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Although most patients with metastatic cancer will not be cured, many of today’s therapies can allow patients to live longer and better. Physicians routinely assess whether a treatment is “working” through use of medical imaging, where a perceptible change in a subset of tumor lesions is measured to gauge a patient’s response to treatment. Historically, this resulted in an “either/or” determination (responding or non-responding) that impacts medical decision-making (continue or stop treatment).

Glenn Liu – MD, CMO, Co-Founder

Dr. Glenn Liu, a UW Health medical oncologist who specializes in treating patients with prostate and other genitourinary cancers, recognized that traditional binary response determinations may have been useful for simplifying data analysis in clinical trials but are not ideal when it comes to clinical decision-making about individual patients.

Through their research spanning several years, Liu and UW medical physicist Robert Jeraj, Ph.D. demonstrated a better way. By examining how each individual lesion responds to treatment — not just a subset — physicians can make decisions about care that result in better patient outcomes.

Robert Jeraj – PhD, CSO, Co-Founder

“Our work shows that patient outcome is driven by resistant lesions,” Liu says. “Identifying and targeting that resistance can improve patient care by optimizing benefit from existing therapy options,” he adds.

Liu and Jeraj put their hypothesis to work, ultimately resulting in a software product. In 2015, they co-founded a Madison-based company, AIQ Solutions, which licensed their product, now called TRAQinform IQ, from the Wisconsin Alumni Research Foundation (WARF). Currently in use at 12 hospitals, including the UW Health | Carbone Cancer Center, TRAQinform IQ has already begun to revolutionize the way oncologists manage the care of patients with metastatic disease.

Seeing tremendous promise in this product, Isthmus Project invested in AIQ Solutions in early 2024.

“Isthmus Project chose to invest in AIQ because this is a product that provides a more comprehensive picture of a metastatic cancer patient’s disease which, in turn, leads to more informed decision-making by the physician and better outcomes for the patient,” says Elizabeth Hagerman, Ph.D., chief innovation officer for UW Health and executive director of Isthmus Project.

Better-informed decision-making about patient care

Eric Horler – President, CEO

Eric Horler, CEO of AIQ Solutions since 2018, says the product does not tell oncologists how to treat a patient, but instead gives them information that is qualitatively and quantitatively superior to what they have relied on historically.

“TRAQinform IQ presents the physician with a visual report that is truly worth a thousand words,” Horler says. “Lesions that are responding show up in green and lesions that are progressing show up in red.”

Even more beneficial to oncologists, Horler says, TRAQinform IQ provides a written report showing the slope, or rate of change of each lesion, as well any change in spatial location of resistant disease.

“Patients with metastatic disease do not, in reality, respond in a binary, thumbs-up or thumbs-down fashion,” Horler says. “Our product is a true enabler of precision medicine because it allows oncologists to make treatment decisions based on the collective behavior of every lesion. Ultimately,” he adds, “the product will revolutionize the way we follow and care for late-stage cancer patients.”

For oncologists, it really comes down to asking a different question, says Liu. “Instead of asking, ‘Is the patient responding or progressing,’” Liu says, “we’ll be asking, ‘Is the patient experiencing overall clinical benefit from a given therapy?’”

AIQ’s story began when Liu and Jeraj were contacted by a company called Medivation (acquired in 2016 by Pfizer), which developed enzalutamide, a drug for treating patients with metastatic prostate cancer. Seeking to incorporate Liu’s and Jeraj’s lesion-imaging research into a clinical trial, Medivation contacted the two UW researchers.

The trial, which concluded in 2019, examined the impact of enzalutamide through the lens of Liu’s and Jeraj’s hypothesis. Published in 2020, the Pfizer study established the foundational science of AIQ’s technology — namely that (a) not every lesion responds similarly to treatment, and (b) drug resistance in just a small percentage of lesions can drive poor overall clinical outcomes.

Customizing care for better patient outcomes

“The study showed that, on average, 91% of the patients’ lesions responded well to treatment while only 9% did not,” Horler says. For the physician, he adds, this might imply a switch from conventional ‘or’ thinking — continue the treatment or abandon it — to ‘and’ thinking — keep the patient on the drug because most lesions are shrinking and use a targeted approach, perhaps radiation or surgery, to address the few lesions that are resisting treatment.

For Liu and his oncology colleagues, there is nothing better a doctor can offer a patient with incurable disease than more time to enjoy life with their friends and families.

“None of this would be possible without the many patients who volunteered to participate in the original and ongoing clinical trials,” Liu says. “Their commitment to help others ultimately made it possible for us to develop the imaging tools that resulted in today’s TRAQinform IQ product.”

Among the dozen health systems that already use TRAQinform IQ, including UW Health, oncologists are incorporating the product while caring for patients with prostate, bladder, melanoma, lymphoma, lung, head and neck, and neuroendocrine cancers.

The product, which received 510(k) premarket approval from the U.S. Food & Drug Administration in 2018, is hopefully not more than a few years away from widespread standard-of-care use.

“We have some big tasks in front of us, such as seeking Medicare reimbursement approval and completing several longitudinal studies,” Horler says. “In time, however, I think we are going to change the world for the better for many patients. That’s what fuels my passion about this product.”