Case Study

GUAR r@P

Lung Cancer Presentation

Guardant360 identifies a 3rd-generation TKI trial drug for an advanced lung cancer patient

Clinical History

A woman in her early sixties complained to her primary physician of chest pains. After initial examination, she was referred
for a thoracic CT. Multiple nodules were found on her lungs and she was later confirmed to have advanced metastatic
non-small cell lung adenocarcinoma.

in

rl

Maj r Gen mic Driver EGFR

9/2013
Thoracic
CT scan
revealed
multiple lung
nodules

9/2013
TTNAbiopsy
showed
EGFR L858R

9/2013
Patient treated
with Erlotinib
and responds

10/2013
Guardant360
ordered to
nonitor
re 1 ission
EGFRL858R
cfDNA9.3%

1/2014
Progression
of disease

1/2014
Guardant360
ordered & finds
EGFRT790M
1 utation
cfDNA20.1%

1/2014
Patient treated
with trial TKI

3/2014
Guadant360
finds
significant
decrease in
tumor burden
cfDNA4.5%

3/2014
Patient
reponding
favorably to
trial TKI

Initial Testing
Thoracic CT scan revealed multiple lung nodules

Transthoracic fine needle aspiration {TINA) biopsy showed EGFR L858R mutation patient treated
with Erlotinib and responds

Guardant360 ordered to monitor remission

After brief remission, disease progresses
Guardant360 ordered to monitor progression after TINA biopsy returns quantity not sufficient'

Guardant360 Testing
1st test: EGFR L858R mutation, tumor burden of 9.3%

2nd test after relapse on Erlotinib: EGFR T790M mutation, tumor burden of 20.1%. Based on this, patient
put on investigational 3rd-generation trial TKI
3rd test: Significant decrease in tumor burden (4.5%)

Result
Guardant360 results led to change in treatment plan and patient responding favorably to trial TKI

GUARDANTH

505 Pe scot Drive

Redwood City, CA 63

1 8887

Fax 1.88 4.4258

www.guard h th.com