The APOLLO Network: Data Liquidity for Cancer Cures

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Cancer is undoubtedly one of today’s deadliest diseases with the American Cancer Society anticipating that over 1.7 million new cases will arise while over 600,000 people will lose their personal battle with the disease just in 2018 alone. The need for patients, providers, and health researchers to be armed with tools that will effectively and optimally fight cancer is more critical than ever. This is where health tech entrepreneurs come in: solutions are needed and you are the ones who can build them.

The APOLLO Network, a tri-federal agency initiative stemming from the Cancer Moonshot, grew out of such a need. In this post, I am both pleased and excited to feature an interview with Cancer Moonshot’s Dr. Jerry Lee.  Dr. Lee is the former Deputy Director for Cancer Research and Technology for the White House Cancer Moonshot Task Force and current Deputy Director for the National Cancer Institute’s (NCI) Center for Strategic Scientific Initiatives.

Jamie: Jerry, thanks again for joining me. If you wouldn’t mind, could you give a quick description of APOLLO? What is its purpose?

Jerry: APOLLO stands for Applied Proteogenomic Organizational Learning and Outcomes. It is a collaboration between the NCI, the Department of Defense (DoD), and the Department of Veterans Affairs (VA) aimed at creating the nation’s first healthcare enterprise where proteomic analysis complements genomic sequencing in cancer patients to inform targeted decision making. More simply it is meant to track cancer patients and survivors in both the DoD and VA systems, following them through their cancer care and beyond to glean what treatments are most effective for each individual. Currently, we are working towards collecting data on a combined cohort of 8,000 patients within the VA and DoD systems. Having started with lung cancer, we are now expanding to additional cancer types, including cancers of the ovary, endometrium, prostate, and breast. As the program grows, our goal is to continually generate new information that will boost the clinician’s ability to treat the disease.

Jamie: If a health tech innovator wants to design a next generation solution aligned with the APOLLO mission, what would you suggest they prioritize?

Jerry: I’d say there are really three key components that make up the APOLLO ideology: precision medicine, interoperability, and health outcomes. Precision medicine is all about customizing healthcare to fit the individual. Through proteogenomic analysis, we get a better sense of the molecular basis of each patient’s unique cancer and are able to make informed decisions about targeted therapies. In this way, proteogenomics has become a keystone of precision oncology, and we use its findings to refer patients to the appropriate clinical trials. But precision is not just based on proteogenomics alone.  Another major factor is imaging (including CT, PET, MRI) which we use in conjunction with proteogenomics to triangulate upon the problem. Pre and post treatment images are taken of the same APOLLO patients that have had his or her tumor sent for proteogenomic analysis in order to see the effect the recommended therapies have on the tissue and the patient. This data and these images help us illuminate major points in a cancer patient’s journey, whether that be survivorship or recurrence. 

In order for digital data to impact patient care, this data needs to be exchanged accurately and efficiently. Part of this is ensuring semantic interoperability right from the start. If the end goal is to see patients using apps and data platforms to share data and get information and treatment options specific to their individual profiles in a timely fashion, then we need systems across the board all speaking the same language. For precision oncology, this includes interoperability of cancer specific genomic, proteomic, imaging, and clinical data.

At the end of the day, the most important part of all of this is the health outcomes. APOLLO is, at its core, creating a learning healthcare system and it is through these outcomes that we learn and adapt. We gain insights about effective therapies and long-term patient outcomes that would simply not be possible without the APOLLO network. 

Jamie:  Finally, what advice would you give to innovators looking to build precision oncology data tools?

Jerry: Don’t reinvent the wheel. It’s something I constantly tell my staff and something that absolutely applies here. Use what has already been done. Take advantage of the data that’s publicly available, through the NCI Genomic Data Commons, Proteomic Data Portal, and Cancer Imaging Archive or engage with a fellowship program, such as BD-STEP, and have a chance to work with the data first hand in the VA system, including data from APOLLO. We are dealing with a world where data needs to be accurate and flow quickly. Having multiple, inoperable libraries only hinders progress as we move towards finding effective intervention strategies for active duty, beneficiaries, veterans, and civilian cancer patients. 

Additional Resources:

https://proteomics.cancer.gov/programs/apollo-network

https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2810

http://onlinelibrary.wiley.com/doi/10.1002/cpt.658/abstract;jsessionid=032755370412D3CF7BEE6E1012FC8171.f04t02

Acknowledgements: Special thanks to Mary Kozlowski and Sarah Elder of NCI who helped to pull together the resources for this post; for more information about anything contained in this article, please email kozlowskimt@mail.nih.gov.

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