Travera Rapid Therapy Selection™ Panels

Introduction to the Panels Selected By Travera For Each Cancer

Each panel of drugs includes select drugs cited in the National Comprehensive Cancer Network (NCCN) guidelines, regardless of disease stage. While a patient may have previously taken and found a specific drug ineffective at an earlier stage, that drug may still be an effective component of a personalized drug combination.

Travera has validated 100+ FDA-approved drugs for its CLIA tests. Panels contain those drugs only.

Methodology

Travera has chosen two measures of breadth to use in selecting its standard drug panels:

• NCCN Guidelines. Travera ranked drugs based on their frequency of occurrence (the number of cancers they are approved for) in the NCCN Guidelines. While this biases old drugs (which have had time to run many clinical trials) over new drugs, we mitigate this bias by ranking drugs by category (cytotoxics, targeted inhibitors, and immunotherapies) and ranking drugs within, not across, categories.

• Anticancer Fund. The Anticancer Fund is a not-for-profit research organization dedicated to improving outcomes for cancer patients. They recently conducted and published a comprehensive analysis of all government-approved anticancer drugs (Panziarka et al., Frontiers in Pharmacology, March 2021). This analysis included a comprehensive literature search that identified the published molecular targets for each anticancer agent. Travera ranks drugs based on their number of molecular targets in the Anticancer Fund database. Including the population frequency of the occurrence of these molecular targets across cancer patients would be ideal, but that data is not available.

The 66 Travera-validated drugs are divided into four categories (Immunotherapies, Targeted Inhibitors, Chemotherapies, and Other Agents) and ranked by the two breadth measurements. The results are qualitatively quite similar, and where they are strikingly different (e.g., Entrectinib), we conclude the Anticancer Fund breadth measurement is better.

In most cases, drugs that are not included in the NCCN Guideline for particular cancer (off-label drugs) are not available to patients with that cancer for two reasons:

• CMS or private insurers will not reimburse the cost of the drug, and

• Most oncologists will not incur the professional risk of prescribing a drug not included in the NCCN Guideline for that cancer.

Consequently, we test as many on-label drugs as possible and only test off-label drugs if fewer than 20 on-label drugs exist.

We have not yet validated the immunotherapies (checkpoint inhibitors and antibodies). Still, we have a test in development for the checkpoint inhibitors that we can run on any sample with sufficient (>100,000) T cells. We do not include immunotherapies in the current generation of our standard drug panels. Still, if we receive enough T cells, we run a panel of checkpoint inhibitors against the sample and return the results in a supplemental report, free of charge.