Subject: Re: next steps
From: "Howard Krein" <[email-masked]>
To: "Yung,W K Alfred" <[email-masked]>
Cc: <[email-masked]>
Date: Tue, 10 Mar 2015 12:44:46 -0400

Agree.. I will discuss with Patrick. For clarification did you want to move our conversation from tonight (tues)at seven to tomorrow night (wed)at seven?

Howard D. Krein MD, PhD
Assistant Professor
Div. of Facial Plastics and Reconstructive Surgery
Dept. of Otolaryngology/ Head and Surgery
Thomas Jefferson University
215-955-6760

StartUp Health
Chief Medical Officer
[email-masked]

> On Mar 10, 2015, at 11:29 AM, Yung,W K Alfred <[email-masked]> wrote:
> 
> Howard, I may be a bit over concerned, I know Mark Hyman and Patrick Soon-Shiaong mean well. But I am concerned the conversation is including too many people all at once. Should we may need to keep some degree of confidentially for Beau.
> Al
> 
> W. K. Alfred Yung, MD 
> From my BlackBerry
>  
> From: Patrick Soon-Shiong [mailto:[email-masked]] 
> Sent: Tuesday, March 10, 2015 11:01 PM
> To: Shaw,Kenna R; Yung,W K Alfred; 'Howard Krein' <[email-masked]>; 'Mark Hyman' <[email-masked]>; Steve Benz <[email-masked]>; Shahrooz Rabizadeh <[email-masked]>; 'Dan Kelly' <[email-masked]>; 'Walter MD Urba' <[email-masked]>; 'Santosh Kesari' <[email-masked]> 
> Cc: 'Hunter Biden' <[email-masked]>; 'Hallie Biden' <[email-masked]>; 'Beau Biden' <[email-masked]>; 'Kim Nicholson' <[email-masked]>; Phil Yang <[email-masked]>; Marci Rodriguez <[email-masked]>; Shahrooz  Rabizadeh <[email-masked]>; Mills,Gordon B; Hwu,Patrick; Chin,Lynda; 'Cassian Yee' <[email-masked]>; DePinho,Ronald A; Kim Nicholson <[email-masked]> 
> Subject: Re: next steps 
>  
> Thanks Kenna
> Could I have Steve Benz reach out to you to receive the raw files and we will analyze on the off chance we find any other variants?
> Also could we receive the frozen smple to perform RNAseq....Kim willl coordinate that...Howard could Kim reach out to you?
> Pat
> 
> Sent from my BlackBerry 10 smartphone on the Verizon Wireless 4G LTE network.
> From: Shaw,Kenna R
> Sent: Tuesday, March 10, 2015 7:48 AM
> To: Patrick Soon-Shiong; Yung,W K Alfred; 'Howard Krein'; 'Mark Hyman'; Steve Benz; Shahrooz Rabizadeh; 'Dan Kelly'; 'Walter MD Urba'; 'Santosh Kesari'
> Cc: 'Hunter Biden'; 'Hallie Biden'; 'Beau Biden'; 'Kim Nicholson'; Phil Yang; Marci Rodriguez; Shahrooz Rabizadeh; Mills,Gordon B; Hwu,Patrick; Chin,Lynda; 'Cassian Yee'; DePinho,Ronald A
> Subject: RE: next steps
> 
> The WGS is low pass.
>  
> (e.g. 4-10X)
>  
> Kenna R. Mills Shaw, Ph.D.
> Executive Director
> Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (IPCT)
> 1400 Holcombe Blvd. | FC12.2002|Houston, TX 77030
> (  713.792-1873 office; 713-792-6670 main; 713-792-6671 fax
>  
> From: Patrick Soon-Shiong [mailto:[email-masked]] 
> Sent: Tuesday, March 10, 2015 9:41 AM
> To: Yung,W K Alfred; Howard Krein; Mark Hyman; Steve Benz; Shahrooz Rabizadeh; Dan Kelly; Walter MD Urba; Santosh Kesari
> Cc: Hunter Biden; Hallie Biden; Beau Biden; Kim Nicholson; Phil Yang; Marci Rodriguez; Shahrooz Rabizadeh; Mills,Gordon B; Hwu,Patrick; Chin,Lynda; Cassian Yee; Shaw,Kenna R; DePinho,Ronald A
> Subject: Re: next steps
>  
> Thanks Alfred
> The over-expressed peptides are of interest. Do you perform RNA -seq. On the previous frozen sample?
> If not if we could receive the sample and we would be happy to do that. Also could we receive the file on the WGS....what depth of coverage was performed on the WGS‎?
> Thanks for the update
> Pat
> PS. Adding some members of our team on the email trail
>  
> Sent from my BlackBerry 10 smartphone on the Verizon Wireless 4G LTE network.
> From: Yung,W K Alfred
> Sent: Monday, March 9, 2015 5:16 PM
> To: Patrick Soon-Shiong; Howard Krein; Mark Hyman
> Cc: Hunter Biden; Hallie Biden; Beau Biden; Kim Nicholson; Phil Yang; Marci Rodriguez; Shahrooz Rabizadeh; Mills,Gordon B; Hwu,Patrick; Chin,Lynda; Cassian Yee; Shaw,Kenna R; DePinho,Ronald A
> Subject: Re: next steps
>  
> We have done deep molecular analysis on Beau's original tumor with our T200 panel and WGS. The profile is quite bland, not too many mutations is found, major GBM associated genes like EGFR, PTEN, PIK3CA, PDGFRA, HER2 are negative, only 2 positive hits: p53 and PTPN11. IHC showed increase pAKT, PDGFRA, pMAPK. Patrick's team have identified 10 over-expressed peptides for the preparation of an immuned-T-cell vaccine which we planned to use with the anti-PD1.
> I certainly welcome any help we can get. We have planned to do another round of deep molecule analysis of the new tumor after it is removed next week.
> Al
>  
>  
> W. K. Alfred Yung, M.D.
> Chair,Department of Neuro-Oncology
> UT M.D. Anderson Cancer Center
> 1515 Holcombe Blvd.
> Houston, TX 77030
> 713-794-1285
>  
>  
> From: Patrick Soon-Shiong <[email-masked]>
> Date: Monday, March 9, 2015 9:36 AM
> To: Howard Krein <[email-masked]>, Mark Hyman <[email-masked]>
> Cc: Hunter Biden <[email-masked]>, Hallie Beiden <[email-masked]>, Beau Biden <[email-masked]>, Alfred Yung <[email-masked]>, Kim Nicholson <[email-masked]>, Phil Yang <[email-masked]>, Marci Rodriguez <[email-masked]>, Shahrooz Rabizadeh <[email-masked]>
> Subject: Re: next steps
>  
>  
> Dear Howard and Mark
> Happy to help in anyway we can. As a first step we should retieve the tissue (both the paraffin block and the fresh frozen) from the surgery performed a year ago. We could begin the panomic sequencing on that sample now and before the next surgery. We will look for eGfr and Her+ markers as potential targets for the NK92 treatment.
> 
> 
> Kim will reach out to you today. Also will coordinate a call for Tuesday with our team to review all images to date
> 
> 
> Keep well
> Patrick
> Sent from my BlackB
> erry 10 smartphone on the Verizon Wireless 4G LTE network.
> From: Howard Krein
> Sent: Monday, March 9, 2015 5:36 AM
> To: Mark Hyman
> Cc: Hunter Biden; Hallie Biden; Beau Biden; Patrick Soon-Shiong; Al Yung MD
> Subject: Re: next steps
>  
> Mark, 
> Thank you once again for arranging this. I had a conversation with Al last night and he is on board with everything. He is in Hong Kong till Thursday but will be available to do a call with Patrick Tuesday at 4 PM PST if that works. He also realizes the time constraints we are under and doesn't want to miss any potential opportunities. I can arrange a call in number if that works for Patrick.
> Warmly, 
> Howard
> 
> Howard D. Krein MD, PhD
> Assistant Professor
> Div. of Facial Plastics and Reconstructive Surgery
> Dept. of Otolaryngology/ Head and Surgery
> Thomas Jefferson University
> 215-955-6760
>  
> StartUp Health
> Chief Medical Officer
> [email-masked]
> 
> On Mar 9, 2015, at 1:41 AM, Mark Hyman <[email-masked]> wrote:
> 
> Dear All,
>  
> I am writing to connect everyone so Dr. Patrick can start the process of gaining access to records and set up integrated team meeting as the next step.
> Thanks for all your time today and allowing us to be part of your care team.
> I have also copied Dr. Yung so that he and Dr. Patrick can connect directly to expedite care coordination.
>  
> Be well,
>  
> Mark
> ------------------
> Mark Hyman, MD
> Director, Cleveland Clinic Center for Functional Medicine
> Founder and Medical Director
> The UltraWellness Center
> Chairman, Institute for Functional Medicine
> 55 Pittsfield Road, Suite 9
> Lenox Commons
> Lenox, MA 01240
> (413) 637-9991
> [email-masked] 
> www.drhyman.com 
>  
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