001 002 003 004 005 006 007 008 009 010 011 012 014 015 016 017 018 019 020 021

022 023 024 025 026 027 029 030 031 032 034 036 038 040 041 042 044 045 046 048

049 050 051 052 054 056 057 058 059 061 068 069 073 074 075 076 077 078 080 083

084 086 088 089 090 091 092 093 094 095 097 098 099 103 104 106 107 108 109 110

111 114 116 117 118 120 122 123 124 125 127 128 129 130 131 132 133 137 138 139

140 141 143 147 148 149 151 153 157 158 162 163 165 166 167 169 170 171 174 175

001 002 003 004 005 006 007 008 009 010 011 012 014 015 016 017 018 019 020 021 176 181 183 184 185 186 187 189 190 192 195 196 197 198 199 200 201 202 203 204

022 023 024 025 026 027 029 030 031 032 034 036 038 040 041 042 044 045 046 048 205 206 208 209 211 212 213 215 216 217 219 221 222 223 225 227 228 230 233 235

049 050 051 052 054 056 057 058 059 061 068 069 073 074 075 076 077 078 080 083 236 237 238 239 243 244 246 247 248 251 252 253 254 255 256 258 261 262 263 264

084 086 088 089 090 091 092 093 094 095 097 098 099 103 104 106 107 108 109 110 265 266 268 269 270 271 272 275 277 279 280 282 284 286 287 289 294 295 296 297

FIVE YEARS OF PERSONALIZED (POG) 001 002 003 004 005 006 007 008 009 010 011 012 014 015 016 017 018 019 020 021

he BC Personalized OncoGenomics such as the Terry Fox Research Institute’s Canadian 022 023 024 025 026 027 029 030 031 032 034 036 038 040 041 042 044 045 046 048 (POG) program is a clinical research initiative Comprehensive Cancer Centre Network and a 111 114 116 117 118 049 050 051 120052 054 056 057 058 059 061 068 122069 073 074 075 076 077 078 123080 083 124 125 127 128 129 130 131 132 133 137 138 139 Tstudying the impact of embedding new pan-Canadian clinical trial called CAPTUR, 298 302 303 304 307 309 311 whole genome sequencing312 into 313which will further align patients in POG314 with 315 084 086 088 089 090 091 316092 093 094 095 097 098 099 103317104 106 107 108 109 110 318 320 323 324 326 328 329 real-time treatment planning targeted treatments. 111 114 116 117 118 120 122 123 124 125 127 128 129 130 131 132 133 137 138 139 for British Columbian patients In 2017, POG research resulted in eight with metastatic . It is 140 141 143 147 148 149 151 153 157 158 162 163 165 166 167 169 170 171 174 175 publications in peer-reviewed journals, a collaborative research study from studies identifying genomic 176 181 183 184 185 186 187 189 190 192 195 196 197 198 199 200 201 202 203 204 including many BC Cancer signatures that can predict responses oncologists, pathologists, other 205 206 208 209 211 212 213 215 216 217 219 221 222 223 225 227 228 230 233 235 to some treatments for breast cancer clinical staff, researchers and patients and the molecular characterization 236 237 238 239 243 244 246 247 248 251 252 253 254 255 256 258 261 262 263 264 technical personnel. of metastatic pancreatic tumours to analyzing 265 266 268 269 270 271 272 275 277 279 280 282 284 286 287 289 294 295 296 297 140 Since the141 launch of the program in 2012, 143 the cost-trajectory of using whole-genome147 analysis 148 149 151 153 157 158 162 163 165 166 167 169 170 171 174 175

POG has successfully recruited 1,000 patients with to guide treatment decisions. Ten presentations 298 302 303 304 307 309 311 312 313 314 315 316 317 318 320 323 324 326 328 329 330 332 336 338 339 341 342 metastatic cancer and343 completed sequencing and were345 delivered at high profile clinical or scientific346 347 348 350 352 353 354 356 357 358 359 330 332 336 338 339 341 342 343 345 346 347 348 350 352 353 354 356 357 358 359 analysis on more than 600. For those 600 patients events and several news stories were

and their clinicians, they had access to additional published about POG, including 360 365 367 369 370 371 372 373 374 375 377 379 381 382 383 384 385 386 387 388 personalized information to inform their treatment an award-winning documentary decision options. BC Cancer is the only centre in the on CBC’s Nature of Things 395 396 397 398 399 400 402 403 404 405 406 408 409 410 411 413 414 415 416 418

world conducting a study on the scope and scale called Cracking Cancer. 419 420 421 425 426 436 438 439 441 442 443 446 448 449 450 453 455 456 457 459 of POG.

Over the past five years, 460 461 462 463 465 468 469 470 472 473 474 475 476 477 478 479 480 482 485 486 The majority of the funding for the direct cost of the POG team has grown POG comes from the BC Cancer Foundation. That to include more than 200 487 488 489 490 491 495 496 497 498 502 505 506 507 509 511 512 513 514 515 517 funding has been leveraged people from across BC Cancer, 176 181 183 184 185 518 519 521 186526 530 532 534 542 546 549 550 187553 554 555 557 558 559 561 189566 569 190 192 195 196 197 198 199 200 201 202 203 204 to obtain additional including at all its regional centres. 360 365 367 369 370 371 372 373support for advanced The 374impact and momentum of the 375 377 571 574 576 577 579 580 379581 583 584 586 588 590 591 594381596 598 600 601 602 604 382 383 384 385 386 387 388

research equipment, resulting collaborations will continue to foster 605 608 609 611 613 615 616 617 622 623 624 625 627 630 631 633 634 635 636 637 trainees, and related research studies and advances in clinical translation research programs and outcomes for the foreseeable future. 638 640 643 646 649 650 652 654 655 656 658 661 662 663 664 665 666 667 670 673

674 675 677 678 680 683 684 687 688 690 691 692 693 694 695 700 701 702 703 704

705 706 707 710 711 712 713 714 716 717 719 720 721 723 724 725 728 730 732 734 001 002 003 004 736 737 738 005739 742 744 745 748 751 752 006754 755 756 757 759 760 761 762 007763 764 008 009 010 011 012 014 015 016 017 018 019 020 021 205 206 208 209 211 765 766 768 212771 774 775 776 777 778 780 782 213783 784 785 789 790 791 792 215793 794 216 217 219 221 222 223 225 227 228 230 233 235 395 396 397 398 399 400 402 403 404 405 406 795 797 798 799 800 802 408803 804 806 807 810 812 813 409814 816 818 819 820 821 826 410 411 413 414 415 416 418 828 829 830 834 835 841 845 846 847 848 852 854 857 859 861 864 867 868 873 875

877 878 880 884 894 5 YEARS OF POG Personalized Oncogenomics Project at Canada’s Michael Smith Genome Sciences Center

Gastrointestinal Breast Thoracic Gynecologic Soft Tissue Skin Urologic Hematologic Head and Neck Endocrine Central Nervous System Other

22 BC Cancer 2017 Research Report BC Cancer 2017 Research Report 23 022 023 024 025 026 027 029 030 031 032 034 036 038 040 041 042 044 045 046 048 236 237 238 239 243 244 246 247 248 251 252 253 254 255 256 258 261 262 263 264 419 420 421 425 426 436 438 439 441 442 443 446 448 449 450 453 455 456 457 459

049 050 051 052 054 056 057 058 059 061 068 069 073 074 075 076 077 078 080 083 265 266 268 269 270 271 272 275 277 279 280 282 284 286 287 289 294 295 296 297 460 461 462 463 465 468 469 470 472 473 474 475 476 477 478 479 480 482 485 486

084 086 088 089 090 091 092 093 094 095 097 098 099 103 104 106 107 108 109 110 298 302 303 304 307 309 311 312 313 314 315 316 317 318 320 323 324 326 328 329 487 488 489 490 491 495 496 497 498 502 505 506 507 509 511 512 513 514 515 517

111 114 116 117 118 120 122 123 124 125 127 128 129 130 131 132 133 137 138 139 330 332 336 338 339 341 342 343 345 346 347 348 350 352 353 354 356 357 358 359 518 519 521 526 530 532 534 542 546 549 550 553 554 555 557 558 559 561 566 569

140 141 143 147 148 149 151 153 157 158 162 163 165 166 167 169 170 171 174 175 360 365 367 369 370 371 372 373 374 375 377 379 381 382 383 384 385 386 387 388 571 574 576 577 579 580 581 583 584 586 588 590 591 594 596 598 600 601 602 604

176 181 183 184 185 186 187 189 190 192 195 196 197 198 199 200 201 202 203 204 395 396 397 398 399 400 402 403 404 405 406 408 409 410 411 413 414 415 416 418 605 608 609 611 613 615 616 617 622 623 624 625 627 630 631 633 634 635 636 637

205 206 208 209 211 212 213 215 216 217 219 221 222 223 225 227 228 230 233 235 419 420 421 425 426 436 438 439 441 442 443 446 448 449 450 453 455 456 457 459 638 640 643 646 649 650 652 654 655 656 658 661 662 663 664 665 666 667 670 673

236 237 238 239 243 244 246 247 248 251 252 253 254 255 256 258 261 262 263 264 460 461 462 463 465 468 469 470 472 473 474 475 476 477 478 479 480 482 485 486 674 675 677 678 680 683 684 687 688 690 691 692 693 694 695 700 701 702 703 704

265 266 268 269 270 271 272 275 277 279 280 282 284 286 287 289 294 295 296 297 487 488 489 490 491 495 496 497 498 502 505 506 507 509 511 512 513 514 515 517 705 706 707 710 711 712 713 714 716 717 719 720 721 723 724 725 728 730 732 734

298 302 303 304 307 309 311 312 313 314 315 316 317 318 320 323 324 326 328 329 518 519 521 526 530 532 534 542 546 549 550 553 554 555 557 558 559 561 566 569 736 737 738 739 742 744 745 748 751 752 754 755 756 757 759 760 761 762 763 764

330 332 336 338 339 341 342 343 345 346 347 348 350 352 353 354 356 357 358 359 571 574 576 577 579 580 581 583 584 586 588 590 591 594 596 598 600 601 602 604 765 766 768 771 774 775 776 777 778 780 782 783 784 785 789 790 791 792 793 794

360 365 367 369 370 371 372 373 374 375 377 379 381 382 383 384 385 386 387 388 605 608 609 611 613 615 616 617 622 623 624 625 627 630 631 633 634 635 636 637 795 797 798 799 800 802 803 804 806 807 810 812 813 814 816 818 819 820 821 826

395 396 397 398 399 400 402 403 404 405 406 408 409 410 411 413 414 415 416 418 638 640 643 646 649 650 652 654 655 656 658 661 662 663 664 665 666 667 670 673 828 829 830 834 835 841 845 846 847 848 852 854 857 859 861 864 867 868 873 875

419 420 421 425 426 436 438 439 441 442 443 446 448 449 450 453 455 456 457 459 674 675 677 678 680 683 684 687 688 690 691 692 693 694 695 700 701 702 703 704 877 878 880 884 894 5 YEARS OF POG 460 461 462 463 465 468 469 470 472 473 474 475 476 477 478 479 480 482 485 486 Personalized705 Oncogenomics706 707 Project at710 Canada’s711 Michael712 Smith713 Genome714 Sciences716 Center717 719 720 721 723 724 725 728 730 732 734

Gastrointestinal Breast Thoracic Gynecologic Soft Tissue Skin Urologic Hematologic Head and Neck Endocrine Central Nervous System Other

487 488 489 490 491 495 496 497 498 502 505 506 507 509 511 512 513 514 515 517 736 737 738 739 742 744 745 748 751 752 754 755 756 757 759 760 761 762 763 764

518 519 521 526 530 532 534 542 546 549 550 553 554 555 557 558 559 561 566 569 765 766 768 771 774 775 776 777 778 780 782 783 784 785 789 790 791 792 793 794

571 574 576 577 579 580 581 583 584 586 588 590 591 594 596 598 600 601 602 604 795 797 798 799 800 802 803 804 806 807 810 812 813 814 816 818 819 820 821 826

605 608 609 611 613 615 616 617 622 623 624 625 627 630 631 633 634 635 636 637 828 829 830 834 835 841 845 846 847 848 852 854 857 859 861 864 867 868 873 875

638 640 643 646 649 650 652 654 655 656 658 661 662 663 664 665 666 667 670 673 877 878 880 884 894 5 YEARS OF POG

674 675 677 678Personalized680 Oncogenomics683 684 Project687 at Canada’s688 690 Michael691 Smith Genome692 693 Sciences694 Center695 700 701 702 703 704

Gastrointestinal Breast Thoracic Gynecologic Soft Tissue Skin Urologic Hematologic Head and Neck Endocrine Central Nervous System Other

705 706 707 710 711 712 713 714 716 717 719 720 721 723 724 725 728 730 732 734

736 737 738 739 742 744 745 748 751 752 754 755 756 757 759 760 761 762 763 764

765 766 768 771 774 775 776 777 778 780 782 783 784 785 789 790 791 792 793 794

795 797 798 799 800 802 803 804 806 807 810 812 813 814 816 818 819 820 821 826

828 829 830 834 835 841 845 846 847 848 852 854 857 859 861 864 867 868 873 875

877 878 880 884 894 5 YEARS OF POG Personalized Oncogenomics Project at Canada’s Michael Smith Genome Sciences Center

Gastrointestinal Breast Thoracic Gynecologic Soft Tissue Skin Urologic Hematologic Head and Neck Endocrine Central Nervous System Other MAKING ART WITH SCIENCE: INTERVIEW WITH MARTIN KRZYWINSKI

Popularizing science make a version depicting the relationship between the characters on the popular television series, Lost. In 2003, Martin did something simple, yet elegant, Circos wasn’t just useful, it was beautiful. that made his colleagues, and the world, take notice. “I think the reason why visualization of complex data “I looked at the way that people would traditionally works so well, is because we’ve been training to represent as horizontal lines, using spot patterns ever since life began on Earth. We’ve diagonal lines to connect to represent had solid schooling in finding patterns, because relationships. I thought: turn the chromosomes into a we wanted to avoid predators. We aren’t trained in circle. Put connecting lines on the inside.” mathematics in the same way. You can’t fall back on natural faculties for it like you can for shapes.” Making a horizontal chart into a circle turned out to be really useful in showing similarity or dissimilarity between regions in a genome, for comparing genetic Facilitating dialogue information between species or analyzing differences Martin’s work has been useful in BC Cancer’s between cancer and normal DNA, for example. It’s We’ve been training to Personalized OncoGenomics (POG) program also a useful “stopgap measure,” Martin says, a way to where whole genomes of cancer patients are spot patterns ever since make-up for what’s missing. “Visualization can indicate sequenced and compared to DNA from their cancer. life began on Earth. where to look when we don’t really know yet.” Visualizations can communicate this information He called the design Circos, and before he knew it, quickly. It can also cut across specializations, which is it was everywhere. After appearing in the Catalogue important to POG’s multidisciplinary teams. of , Martin began to see it in all To celebrate POG’s fifth anniversary in July 2017, sorts of peer-reviewed publications. But it wasn’t Martin made a graphic of all the individual POG just interesting to scientists. It appeared in the New patients that had been sequenced. He represented York Times and on the back of a coffee table book each patient as a circle with three concentric rings, by David Cronenberg. Wired Magazine asked him to shaded with 12 different colours representing different tumour types (see page 23). What you see in a circle is the three most similar tumour types, based on the genetic information of the patient’s tumour sample, to their cancer. For example, despite ancer is complicated. Decades of painstaking plethora of cancers we know too well. To date, the a diagnosis of breast cancer, the mutations in a experiments, meticulous measurements and GSC has sequenced more than two petabases patient’s cancer may be similar to a patient with reams of computer code have resulted in a of DNA, or about the same as 66,000 whole C colorectal cancer or quite different to another with dizzying array of data about the disease that even the human genomes. breast cancer. most mathematically inclined minds find boggling. How to make sense of all of these numbers? Enter “Between the fundamental aspects to the At BC Cancer’s Genome Sciences Centre (GSC), Martin Krzywinski, staff scientist with the GSC. overwhelming aspects of cancer, is where this art scientists use this data to crack cancer’s code, He makes art from it. From popularizing science comes into play. Does it tell a story? Does it look like running DNA sequencing machines 24 hours a day, to facilitating dialogue between disciplines and something you could understand even if you don’t seven days a week, analyzing the three billion base inspiring ideas for research, his data visualizations know what it is? In this example, the colours obviously pairs that make up approximately 30,000 genes and illustrations aren’t just pretty; they’re helping to mean something. The circles do too. So, now I can within the 23 chromosomes of the human genome; uncover clues about cancer. tell you a story about cancer.” errors in the code, known as mutations, result in the

24 BC Cancer 2017 Research Report BC Cancer 2017 Research Report 25 PAIN & SYMPTOM MANAGEMENT

Insights and inspiration The role of nutrition and exercise during Post-operative pain control for breast cancer treatment surgeries using breast block technique Every December, Nature publishes its “10” issue highlighting 10 science stories that had a big impact xercise and healthy eating programs have Pectoral nerve block (aka, breast block) is a relatively in the past year. In 2017, the themes included been shown in research studies to improve new technique for providing surgical anaesthesia quantum entanglement and artificial intelligence. Ethe health and well-being of women receiving and postoperative analgesia during breast surgery Generally the number 10 appears somewhere on the chemotherapy for breast cancer. However, access that relies upon the placement of local anaesthetic cover and the publication solicits for art. Martin took to such programs is currently not a common part of between the thoracic wall muscles. It allows local up the challenge. cancer care. A project led by the BC Cancer Nutrition anesthesia for up to 36 hours postoperatively, and and Rehabilitation program, in collaboration with the is even safe for patients who cannot receive general “I only make 2D flat stuff, so I thought of the Traveling Department of Physical Therapy anesthesia. At the BC Cancer Surgical Retreat, Drs. Salesman Problem.” at UBC, has examined how Sara Gough and Frances Chow presented the results The Travelling Salesman Problem (TSP) is all about many physicians would of retroactive analysis of 200 breast cancer surgeries finding the shortest route through a number of refer patients to such using breast blocks. They found that providing points without crossing the same point twice, and it’s a program, how many breast blocks gave superior pain control and fewer inspired a genre of art. TSP art are black and white women would attend post-anesthetic complications of drowsiness, nausea images represented by dots that the artist tries to find and what the benefits and vomiting. Breast blocks may also be correlated the shortest path through without doubling back. The would be. As published in with reduced , which the researchers final product is zebra-like, full of dense lines where it The Oncologist and Medicine intend to explore through future research. is black, less dense where it is grey and no lines where & Science in Sports & Exercise, the researchers it’s white. Depending on the solution, the image could found that physicians liked having a pathway to refer be compelling or just a bunch of lines. Martin did this women to a program they trusted. Women enjoyed with the number 10. the program and had improvements in fitness. Now the team, co-led by Drs. Ryna Levy-Milne, “You have to throw an algorithm at TSP art. “A lot of the stuff that I make is not useful in the way Provincial Director for Therapeutic Oncology There’s the artificial intelligence angle. And it looks that a hammer is useful. It’s not a tool for getting Services, and Kristin Campbell, Affiliate Scientist in kind of tangled too, right? So I ran it and Nature something done. But hopefully it’s inspiring. I think Cancer Control Research, has ended up using it. It’s striking. It’s jarring. I like it. It it gives people ideas. Or, perhaps, it helps to relieve received an MSFHR Reach fits my personality. the crushing burden of trying to understand science. Award to investigate I hope it puts people in a better mood; a mood that the development of helps to maintain focus on science but provides relief an exercise guidance in the form of a pleasant pattern. Maybe it even gives program specific to a scientist hope that their data has a pleasant pattern cancer survivors in British too. They just haven’t found it yet.” Columbia. The Reach Program provides funding to support teams to co-develop activities that inform or improve further health research practice or policy- making. Previous research by Drs. Levy-Milne and Campbell has established that structured exercise after a cancer diagnosis is effective in managing symptoms, improving health and returning to normal life.

26 BC Cancer 2017 Research Report BC Cancer 2017 Research Report 27