Discussant Slides Title Radiosensitivity Index Shows Promise for

Discussant Slides: Title: Radiosensitivity Index Shows Promise for Predicting Outcomes with Adjuvant Radiation in Resected Pancreatic Cancer Patients Poster #: Monitor 4 Author: Ravi Shridhar MD, Ph. D

Title: Index Shows Promise for Predicting Outcomes with Adjuvant Radiation in Resected Pancreatic Cancer Patients Poster #: Monitor 4 Author: Ravi Shridhar MD, Ph. D • Aims: 1. To compare intrinsic radiosensitivity of pancreatic cancers to other tumor types utilizing a novel 10 gene radiation specific biomarker that derives a radiosensitivity score (RSI) 2. To determine if RSI is prognostic for overall survival in resected pancreatic cancer

Title: Radiosensitivity Index Shows Promise for Predicting Outcomes with Adjuvant Radiation in Resected Pancreatic Cancer Patients Poster #: Monitor 4 Author: Ravi Shridhar MD, Ph. D • Methods: – RSI score was calculated from a deidentified pool of 13261 genomically-profiled tumor specimens (Affymetrix Hu-RSTA -2 a 520709) from our Total Cancer Care Program (20062010) – RSI scores from 452 pancreatic cancer specimens were compared against the rest – From our tumor registry, we identified 251 resected pancreatic adenocarcinomas, of which 80 patients (49 who received postop CRT) had profiles from which we could derive RSI scores – From this dataset, a median RSI score was calculated and used a cutpoint to determine prognosis

Title: Radiosensitivity Index Shows Promise for Predicting Outcomes with Adjuvant Radiation in Resected Pancreatic Cancer Patients Poster #: Monitor 4 Author: Ravi Shridhar MD, Ph. D

Title: Radiosensitivity Index Shows Promise for Predicting Outcomes with Adjuvant Radiation in Resected Pancreatic Cancer Patients Poster #: Monitor 4 Author: Ravi Shridhar MD, Ph. D • Results – Pancreatic cancer was more radioresistant than other cancers based on RSI P<0. 0001 PDF – probability density function

Title: Radiosensitivity Index Shows Promise for Predicting Outcomes with Adjuvant Radiation in Resected Pancreatic Cancer Patients Poster #: Monitor 4 Author: Ravi Shridhar MD, Ph. D • Results – We defined • High risk (HR) (R 1, N 1, and postop CA 19 -9>90) • Low risk (LR) (R 0, N 0, postop CA 19 -9<90) • RSI high = Radioresistant (RR) • RSI low = Radiosensitive (RS) – HR patient had worse OS (hazard ratio 4. 4: 1. 8 -11. 1; p=0. 001) compared to LR. – In HR radiated pts, 3 y OS for RS vs RS was 38% vs 8% (p=0. 07). RSI was not prognostic in unirridiated pts (p=0. 79). – Integrating RSI into risk stratification to define intermediate risk (IR) • No difference in OS between HR-RS vs LR-RR (3 y OS 38% vs 50%; p=0. 29). – RSI adds significant prognostic value to the risk stratification defined in this analysis (Figure 2, Table 1).

Title: Radiosensitivity Index Shows Promise for Predicting Outcomes with Adjuvant Radiation in Resected Pancreatic Cancer Patients Poster #: Monitor 4 Author: Ravi Shridhar MD, Ph. D • Results Population Median Survival (y) 3 -yr Survival (%) p-value All Patients RT Patients (N=49) No RT Patients (N=31) High RSI Low RSI 2. 1 3. 1 1. 5 2. 7 3. 1 32 50 47 29 36 55 0. 32 0. 35 0. 57 RSI integrated into risk stratification Population Median Survival (y) 3 -yr Survival (%) p-value All Patients RT Patients (N=49) No RT Patients (N=31) Low-risk Intermediate-risk High-risk Not reached 2. 6 1. 3 Not reached 2. 4 1. 2 Not reached 2. 7 2. 3 73 39 21 78 42 8 69 33 38 0. 006 0. 001 0. 58

Title: Radiosensitivity Index Shows Promise for Predicting Outcomes with Adjuvant Radiation in Resected Pancreatic Cancer Patients Poster #: Monitor 4 Author: Ravi Shridhar MD, Ph. D • Results P=0. 001