Geoff Oxnard MD
@geoff_oxnard
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Drug & diagnostic developer | Thoracic oncology, Boston Medical Center | Husband, father of 4, splitter of wood | Opinions my own
Joined September 2016
Excited to announce I'm joining BlossomHill Therapeutics as CMO! I’ve always believed in patient-centered cancer therapies. None better to team with than our CEO Jean Cui who designed some of the most effective & creative macrocyclic TKIs on the market:.
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Oncologists, what's more HOPEFUL than:. - caring for a tragically young pt w refractory cancer. - achieving response to investigational tx. - referring him/her back to local doc. - and then stumbling upon him/her years later on TWITTER, now married and thriving?!?.
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Here come 4th generation EGFR inhibitors! New allosteric EGFR inhibitor from Pasi Janne, Nathanial Gray & Michael Eck @DanaFarber, synergistic with osimertinib, just out @CD_AACR. @EGFRResisters #LCSM
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Super exciting to work with @genentech on this creative analysis in @NatureMedicine of IMpower150 demonstrating the power of ctDNA monitoring to predict outcome on chemoIO: .
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More cool work from the Janne lab @DanaFarber figuring out the vulnerabilities of dormant EGFR-mutant NSCLC on TKI. Inhibiting MEK plus YAP/TEAD tips these surviving cells into apoptosis!
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Nice paper from @MDAndersonNews showing that levels of tumor DNA shed are prognostic. Let's start using liquid biopsies as quantitative tools not just positive/negative! @CCR_AACR.
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For EGFR resistance, remember to biopsy and test for MET amp! SAVANNAH trial of osimertinib / savolitinib now enrolling globally: @LeciaSequist.
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So cool to see EGFR C797S being targeted @AACR ! Proud to support a new paradigm of real-time ctDNA response assessment in first-in-human trials - congrats to @ElaineShumMD & @BlueprintMeds:
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Our new editorial @CCR_AACR: "Effective cancer genotyping -- many means to one end" A joy to write with Dr. Catherine Meador @BrighamWomens, soon a fellow @DanaFarber! Many tools available so ALL patients can receive effective cancer genotyping.
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Does testing error underlie liquid biopsy discordance? "Bake-off" from @AstraZeneca suggests that, in the wild world of plasma NGS assays, technical factors impact assay variability more than we realize:
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1/10 I left #ASCO23 last week feeling INSPIRED about the pace of progress & discovery for cancer patients!. I'm excited about2⃣ precision oncology themes from the meeting, and it seems others in the oncology community share my excitement:
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Super excited for our #ASCO23 ctDNA evidence!. 🧬ctDNA monitoring w @BrunaPellini @genentech & @NIVokes @Regeneron.🧬ctDNA tumor fraction w @ChristianRolfo @flatironhealth & @LungMAP.🧬ctDNA fusions w @pashtoonkasi.🧬ctDNA HRRm w @pfizer. See you there!.
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Trust your favorite liquid biopsy assay? Our @DanaFarber @DCcloudy data comparing 2 hybrid capture plasma NGS assays finds what many suspected - targetable fusions are being missed. Fortunately, assays are constantly improving, as they should be!
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So excited to publish w @FoundationATCG on 'The pan-tumor landscape of targetable kinase fusions in ctDNA' in @CCR_AACR: 571 ctDNA fusions, reliable detection when adequate ctDNA shed, no evidence of dropped fusions apparent w some liquid biopsies!
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With TKI for METex14 now SOC, even more essential that all NSCLC pts get NGS (tissue, plasma, or both)! Don't choose pts based on clinical features ➡️ NGS for young (ALK, ROS1) & old (BRAF, MET), for adeno (EGFR, etc) & squam/poorly diff (MET):.
Our new editorial @CCR_AACR: "Effective cancer genotyping -- many means to one end" A joy to write with Dr. Catherine Meador @BrighamWomens, soon a fellow @DanaFarber! Many tools available so ALL patients can receive effective cancer genotyping.
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Headed back to clinic - what a privilege to be caring for lung cancer patients again! Weekly at @The_BMC (appts 617-638-8000) while I continue development of precision diagnostics at @FoundationATCG. Thank you Drs. Matt Kulke and Umit Tapan for your collaboration!.
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"Tumor agnostic efficacy of selpercatinib" - now showing at the posters! @VivekSubbiah @alexdrilon
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Sensitivity of liquid biopsy actually quite GOOD when there is high tumor content (>5%AF). But if you only see low level mutations, you need a biopsy to look for what you might have missed! @DanaFarber #ASCO18
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We can't let cancer pts be the hidden victims of #COVID19. We can take care of them, we can do this. via @BostonDotCom @sands_jacob @DanaFarber.
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A joy to contribute to this @DanaFarber work led by the talented Yoshi Kobayashi, incl 2 pts of mine I remember fondly. Fusions are a key targetable component of EGFR resistance! Those days of EGFR T790M seem so long ago @RielyMD .
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Now out in JCOPO @ASCO_pubs with @DrMarkAwad: clinicogenomics of >1500 NSCLC pts w METex14 mutations detected on NGS:. Similar prevalence and distribution in tumor tissue DNA (left) vs ctDNA (right):
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Nice @CCR_AACR report showing MET amp can mediate TKI resistance in ALK positive NSCLC, highlighting the value of NGS at resistance. And pts can get free plasma NGS on our SPACEWALK study! See for details.
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Excited to be nominated for the Cancer Community (C2) Precision Medicine Award with my friend Barbara Gitlitz! Looking forward to the event tonight in NYC, thanks to @sciam and @AstraZenecaUS. @DanaFarber @TheALCF
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Bravo @ChristianRolfo presenting our new RWD w @flatironhealth studying the value of early LBx during the "diagnostic odyssey" of NSCLC pts. A compelling paradigm to help pts start precision tx earlier. Prospective validation planned!
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Nice report in @JTOonline showing that even when starting with tissue NGS, genomic yield can be increased by using liquid NGS as backup. 'Reflex' can go both ways - oncologists needs to be ready to use both tissue and liquid platforms to maximize effective genotyping.
Li et al. assessed an optimized workflow integrating multiple molecular detection platforms to improve efficiency in pt selection for targeted therapy among pts newly diagnosed w/metastatic #NSCLC w/limited tissue samples #JTOCRR @OncologyAdvance @IASLC
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🎉 My first paper in JLB @isliquidbiopsy! 🤓. A pleasure to collaborate with SCRUM-Japan to describe pan-tumor bTMB 🩸concordance w TMB 🔬& identification of cancer pts w better outcomes on IO:.
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Beautiful concept from parents' @exeterucc virtual service yest:. "Social distancing" is a misnomer!. Actually want PHYSICAL distancing - can we do it while maintaining our SOCIAL connection?. Virtual coffeebreaks, storytimes, family dinners, group visits, ETC. We can do this.
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What a crazy finding - of 74 canine pulmonary adenos, 26 had HER2 V659E TMD mutations which are vanishingly rare in human lung adenocarcinoma! Want to launch a co-clinical trial of afatinib in dogs w HER2 mutant NSCLC? @CCR_AACR
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I am honored to be featured in the YOUR Cancer #C2Awards podcast for my work in precision cancer care! It was wonderful to speak with Scientific American and discuss the patient-centered future of oncology. @AstraZeneca @Sciam @GO2Foundation.
Detecting lung cancer through blood tests. Geoffrey Oxnard winner of the 2019 C2 Catalyst for Precision Medicine Award, tells us about the new technique [Sponsored by @AstraZenecaUS] #C2Awards
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Excited to launch, for research use, F1-Tracker: a bespoke ctDNA MRD/monitoring assay built off variants detected on actionable @FoundationATCG tissue CGP, in collaboration with @NateraOncology!.
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What is the best biomarker for MET-driven EGFR resistance? Elegant work from @danieltanmd suggesting we shouldn't use MET polysomy (i.e. CNG>=5) as a marker of resistance!
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Exciting new data from @yonsei_u & @JanssenUS in @CD_AACR re "amivantamab" in #EGFR exon20ins. The EGFR/MET mAb induces greater response than poziotinib or cetuximab in vivo. 2 dramatic pt responses shown too! More data soon at #ASCO20:
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Action packed introduction to ctDNA - "dawn of a new era" by @BrunaPellini at @ASCO this AM. Bravo Bruna!
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Tricky to manage brain mets, here’s some added complexity from my colleagues @DanaFarber: Association of Neurosurgical Resection With Development of Pachymeningeal Seeding in Patients With Brain Metastases. | JAMA Oncology
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Fascinating and consistent w my clinical experience. Several NSCLC drivers are IO resistant, not clear MET is one of them. Would love to see a tolerable MET/IO combo? @DrMarkAwad @alexdrilon @DrRaviSalgia.
Just out @ClinicalLung!. First-line #pembrolizumab in metastatic NSCLC with MET exon 14 skipping mutation and PD-L1 ≥50% (GFPC 01-20 study). The obective response rate was 43% (14% complete response) with duration of response 13.9 months. Learn more:
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Excited to collaborate this evidence re ctDNA tumor fraction with our colleagues @ChristianRolfo and @HatimHusainMD ! Please come by the poster and check it out.
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Nice @BrJCancer review of liquid biopsy in prostate cancer, describing detection of HRRm, AR alts, MSI-H, TMPRSS2-ERG fusions, ctDNA fraction, etc:
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@JFreemanDaily @theNCI Oncologists must remember the changing treatment landscape when asked to estimate a patient's prognosis. Prognosis estimates are based on historical precedent, and these data show that historical precedent is rapidly out of date! Am carrying that optimism with me to #ASCO2019.
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Nice report from Foundation Medicine in JTO showing acquired gene fusions are real and potentially targetable in EGFR-mutant NSCLC, confirming our findings in osi resistance:
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F1LCDx now FDA approved for detection of MET exon 14 skipping mutations as a companion diagnostic for capmatinib! Now with CDx indications for 9 therapies in 4 cancer types. So proud of the @FoundationATCG team.
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8/10 I’m also AMAZED🤯by the #ASCO23 LIBELULE study, a randomized trial demonstrating that early liquid biopsy for radiologic suspicion of stage IV lung cancer reduces time to initiation of 1st-line therapy:
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Gorgeous day for a visit to the growing @FoundationATCG site in La Jolla. It's been 20 years since I was here last - it's become a truly remarkable health sciences hub.
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A thought provoking look back and forward by Dr. Julia Rotow. Who could have predicted that our most compelling drug combos today would be with chemo! What’s Old Is New Again: Revisiting Up-Front Chemotherapy in EGFR-Mutated NSCLC
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Thank you Takayuki Yoshino for presenting #ASCO2021 on bTMB experience from 9312 F1LCDx cases. With elevated tumor fraction (TF) the concordance with tissue TMB is clear. Key to understand the TF of our liquid biopsies for maximal learnings!.
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I love discovering a new flavor of statistical bias. Here is a nice article studying ‘optimism bias’, which impairs us from designing adequately powered clinical trials:
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Craziest part of this monitoring study may be the extensive CH filtering:.⏩ctDNA panel avoided 'CHIP genes'.⏩still, paired PBMC filtered plasma variants in 64% pts, switching ~10% pts from ctDNA+ to neg. 🤯Any ctDNA monitoring assay needs a plan to address CH contamination!.
Super exciting to work with @genentech on this creative analysis in @NatureMedicine of IMpower150 demonstrating the power of ctDNA monitoring to predict outcome on chemoIO: .
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Super excited to attend @isliquidbiopsy 2022 in Miami next week & present some 🔥 new research w liquid biopsy thought leaders like @ChristianRolfo and @pashtoonkasi!. Hope to see you all there. .
Meet Christian Rolfo at #ISLB2022! . Christian is Professor of Medicine (Hematology and Medical Oncology) and Associate Director for Clinical Research in the Center for Thoracic Oncology at The Tisch Cancer Institute. Register today: . @ChristianRolfo
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Such a privilege to be invited to Kokilaben Dhirubhai Ambani, Mumbai to speak on liquid biopsy and the future of precision oncology! @isliquidbiopsy @The_BMC.
Keynote: Evolution of Precision Oncology (Liquid Biopsy) 🔥.Always motivating to hear @geoff_oxnard !.@HarvardAlumni @ASCO #precisiononcology #liquidbiopsy #CancerResearch #oncotwitter #Cancer.Intl Symposium on Precision Oncology, Mumbai.
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Pull up a chair and watch the @pashtoonkasi masterclass on LBx! Happening now at the GI #ASCO23 posters:
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What a pleasure for @FoundationATCG to be able to contribute to this @DanaFarber @Mirati & friends @NEJM study. Check out the striking poly-clonality of #G12C resistance detected in ctDNA! Thanks @DrMarkAwad @oncoOuLungCA & colleagues for including our data.
A number of activating KRAS mutations were also detected, both in cis with G12C (G12C --> G12W) and in trans with G12C (G12D/R/V/W, G13D, Q61H, likely due to mutation of the wild-type KRAS allele). Two cases showed high-level focal amplification of the KRAS G12C allele.
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She Had Stage 4 Lung Cancer, and a Mountain to Climb - The New York Times
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Agreed! Fusions in RET, ALK, BRAF, FGFR all appear targetable in EGFR resistance @EGFRResisters, are a key component to resistance profiling, and should be detectable with an appropriately designed LBx:.
More data to support paradigm of identifying additional drivers in NSCLC at time of resistance to first targeted therapy. In rare patients with EGFRm NSCLC that acquire RET fusions, osimertinib + selpercatinib leads to 50% resp rate. from @alexdrilon @MSK_DeptOfMed in @CCR_AACR
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My team @FoundationATCG is looking for an experienced investigator passionate about NGS to serve as ▶️Global Medical Lead◀️ for our CGP Franchise (both🔬 & 🩸). Bring your 🔥💡🧠🔨& come help us to change precision cancer care! Please DM or
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Super excited for our new data @myESMO:.⏩New HRDsig could select pancreatic cancer pts for FOLFIRINOX, w @PancPathologist.⏩SPOP muts could select HSPC pts for anti-androgen over chemo, w @neerajaiims.⏩RICTOR amp enriched in NSCLC brain mets, w @DrSteveMartin.⏩And more. .
Excited to join oncology leaders and researchers at #ESMO2022 and feature new research, including data that reinforces the value of Foundation Medicine’s emerging novel homologous recombination deficiency signature. More about the data being presented:
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More🧬ctDNA monitoring on IO! But using paired PBMC to filter CHIP, like our recent @NatureMedicine paper, so hard to scale clinically: Could a tumor-informed approach offer a cleaner signal & greater sensitivity? Tune in at #ASCO23 for 🔥 new data!.
ctDNA kinetics during the first 3 weeks of immunotherapy can predict treatment outcomes in early phase clinical trials ➡️
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How about that - work from @DrMarkAwad shows higher recurrence risk with elevated TMB and PDL1 IHC in resected NSCLC. Anyone else sense a therapeutic opportunity?!.
At #AACR22 João Alessi, MD (@alessi_joao), presents on genomic and immunologic factors associated with recurrence after surgery in stage I #NSCLC. Abstract 👉
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I am an oncologist because of Dr. Vogelzang, my first mentor in med school @UChiPritzker. Thank you Nick for helping to send me (and so many others) on this rewarding path. May your memory be eternal.
He was a world-renowned cancer doctor who gave his cellphone number to his patients. Las Vegas oncologist Nicholas Vogelzang dies at 72:
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A privilege to collaborate with Arnaud Bayle and @GustaveRoussy to study the utility of liquid biopsy for detecting actionable alterations and enabling trial enrollment across cancer types:
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@tmprowell At a minimum I can say that, zoom or no-zoom, neck ties are OUT. Those things have been collecting pathogens for years. No, I'm going full @TonyMok9! Who else is with me? #LCSM
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Love the ctDNA response waterfall plots! Great to see drugs targeting EGFR C797S progressing. 👇 Congrats @YYElamin and colleagues! 👏.
BLU-945, 4th generation EGFR TKI, in monotherapy and in combination with osimertinib in previously treated patients with advanced EGFR-mutant NSCLC (phase 1/2 SYMPHONY study) #ASCO23 #LCSM
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Appreciate forward thinking from @myESMO! Including need for LBx (in a hard to bx dz) covering IDH1, HER2, BRAF, FGFR2 fusions, NTRK fusions, MSI, Lynch genes. Would appreciate some guideline alignment w @NCCN given exploding tx landscape! @pashtoonkasi @VivekSubbiah @jberchuck.
🔥Biliary tract cancer: EMSO Clinical practice guideline for diagnosis, treatment and follow-up🔥.@Annals_Oncology .👉We provide update &💪 recommendations for adjuvant 💊, NGS &🎯 therapies.🙏 to all authors & ESMO team. @EASLedu @myESMO #LiverTwitter
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With two FDA approved CGP tests, we’re now able to help more patients benefit from precision #cancer care. @PritiHegde and I shared our thoughts on this important milestone in a recent blog:
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HER3/ERBB3 is such an interesting emerging oncogene! This same co-existence with HER2 is seen in NSCLC ( and CRC (. Presumably can either occur de novo or through acquired resistance?.
Good read just out on @NEJM, highlighting the clinical implications of the @Cancer_Cell paper by Hanker et al. on HER3 mutations within HER2-mutant BC.#bcsm.
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Wow. 👉 More evidence FGFR2 is a pan-tumor biomarker AND.👉 More FGFR2 drugs available AND.👉 New data coming this week @isliquidbiopsy 2023 w @pashtoonkasi showing detection of FGFR2 rearr across cancer types in ctDNA!. Sounds like a recipe for patient impact?. .
🔥FGFR2 fusion in metastatic pancreatic ductal adenocarcinoma: Is there hope? 🔥. ✅4 intersting cases responding to FGFRi.👉all KRAS WT with comparable long survival.🧐non-typical fusion partners.🎯Early NGS in KRAS WT #PDAC❗️.@myESMO @OncoAlert
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Great podcast by #LCSM master @JackWestMD discussing with @DrMarkAwad @DanaFarber his new @JAMAOnc paper! .They propose "very high TMB" can be used to "tip the scales" towards IO alone in some pts with advanced NSCLC:.
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Wow, fantastic. Anyone else wish they had THIS guy as a boss for a few formative years? 'lets get this guy in front of a crowd'! @sloan_kettering @MSK_DeptOfMed @ASCO @CliffordHudis.
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Seems like these cfDNA MRD approaches keep getting cooler! This from @hthrparsons @DanaFarber and Blood Biopsy Team @broadinstitute. In resected breast cancer, first WES then a bespoke assay tracking up to 346 variants:
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More evidence highlighting the value of CGP🧬 to guide first-line NSCLC care!. Fortunate to have been involved in the development of this therapy💊, which dramatically impacted my many RET+ pts back at @DanaFarber. 👉 @RetRenegades @LoxoLillyOnc.
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Super proud of the @FoundationATCG team, in collab with Nadine Tung & @BIDMChealth, reporting in @Nature_NPJ on potential germline variants on our clinical CGP. Huge opportunity to help pts through referral to germline testing:.
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@drnirmalraut @OncJournal @LeciaSequist @JackWestMD @CharuAggarwalMD @PatelOncology @VanitaNoronha @Alfdoc2 Are we sure these PIK3CA/BRCA/NOTCH mutations should be considered TKI-resistant? De novo TKI resistance in EGFR-mutant NSCLC can certainly occur, but preclinical studies (&clinical experience) suggests it is thankfully the exception, not the rule.
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POLE and POLD1 are already on the F1LCDx ctDNA platform, two of >300 genes reported! Somatic and germline both detected. Label with more details at @FoundationATCG.
@pashtoonkasi @TumorBoardTues @BHuffmanMD ctDNA platforms need to add POLE and POLD to their panels.
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Looking forward to @ASCO #GU21 presentation today by my @FoundationATCG colleague Hanna Tukachinsky! Prostate cancer ctDNA rich with signal, including BRCA1/2, complex AR resistance mechanisms, etc. More details in our concurrent @CCR_AACR paper:
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Great TMB review! One added paper to consider, just out in @jitcancer w @DavidRSpigel @DCarboneMD @sands_jacob: . 👉Our RWE suggests aNSCLC w TMB>20 may be candidates for a chemo-sparing IO alone approach (even when PDL1<50).
Clinical and technical insights of tumour mutational burden in NSCLC. 🔹At least how many genes should be evaluated?. 🔹What should be the cut-off for TMB?. 🔹Can TMB be evaluated with liquid biopsy?. An excellent review👇. @ChristianRolfo @OncoAlert.
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And here's the newest data from David Gandara at #ASCO23 across >8000 pts! Using the FDA approved TMB biomarker, consistent prognostic effect across cancer types:
@marklewismd @NEJM @MSKCancerCenter Heh not gonna get triggered this time Mark😂😂. But I will just mention that this paper is underpowered and uninterpretable. One example… many others show in head and neck SCC tmb is predictive. Example below.
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Excellent commentary by @harpreet_md @FDAOncology on a complex drug development challenge that has bedeviled me for years! 👏. 💡Am hopeful that ctDNA 🩸🧬 monitoring could help to solve the contribution of components challenge with less risk to pts?🤞.
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Stakeholders Urge Collaboration to Prove ctDNA as Regulatory Endpoint for Early Cancer Drugs
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We treated a number of pts with germline T790M in our cohort @DanaFarber and they have no excess toxicity, and in fact can have quite durable benefit! Osimertinib inhibits driver EGFRm +/- T790M, but not clear it inhibits just T790M (which likely is not a driver on its own).
@Jbauml @drandrewrob @StephenVLiu @VamsiVelcheti @CarolineMccoach @DrJaredWeiss @kamarrone @benlevylungdoc @xako22 @christine_lovly @rdoebele @WadeIams @HornLeora @patilmd3 @geoff_oxnard Amazing collab! Side q-Have you seen any pts with germline T790m on Osi? , does Osi cause more toxicity in those?.
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Are you age 50 or older and receive care within Partners Healthcare? PATHFINDER study @DanaFarber is still looking for men and women to help evaluate a blood test to detect cancer early. For more information, email pathfinderstudy@dfci.harvard.edu.
Results published today in @Annals_Oncology show a new blood test can detect a wide range of #cancers. The test is now available to at risk individuals in clinical study at Dana-Farber:
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@Tony_Calles @myESMO @OncoAlert And if you believe in lung cancer screening, please also check out our GRAIL data Saturday morning 9:30!
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Listening to @JackWestMD it becomes clear that, in another life, he could have been a Bob Hope / Howard Cosell radio personality. but I'm glad he's OUR #LCSM @Twitter personality instead!. Insightful commentary on this @ASCO podcast with @VamsiVelcheti:.
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Awesome podcast on HRD in pancreatic cancer from @DrNeilLove! Great work @MPishvaian (with a shout out to @KReissMD):.
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@AzadOncology @neerajaiims @ASCO Looks like PROpel determined HRRm by ctDNA, which is great for finding positives BUT negatives should be confirmed on tissue, esp given lower shed in 1L mCRPC. Perhaps MAGNITUDE used tumor for HRRm, thus a more reliable negative result predicting lack of benefit? @EAntonarakis.
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Have to share a fascinating case from a @The_BMC colleague:. ▶️Youngish never-smoker p/w advanced lung cancer, mets to bone. ▶️LBx sent while path review pending, see below. Anyone want to take a guess at the diagnosis? And what tx you'd start with?
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$LOXO-292 with dramatic plasma responses seen across a full range of doses in RET positive cancers. Very potent drug. #ASCO18
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Thanks for these tangible action steps by @rschilsky @NEJM! Many are in flight - guideline updates, EMR linkage, etc. Accessibility of comprehensive LBx will be a key piece of enabling adoption. @isliquidbiopsy. Closing the Gap in Cancer Genomic Testing:
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Congrats to @MGHBreastOnc on this paper showing how a panel of resistance alterations complement ESR1 to inform outcomes to CDK4/6i in MBC!. Like T790M in NSCLC, ESR1 is going to just be the tip of the resistance iceberg.
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Proud of this study of LBx NGS in NSCLC @JTOonline! Clear value of LBx to detect NCCN biomarkers if added to limited tissue testing. No additional NCCN biomarkers when adding LBx to tissue CGP! With negative LBx, tissue can detect missed NCCN biomarkers: .
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Here a fascinating reminder from @RebeccaDRobbins that our plasma cell free DNA is a rich mixture from many sources - germline, tumor, white blood cell, and even microbial:
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@n8pennell I would bet that brain mets are merely one potential surrogate for tumor burden. I would be interested in seeing this broken down by other measures of aggressiveness like liver mets, TP53 mutation or ctDNA tumor fraction.
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New in @JTOonline w @n8pennell!. 👉9% of NSCLC CGP results ordered in the early disease setting. 👉CGP prior to recurrence had a shorter time to initiation of therapy. 👉Could CGP also inform adjuvant IO use?.
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The first liquid biopsy CDx specifically for CRC! Punctuating evidence of the utility of LBx in GI cancers ⏩ increasing the accessibility of CGP testing. @skopetz @pashtoonkasi @aparna1024 @isliquidbiopsy.
#Announcement – FDA approves FoundationOne®Liquid CDx* as a companion diagnostic to identify patients w/ BRAF V600E alterations in mCRC: *Rx only; doesn't guarantee treatment match or that all alterations will be found
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