Faculty Disclosure

In accordance with ACCME guidelines, any individual in a position to influence and/or control the content of this ASCP CME activity has disclosed all relevant financial relationships within the past 12 months with commercial interests that provide products and/or services related to the content of this CME activity.

The individual below has responded that he/she has no relevant financial relationship(s) with commercial interest(s) to disclose:

William K. Funkhouser, MD PhD

Molecular Pathology: The Future

Wm. K. Funkhouser, MD PhDUNC Pathology & Lab Medicine

Our Future Pathology Practice will be:

Citius - FasterAltius - HigherFortius - Stronger

Citius - Faster

Faster Transfer from Discovery to Practice

Galen to Harvey: Millennium Scurvy to citrus on ships: Century PCN to production: Decades HER2 amp, EGFR muts to Rx: Years ASCO meets annually….

Faster Technology

Automation of chemistry

Miniaturization of chemistry

Computer analysis of data

Faster Risk Estimates

For clinically unaffected individuals:

Etiologic mutation screening for couples Etiologic mutation screening of relatives

Faster Diagnosis

Molecular subtypes

Specific translocations

Germline etiologic mutations

Faster Prognosis

HemochromatosisA1AT deficiencyCystic fibrosis

Medullary thyroid Ca in MEN2 MMR-defective colorectal Ca

Faster Prediction of Therapeutic ResponseIndividual differences in drug metabolism

“Druggable” mutant protein kinases ID of resistance mutations

Faster Detection of Copy Number Variation

Gene Amplification

Allelic Loss

Multiplex testing

ISH

Faster Translocation Detection

Metaphase spreads

Locus-specific probes

Faster Sequence Variation Detection

Prenatal/Newborn screeningHLA loci Germline vs. neoplasm mutsFusion partners Clonal Ig or TCR

Faster Epigenetic Testing

Histone protein modification

DNA promoter methylation

Imprinting abnormalities

Faster RNA Abundance Cluster Analysis

mRNAs µRNAs

Their equilibria

Altius - Higher

Higher Complexity

Multi-analyte tests

Traits

Statistics

Higher Confidence

Risk prediction

Diagnostic, prognostic, predictive

Management guidance

Higher Productivity

Timely reporting of accurate diagnoses with useful predictive data

Prompt guidance of the treating clinician, particularly re. expensive targeted therapies

Fortius - Stronger

Stronger Associations

Statistical associations

Organizational associations

Stronger Opinions

Education of lawyers, legislators, judges, and payors

Stronger Conclusions

Better diagnostic reproducibilityBetter diagnostic accuracyBetter outcome prediction Better management guidance

.

Going forward, Molecular Pathology will

Improve our understanding of disease risk, etiology, pathogenesis, and outcomes

Complement morphology

Benefit our patients, our treating clinicians, and ourselves

Thanks to:

Drs. Myers, Humphrey, DeYoung (ADASP Leaders)Drs. Eberhard, Sepulveda, and Pfeifer (Speakers)Drs. Gulley, Weck, Tsongalis, and Nowak (AMP)

You, for participating in this ADASP meeting