Lisa Hatfield:

Dr. Hwang, can you tell us more about the gastric precancerous condition study, the GAPS Study and its key findings so far? And how do you combine clinical and endoscopic data with bio-specimens in the GAPS Study to improve early cancer detection?

Dr. Joo Ha Hwang:

So, the GAPS study is a study that we started at Stanford when I first got there about six years ago. This is a prospective study where we enroll patients who we feel are at high risk for developing gastric cancer and then follow them longitudinally. And we do endoscopy and we do biopsies, we do systematic biopsies using something called the Sydney Protocol, where we basically map the stomach and take biopsies. And then with those biopsies, we run several different analysis on them.

And our goal is to identify biomarkers that would help to identify patients who are particularly high risk. So the thing that we’re looking for in particular, there’s a condition called gastric intestinal metaplasia. And that’s the pre-cancerous condition. That’s a change in the lining of the stomach, typically from chronic inflammation, and most commonly due to chronic H. pylori infection.

So unfortunately it’s quite prevalent. If you look at the Asian population, it can be over 30 percent of the population of Asians, East Asians can have gastric intestinal metaplasia, but not all of those patients will then go on to gastric cancer. And so, there’s a cost, especially in the U.S. the cost is pretty high to do endoscopic screening and surveillance. And so what we’re trying to do is further identify those patients who are at particularly high risk, who have gastric intestinal metaplasia, who would warrant ongoing surveillance given their risk of developing gastric cancer in the future.

So, this is going to take many, many years because it takes a long time for this to evolve. And so, we’re hoping to follow hundreds of patients longitudinally and determine what biomarkers, what other clinical factors may help to predict the progression onto gastric cancer so that we can detect gastric cancer early in those patients and cure them of gastric cancer.

So my activation tip for this particular question or for this particular topic would be that, again, talk with your physician on whether or not you’re at high risk and you should have endoscopic screening or if you have gastric intestinal metaplasia (GIM). So let’s say you’ve had endoscopy and you have been diagnosed with gastric intestinal metaplasia, there are some guidelines out there that actually are deceptive. And if you are in the group that is at higher risk of developing gastric cancer, you should talk to your physician about how having endoscopic surveillance and what that interval should be for having endoscopic surveillance to make sure that you don’t progress onto developing gastric cancer.

Lisa Hatfield:

And just out of curiosity, with this GAPS Study, trying to identify biomarkers that might be used in the future to track that, are these biomarkers something that you find in the tissue from the biopsy, are they biomarkers you might find in the blood or saliva? So people can have less invasive means to have surveillance for gastric cancer?

Dr. Joo Ha Hwang:

We’re investigating all of that. So when we enroll a patient in GAPS, we collect saliva, we collect blood, serum. So ideally it would be a noninvasive biomarker, but the best biomarker is something that wouldn’t require endoscopy. But we are also looking at the tissue itself. So all of these things are being investigated. So stay tuned.

Lisa Hatfield:

And my last question about that, in case if a patient is watching this in the Bay Area, is your study currently enrolling participants?

Dr. Joo Ha Hwang:

Yes, we are actively enrolling and we welcome anyone’s participation.