AstraZeneca highlights continued progress of oncology pipeline at ASCO 2016

On May 19, 2016 AstraZeneca and its global biologics research and development arm, MedImmune, reported that they will provide an update on their extensive oncology pipeline at the annual meeting of the American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) in Chicago, USA, on 3-7 June 2016 (Press release, AstraZeneca, MAY 19, 2016, View Source [SID:1234512562]).

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Highlights will include new data demonstrating the strength and versatility of AstraZeneca’s industry-leading line of DNA damage response (DDR) medicines in multiple types of cancer. New data will highlight the continued momentum behind AstraZeneca’s numerous immuno-oncology (IO) programmes, and showcase small-molecule developments including Tagrisso (osimertinib) in leptomeningeal (brain) disease and the highly-selective Bruton’s tyrosine kinase (BTK) inhibitor, acalabrutinib, in chronic lymphocytic leukaemia (CLL).

Sean Bohen, Executive Vice President, Global Medicines Development and Chief Medical Officer at AstraZeneca, said: "Oncology is a strategic priority for AstraZeneca because of the potential of our broad pipeline to offer transformational therapies in cancer care. At ASCO (Free ASCO Whitepaper), we will update on our next-generation portfolio focusing on DNA damage response as a breakthrough paradigm in cancer treatment, including new long-term overall survival data for Lynparza. Our increased commitment to DDR therapies complements developments in our exciting immuno-oncology pipeline, from which we are expecting clinical results over the coming year."

DDR: A promising scientific platform, a leading position for AstraZeneca

DDR is a term describing the network of cellular pathways that minimise the daily impact of DNA damage. Currently, many cancers are known to have defects in DDR pathways, which makes them dependent on and therefore, highly sensitive to inhibition of the remaining DDR pathways. Targeting DDR deficiencies to preferentially kill cancer cells, while minimising the impact on normal cells, has potential for more selective, better tolerated therapies to improve survival in multiple cancers.

AstraZeneca is developing a comprehensive pipeline of compounds that target molecular pathways across the DDR system. These include the PARP inhibitor Lynparza (olaparib); Wee1 inhibitor AZD1775, ATM inhibitor AZD0156; ATR inhibitor AZD6738, and Aurora B Kinase inhibitor AZD2811. These compounds act on different cell-cycle points to prevent tumour cells from reproducing.

At the ASCO (Free ASCO Whitepaper) congress, DDR presentations will highlight:

The potential for maintenance of DDR therapies as shown by Lynparza overall survival data from Study 19 in ovarian cancer (Abstract # 5501). This abstract has been selected as a "Best of ASCO (Free ASCO Whitepaper)" abstract.
Opportunities for combination approaches with DDR and immuno-oncology therapies as shown in a Phase I study of the PD-L1 inhibitor, durvalumab, in combination with Lynparza or a VEGFR inhibitor, cediranib, in women’s cancers (Abstract # 3015)
The importance of selecting patients with a DDR pathway defect using the right diagnostic tool (abstract #4041)
The potential of DDR therapies against multiple biological DDR targets in different tumour types, with studies of the highly-selective WEE1 inhibitor, AZD1775, in advanced high-grade serous ovarian cancer (Abstract # TPS5610), squamous cell carcinoma of the head and neck (SCCHN) (Abstract # TPS6106), advanced solid tumours (Abstract # TPS2608) and glioblastoma (GBM) (Abstract # 2008)
Immuno-Oncology: Robust development momentum on track for read-outs in H1 2017

AstraZeneca is leading in a number of first-line studies with its IO strategy, where combined PD-L1 and CTLA-4 blockade – through the combination of durvalumab and tremelimumab – may address a significant unmet medical need for cancer patients who may not benefit from PD-1 pathway drugs in monotherapy.

Key updates include presentations covering pre-clinical data, late-stage trials and biomarker research:

Early study results of durvalumab monotherapy in urothelial bladder cancer from Phase Ib Study 1108 (Abstract # 4502)
Final results from a Phase III study of tremelimumab in mesothelioma (Abstract # 8502)
New study results on safety and clinical activity of durvalumab as first-line treatment in non-small cell lung cancer (NSCLC) (Abstract # 9029)
Ongoing investigation of the potential synergistic effects of durvalumab and the CTLA-4 inhibitor, tremelimumab, in bladder cancer (DANUBE trial – Abstract # TPS4574) and SCCHN (KESTREL trial – Abstract # TPS6101)
Enhanced understanding of PD-L1 biomarker expression in relation to primary versus metastatic tumours and sample age (Abstract # 3025)
Tagrisso in brain metastasis; acalabrutinib in CLL

AstraZeneca’s strong heritage in developing innovative targeted small molecules was underscored by the recent approval of Tagrisso as the first indicated treatment for EGFR T790M mutation-positive metastatic NSCLC in the US, EU and Japan. At ASCO (Free ASCO Whitepaper), new data will highlight the importance of Tagrisso activity in leptomeningeal disease through its ability to penetrate the blood-brain barrier. Further presentations will show the growing role of circulating tumour DNA (ctDNA) testing for diagnosis and treatment monitoring.

Key updates will also include presentation on the potential of our potent, highly-selective BTK inhibitor, acalabrutinib, in chronic lymphocytic leukaemia (CLL):

Data from the BLOOM study of Tagrisso in patients with leptomeningeal disease as a complication of EGFRm-metastatic NSCLC (Abstract # 9002)
Intensive plasma ctDNA profiling in experimental trials to identify markers of acquired drug resistance (Abstract # 11530)
Acalabrutinib – preliminary results from a first-line study as first-line therapy in CLL (Abstract # 7521) and in a Phase II study in combination with pembrolizumab in metastatic pancreatic cancer (Abstract # 4130)

Syros Pharmaceuticals to Present on its Two Lead Programs, SY-1425 and SY-1365, at 21st Congress of the European Hematology Association

On May 19, 2016 Syros Pharmaceuticals reported that preclinical data on its lead program, SY-1425, in genomically defined subsets of patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) will be highlighted in an oral presentation at the 21st Congress of the European Hematology Association (EHA) (Free EHA Whitepaper) taking place June 9-12 in Copenhagen, Denmark (Press release, Syros Pharmaceuticals, MAY 19, 2016, View Source [SID:1234512614]). The Company will also present new preclinical data on its first-in-class selective cyclin-dependent kinase 7 (CDK7) inhibitor, SY-1365, in acute leukemia.

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SY-1425 in Novel Genomically Defined Subset of AML and MDS Patients Using its gene control platform, Syros identified a subset of AML and MDS patients whose tumors have a highly specialized regulatory region of non-coding DNA, known as a superenhancer, associated with the RARA gene. The super-enhancer associated with RARA is believed to lead to over-production of the RARα transcription factor, locking cells in an immature, undifferentiated and proliferative state. Treatment with SY-1425, an oral, potent and selective agonist of RARα, appears to promote differentiation of cancer cells with the RARA-associated super-enhancer, inhibiting the cancer’s growth. The oral presentation at EHA (Free EHA Whitepaper) will detail SY-1425’s mechanism of action as well as in vitro and in vivo data showing that a biomarker for the RARA super-enhancer discovered by Syros is predictive of response to treatment with SY-1425 in models of AML, including a survival benefit observed in the mice with the RARA biomarker when treated with SY-1425. Syros is on track to advance SY-1425 into a Phase 2 trial in mid-2016 in subsets of AML and MDS patients whose tumors are positive for the RARA biomarker.

Date & Time: Sunday, June 12, from 9-9:15 a.m. CEST Presentation Title: Super-Enhancer Analysis Defines Novel AML and MDS Sub-Types Sensitive to SY-1425, a Potent and Selective RARα Agonist Session Title: AML Biology – Novel Targeted Therapies Presenter: Michael R. McKeown, Ph.D., Senior Scientist, Syros Pharmaceuticals Abstract Number: S807 Location: Bella Center, Auditorium 2

CDK7 Inhibition as a Novel Treatment Strategy for Acute Leukemia
Certain cancers, including AML and acute lymphoblastic leukemia (ALL), are dependent on high and constant expression of transcription factors for their growth and survival and have been shown to be particularly responsive to selective inhibition of the transcriptional kinase CDK7. The poster presentation at EHA (Free EHA Whitepaper) details preclinical data demonstrating that SY-1365, the Company’s first-in-class selective and potent CDK7 inhibitor, preferentially kills cancer cells by inducing robust and dose-dependent apoptosis in acute leukemia cell lines while not inducing apoptosis in non-cancerous cells. The data also show that SY-1365 produces a significant survival benefit in patient-derived xenograft models of AML. Syros expects to advance SY-1365 into a Phase 1/2 trial in the first half of 2017 in patients with acute leukemia, including AML and ALL.

Date & Time: Saturday, June 11, from 5:30-7 p.m. CEST Presentation Title: First-in-Class CDK7 Inhibitor Induces Robust Apoptosis in Acute Myeloid Leukemia and Demonstrates Durable In Vivo Efficacy Session Title: Acute Myeloid Leukemia – Biology 3 Presenter: Yoon J. Choi, Ph.D., Senior Scientist, Syros Pharmaceuticals Abstract Number: P558 Location: Bella Center, Hall H, Poster Area

Cerulean Announces Oral Presentation of CRLX101 Clinical Data at Gynecologic Oncology 2016 Conference

On May 19, 2016 Cerulean Pharma Inc. (NASDAQ:CERU), a clinical-stage company developing nanoparticle-drug conjugates (NDCs), reported that the Company will present in an oral session Phase 1b results of an ongoing clinical trial of CRLX101 in combination with weekly paclitaxel in patients with relapsed ovarian cancer at the Gynecologic Oncology 2016 Conference being held May 19-21 in San Antonio, Texas (Press release, Cerulean Pharma, MAY 19, 2016, View Source [SID:1234512613]). This trial is being conducted by Cerulean in collaboration with the GOG Foundation, Inc.

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Details of the presentation are as follows:

Title: A Phase 1b study of the nanoparticle-drug conjugate (NDC) CRLX101 in combination with weekly paclitaxel in patients with advanced neoplasms including platinum-resistant tumors
Date/Time: Thursday, May 19, 2016, 12:20-12:50 pm CDT
Location: Hilton San Antonio Airport Hotel
Summary: As previously announced, a maximum tolerated dose and a recommended Phase 2 dose of 15 mg/m2 for CRLX101 (bi-weekly) and weekly paclitaxel 80 mg/m2 (3 weeks on; 1 week off) have been declared. Three patients were treated with 12 mg/m2 of CRLX101 and six patients were treated with 15 mg/m2 of CRLX101. The combination appears to be generally well tolerated, and no dose limiting toxicities observed at either dose level. To date, the only treatment-related adverse events were one Grade 3 and one Grade 4 neutropenia. The most common adverse events ( > 30%) were fatigue, neutropenia, and nausea. Objective RECIST responses were achieved by 5 of 9 patients (56%), including one patient who experienced complete disappearance of the tumor but had detectable CA125. Importantly, 3 of the 5 patients who achieved objective RECIST responses were previously treated with Avastin (bevacizumab). Based on the antitumor effect observed in these first nine patients, the trial will be expanded.

About GOG Foundation, Inc. (GOG Foundation)

The GOG Foundation, Inc. (GOG Foundation) is an independent international non-profit organization with the purpose of promoting excellence in the quality and integrity of clinical and basic scientific research in the field of gynecologic malignancies. The GOG Foundation is committed to maintaining the highest standards in clinical trials development, execution, analysis and distribution of results. Continuous evaluation of the GOG Foundation’s processes is utilized in order to constantly improve the quality of patient care. The GOG Foundation conducts clinical trials for patients with a variety of gynecologic malignancies, including cancers that arise from the ovaries, uterus, cervix, vagina, and vulva. The GOG Foundation is a separate entity from the National Clinical Trials Network groups that are funded by the National Cancer Institute.

About CRLX101

CRLX101 is a nanoparticle-drug conjugate (NDC) designed to concentrate in tumors and slowly release its anti-cancer payload, camptothecin, inside tumor cells. CRLX101 inhibits topoisomerase 1 (topo 1), which is involved in cellular replication, and also inhibits hypoxia-inducible factor-1α (HIF-1α), which research suggests is a master regulator of cancer cell survival mechanisms. CRLX101 has shown activity in four different tumor types, both as monotherapy and in combination with other cancer treatments. CRLX101 is in Phase 2 clinical development and has been dosed in more than 350 patients. The U.S. FDA has granted CRLX101 Orphan Drug designation for the treatment of ovarian cancer and Fast Track designation in combination with Avastin in metastatic renal cell carcinoma.

Castle Biosciences Announces New Clinical Data to be Presented at ASCO 2016 Confirming Performance of DecisionDx-UM Gene Expression Profile (GEP) Test in Uveal Melanoma

On May 19, 2016 Castle Biosciences, Inc., a provider of molecular diagnostics to improve cancer treatment decisions, reported new clinical data on DecisionDx-UM, its gene expression profile (GEP) test to predict metastasis in patients diagnosed with uveal melanoma (Press release, Castle Biosciences, MAY 19, 2016, View Source [SID:1234512612]). The new data will be highlighted in a presentation at the 2016 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting being held in Chicago, IL from June 3-7.

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In a poster presentation titled, "A Prospective, Multi-Center Study to Evaluate the Performance and Clinical Utility of a 15-Gene Expression Profile for Uveal Melanoma" (Abstract #9575), Castle Biosciences researchers and collaborators will present findings from 70 patients in the prospective, multi-center CLEAR (Clinical Application of DecisionDx-UM Gene Expression Assay Results) study. The CLEAR study tracked clinical management and metastatic outcomes of patients with low-risk Class 1 or high-risk Class 2 gene test results who had no evidence of distant metastasis at the time of primary tumor treatment. Surveillance mode and frequency were independently determined by participating physicians as they deemed appropriate for low-risk Class 1 and high-risk Class 2 patients.

Study Results

37 patients (53%) had a low-risk Class 1 GEP test result; 33 patients (47%) had a high-risk Class 2 result;
Impact on clinical management:
All Class 2 patients were managed with high intensity surveillance (imaging and/or liver function tests every 3-6 months);
81% of Class 1 patients were managed with low intensity surveillance (imaging and/or liver function tests every year);
There was a significant difference in management of Class 1 and Class 2 patients (p=2.1×10-13);
33% of Class 2 patients were referred to a medical oncologist for surveillance and/or clinical trial enrollment, compared to 11% of Class 1 patients (p=0.04).
Clinical outcomes:
Overall, two Class 1 patients and 12 Class 2 patients developed metastasis (p=0.002) with a median follow-up of 27.3 months;
At 3 years, metastasis-free survival rates were 100% for Class 1 and 63% for Class 2 (p=0.003).
"This prospective study demonstrated clinically and statistically significant impact on follow-up treatment consistent with a previously published retrospective multi-center clinical utility study," commented Derek Maetzold, President and CEO of Castle Biosciences. "In addition, the clinical performance of the test is consistent with previously published prospective multi-center and single-center studies, confirming the robustness of the DecisionDx-UM test."

About Uveal Melanoma
Uveal melanoma, while rare, is the most common form of eye cancer in the United States with about 1,600 diagnoses per year. This form of eye cancer may occur in any of the three parts of the uvea. Similar to other melanomas, uveal melanoma begins in cells called melanocytes that help produce the pigments of the skin, hair and eyes. While more common in patients who are middle-aged with fair skin, uveal melanoma can affect people of all complexions and ages.
Although a small percentage (3%) of patients with uveal melanoma have detectable metastatic lesions at the time of diagnosis or treatment of the primary tumor, up to 50% of patients will subsequently develop metastatic disease. This necessitates a rigorously validated, accurate and reliable tool to identify patients likely to develop distant metastasis.

About DecisionDx-UM
The DecisionDx-UM test measures the gene expression profile (GEP), or molecular signature, of an individual’s tumor and identifies with high accuracy the likelihood of metastasis.
The DecisionDx-UM test is standard of care in the management of uveal melanoma in the majority of ocular oncology practices. It is the only test for uveal melanoma that has achieved National Cancer Institute/National Comprehensive Cancer Network Level of Evidence 1A, a critical factor in test adoption and clinical decision-making. Additionally, the American Joint Committee on Cancer recommends gene expression profile testing for use as the results are "clinically significant." The American Joint Committee on Cancer (AJCC, version 7, 2010) is the only national organization that reviews uveal melanoma and the DecisionDx-UM test is the only clinically available GEP test for use in the U.S. The test has been validated in multiple prospective and retrospective studies. More information about the test and disease can be found at www.MyUvealMelanoma.com.

Castle Biosciences Announces New Clinical Data Presentations at ASCO 2016 Underscoring the Accuracy and Clinical Utility of Gene Expression Profile Test for Cutaneous Melanoma

On May 19, 2016 Castle Biosciences, Inc., a provider of molecular diagnostics to improve cancer treatment decisions, reported that several abstracts on the Company’s gene expression profile (GEP) tests for cancer were accepted for poster presentation at the 2016 American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting being held in Chicago, IL from June 3-
7 (Press release, Castle Biosciences, MAY 19, 2016, View Source [SID:1234512611]). Included in the presentations are results from a new multicenter performance study of cutaneous melanoma tumors from 334 patients, confirming the positive results from the two previously published multicenter clinical validation studies,
and a new multicenter decision impact study of the DecisionDx-Melanoma test.

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Multicenter Performance Study in Cutaneous Melanoma: In a study, titled "Performance of a 31-Gene Expression Profile in a Previously Unreported Cohort of 334 Cutaneous Melanoma Patients" (Abstract # 9581), 334 cutaneous melanoma tumors from 12 centers in the U.S. were analyzed using the DecisionDx-Melanoma gene expression profile (GEP) test. Tumors were classified as low-risk Class 1 or high-risk Class 2. The Class status was compared to traditional methods for predicting distant metastasis at diagnosis.

Summary of Results:

Cox univariate regression analysis of the cohort indicated that Breslow’s thickness, ulceration, mitotic rate, sentinel lymph node (SLN) status and results of the GEP test were significant predictors of distant metastasis risk (p<0.008 for all; median Breslow’s thickness = 1.5 mm, median follow up = 5.3 years); However, only the GEP test (p=0.031) and SLN status (p= 0.002) were shown to be independent predictors of distant metastasis (Cox multivariate regression analysis); 13 of 83 (16%) SLN negative cases had a distant metastatic event; 10 (77%) of these cases were predicted to be high-risk (Class 2 result) by the GEP test;
Accuracy of distant metastasis risk prediction by the GEP test showed 76% sensitivity, 55% specificity, 42% positive predictive value and 85% negative predictive value, compared to 72%, 64%, 45% and 84%, respectively, for SLN
status.

"The results from this multicenter performance study confirm the accuracy of the
test in predicting metastasis as documented in previously published clinical
validation studies of DecisionDx-Melanoma," commented Federico A. Monzon,
M.D., FCAP, Chief Medical Officer of Castle Biosciences. "Our test complements
traditional staging tools to better identify patients at risk for recurrence, enabling
implementation of follow-up plans that are consistent with a patient’s individual
risk of recurrence."

Independent, Prospective Study in Cutaneous Melanoma:
Also at the meeting, a study titled "Prospective Validation of Gene Expression
Profiling in Primary Cutaneous Melanoma" (Abstract #9565), will be presented
from a prospectively designed and conducted study of 174 melanoma patients
undergoing sentinel lymph node biopsy (SLNB) and testing with the DecisionDx-
Melanoma GEP test. The data show that GEP classification is significantly
associated with early recurrence in patients diagnosed with melanoma.

In the study, 174 melanoma patients undergoing SLNB also underwent GEP
testing of their primary tumor at the time of the initial evaluation. The GEP test
result was reported as Class 1 low-risk or Class 2 high-risk of metastasis, or
insufficient tumor sample (INS). Median follow-up was 12 months.

Summary of Results:

Analysis was conducted on 159 patients with GEP test results:
Gender (p=0.008), Breslow’s thickness (<0.0001), ulceration (<0.0001), SLN positivity (=0.01) and Disease-Free Survival (<0.0001) were significantly associated with GEP test classification;
SLN was positive for 20 patients (13%) and negative for 139 patients
(87%):
Seven (35%) of 20 SLN positive patients and seven (5%) of 139
SLN negative recurred within 2 years;
GEP test results: 42 were high-risk Class 2 and 117 patients were low-risk
Class 1;
13 (31%) of the 42 Class 2 patients, and one (<1%) of the 117 Class 1 patients recurred within 2 years;
Of 10 patients with both a Class 2 GEP status and positive SLN, seven
(70%) recurred.
Multicenter, Decision Impact Study in Cutaneous Melanoma:
A third abstract related to cutaneous melanoma entitled, "Impact of Prognostic
Genomic Classification of Melanoma with a 31-Gene Expression Profile on
Clinical Decision-Making in a Retrospective Cohort" (Abstract #e21066), was
accepted for publication at the meeting.
In this study, medical records of cutaneous melanoma patients consecutively tested with DecisionDx-Melanoma at 6 medical practices from May 2013 to September 2015, were reviewed under an IRB-approved protocol. Investigators
reported clinical management plans included frequency of visits, frequency and modality of imaging, use of laboratory tests and specialty referrals. Clinical
management plans before and after receipt of the DecisionDx-Melanoma test results were collected to assess the impact on clinical decision making. Results
showed that the GEP test outcome changed clinical management for over half of the tested patients.

Summary of Results:

153 cutaneous melanoma patients met inclusion criteria with complete AJCC staging and management information:
44% were Stage I, 50% Stage II, and 6% Stage III;
61% (94) had low-risk Class 1 GEP test results and 39% (59) had high-risk Class 2;
Test results prompted a change in clinical management in 52% of patients:
78% of Class 2 and 36% of Class 1 patients had management changes (p<0.0001);
Of the 80 cases with observed changes in management, 95% (76) were adjusted in a manner consistent with DecisionDx-Melanoma Class prediction (higher intensity management in Class 2 patients versus lower intensity management in Class 1 patients);
Association between GEP test class and change in management intensity was statistically significant (p< 0.0001).
"The DecisionDx-Melanoma test has now been evaluated in clinical studies that included more than 900 melanoma patient cases, with more than 400 in independent, prospectively designed trials," commented Derek Maetzold, President and CEO of Castle Biosciences. "Each study showed a consistent, high rate of accuracy and clinical utility. These new results and the high negative predictive value rates for melanoma-specific survival observed across the DecisionDx-Melanoma studies give physicians and patients comfort when following a disease management plan based on results of staging and our GEP test."

Development Study in Soft Tissue Sarcoma:
Also at the meeting, in a study called "Metastasis Risk Prediction in Non-Translocation Soft tissue Sarcoma with a Novel Gene Expression Profile Assay" (Abstract #11055), investigators will present data from a new test developed by Castle Biosciences to assess the risk of cancer recurrence in patients diagnosed with soft tissue sarcomas (STS). Results showed that the STS-profile assay was able to distinguish two groups with significantly different metastatic risk.

About Melanoma
Cutaneous melanoma is diagnosed in approximately 76,000 people in the U.S.
each year, according to the American Cancer Society. Seventy-five percent are
diagnosed as Stage I or II, meaning there is no evidence of the melanoma
spreading beyond the primary tumor. It is not the most prevalent form of skin
cancer, but it is the most aggressive. Unlike other more common skin
malignancies such as basal cell and squamous cell carcinomas, melanoma often
spreads to other parts of the body, either via the lymphatic or blood system,
resulting in cancers of distant organs including the brain or lungs. So, while it
represents just 4% of skin cancers, melanoma accounts for about 80% of skin
cancer-related deaths.

About Soft Tissue Sarcoma
Soft tissue sarcoma is a type of cancer that occurs in the soft tissues of the body,
including muscle, tendons, fat, lymph and blood vessels, nerves and the tissue
surrounding joints. While soft tissue sarcoma can be found anywhere in the body,
approximately 40% of these tumors originate in the arms and legs. There are
more than 70 types of soft tissue sarcomas, which are diagnosed through
physical exam, imaging tests and ultimately, biopsy. The American Cancer
Society estimates approximately 12,000 new cases of soft tissue sarcomas in the
United States in 2015. Treatment includes surgical removal of tumor,
chemotherapy, radiation or experimental therapies administered through clinical
trials.