343 --> 00:27:15,415 THEN WE REALIZED BURIED IN OUR E 669 00:27:15,415 --> 00:27:20,854 CANCER CARE DATA IS THE 670 00:27:20,854 --> 00:27:21,688 RETROSPECTIVE DIAGNOSIS AND HERE 671 00:27:21,688 --> 00:27:26,059 IS THE VIEW OF THE CANS S-R 672 00:27:26,059 --> 00:27:27,594 TREATMENT FOR RETINOBLASTOMA. 673 00:27:27,594 --> 00:27:29,696 BEFORE 2010 AND MUCH LONGER THAN 674 00:27:29,696 --> 00:27:31,398 THAT BUT WE'RE ONLY SHOWING THAT 675 00:27:31,398 --> 00:27:39,773 HERE, IT IS MAINLY EXTERNAL' 676 00:27:39,773 --> 00:27:42,810 RADIATION AND IF WE WENT FURTHER 677 00:27:42,810 --> 00:27:44,711 THAN THAT, I DON'T HAVE THAT 678 00:27:44,711 --> 00:27:46,914 DATA AVAILABLE. 679 00:27:46,914 --> 00:27:52,553 AND THEN Dr. HELEN CHEN WHO IS 680 00:27:52,553 --> 00:27:57,524 A ENTHUSIASTIC, ENERGETIC 681 00:27:57,524 --> 00:27:59,159 CHEMOPLAQUE ONCOLOGIST DEVELOPED 682 00:27:59,159 --> 00:28:02,763 CHEEP THERAPY FOR RETINOBLASTOMA 683 00:28:02,763 --> 00:28:07,968 AND THAT WAS CONSIDERED HERE SY. 684 00:28:07,968 --> 00:28:13,273 AND MORE RECENTLY, THINKING THE 685 00:28:13,273 --> 00:28:15,809 CHEMOTHERAPY THAT YOU GIVE IT 686 00:28:15,809 --> 00:28:21,181 ONLY TO THE EYE OR NEAR THE 687 00:28:21,181 --> 00:28:22,983 OPHTHALMIC WORLD OR NEAR THE 688 00:28:22,983 --> 00:28:25,118 ARTERY AND THAT IS DOMINATING 689 00:28:25,118 --> 00:28:35,629 THE WORLD FOR RETINOBLASTOMA. 690 00:28:40,601 --> 00:28:46,607 CHEMOTHERAPY IS STILL THE MAIN 691 00:28:46,607 --> 00:28:48,442 TREATMENT WITH LOTS OF RISKS TO 692 00:28:48,442 --> 00:28:50,344 THE EYE AND THE PATIENT. 693 00:28:50,344 --> 00:28:52,646 HERE ARE THE RISKS TO ADULTS 694 00:28:52,646 --> 00:28:54,214 SHOWING WHY WE RECOMMEND THE 695 00:28:54,214 --> 00:28:56,149 PHASE 2 DOSE AND COMBINED 696 00:28:56,149 --> 00:28:58,151 TOGETHER AT 77 PERCENT COMPLETE 697 00:28:58,151 --> 00:28:59,019 RESPONSE RATE. 698 00:28:59,019 --> 00:29:01,889 AND THAT IS SUSTAINED COMPLETE 699 00:29:01,889 --> 00:29:04,558 RESPONSE AS LONG AS WE FOLLOWED 700 00:29:04,558 --> 00:29:06,226 THE PATIENT. 701 00:29:06,226 --> 00:29:11,798 SO HERE IS RED THROW RESPECTIVE 702 00:29:11,798 --> 00:29:15,602 CONTROLS TREATED WITH INTERIOR 703 00:29:15,602 --> 00:29:17,671 ARTERIAL CHEMOTHERAPY IN A 704 00:29:17,671 --> 00:29:22,409 EQUIVALENT TIME WINDOW WHEN THE 705 00:29:22,409 --> 00:29:23,076 CHEMOPLAQUES HAD THEIR DIAGNOSIS 706 00:29:23,076 --> 00:29:25,846 AND YOU CAN SEE THE BEST 707 00:29:25,846 --> 00:29:28,248 RESPONSE RATE COMPARED TO 708 00:29:28,248 --> 00:29:31,685 77 PERCENT FOR THE CHEMOPLAQUE 709 00:29:31,685 --> 00:29:32,953 WHICH IS SUSTAINED RELEASE. 710 00:29:32,953 --> 00:29:34,454 AND THAT MAKES SENSE. 711 00:29:34,454 --> 00:29:36,690 AS SOON AS YOU GIVE A PULSE, IT 712 00:29:36,690 --> 00:29:38,959 KILLS LOTS OF CELLS, IT CAN GET 713 00:29:38,959 --> 00:29:41,561 SMALLER BUT THE CELLS THAT 714 00:29:41,561 --> 00:29:42,996 SURVIVE HAVE ACQUIRED HUGE 715 00:29:42,996 --> 00:29:44,998 CHANGES AND BECOME MORE AND MORE 716 00:29:44,998 --> 00:29:47,567 RESISTANT THE MORE YOU GIVE THEM 717 00:29:47,567 --> 00:29:49,269 A PULSE BUT THE SUSTAINED 718 00:29:49,269 --> 00:29:54,041 DELIVERY TO THE WHOLE EYE 719 00:29:54,041 --> 00:29:55,742 DOESN'T GIVE THEM ANY CHANCE TO 720 00:29:55,742 --> 00:29:57,311 ESCAPE WHICH I THINK IS PART OF 721 00:29:57,311 --> 00:29:58,679 THE ANSWER. 722 00:29:58,679 --> 00:30:01,048 THEN WE LOOKED BACK ON THIS AND 723 00:30:01,048 --> 00:30:04,751 SAID IF WE LOOK ON OUR SWIMMER 724 00:30:04,751 --> 00:30:09,056 PLOT, WE CAN SEE HOW MANY EYES 725 00:30:09,056 --> 00:30:10,590 HAVE BEEN ENUCLEATED AND YOU CAN 726 00:30:10,590 --> 00:30:13,260 SEE HERE IT WOULD SCORE ON THE 727 00:30:13,260 --> 00:30:14,728 YELLOW TRIANGLE AND THERE WERE 728 00:30:14,728 --> 00:30:21,168 TWO FROM THE CHEMO FLAK 729 00:30:21,168 --> 00:30:23,136 ROTATIONS AND MANY MORE FROM THE 730 00:30:23,136 --> 00:30:23,537 IAC. 731 00:30:23,537 --> 00:30:26,840 SO NOW WE WANT TO DO 732 00:30:26,840 --> 00:30:27,574 RETROSPECTIVE PROPER COMPARISON 733 00:30:27,574 --> 00:30:30,978 SO THE E CANCER CARE PATIENTS IN 734 00:30:30,978 --> 00:30:32,479 THIS RETROSPECTIVE WINDOW 735 00:30:32,479 --> 00:30:36,850 COMPARED TO THE .9 AND 1.2 736 00:30:36,850 --> 00:30:38,652 CHEMOPLAQUE STUDY. 737 00:30:38,652 --> 00:30:40,687 HERE WE HAD 22 EYES BUT CAN'T 738 00:30:40,687 --> 00:30:42,456 SCORE FOR THIS MATCH BECAUSE 739 00:30:42,456 --> 00:30:45,625 THEY HAD NO OTHER TREATMENT OR 740 00:30:45,625 --> 00:30:48,195 THEY WERE A LOT OLDER. 741 00:30:48,195 --> 00:30:50,364 SO THE STUDY FOR EYES MATCHING 742 00:30:50,364 --> 00:30:52,833 WERE 18 AND THEN WE WENT THROUGH 743 00:30:52,833 --> 00:30:55,268 A PATH STARTING WITH 97 EYES AND 744 00:30:55,268 --> 00:30:58,138 WORKING OUR WAY DOWN TO ONES 745 00:30:58,138 --> 00:31:00,374 THAT COULD REASONABLY MATCH THE 746 00:31:00,374 --> 00:31:02,309 CONTROL EYE OF 45 AND WE THOUGHT 747 00:31:02,309 --> 00:31:04,244 WE SHOULD BE RANDOMIZING UP WITH 748 00:31:04,244 --> 00:31:05,779 OF THESE EYES FROM ONE OF THESE 749 00:31:05,779 --> 00:31:07,147 BUT I LEARNED LAST NIGHT THAT IS 750 00:31:07,147 --> 00:31:09,516 NOT THE CASE AND WE SHOULD HAVE 751 00:31:09,516 --> 00:31:10,083 MANY AS POSSIBLE. 752 00:31:10,083 --> 00:31:12,519 SO THIS WILL BE REVISED SOON. 753 00:31:12,519 --> 00:31:19,026 AND THIS IS ANOTHER CANADIAN 754 00:31:19,026 --> 00:31:24,598 REFUGEE, WE HAVE MANY GREAT 755 00:31:24,598 --> 00:31:27,701 REFUGEES IN CANADA AND CONTROL 756 00:31:27,701 --> 00:31:31,471 EYES FOR MATCH, WE HIRED HIM AS 757 00:31:31,471 --> 00:31:32,973 A RESEARCH ASSISTANT FROM HONG 758 00:31:32,973 --> 00:31:35,308 KONG, HE IS ABSOLUTELY BRILLIANT 759 00:31:35,308 --> 00:31:38,412 AND HAS DONE ALL OF THIS WORK 760 00:31:38,412 --> 00:31:39,479 MAKING THE SWIMMER PLOT BETTER 761 00:31:39,479 --> 00:31:41,648 AND VERY MUCH A KEY PERSON TO 762 00:31:41,648 --> 00:31:42,783 THE WHOLE STUDY. 763 00:31:42,783 --> 00:31:44,551 SO THE PROPENSITY MATCH IS 764 00:31:44,551 --> 00:31:45,452 MATCHING THE PATIENTS ACROSS 765 00:31:45,452 --> 00:31:49,423 HERE AND THE PLAN IS TO 766 00:31:49,423 --> 00:31:51,124 CALCULATE THE CONSEQUENCE SCORE 767 00:31:51,124 --> 00:31:52,025 FOR EACH EYE. 768 00:31:52,025 --> 00:31:55,095 YOU HAVEN'T HEARD ABOUT 769 00:31:55,095 --> 00:31:57,364 CONSEQUENCE SCORE, HAVE YOU? 770 00:31:57,364 --> 00:32:00,100 WE JUST INVENTED OUT OF OUR 771 00:32:00,100 --> 00:32:02,202 HEADS THE CONSEQUENCE SCORE AND 772 00:32:02,202 --> 00:32:03,970 SAID IT IS ARBITRARY BUT 773 00:32:03,970 --> 00:32:06,339 INTENDED TO ESTIMATE THE 774 00:32:06,339 --> 00:32:07,207 PERCEIVED RELATIVE HARMFUL SIDE 775 00:32:07,207 --> 00:32:08,308 EFFECTS OF ANY OF THESE 776 00:32:08,308 --> 00:32:09,643 TREATMENTS AND YOU CAN SEE THE 777 00:32:09,643 --> 00:32:17,984 ONES THAT HIT THE TOP ARE EBRT 778 00:32:17,984 --> 00:32:19,152 AND ENUCLEATION OF THE EYE AND 779 00:32:19,152 --> 00:32:21,021 THAT WOULD BE ONE TREATMENT, NOT 780 00:32:21,021 --> 00:32:22,489 COUNTING THE NUMBER OF BURNS IN 781 00:32:22,489 --> 00:32:24,658 THE EYE BUT THAT EPISODE THAT 782 00:32:24,658 --> 00:32:26,159 SCORES ON THE SWIMMER PLOT. 783 00:32:26,159 --> 00:32:29,062 AND THAT IS WHAT WE DECIDED WE 784 00:32:29,062 --> 00:32:29,596 WOULD USE. 785 00:32:29,596 --> 00:32:31,731 IT DOESN'T MATTER WHAT THE REAL 786 00:32:31,731 --> 00:32:34,267 NUMBERS ARE BECAUSE IN ALL THE 787 00:32:34,267 --> 00:32:34,968 CALCULATIONS, THE NUMBERS ARE 788 00:32:34,968 --> 00:32:36,536 THE SAME ON BOTH SIDES. 789 00:32:36,536 --> 00:32:38,839 IT JUST LETS US QUANTITATE 790 00:32:38,839 --> 00:32:41,241 OUTCOMES AND EVENTS AND 791 00:32:41,241 --> 00:32:42,042 PROPENSITY MATCHING. 792 00:32:42,042 --> 00:32:46,413 SO HERE WE ARE THE CHEMOPLAQUE 793 00:32:46,413 --> 00:32:49,449 AND COUNT THE SCORE BY THREE 794 00:32:49,449 --> 00:32:52,452 ARTERIALS, THAT GIVES THE TOTAL 795 00:32:52,452 --> 00:32:57,390 OF 12 TOTAL CONSEQUENCE SCORE 796 00:32:57,390 --> 00:33:00,894 BEFORE CHEMOPLAQUE IN THAT STUDY 797 00:33:00,894 --> 00:33:02,295 OF KIDS UNDER 25. 798 00:33:02,295 --> 00:33:04,764 THEN WE LOOKED THROUGH OUR OTHER 799 00:33:04,764 --> 00:33:07,467 CONTROLS AND FIND OTHERS WITH A 800 00:33:07,467 --> 00:33:11,705 CONSEQUENCE SCORE OF 12, THEN WE 801 00:33:11,705 --> 00:33:15,108 PICK THE DAY ZERO THAT MIGHT BE 802 00:33:15,108 --> 00:33:16,943 THE NEXT TREATMENT, THAT MIGHT 803 00:33:16,943 --> 00:33:19,546 HAVE GOTTEN THE CHEMOPLAQUE BUT 804 00:33:19,546 --> 00:33:19,779 DIDN'T. 805 00:33:19,779 --> 00:33:20,947 DOES THAT MAKE SENSE? 806 00:33:20,947 --> 00:33:21,548 HOPE SO. 807 00:33:21,548 --> 00:33:24,151 SO THIS GIVES US A NEW MATCHING 808 00:33:24,151 --> 00:33:26,486 SET BY THAT CRITERIA, THEN WE 809 00:33:26,486 --> 00:33:28,255 ALSO IMPROVED THE MATCH BY 810 00:33:28,255 --> 00:33:29,723 LOOKING AT THE TREATMENT 811 00:33:29,723 --> 00:33:29,956 PATTERN. 812 00:33:29,956 --> 00:33:35,595 SO YOU CAN SEE HERE OUR 813 00:33:35,595 --> 00:33:37,330 CHEMOPLAQUE CITATION HAS FOUR 814 00:33:37,330 --> 00:33:39,332 EYES OF MATERIALS, THIS PATIENT 815 00:33:39,332 --> 00:33:46,740 HAD 12 BUT ONLY THREE ARTERIAL 816 00:33:46,740 --> 00:33:48,408 AND THREE LASER. 817 00:33:48,408 --> 00:33:51,311 SO THAT WOULD FIT IF WE'RE 818 00:33:51,311 --> 00:33:53,046 MATCHING ONLY BY TUMOR PATTERN, 819 00:33:53,046 --> 00:33:56,249 BUT THIS ONE FITS BETTER BECAUSE 820 00:33:56,249 --> 00:33:59,386 THESE ARE INTRAARTERIAL THAT 821 00:33:59,386 --> 00:34:00,587 MATCH THE OTHER INTRAARTERIAL 822 00:34:00,587 --> 00:34:03,256 THERE AND IN A MOMENT WE SAID WE 823 00:34:03,256 --> 00:34:04,624 WOULD DO RANDOM SELECTION BUT 824 00:34:04,624 --> 00:34:06,593 LEARNED LAST NIGHT WE WILL USE 825 00:34:06,593 --> 00:34:08,929 BOTH OF THEM BECAUSE WE WANT TO 826 00:34:08,929 --> 00:34:10,964 ENRICH THE NUMBERS IN OUR 827 00:34:10,964 --> 00:34:11,865 RETROSPECTIVE CONTROL. 828 00:34:11,865 --> 00:34:15,569 SO HERE WE ARE LOOKING AT THE RB 829 00:34:15,569 --> 00:34:17,637 TD FOR ONE-TO-ONE MATCHES 830 00:34:17,637 --> 00:34:28,114 BETWEEN THE CHEMOPLAQUES AND 831 00:34:28,648 --> 00:34:30,350 THEN THE OUTCOME MATCHED BETWEEN 832 00:34:30,350 --> 00:34:31,885 THE GROUPS AND DON'T HAVE ANY 833 00:34:31,885 --> 00:34:33,787 DIFFERENCE BETWEEN THEM. 834 00:34:33,787 --> 00:34:37,257 AND THE PROPENSITY MATCH AT WEEK 835 00:34:37,257 --> 00:34:41,962 ZERO, HERE IS THE INSERTION OF 836 00:34:41,962 --> 00:34:43,230 THE CHEMOPLAQUE. 837 00:34:43,230 --> 00:34:46,733 SO IF YOU LOOK AT THE RESULTS, 838 00:34:46,733 --> 00:34:49,135 THE MATCHED RETROSPECTIVE FOR 839 00:34:49,135 --> 00:34:51,271 CONTROL VERSUS THE CHEMOPLAQUE, 840 00:34:51,271 --> 00:34:53,373 THAT SHOWS A VERY SIGNIFICANT 841 00:34:53,373 --> 00:34:56,076 VALUE TO THE CHEMOPLAQUE 842 00:34:56,076 --> 00:34:57,210 COMPARED TO MATCHED CONTROLS. 843 00:34:57,210 --> 00:35:01,181 I WILL SHOW YOU ONE BEAUTIFUL 844 00:35:01,181 --> 00:35:07,787 LITTLE PATIENT. 845 00:35:07,787 --> 00:35:10,023 THIS IS STEP RB AND THE CHILD 846 00:35:10,023 --> 00:35:13,660 SHOULD HAVE BEEN DIAGNOSED AT 847 00:35:13,660 --> 00:35:14,027 WEEK 30. 848 00:35:14,027 --> 00:35:16,930 DIAGNOSED NOW AT GESTATIONAL 849 00:35:16,930 --> 00:35:20,900 WEEK 36 WHICH WE DO COMMONLY IN 850 00:35:20,900 --> 00:35:24,170 CANADA BUT GOT MISSED BECAUSE 851 00:35:24,170 --> 00:35:27,274 THE PASSING BACK AND FORTH 852 00:35:27,274 --> 00:35:28,942 BETWEEN GENETIC LABS AND 853 00:35:28,942 --> 00:35:31,011 FAMILIES AND TESTING FOR 854 00:35:31,011 --> 00:35:35,949 GENETICS WAS DELAYED SO NO ONE 855 00:35:35,949 --> 00:35:38,285 RECOGNIZED HER COUSIN, BOTH 856 00:35:38,285 --> 00:35:40,587 FATHERS FROM IDENTICAL TWINS WHO 857 00:35:40,587 --> 00:35:45,725 ACTUALLY HAD NEVER HAD RED 858 00:35:45,725 --> 00:35:47,027 RETINOBLASTOMA SO THIS CHILD 859 00:35:47,027 --> 00:35:48,461 ALREADY HAD THIS TUMOR AT THAT 860 00:35:48,461 --> 00:35:48,828 POINT IN TIME. 861 00:35:48,828 --> 00:35:51,931 AND THIS IS THE ONLY PICTURE I 862 00:35:51,931 --> 00:35:55,302 HAVE BUT IT IS AN ULTRASOUND 863 00:35:55,302 --> 00:35:59,973 DONE ACROSS THERE SHOWING TUMOR 864 00:35:59,973 --> 00:36:01,341 AND CHEMOPLAQUE ON ULTRASOUND. 865 00:36:01,341 --> 00:36:05,512 YOU CAN SEE HOW IT IS GLUED WITH 866 00:36:05,512 --> 00:36:07,514 CRAZY GLUE HERE AT THE FRONT OF 867 00:36:07,514 --> 00:36:09,416 THE EYE AND FITS THE PROFILE 868 00:36:09,416 --> 00:36:10,850 THERE. 869 00:36:10,850 --> 00:36:16,056 THIS IS WEEK 9 OF TOXICITY AND 870 00:36:16,056 --> 00:36:19,426 SHOWS THE MAJOR TOXICITY, THE 871 00:36:19,426 --> 00:36:23,763 GREEN DOTTED CIRCLE IS THE 872 00:36:23,763 --> 00:36:26,032 FOOTPRINT OF THE CHEMO PLAQUE 873 00:36:26,032 --> 00:36:28,902 AND SOMETIMES SHOWS MORE TIRATIS 874 00:36:28,902 --> 00:36:31,404 AND ULTIMATELY THE RETINA IS 875 00:36:31,404 --> 00:36:33,239 DESTROYED BUT THIS SHOWS THAT 876 00:36:33,239 --> 00:36:34,274 ACTIVE TUMOR SITTING RIGHT THERE 877 00:36:34,274 --> 00:36:36,676 ON TOP OF THE CALCIUM. 878 00:36:36,676 --> 00:36:39,646 BUT WE JUST KEPT FOLLOWING THAT 879 00:36:39,646 --> 00:36:43,983 AND DID NOT DO ANY 880 00:36:43,983 --> 00:36:46,353 INTERVENTIONAL TREATMENT AND BY 881 00:36:46,353 --> 00:36:48,254 WEEK 35 AT 3.3 YEARS FOLLOW-UP, 882 00:36:48,254 --> 00:36:49,856 IT LOOKS JUST LIKE THAT. 883 00:36:49,856 --> 00:36:52,459 THIS IS THE SCAR WHICH WILL BE 884 00:36:52,459 --> 00:36:54,761 IN HER SUPERIOR FIELD AND THEY 885 00:36:54,761 --> 00:36:58,498 ALL HAVE THIS OUTCOME FROM THE 886 00:36:58,498 --> 00:36:59,432 CHEMOPLAQUE FOOTPRINT AND NOW 887 00:36:59,432 --> 00:37:01,067 THERE IS NO LONGER A TUMOR 888 00:37:01,067 --> 00:37:01,735 THERE. 889 00:37:01,735 --> 00:37:05,438 AND THE TIMELINE IS CHEMOPLAQUE 890 00:37:05,438 --> 00:37:07,941 AND NO OTHER TREATMENT SO SHE IS 891 00:37:07,941 --> 00:37:09,843 STILL IN COMPLETE RESPONSE AT 892 00:37:09,843 --> 00:37:13,613 3.3 YEARS AND THIS METHOD AND CR 893 00:37:13,613 --> 00:37:15,281 LEAVES NOT MUCH ROOM FOR 894 00:37:15,281 --> 00:37:16,149 DISCUSSION AROUND IT. 895 00:37:16,149 --> 00:37:18,952 ACTUALLY IF I GO BACK HERE TO 896 00:37:18,952 --> 00:37:21,988 THIS, HERE IS A LITTLE DROPDOWN 897 00:37:21,988 --> 00:37:24,824 WAY OVER HERE AT 90-SOMETHING 898 00:37:24,824 --> 00:37:25,024 WEEKS. 899 00:37:25,024 --> 00:37:26,760 THAT WAS ONE PARTICIPANT IN THE 900 00:37:26,760 --> 00:37:29,896 STUDY WHO SHOWED A HOT SPOT ON 901 00:37:29,896 --> 00:37:32,732 THE SOFT PART OF THE REGRESSED 902 00:37:32,732 --> 00:37:35,368 TUMOR AND WE LASERED IT BECAUSE 903 00:37:35,368 --> 00:37:36,736 THE WHOLE TEAM MAKES THE 904 00:37:36,736 --> 00:37:38,905 DECISION THAT IS THE SAFEST 905 00:37:38,905 --> 00:37:40,407 THING TO DO FOR HIS EYE EVEN 906 00:37:40,407 --> 00:37:43,109 THOUGH IT MAY NOT HAVE BEEN A 907 00:37:43,109 --> 00:37:43,543 TUMOR. 908 00:37:43,543 --> 00:37:46,713 WE DID ONE TREATMENT AND THAT 909 00:37:46,713 --> 00:37:48,014 DROPPED HIM DOWN ONE POINT AND 910 00:37:48,014 --> 00:37:50,116 HE NO LONGER IS A COMPLETE 911 00:37:50,116 --> 00:37:51,451 RESPONSE BECAUSE WE TREATED HIM 912 00:37:51,451 --> 00:37:54,721 BUT THAT IS NO PROBLEM AS WE PUT 913 00:37:54,721 --> 00:37:56,356 PATIENT CARE FIRST. 914 00:37:56,356 --> 00:37:58,591 SO NOW WE ARE OUT HERE AND THIS 915 00:37:58,591 --> 00:38:00,660 LITTLE GIRL WHO TAUGHT US 916 00:38:00,660 --> 00:38:01,828 SOMETHING WE DIDN'T THINK OF 917 00:38:01,828 --> 00:38:03,029 BEFORE. 918 00:38:03,029 --> 00:38:05,432 THIS IS EVA, VERY PROUD OF BEING 919 00:38:05,432 --> 00:38:08,935 IN MY TALK SO I CAN USE HER 920 00:38:08,935 --> 00:38:12,172 PICTURE WITH PERMISSION AND HER 921 00:38:12,172 --> 00:38:13,273 VISION MEASURES POORLILY BECAUSE 922 00:38:13,273 --> 00:38:15,074 HER CENTRAL VISION IS RIGHT 923 00:38:15,074 --> 00:38:17,677 THERE SO SHE WILL NEVER HAVE 924 00:38:17,677 --> 00:38:19,212 GOOD VISION OUT OF THIS EYE. 925 00:38:19,212 --> 00:38:22,282 BUT SHE IS PATCHED TO THE BETTER 926 00:38:22,282 --> 00:38:26,052 EYE SO SHE WILL HAVE OPTIMIZED 927 00:38:26,052 --> 00:38:26,853 VISION OF THIS EYE. 928 00:38:26,853 --> 00:38:29,189 BUT WISE PEOPLE SAID WHY ARE YOU 929 00:38:29,189 --> 00:38:31,191 BOTHERING TO PATCH, THERE IS NO 930 00:38:31,191 --> 00:38:32,192 CHANCE TO CHANGE HER CENTRAL 931 00:38:32,192 --> 00:38:34,494 VISION AND YOU ARE RIGHT BUT SHE 932 00:38:34,494 --> 00:38:37,931 RUNS AROUND WITH HER PATCH AND 933 00:38:37,931 --> 00:38:39,499 CATCHES BALANCE BECAUSE SHE IS 934 00:38:39,499 --> 00:38:44,704 USING ALL THE REST OF THE 935 00:38:44,704 --> 00:38:46,773 RETINA AND SO WE SAY KEEP 936 00:38:46,773 --> 00:38:48,041 PATCHING FOREVER, MAYBE THE REST 937 00:38:48,041 --> 00:38:50,043 OF YOUR LIFE BECAUSE YOU DON'T 938 00:38:50,043 --> 00:38:52,245 WANT TO LOSE THE FUNCTION OF 939 00:38:52,245 --> 00:38:53,413 THIS BEAUTIFUL RETINA THAT SHE 940 00:38:53,413 --> 00:38:55,415 CAN USE TO DO A LOT OF THINGS IN 941 00:38:55,415 --> 00:38:55,748 LIFE. 942 00:38:55,748 --> 00:38:57,684 SO WE HAVE NEVER PAID ATTENTION 943 00:38:57,684 --> 00:38:59,352 TO THE VISUAL FIELD AND THAT IS 944 00:38:59,352 --> 00:39:03,389 A NEW STUDY. 945 00:39:03,389 --> 00:39:05,592 PLEASE COME AND FOLLOW THIS 946 00:39:05,592 --> 00:39:07,193 STUDY WITH PATIENTS WITH SCARS 947 00:39:07,193 --> 00:39:11,664 ALL OVER THE PLACE FROM INFANCY 948 00:39:11,664 --> 00:39:14,000 AND HOW THAT VISION FIELD 949 00:39:14,000 --> 00:39:15,602 CHANGES CORRELATING TO THEIR JOB 950 00:39:15,602 --> 00:39:17,036 PROSPECTS AND WHAT THEY LIKE TO 951 00:39:17,036 --> 00:39:18,938 DO IN THE WORLD AND THAT IS VERY 952 00:39:18,938 --> 00:39:20,940 IMPORTANT FOR FOLLOW-UP FOR THE 953 00:39:20,940 --> 00:39:21,241 FAMILIES. 954 00:39:21,241 --> 00:39:23,243 SO YOU CAN SEE I HAVE USED THE 955 00:39:23,243 --> 00:39:24,310 DATA IN MANY WAYS. 956 00:39:24,310 --> 00:39:27,780 I WILL JUST POINT OUT THAT THIS 957 00:39:27,780 --> 00:39:28,915 DATA HERE -- NO, THIS DATA FROM 958 00:39:28,915 --> 00:39:31,117 NEW YORK AND BOSTON, I COMMENTED 959 00:39:31,117 --> 00:39:33,486 ON THAT, AND THAT EVENTUALLY LED 960 00:39:33,486 --> 00:39:35,989 TO THE RECOGNITION THAT EBRT WAS 961 00:39:35,989 --> 00:39:41,060 NOT A GOOD THING TO DO TO H1 962 00:39:41,060 --> 00:39:41,995 PATIENTS. 963 00:39:41,995 --> 00:39:43,029 THE RETROSPECTIVE REPOSITORY 964 00:39:43,029 --> 00:39:47,367 WHICH I BUILT FROM 2001 TO 2013 965 00:39:47,367 --> 00:39:49,602 AT UNIVERSITY HEALTH NETWORK, 966 00:39:49,602 --> 00:39:53,473 THAT FED INTO THE CANCER STAGING 967 00:39:53,473 --> 00:39:57,710 AND NOW A J.C. CANCER STAGING 968 00:39:57,710 --> 00:39:58,444 INCLUDING H1. 969 00:39:58,444 --> 00:40:00,914 AND ANOTHER EVEN OLDER REGISTRY 970 00:40:00,914 --> 00:40:03,516 FROM THE NETHERLANDS THAT THEY 971 00:40:03,516 --> 00:40:05,919 PULLED FANTASTIC DATA OUT OF. 972 00:40:05,919 --> 00:40:08,121 SO HAVING REALLY RETROSPECTIVE 973 00:40:08,121 --> 00:40:10,557 REPOSITORIES IS VERY USEFUL. 974 00:40:10,557 --> 00:40:14,027 THE CHINESE GROUP WORK WITH 975 00:40:14,027 --> 00:40:16,229 MANY, MANY PATIENTS JOINING 28 976 00:40:16,229 --> 00:40:18,164 CENTERS TOGETHER BUT ALL THE 977 00:40:18,164 --> 00:40:20,500 PATIENTS IN ONE DATABASE, AND I 978 00:40:20,500 --> 00:40:23,469 HAVE HAD THE PRIVILEGE TO WORK 979 00:40:23,469 --> 00:40:25,872 WITH Dr. CHAO IN CHINA AND NOW 980 00:40:25,872 --> 00:40:27,540 A MEDICAL STUDENT WHO WAS 981 00:40:27,540 --> 00:40:31,444 ORIGINALLY BORN IN CHINA BUT IS 982 00:40:31,444 --> 00:40:33,813 NOW A RESIDENT IN OTTAWA, 983 00:40:33,813 --> 00:40:34,914 CANADA, AND WORKS THROUGH THE 984 00:40:34,914 --> 00:40:36,716 STATE WITH THE THREE OF US 985 00:40:36,716 --> 00:40:39,085 WRITING ALL SORTS OF PAPERS OUT 986 00:40:39,085 --> 00:40:40,486 OF THIS REPOSITORY WHICH SHOW 987 00:40:40,486 --> 00:40:42,956 FOR EXAMPLE THE SAFEST WAY TO 988 00:40:42,956 --> 00:40:49,629 SAVE A CHILD'S LIFE IS TO 989 00:40:49,629 --> 00:40:50,263 ENUCLEATE. 990 00:40:50,263 --> 00:40:51,998 PRIMARY ENUCLEATION IS A REALLY 991 00:40:51,998 --> 00:40:54,767 IMPORTANT TREATMENT FOR THE 992 00:40:54,767 --> 00:40:55,969 WHOLE WORLD. 993 00:40:55,969 --> 00:40:58,538 THIS IS THE E CANCER CARE 994 00:40:58,538 --> 00:41:00,273 REPOSITORY AND I WILL COME BACK 995 00:41:00,273 --> 00:41:02,041 TO THAT. 996 00:41:02,041 --> 00:41:03,476 SO DEPICT WORLDWIDE, WE NEED TO 997 00:41:03,476 --> 00:41:08,147 KNOW HOW TO REACH CENTERS 998 00:41:08,147 --> 00:41:17,557 WORLDWIDE. 999 00:41:17,557 --> 00:41:21,728 HELEN DIMARAS WHO WAS IMPORTANT 1000 00:41:21,728 --> 00:41:24,397 IN THE RB SITES WORLDWIDE HAS 1001 00:41:24,397 --> 00:41:27,066 BUILT A TUMOR BANK FOR THE WORLD 1002 00:41:27,066 --> 00:41:29,569 ALL BASED IN SICK KIDS AND MANY 1003 00:41:29,569 --> 00:41:32,138 YEARS AGO SET UP THIS MAP, YOU 1004 00:41:32,138 --> 00:41:34,207 CAN GO FROM THAT URL AND JUMP 1005 00:41:34,207 --> 00:41:36,009 RIGHT TO THIS MAP AND ANY TIME 1006 00:41:36,009 --> 00:41:38,678 YOU POINT TO A GREEN SPOT, IT 1007 00:41:38,678 --> 00:41:39,812 WILL TELL YOU PRETTY UP-TO-DATE 1008 00:41:39,812 --> 00:41:42,315 HOW MANY PATIENTS THEY ARE 1009 00:41:42,315 --> 00:41:44,350 SEEING THERE, WHAT KIND OF 1010 00:41:44,350 --> 00:41:45,852 TREATMENT TUMORS DO THEY HAVE 1011 00:41:45,852 --> 00:41:48,788 AVAILABLE IN THAT SITE AND WHO 1012 00:41:48,788 --> 00:41:51,190 ARE THE ACTIVE ONCOLOGISTS AND 1013 00:41:51,190 --> 00:41:51,891 OPHTHALMOLOGISTS AND ANYONE 1014 00:41:51,891 --> 00:41:54,027 INVOLVED IN THE CARE IN THOSE 1015 00:41:54,027 --> 00:41:54,227 SITES. 1016 00:41:54,227 --> 00:41:55,695 AND WE KNOW MOST OF THESE 1017 00:41:55,695 --> 00:41:57,463 PEOPLE, NOT ALL OF THEM OF 1018 00:41:57,463 --> 00:41:59,265 COURSE BUT KNOW LOTS OF THEM AND 1019 00:41:59,265 --> 00:42:04,504 THOSE ARE HOW WE HAVE BEEN ABLE 1020 00:42:04,504 --> 00:42:05,772 TO EXPEDITE MOVING DEPICT HEALTH 1021 00:42:05,772 --> 00:42:07,173 THROUGH THE WORLD. 1022 00:42:07,173 --> 00:42:10,243 SO THIS IS DEPICT HEALTH WHICH 1023 00:42:10,243 --> 00:42:13,680 ANCHORS THE CIRCLE OF CARE AND 1024 00:42:13,680 --> 00:42:18,851 THAT IS THE BLUE CIRCLES WHICH 1025 00:42:18,851 --> 00:42:19,852 INCLUDES FAMILIES, PATIENTS, 1026 00:42:19,852 --> 00:42:21,554 Dr., ET CETERA, THEY CAN VIEW 1027 00:42:21,554 --> 00:42:22,288 ALL THE DATA. 1028 00:42:22,288 --> 00:42:25,124 BUT ALL THE PEOPLE IN THE BLUE 1029 00:42:25,124 --> 00:42:29,429 CIRCLE HERE ARE CLINICIANS OF 1030 00:42:29,429 --> 00:42:32,231 ALL DESCRIPTIONS WHO WOULD ENTER 1031 00:42:32,231 --> 00:42:35,001 DATA INTO DEPICT HEALTH. 1032 00:42:35,001 --> 00:42:39,072 THIS IS NOT IN THE E MR OF A 1033 00:42:39,072 --> 00:42:42,075 HOSPITAL SITE, IT IS FILLED OUT 1034 00:42:42,075 --> 00:42:43,876 BY THE CLINICIANS OF ALL 1035 00:42:43,876 --> 00:42:45,745 DIFFERENT TYPES BUT VERY SIMPLE, 1036 00:42:45,745 --> 00:42:47,447 VERY EASY AND BECOMES A 1037 00:42:47,447 --> 00:42:48,448 COMMUNICATION SERVICE ACROSS 1038 00:42:48,448 --> 00:42:49,749 THIS CIRCLE OF CARE. 1039 00:42:49,749 --> 00:42:52,618 THEY PUT IN THE ACCURATE DATA 1040 00:42:52,618 --> 00:42:55,788 BUT THE AUDITORS IS TO SAY DID 1041 00:42:55,788 --> 00:42:57,857 THEY MAKE A MISTAKE ARE THE 1042 00:42:57,857 --> 00:42:59,258 PATIENTS AND PARENTS BECAUSE 1043 00:42:59,258 --> 00:43:02,128 THEY CAN WATCH THIS IN THE 1044 00:43:02,128 --> 00:43:03,629 WAITING ROOM, READY FOR THIS 1045 00:43:03,629 --> 00:43:06,733 WHILE WE'RE ACTUALLY PUTTING THE 1046 00:43:06,733 --> 00:43:09,769 DATA INTO DEPICT HEALTH IN THE 1047 00:43:09,769 --> 00:43:12,038 OR. 1048 00:43:12,038 --> 00:43:14,507 SO THE PATIENTS PARTICIPATE WITH 1049 00:43:14,507 --> 00:43:16,442 A COMMUNICATION CONSENT SIGNED 1050 00:43:16,442 --> 00:43:19,545 BY THEM TO THE HOSPITAL THAT IS 1051 00:43:19,545 --> 00:43:22,782 THE CUSTODIAN OF THE DATA, 1052 00:43:22,782 --> 00:43:23,850 ALBERTA HEALTH OR SICK KIDS AND 1053 00:43:23,850 --> 00:43:25,518 THEY HAVE TO HAVE ONE 1054 00:43:25,518 --> 00:43:27,286 COMMUNICATION SENT WITH EACH OF 1055 00:43:27,286 --> 00:43:29,122 THOSE INSTITUTIONS. 1056 00:43:29,122 --> 00:43:31,057 AND THEN IF THE PATIENT'S 1057 00:43:31,057 --> 00:43:33,726 PARENTS SIGN AN OPTIONAL 1058 00:43:33,726 --> 00:43:36,062 RESEARCH CONSENT, THEN CODED 1059 00:43:36,062 --> 00:43:37,797 AGGREGATE DATA CAN BE DELIVERED 1060 00:43:37,797 --> 00:43:40,933 BACK TO EACH SITE SO IN A 1061 00:43:40,933 --> 00:43:42,435 RESEARCH READY FORMAT, WE DON'T 1062 00:43:42,435 --> 00:43:44,103 STEAL THEIR DATA FROM THEM, THEY 1063 00:43:44,103 --> 00:43:46,072 CAN DO THEIR OWN RESEARCH AND 1064 00:43:46,072 --> 00:43:47,507 PASS THAT BACK TO THE SITE. 1065 00:43:47,507 --> 00:43:50,409 SO WE HELP THEM TO DO THEIR OWN 1066 00:43:50,409 --> 00:43:51,944 RESEARCH, BUT WE ALSO TAKE THAT 1067 00:43:51,944 --> 00:43:54,347 DATA FROM THERE AND TAKE IT 1068 00:43:54,347 --> 00:43:56,482 THROUGH GLOBAL REACH AND OTHER 1069 00:43:56,482 --> 00:43:59,685 MEANS BUT THE ONE THAT IS RIGHT 1070 00:43:59,685 --> 00:44:04,390 NOW REALLY FUNCTIONAL IS THIS 1071 00:44:04,390 --> 00:44:06,826 PEDIATRIC DATA COMMONS, 1072 00:44:06,826 --> 00:44:07,860 PEDIATRIC CANCER DATA COMMONS 1073 00:44:07,860 --> 00:44:09,829 BUILT BY A FANTASTIC GROUP IN 1074 00:44:09,829 --> 00:44:14,033 CHICAGO AND THEY DID NOT HAVE 1075 00:44:14,033 --> 00:44:18,271 ANY COMMONS FOR RETINOBLASTOMA. 1076 00:44:18,271 --> 00:44:20,673 ALL THE OTHER PEDIATRIC CANCER 1077 00:44:20,673 --> 00:44:23,442 CENTERS SAID WE WANT TO IoT 1078 00:44:23,442 --> 00:44:25,611 RETINOBLASTOMA, THIS HE CAME TO 1079 00:44:25,611 --> 00:44:27,446 US, THEY HEARD ABOUT DEPICT 1080 00:44:27,446 --> 00:44:29,315 HEALTH AND WE GIVE THEM THE 1081 00:44:29,315 --> 00:44:31,617 DATABASE SO IT IS MATCHED UP 1082 00:44:31,617 --> 00:44:35,888 REALLY WELL TO THE DATA WITH THE 1083 00:44:35,888 --> 00:44:40,226 COMMONS AND THAT CAN GO TO 1084 00:44:40,226 --> 00:44:40,693 REB-APPROVED RESEARCH. 1085 00:44:40,693 --> 00:44:42,562 SO WE DON'T HAVE TO JUDGE WHO IS 1086 00:44:42,562 --> 00:44:46,866 ALLOWED TO HAVE THE DATA BECAUSE 1087 00:44:46,866 --> 00:44:48,801 PEDIATRIC CANCER DATA COMMONS 1088 00:44:48,801 --> 00:44:51,037 HAVE ALL OF THAT IN PLACE WHICH 1089 00:44:51,037 --> 00:44:51,637 IS REALLY NICE. 1090 00:44:51,637 --> 00:44:54,140 BUT THE OTHER THING IS THAT DATA 1091 00:44:54,140 --> 00:44:56,242 CAN PRODUCE AND SUPPORT NATIONAL 1092 00:44:56,242 --> 00:44:57,710 GUIDELINES BECAUSE THE DATA IS 1093 00:44:57,710 --> 00:44:58,978 SPECIFIC TO WHATEVER SITES ARE 1094 00:44:58,978 --> 00:45:01,414 INVOLVED AND THAT CAN REFLECT 1095 00:45:01,414 --> 00:45:03,916 REGIONAL REALITY AND IN THAT WAY 1096 00:45:03,916 --> 00:45:05,117 PATIENTS BECOME ADVOCATES TO 1097 00:45:05,117 --> 00:45:07,386 HELP OTHER PATIENTS SO IT GOES 1098 00:45:07,386 --> 00:45:09,288 REALLY FULL CIRCLE AROUND. 1099 00:45:09,288 --> 00:45:11,324 AND AS I HAVE SHOWED YOU, THE 1100 00:45:11,324 --> 00:45:15,127 POWER OF THIS LONGITUDINAL DATA 1101 00:45:15,127 --> 00:45:17,096 GOING FORWARD HERE ALSO CAN BE 1102 00:45:17,096 --> 00:45:19,365 USED AS A PROPENSITY MATCH OUT 1103 00:45:19,365 --> 00:45:20,299 OF DEPICT HEALTH. 1104 00:45:20,299 --> 00:45:23,169 SO YOU CAN IMAGE AS THIS IS 1105 00:45:23,169 --> 00:45:24,904 REALLY SITE SPECIFIC, YOU CAN 1106 00:45:24,904 --> 00:45:26,472 TOOL WHICH DATA ARE YOU GOING TO 1107 00:45:26,472 --> 00:45:28,474 LOOK AT TO MATCH WHICH PATIENTS 1108 00:45:28,474 --> 00:45:30,309 IN WHICH LOCATION FOR WHICH KIND 1109 00:45:30,309 --> 00:45:33,679 OF CIRCUMSTANCES AND THAT IS 1110 00:45:33,679 --> 00:45:35,448 VERY EXCITING THINGS COMING 1111 00:45:35,448 --> 00:45:41,020 ARISING OUT OF OUR FIRST SITE 1112 00:45:41,020 --> 00:45:41,954 ONLY CLINICAL TRIAL. 1113 00:45:41,954 --> 00:45:44,290 SO JUMPING TO THIS PATIENT, YOU 1114 00:45:44,290 --> 00:45:45,424 MAY RECOGNIZE HIM BECAUSE ALL I 1115 00:45:45,424 --> 00:45:49,095 HAVE DONE IS TAKE HIS DEPICT 1116 00:45:49,095 --> 00:45:57,436 HEALTH TIMELINE TO MARCH 2036 1117 00:45:57,436 --> 00:45:58,271 ALL CONDENSET DOWN. 1118 00:45:58,271 --> 00:46:02,475 NOW HE IS ABOUT HERE, THAT SHOWS 1119 00:46:02,475 --> 00:46:05,077 HIS CHEMOPLAQUE THERE BUT HE IS 1120 00:46:05,077 --> 00:46:11,050 HERE WITH A WHOLE LIFE TO LEAD. 1121 00:46:11,050 --> 00:46:13,452 HE HAS HAD NO EXTERNAL RADIATION 1122 00:46:13,452 --> 00:46:15,187 BUT OTHER THINGS DONE TO HIS EYE 1123 00:46:15,187 --> 00:46:20,059 SO NOW WE CAN USE DEPICT HEALTH 1124 00:46:20,059 --> 00:46:23,129 TO FOLLOW HIS SECOND MALIGNANT 1125 00:46:23,129 --> 00:46:25,231 THAT WANT NEO ALARMS. 1126 00:46:25,231 --> 00:46:33,940 WE HOPE OUT OF THE DNA STUDIES 1127 00:46:33,940 --> 00:46:39,011 LED BY A COLLEAGUE OUT OF LA TO 1128 00:46:39,011 --> 00:46:43,015 ULTIMATELY DEVELOP BLOOD TESTS 1129 00:46:43,015 --> 00:46:44,951 THAT WILL SEE DNA COMING FROM 1130 00:46:44,951 --> 00:46:47,787 THE BLOOD FOR ANY CANCER 1131 00:46:47,787 --> 00:46:49,789 ANYWHERE, NOT JUST 1132 00:46:49,789 --> 00:46:50,823 RETINOBLASTOMA. 1133 00:46:50,823 --> 00:46:52,491 AND THAT CANCER SIGNAL, SO FAR 1134 00:46:52,491 --> 00:46:55,194 WE PUT A GRAB IN, DIDN'T GET IT 1135 00:46:55,194 --> 00:46:56,862 BECAUSE OUR PATIENTS AT RISK ARE 1136 00:46:56,862 --> 00:46:58,998 TOO RARE BUT FOR THE SYNDROME 1137 00:46:58,998 --> 00:47:01,834 THEY HAVE DATA TO SAY THIS CAN 1138 00:47:01,834 --> 00:47:07,540 PREDICT CANCER BEFORE IT IS 1139 00:47:07,540 --> 00:47:08,808 OTHERWISE EVIDENT. 1140 00:47:08,808 --> 00:47:10,676 SO THIS MEANS THIS IS A 1141 00:47:10,676 --> 00:47:12,445 SURVEILLANCE TEST THAT WILL BE 1142 00:47:12,445 --> 00:47:14,747 ORDERED BY A SIMPLE BLOOD TEST 1143 00:47:14,747 --> 00:47:16,983 ON SOME REGULAR INTERVAL BASED 1144 00:47:16,983 --> 00:47:18,451 ON THE DATA. 1145 00:47:18,451 --> 00:47:20,019 WE'RE GOING TO RESUBMIT THIS 1146 00:47:20,019 --> 00:47:21,487 WITH THE POWER OF PATIENTS WHO 1147 00:47:21,487 --> 00:47:23,122 ARE EAGER TO KNOW WHEN THEY ARE 1148 00:47:23,122 --> 00:47:26,759 GOING TO HAVE A SECOND CANCER. 1149 00:47:26,759 --> 00:47:28,794 SO THAT'S MY TALK. 1150 00:47:28,794 --> 00:47:31,230 I WOULD LOVE TO HEAR IF THERE 1151 00:47:31,230 --> 00:47:32,932 ARE QUESTIONS AND SUGGESTIONS 1152 00:47:32,932 --> 00:47:37,436 THAT COULD MAKE OUR WORK BETTER. 1153 00:47:37,436 --> 00:47:39,605 THANK YOU, AND ONLINE. 1154 00:47:39,605 --> 00:47:40,039 [APPLAUSE] 1155 00:47:40,039 --> 00:47:42,041 >> THANK YOU, CAUGHT ME A LITTLE 1156 00:47:42,041 --> 00:47:43,776 BIT OFFGUARD THERE. 1157 00:47:43,776 --> 00:47:45,644 WE WELCOME QUESTIONS AT THE MICS 1158 00:47:45,644 --> 00:47:45,911 OF COURSE. 1159 00:47:45,911 --> 00:47:49,215 I DO HAVE A FEW TO GET STARTED. 1160 00:47:49,215 --> 00:47:51,150 JUST ONE THAT CAME EARLY ON SO 1161 00:47:51,150 --> 00:47:55,321 YOU KIND OF ALLUDED TO IT, WHEN 1162 00:47:55,321 --> 00:47:58,324 DOES TUMOR FORMATION AND VISION 1163 00:47:58,324 --> 00:48:00,292 DETERIORATION START, IN UTERO? 1164 00:48:00,292 --> 00:48:03,562 AND HOW SOON CAN THE CHEMOPLAQUE 1165 00:48:03,562 --> 00:48:04,530 THERAPY START? 1166 00:48:04,530 --> 00:48:06,532 IS TIME OF THE ESSENCE OR IS 1167 00:48:06,532 --> 00:48:10,036 THERE A OPEN WINDOW FOR THERAPY 1168 00:48:10,036 --> 00:48:11,203 TO ACHIEVE SIGNIFICANT POSITIVE 1169 00:48:11,203 --> 00:48:11,470 OUTCOMES? 1170 00:48:11,470 --> 00:48:11,771 $$TRANSMIT 1171 00:48:11,771 --> 00:48:17,743 >> THAT IS A VERY GOOD 1172 00:48:17,743 --> 00:48:18,377 QUESTION/COMMENT. 1173 00:48:18,377 --> 00:48:20,413 WE AT 36 WEEKS GESTATION, 1174 00:48:20,413 --> 00:48:23,783 30 PERCENT WILL ALREADY HAVE A 1175 00:48:23,783 --> 00:48:27,753 TUMOR DETECTABLE BY INTENSE OC T 1176 00:48:27,753 --> 00:48:28,054 SCREENING. 1177 00:48:28,054 --> 00:48:29,989 SO SOME YOUNGER THAN THAT BEFORE 1178 00:48:29,989 --> 00:48:31,490 WE ARE READY TO DELIVER THEM AND 1179 00:48:31,490 --> 00:48:34,427 SOME OF THOSE IN THE STUDY WE 1180 00:48:34,427 --> 00:48:36,862 FIRST PUBLISHED ON THIS WERE 1181 00:48:36,862 --> 00:48:37,997 BORN EARLIER THAN THAT BECAUSE 1182 00:48:37,997 --> 00:48:39,832 THEY CHOSE TO BE BORN FOR OTHER 1183 00:48:39,832 --> 00:48:41,400 REASONS BUT THAT IS ABOUT THE 1184 00:48:41,400 --> 00:48:42,001 TIME WINDOW. 1185 00:48:42,001 --> 00:48:44,170 SO IF YOU LOOK AT THE BEAUTIFUL 1186 00:48:44,170 --> 00:48:49,442 WORK BY DAVID OOLBRENIK IN L.A. 1187 00:48:49,442 --> 00:48:52,244 ON HOW THE RETINOBLASTOMA FORMS 1188 00:48:52,244 --> 00:48:59,685 IN THE CODAL PRECURSORS AND THAT 1189 00:48:59,685 --> 00:49:02,188 IS HOW THEY START. 1190 00:49:02,188 --> 00:49:03,322 BUT PRESCREENING AT 36 WEEKS, 1191 00:49:03,322 --> 00:49:06,292 THAT IS A GOOD TIME AND WE DO 1192 00:49:06,292 --> 00:49:07,593 THAT ROUTINELY ACROSS CANADA BUT 1193 00:49:07,593 --> 00:49:10,796 THE U.S. DOES NOT DO THAT 1194 00:49:10,796 --> 00:49:12,231 BECAUSE OBSTETRICIANS SAY IF I 1195 00:49:12,231 --> 00:49:17,403 DELIVER AN EARLY TERM BABY 1196 00:49:17,403 --> 00:49:18,971 ELECTIVELY, I MIGHT BE SUED AND 1197 00:49:18,971 --> 00:49:21,207 THAT IS A PROBLEM BECAUSE IF 1198 00:49:21,207 --> 00:49:23,442 BORN AT 40 WEEKS, THEY COULD 1199 00:49:23,442 --> 00:49:24,777 HAVE A BIG TUMOR ALREADY. 1200 00:49:24,777 --> 00:49:29,548 THERE ARE OTHER WAYS TO FIND 1201 00:49:29,548 --> 00:49:31,717 TUMORS IN UTERO BY ULTRASOUND 1202 00:49:31,717 --> 00:49:34,053 AND PUBLISHED THAT BUT ANOTHER 1203 00:49:34,053 --> 00:49:35,688 FOUND ANOTHER ONE BY ULTRASOUND 1204 00:49:35,688 --> 00:49:39,125 AS IT IS A VERY DIFFICULT JOB. 1205 00:49:39,125 --> 00:49:42,228 LIN MURPHY DID A MRI STUDY ON 1206 00:49:42,228 --> 00:49:45,631 PREGNANT PEOPLE TO SEE IF HE 1207 00:49:45,631 --> 00:49:48,567 COULD FIND SOMETHING AND IT DID 1208 00:49:48,567 --> 00:49:50,069 NOT DELIVER NIGH USEFUL DATA. 1209 00:49:50,069 --> 00:49:52,171 SO THE BEST IS TO DELIVER THEM 1210 00:49:52,171 --> 00:49:54,039 AT 36 WEEKS AND SEE WHAT WE HAVE 1211 00:49:54,039 --> 00:49:54,340 GOT. 1212 00:49:54,340 --> 00:50:00,479 IN OUR NEXT STUDY, WE HAVE A .3 1213 00:50:00,479 --> 00:50:03,549 CHEMOPLAQUE DOSE AVAILABLE WHICH 1214 00:50:03,549 --> 00:50:04,884 WAS MANUFACTURED BUT NEVER USED. 1215 00:50:04,884 --> 00:50:08,120 WE WOULD PUT THAT ON A BABY THAT 1216 00:50:08,120 --> 00:50:10,422 HAD A LARGER TUMOR, NOT ONE YOU 1217 00:50:10,422 --> 00:50:12,625 COULD LASER OR FIND A FOCAL 1218 00:50:12,625 --> 00:50:14,860 POINT BUT EVEN A MACULAR TUMOR 1219 00:50:14,860 --> 00:50:17,663 YOU WOULDN'T WANT TO LASER 1220 00:50:17,663 --> 00:50:18,364 BECAUSE IT WOULD DAMAGE VISION 1221 00:50:18,364 --> 00:50:23,269 AND WOULD BE GREAT FOR A .3, 1222 00:50:23,269 --> 00:50:26,672 WITH BUT HAS NOT BEEN DONE. 1223 00:50:26,672 --> 00:50:27,673 $$TRANSMIT 1224 00:50:27,673 --> 00:50:30,176 >> THAT WAS A GREAT TALK. 1225 00:50:30,176 --> 00:50:31,810 WONDERING WHAT YOUR UPCOMING 1226 00:50:31,810 --> 00:50:38,317 CONTROL GROUP IS FOR PHASE 1 1227 00:50:38,317 --> 00:50:38,984 CHEMOPLAQUE? 1228 00:50:38,984 --> 00:50:40,920 >> IT IS RETRO EXPERTIVE. 1229 00:50:40,920 --> 00:50:42,388 $$TRANSMIT RETROSPECTIVE. 1230 00:50:42,388 --> 00:50:45,357 $$TRANSMIT 1231 00:50:45,357 --> 00:50:48,594 >> AND THE FDA WILL ALLOW THAT 1232 00:50:48,594 --> 00:50:50,095 IN THIS CASE? 1233 00:50:50,095 --> 00:50:54,567 >> WELL, WE HAD ALREADY DESIGNED 1234 00:50:54,567 --> 00:50:56,368 A RANDOMIZED STUDY AND SOME SAID 1235 00:50:56,368 --> 00:50:58,070 YOU COULDN'T DO THAT BUT I 1236 00:50:58,070 --> 00:50:59,471 THOUGHT IT WAS MICE BECAUSE IT 1237 00:50:59,471 --> 00:51:01,707 HAD A CROSSOVER AND MA MADE IT 1238 00:51:01,707 --> 00:51:03,342 ALL RIGHT ETHICALLY, I THOUGHT. 1239 00:51:03,342 --> 00:51:05,811 BUT AS THEY WALKED THROUGH THE 1240 00:51:05,811 --> 00:51:07,146 DOOR, THEY STATE RETROSPECTIVE 1241 00:51:07,146 --> 00:51:08,681 CONTROLS ARE SO GOOD, IT WOULD 1242 00:51:08,681 --> 00:51:13,319 BE IMMORAL FOR US TO ASK FOR A 1243 00:51:13,319 --> 00:51:15,387 RANDOMIZED STUDY. 1244 00:51:15,387 --> 00:51:16,722 >> VERY COMFORTING, THANK YOU. 1245 00:51:16,722 --> 00:51:19,959 $$TRANSMIT 1246 00:51:19,959 --> 00:51:23,963 >> AND APPARENTLY THIS NEW LOGIC 1247 00:51:23,963 --> 00:51:25,531 HAS PERMEATED IN OTHER DISEASE 1248 00:51:25,531 --> 00:51:27,566 SO OUR PLAN PHASE 3 AND NOW I 1249 00:51:27,566 --> 00:51:30,102 LEARNED WE DON'T NEED TO DO A 1250 00:51:30,102 --> 00:51:31,670 PHASE 2 BECAUSE OUR DATA IS SO 1251 00:51:31,670 --> 00:51:35,274 GOOD AND CAN MOVE TO A PHASE 3. 1252 00:51:35,274 --> 00:51:36,442 NEVER DONE CLINICAL TRIALS 1253 00:51:36,442 --> 00:51:40,012 BEFORE AND DON'T KNOW WHAT A 1254 00:51:40,012 --> 00:51:41,580 PHASE 3 IS, I DON'T HAVE TO DO 1255 00:51:41,580 --> 00:51:43,349 ALL OF THIS MYSELF SO SOMEBODY 1256 00:51:43,349 --> 00:51:46,085 DOES AND THAT WILL BE USED IN 1257 00:51:46,085 --> 00:51:48,687 DEPICT HEALTH IF I JUMP BACK IN 1258 00:51:48,687 --> 00:51:49,788 THE SLIGHT -- I DON'T KNOW IF 1259 00:51:49,788 --> 00:51:52,658 YOU CAN SEE IT. 1260 00:51:52,658 --> 00:51:54,059 THIS PROPENSITY DATA FROM EVERY 1261 00:51:54,059 --> 00:51:56,128 PATIENT WILL COME FROM THAT SITE 1262 00:51:56,128 --> 00:52:00,099 FROM ALL THE PATIENTS WHO DID 1263 00:52:00,099 --> 00:52:02,334 NOT GET THE PERFECTLY MATCHED 1264 00:52:02,334 --> 00:52:05,771 FOR PATIENTS WHO DID NOT GET 1265 00:52:05,771 --> 00:52:06,305 CHEMOPLAQUE. 1266 00:52:06,305 --> 00:52:08,707 >> THAT IS GREAT, THANK YOU. 1267 00:52:08,707 --> 00:52:10,142 >> ANOTHER ONE, YOU MIGHT HAVE 1268 00:52:10,142 --> 00:52:11,110 BEEN EXPECTING THIS. 1269 00:52:11,110 --> 00:52:12,177 AMAZING WORK. 1270 00:52:12,177 --> 00:52:14,113 CAN YOU SPEAK MORE OF THE 1271 00:52:14,113 --> 00:52:15,114 CONSEQUENCE SCORE? 1272 00:52:15,114 --> 00:52:16,782 WHICH FACTORS GO INTO THE 1273 00:52:16,782 --> 00:52:17,116 ESTIMATE? 1274 00:52:17,116 --> 00:52:19,918 IS THIS MORE OF A INTUITION OR 1275 00:52:19,918 --> 00:52:20,819 SET OF CHECKLIST CHECKS? 1276 00:52:20,819 --> 00:52:24,023 $$TRANSMIT 1277 00:52:24,023 --> 00:52:25,557 >> THE CONSEQUENCE SCORE WAS 1278 00:52:25,557 --> 00:52:27,159 MADE UP BY ME. 1279 00:52:27,159 --> 00:52:29,862 THOSE NUMBERS, I SAID WE HAVE TO 1280 00:52:29,862 --> 00:52:32,798 MAKE THE WORST EBRT AND STANDARD 1281 00:52:32,798 --> 00:52:37,736 FOR FAILURE IN OPHTHALMOLOGY 1282 00:52:37,736 --> 00:52:38,504 LITERATURE FOR RETINOBLASTOMA 1283 00:52:38,504 --> 00:52:41,373 PATIENTS AND THAT IS IN THE 1284 00:52:41,373 --> 00:52:42,107 LITERATURE EVERYWHERE. 1285 00:52:42,107 --> 00:52:47,246 SO I PUT 30 ON IT, ADDED EUA'S 1286 00:52:47,246 --> 00:52:49,014 WHICH HAVE CONSEQUENCES TOO BUT 1287 00:52:49,014 --> 00:52:51,050 GAVE IT A .5 AND THEN WE DID 1288 00:52:51,050 --> 00:52:53,752 DESIGN A LITTLE STUDY TO SAY ARE 1289 00:52:53,752 --> 00:52:55,821 THESE NUMBERS THE RIGHT GUESSES 1290 00:52:55,821 --> 00:52:57,890 BUT IT DOESN'T MATTER THE WAY WE 1291 00:52:57,890 --> 00:53:01,293 ARE HE USING IT BECAUSE THEY ARE 1292 00:53:01,293 --> 00:53:02,761 MATCHED ON BOTH SIDES WITH THE 1293 00:53:02,761 --> 00:53:04,330 SAME NUMBERS. 1294 00:53:04,330 --> 00:53:06,999 SO JUST IMPACT COUNTING HOW MANY 1295 00:53:06,999 --> 00:53:13,472 EVENTS HAPPENED, A DIFFERENT 1296 00:53:13,472 --> 00:53:15,174 IMPACT COMPARING ENUCLEATION OF 1297 00:53:15,174 --> 00:53:17,376 THE EYES VERSUS CHEMOPLAQUE. 1298 00:53:17,376 --> 00:53:19,345 BUT I DON'T KNOW ANY OTHER 1299 00:53:19,345 --> 00:53:22,081 CANCER THAT SHOWS THAT 1300 00:53:22,081 --> 00:53:22,481 CONSEQUENCE SCORE. 1301 00:53:22,481 --> 00:53:23,782 $$TRANSMIT 1302 00:53:23,782 --> 00:53:29,054 >> IT COULD BE APPLICABLE TO -- 1303 00:53:29,054 --> 00:53:30,556 >> ABSOLUTELY AND MAYBE 1304 00:53:30,556 --> 00:53:30,956 APPLICABLE TO AMD. 1305 00:53:30,956 --> 00:53:33,525 AND I WOULD LOVE TO HEAR FROM 1306 00:53:33,525 --> 00:53:36,462 EMILY MORE ABOUT THESE THINGS 1307 00:53:36,462 --> 00:53:38,097 BECAUSE THE CHEMOPLAQUE IS 1308 00:53:38,097 --> 00:53:38,797 SUSTAINED RELEASE. 1309 00:53:38,797 --> 00:53:42,067 THERE IS LOTS OF WAYS AND IN OUR 1310 00:53:42,067 --> 00:53:44,236 FANTASTIC LUNCH I HAD WITH ALL 1311 00:53:44,236 --> 00:53:45,003 THE FELLOWS AND STUDENTS, THERE 1312 00:53:45,003 --> 00:53:48,173 ARE LOTS OF DRUGS YOU GUYS ARE 1313 00:53:48,173 --> 00:53:49,375 INVENTING OR DISCOVERING OR 1314 00:53:49,375 --> 00:53:51,844 WORKING ON FOR THE EYE, THIS 1315 00:53:51,844 --> 00:53:56,148 BEAUTIFUL ORGAN, THE EYE, THAT 1316 00:53:56,148 --> 00:53:58,217 TEACHES SO MUCH ABOUT THE BODY, 1317 00:53:58,217 --> 00:54:00,753 A CONSEQUENCE SCORE COULD BE A 1318 00:54:00,753 --> 00:54:02,588 RELEVANT THING TO EVALUATE 1319 00:54:02,588 --> 00:54:05,357 OUTCOMES. 1320 00:54:05,357 --> 00:54:07,726 BUT YES, RETINOBLASTOMA 1321 00:54:07,726 --> 00:54:10,763 INVENTION IS OF CONSEQUENCE. 1322 00:54:10,763 --> 00:54:12,698 NICHE WHY IS EXTERNAL THEME 1323 00:54:12,698 --> 00:54:17,870 RADIATION SUCH A RISK FACTOR FOR 1324 00:54:17,870 --> 00:54:18,370 SUBSEQUENT NEO PLASMS? 1325 00:54:18,370 --> 00:54:22,641 $$TRANSMIT 1326 00:54:22,641 --> 00:54:29,148 >> BECAUSE RADIATION INDUCES 1327 00:54:29,148 --> 00:54:33,752 CANCER PRE DISPOSITION, CHANGES 1328 00:54:33,752 --> 00:54:37,022 IN THE AREA AND IF YOU GO TO THE 1329 00:54:37,022 --> 00:54:40,292 SUITE, YOU WEAR A ZILLION LAYERS 1330 00:54:40,292 --> 00:54:43,896 OF PROTECTION BECAUSE THERE IS 1331 00:54:43,896 --> 00:54:45,831 RADIATION EVERYWHERE AND THAT IS 1332 00:54:45,831 --> 00:54:46,265 WHAT THE DATA SHOWS. 1333 00:54:46,265 --> 00:54:48,000 I DON'T KNOW OF ANY SCIENCE 1334 00:54:48,000 --> 00:54:51,937 PROVING THAT BUT THE MOST COMMON 1335 00:54:51,937 --> 00:54:55,174 KAEPBS SERIOUS ARE MELANOMA AND 1336 00:54:55,174 --> 00:54:56,575 IN WHIM HIDDEN TILL VERY 1337 00:54:56,575 --> 00:55:05,951 RECENTLY WHEN WE LOOKED AT THE 1338 00:55:05,951 --> 00:55:07,953 DATA WAS OVARIAN BLASTOMA. 1339 00:55:07,953 --> 00:55:14,726 THAT WAS A PARTICULARLY NASTY 1340 00:55:14,726 --> 00:55:19,465 ONE BECAUSE OVARIAN CANCER GETS 1341 00:55:19,465 --> 00:55:21,266 MASKED AND CALLED FIBROIDS SO 1342 00:55:21,266 --> 00:55:26,071 THAT IS THE INHERENT RD1 DAMAGED 1343 00:55:26,071 --> 00:55:26,572 GENE. 1344 00:55:26,572 --> 00:55:27,406 >> ONE MORE QUESTION ONLINE. 1345 00:55:27,406 --> 00:55:30,375 THANK YOU FOR A WONDERFUL TALK. 1346 00:55:30,375 --> 00:55:31,977 PERHAPS NOT ENTIRELY RELEVANT 1347 00:55:31,977 --> 00:55:34,279 BUT CAN YOU SHARE ANYTHING ABOUT 1348 00:55:34,279 --> 00:55:36,081 THE CANADIAN HEALTH INSURANCE 1349 00:55:36,081 --> 00:55:36,615 LANDSCAPE? 1350 00:55:36,615 --> 00:55:40,419 THE THERAPY DOESN'T SEEM 1351 00:55:40,419 --> 00:55:40,853 EXTREMELY EXPENSIVE. 1352 00:55:40,853 --> 00:55:42,988 ARE THESE PROCEDURES COVERED OR 1353 00:55:42,988 --> 00:55:48,994 IS CHARITABLE SUPPORT NEEDED? 1354 00:55:48,994 --> 00:55:50,162 >> THE CANADIAN HEALTHCARE 1355 00:55:50,162 --> 00:55:51,997 SYSTEM COVERS BASIC CARE, NONE 1356 00:55:51,997 --> 00:55:55,234 OF THESE ARE CHARGED TO THE 1357 00:55:55,234 --> 00:55:55,467 PUBLIC. 1358 00:55:55,467 --> 00:55:57,002 THE CHEMOPLAQUE IS SO FAR 1359 00:55:57,002 --> 00:55:58,770 RESEARCH AND WE DON'T KNOW THE 1360 00:55:58,770 --> 00:56:00,105 PRICE OF THAT. 1361 00:56:00,105 --> 00:56:02,040 ONCE IT GETS THAT FAR AND IS 1362 00:56:02,040 --> 00:56:03,809 ALLOWED TO BE SOLD, I DON'T 1363 00:56:03,809 --> 00:56:07,079 THINK COMPARED TO THE COST OF 1364 00:56:07,079 --> 00:56:09,448 INTERVENTIONAL RADIOLOGY IN AN 1365 00:56:09,448 --> 00:56:13,218 INTERVENTIONAL SUITE WITH ALL 1366 00:56:13,218 --> 00:56:14,653 THE DIFFERENT THINGS IS PRETTY 1367 00:56:14,653 --> 00:56:14,853 PLUS. 1368 00:56:14,853 --> 00:56:17,990 SO I THINK IT IS A REALLY GOOD 1369 00:56:17,990 --> 00:56:20,025 THING FOR GLOBAL RED THOUGH 1370 00:56:20,025 --> 00:56:23,262 BLASTOMA BECAUSE IF YOU PUT IT 1371 00:56:23,262 --> 00:56:28,534 IN A PATIENT IN AFRICA, THE 1372 00:56:28,534 --> 00:56:31,103 CANCER JUST DISAPPEARS. 1373 00:56:31,103 --> 00:56:33,438 BUT COST IS, I AM SORRY, CAN'T 1374 00:56:33,438 --> 00:56:36,441 SPEAK TO THE U.S. AS IT IS VERY, 1375 00:56:36,441 --> 00:56:38,210 VERY DIFFERENT THERE. 1376 00:56:38,210 --> 00:56:41,280 $$TRANSMIT . 1377 00:56:41,280 --> 00:56:43,415 >> THANK YOU VERY MUCH FOR A 1378 00:56:43,415 --> 00:56:44,583 WONDERFUL TALK AND ALL YOUR 1379 00:56:44,583 --> 00:56:46,184 DISCUSSION AND THANK YOU ALL FOR 1380 00:56:46,184 --> 00:56:47,019 BEING HERE. 1381 00:56:47,019 --> 00:56:48,687 WE REALLY LOOK FORWARD TO YOUR 1382 00:56:48,687 --> 00:56:50,355 NEXT TRIAL TO SEE WHAT HAPPENS 1383 00:56:50,355 --> 00:56:51,356 WITH THESE LITTLE CHILDREN AND I 1384 00:56:51,356 --> 00:56:53,225 THINK IT IS HEART WARMING YOU 1385 00:56:53,225 --> 00:56:54,660 ARE DOING THIS GLOBALLY AROUND 1386 00:56:54,660 --> 00:56:57,896 THE WORLD AND THAT PEOPLE ARE 1387 00:56:57,896 --> 00:56:59,298 GETTING BENEFITS FROM YOUR 1388 00:56:59,298 --> 00:57:01,266 RESEARCH WHICH IS FANTASTIC. 1389 00:57:01,266 --> 00:57:04,403 I WELCOME ALL OF YOU TO A 1390 00:57:04,403 --> 00:57:05,304 RECEPTION OUTSIDE AND THANK YOU 1391 00:57:05,304 --> 00:57:08,106 VERY MUCH FOR ATTENDING AND FOR 1392 00:57:08,106 --> 00:57:10,275 ALL THESE QUESTIONS HERE AND 1393 00:57:10,275 --> 00:57:12,778 ONLINE AND THANK YOU FOR BEING 1394 00:57:12,778 --> 00:57:23,322 HERE, BRENDA, REALLY APPRECIATE.