CENTRAL LABORATORY SERVICES

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1 CENTRAL LABORATORY SERVICES Bridging the Gaps in Biomarker Development and Testing for Global Clinical Trials Biomarkers, Digital Pathology & the Central Lab Presentation Title Presenter Name July 16, 2008 Christopher Ung, M.S., MBA Vice President, Global Central Laboratories TMD, A Quintiles Central Laboratory January 26,

2 Complexity of Signaling Pathways in Cancer Cell ECM Growth factors (e.g. EGF, amphiregulin TGFα) GPCR ligands Nuclear receptors (e.g. oestrogen) Survival factors (e.g. IGF1) WNT Integrins RTK 7-TMR E-Cadherin RTK Fyn Shc NF1 Grb2 SOS Abl Frizzled Cytokines (e.g. ILs, IFNs) Dishevelled GSK-3β APC β-cutenin CdC42 PI3K Rac Ras PLC Fak Src Cas Crk TCF PKC Mos MKKs JNKs Tubulin Ral MEK MAPK MAPK ELK Max:Max MEKK CdC42 Rac Rho Myc:Max β-cutenin:tcf JUN G-Prol Ad Cycl PKA CREB PKC P13K Akt Akka IKB? PTEN Stat 3.5 Jaks Cytokine R NF-κB Fos NHR (e.g. ER) Stat 3.5 Bcl XL NF-κB Bad Abnormality sensor p16 Changes in Gene Expression Stat 3.5 Cell Death (Apoptosis) Caspase 8 Caspase 9 Cytochrome C Mitochondria Bim, etc. ARF Bcl-2 Anti-growth factors (e.g. TGFβ) Cycl D:CDK+ p15 Smads Rb E2Fs HPVE7 p27 Cycl E:CDK2 Cell Proliferation (cell cycle) MDM2 p21 p53 Bid TGFβR DNA damage sensor Fap Bax Mitochondria Decoy R Surface Ag Bcl-2 FADD Fas Hanahan D. Weinberg RA. Cell (2000). Vol 100: Death factors (e.g. FasL) Hanahan D, Weinberg RA. Cell (2000). Vol 100:

3 Challenge of Using Biomarkers in Drug Development Validation > Is the biomarker specific? > What methods were used to establish/ confirm specificity? > Is it reproducible? > Were associated proteins activated or inhibited to confirm specificity? > How will regulatory bodies regard this data? Geography > Are the assays reproducible inter-laboratory? > Will the SOPs be the same in different countries? > Are the logistics capabilities standardized? > How will data from a multisite trial be integrated? 3

4 Quintiles Oncology Service Offerings Quintiles Translational Research & Development Early Compound Differentiation Services Consultation Services Targeted Therapy, Biomarker, Protocol Design Companion Diagnostics Central Lab Services for Clinical Trials Tissue Management Anatomic Pathology Tissue-based Biomarkers Soluble Biomarkers Digital Pathology

5 Quintiles Integrated Laboratory Solution for Oncology Clinical Trials Enhanced Specimen Management Biorepository Quintiles Oncology Histopathology Digital Pathology Solution Biomarker Testing Assay Development Lab 5

6 Validation the Central Lab Approach > Assays will be developed in a single location > Technology transfer takes place in a standardized fashion following established SOPs > QC and QA metrics in place to ensure reproducibility > Standardized training for all activities > Use digital pathology for training, quality assurance and assessment of complex biomarkers (e.g. PTEN) 6

7 PTEN IHC Assay Background: PTEN is a tumor suppressor gene whose expression is frequently lost in human tumors (2 nd only to loss of p53). Objective: To develop a specific, sensitive and reproducible immunohistochemistry (IHC) assay for the detection of PTEN in human tissue specimens. > To develop an image analysis method to measure PTEN expression in both tumor and stromal cells in human specimens. Importance: Comparison of tumor to stromal cell staining may indicate if a tumor has reduced PTEN expression relative to normal cells. 7

8 IHC Assay Validation Stroma MWM MCF-7 T47D ZR75-1 DU145 PC3 LNCap T47D (Wild-type PTEN) Tumor PTEN Actin No tumor PTEN staining, high stromal cell staining Du145 (1 Wild-type Allele, 1 Mutant Allele) Stroma Tumor PC3 (PTEN homozygous deletion) Moderate tumor PTEN staining, high stromal cell staining 8

9 PTEN IHC Assay Reproducibility Optical Density (tumor) Optical Density (stroma) Day Day Day The PTEN IHC assay was run on an automated staining platform on 3 different days. Tumor and stromal cells were measured by image analysis. This particular tissue exhibits strong staining in the tumor and weaker staining in the stroma. PTEN Day 1 PTEN Day 2 PTEN Day 3 9

10 (Analyzing) Tissue is the Issue FFPE Tissue Tissue Microarray (TMA) Xenografts Frozen Tissue Immunohistochemistry (IHC) Immunofluorescence (IF) Fluorescent in situ hybridization (FISH) Chromogenic in situ hybridization (CISH) Digital Pathology & Image Analysis Real Time PCR 10

11 Image Analysis in the Era of Digital Pathology > Optical density measurement of biomarker stains to convert subjective IHC assessment into semi-quantitative data > Whole slide captured as digital image anyone, anywhere can review specimens together via internet > Multiple biomarker stains including H&E can be reviewed on the same screen (useful for pre- and post-treatment paired specimens) ScanScope XT 11

12 Geography the Central Lab Approach > Reduces logistics, cost and risks (loss of specimens, slide breakage, etc.) > Greater flexibility (ie. faster TAT) globally with high quality consistent validations transferred from a central assay development laboratory > Regional shipping/processing of specimens increases stability and quality (ie. less transit time) > Eliminate challenges associated with import/export restrictions 12

13 Quintiles Laboratories Global Coverage Today, Quintiles has the greatest global reach of wholly owned, entirely CAP-accredited central laboratories in the industry. Quintiles Laboratories US EDINBURGH, SCOTLAND Europe South Africa India BEIJING China Singapore Japan GLOBAL HEADQUARTERS ATLANTA, UNITED STATES MUMBAI, INDIA TOKYO, JAPAN SINGAPORE = Owned Facility = Affiliated Facility SAO PAULO, BRAZIL PRETORIA, SOUTH AFRICA SUPPORT SERVICES BUENOS AIRES, ARGENTINA 13

14 Oncology Laboratory Support in China > CAP, CLIA, GLP, GCP Laboratory > Stage 1 Offerings > Basic anatomic pathology (accessioning, microtomy, processing, H&E) > Immunohistochemistry (common signaling pathways) > FISH HER2, EGFR > High resolution scanning of images (Aperio ScanScope) > Tissue MicroArray prep, staining and reporting > Biorepository > Supported by experienced histotechnologists > Dual platform DAKO + Ventana 14

15 Conclusions > With the expanding use of morphological biomarkers in drug development, standardized biomarker validation is critical > Quintiles harnesses digital pathology to quantitatively assess consistency and reproducibility of IHC assay development and check lot to lot variation > By centrally developing these assays and then deploying these methodologies globally via digital pathology, QLAB leverages the experience and consistency of its experts > This enables analysis of routine and complex biological markers (eg. PTEN) for our clients globally 15

16 Thank You For more information, please leave a business card or contact us at clinical.info@quintiles.com. 16