COVID-19 and Cancer Patients: What You Should Know

Facebook Event COVID-19 and Cancer Patients

The Facebook live event, COVID-19 and Cancer Patients: What You Should Know was hosted by Massive Bio on January 13, 2021. The live event featured interviews about COVID-19 and its effect on cancer patients from Massive Bio medical experts. Guests included Massive Bio’s Co-founder and Chief Medical Advisor, Dr. Arturo Loaiza-Bonilla, MD; Chief Nursing Officer, Kristin Johnston, BSN, RN; and host Chief Customer Delivery Manager, Stephanie Tran.

Topics covered include:

  • COVID-19 risks for cancer patients
  • Enrolling in clinical trials during the COVID-19 pandemic
  • COVID-19 vaccine
  • Virtual Cancer Care Services

If you are looking for information about how COVID-19 effects cancer patients in life, treatment, clinical trials, diagnosis and more, watch the live event here and share it with your community.

COVID-19 and Cancer Patients: What You Should Know

Stephanie Tran: Hello everyone, thank you so much for joining us with this event today, COVID-19, and cancer patients: What you should know. Now, some of you may already be familiar with Massive Bio and what we do. We are constantly dedicated to creating solutions to tackle the inefficiencies of clinical trials for cancer patients and their physicians. Now, we find you the right trial at the right time, taking it even a step further and virtually pre-screen you over 125 different parameters to make sure that you are eligible for that trial before you even leave your home to go to the trial site. We also have a concierge service, who sticks with you throughout your enrollment period and throughout your journey with the clinical trial. But as we do that in the middle of the COVID-19 pandemic. We recognize that you all have questions and concerns about COVID-19, and what you should do as a cancer patient. So, we want to do our part today, to try to answer any of those questions that you have and provide you with the most information. We truly hope that you find today's event, informative and hopefully we can answer any of your questions, and maybe even bring you a little bit of peace of mind. In a time that is, is full of unknowns right now. We have two speakers today, and I want to, just move on without further ado and introduce our first guest, Dr. Arturo Loaiza-Bonilla. Now Dr. Arturo, is the Co-founder and Chief Medical Officer here at Massive Bio. Hello, Dr. Arturo How are you?

Dr. Arturo Loaiza-Bonilla: Good how are you. Thank you for having me.

Stephanie Tran: I'm doing really well thank you. Thank you for joining us. We're pretty excited about kicking this off and talking to our patients and their families and anyone else who's tuning in today about COVID-19 and concerns for cancer patients, so I appreciate you taking the time today. So just to jump in and talk a little bit about the COVID-19 pandemic for cancer patients. What are some concerns for cancer patients about the COVID-19 pandemic or, what's your feedback or what have you been hearing?

Dr. Arturo Loaiza-Bonilla: Well, you know the pandemic. As we all know, has affected every single aspect of our life, and when we're dealing with cancer, it's not and no exception. Of course, we need to continue fighting this disease and cancer doesn't stop. So, we had to adapt ourselves, we as providers and our patients to that new reality so he was affected by multiple ways and it has evolved over time of course but everyone's still committed to continue their treatments as much as possible. Amid disruptions so their first challenges when they look to you know lockdowns started or the stay-at-home orders, is that the patients have some issues with logistics right they needed to go to the hospital back and forth to pick up the treatments in other container longer could do it in an efficient fashion. Some other patients had issues because of the caregivers that they had, now can no longer accompany them because of these problems. And lastly the concern from COVID-19 itself, which is of course very relevant.
Even you know healthy patients are concerned about, you know, contracting the disease so imagine someone with cancer, they don't want the double whammy of getting the two diseases now the same time, which is significantly affected by them, and also their colleges and the practices, they were on clinical trials or something like that then that could be also affected, to some extent, so it's an evolving situation. And as we all said and it sounds cliche, but it is true, we're all in this together, and we want to overcome this as soon as possible and, there's some glimpse of hope, coming ahead but we will just continue to not to let the guard down and moving forward.

Stephanie Tran: Absolutely, yeah. That is very helpful and you’re right you know we all are in this together. And, you know, there are, I'm sure, cancer patients tuning into this today. We're all kind of in the same boat. So, I guess if there's a silver lining is that we can all at least relate right now and give you the best advice that we can during this time, so when it comes to the treatment of cancer treatment and COVID-19. How has the pandemic affected cancer treatment? Clearly, you know clinical trials still need to happen. But as far as the treatment goes, has it affected that can patients still get the normal treatment that they, they would need?

Dr. Arturo Loaiza-Bonilla: Yes, I think it's a twofold situation. The first one is, you know, have patients on active treatment, and those are the ones that are most affected at this point in time because they got an infection. So, do they have to stay at home and take care of themselves, or go to the hospital? But hopefully that doesn't happen as often, but we know that that's something that really does require treatment, we, as physicians try to make some changes in, just to allow patients to continue treatment. And then included maybe having a lot of telemedicine visits in between so of course that doesn't replace completely. The interaction we have with our patients we need to have them sometimes in clinic so they can get treatments through their IVs. But when they're on drugs we tried to get patients treated locally by getting them, you know, blood work and stuff that they can do close to home and then review it and then discuss it further. So, but that's a disruption because we're used to seeing our patients as we used to have them talk to us, even we used to, you know, hug them and we talked with them good news and bad news we went out with them and those moments or mourn with them when they come in, that has been limited because of the pandemic. So, that's been some significant interaction problem issues there. The other things are that some chemotherapy agents can be suppressant to the immune system as we all know, so we need to be mindful of them, and then have to use more growth factors in some cases or we need to change the schedule or modify when possible the regimens for, you know, the main oral drugs instead of having divisions been on those pumps for example five review for a certain disease types we continue to keep sending bills. That's just a few examples that we're trying to be creative to keep our patients on going, treatment. But still, even with those cases we have seen patients have disruptions, so we encourage everyone to just be in constant communication with us, because that's the key for optimized care this is possible. And the other portion of patients that I want to mention are those who have not had cancer yet or are in a survivorship. So those are also relevant because we may think that, you know, maybe I can delay my mammogram or a colonoscopy. And that could be farther from the truth. Now we know there's one called the shadow curve of oncology and cancer, where we are facing the reality that many patients are {Sound dropped} We cannot get it done. And it may be found these cancers you know a much more advanced setting when they could have been caught earlier and maybe improve outcomes. So, we encourage everyone to still, you know, use telehealth anything possible so they can continue getting access to those screening procedures, and hopefully we can continue fighting this cancer is at an early stage where we can be much more successful.

Stephanie Tran: Absolutely. It's a very important thing to mention so thank you Dr. Arturo for mentioning that it is still very important to keep up with those sorts of preventative measures as well. So, I mentioned briefly earlier clinical trials, patients who are looking for clinical trials cancer patients. Do they have access to clinical trials right now? What does that look like?

Dr. Arturo Loaiza-Bonilla: Yes, so of course everything with COVID-19 is an evolving situation but what we saw, particularly at the beginning of the pandemic and still we will see in the aftermath of that for probably a number of years. Is that all the attention of the pharmaceutical companies rightly so shifted to COVID-19 right, so we need to focus on therapeutics repurposing drugs, finding new drugs using you know sometimes AI technologies. And that lead to a halt on other theories, we cannot just be going around, and you know have everyone doing the same thing we need to focus. So that led to us from the sponsor pharmaceutical side to some somewhat of a halt of activity so new studies were not activated. Current studies, some of them stopped they felt that there was no opportunity for the publishers to continue accessing so they did put a pause on some of them that we've seen better improvement on that but still we have some studies, they're still slow to pay for something close all together because when you have a molecule that is promising but you have a limited budget and that budget is being drowned out by every month by activities of research. You may need to find something else or the same way as the restaurant requires to have, you know, clientele and people going to eat. If you're not coming, you know you're running out of money to rent a space you may need to close. So is the same analogy in oncology in a researcher, as a whole, I believe, but oncology was severely affected by it. And those effects are going to be seen from the years to come. We saw some advances, at least in the FDA approvals because I guess they had more time to review things and data that was really mature. So, we saw an incremental number of studies finalized in a number of the approvals, but as a whole. We are just starting to get back to normal in clinical research and I encourage everyone because that's the way to go right so that's the way we are going to find novel treatments that are going to be late. Now, even more and get access to those precision oncology or very specific studies that may help you to find your cancer better. So, we will see what happens but certainly a major significant disruption because of the COVID-19 situation.

Stephanie Tran: Yeah, absolutely. Yeah, thank you for that. So, it sounds like they're you know they're certainly still some clinical trials that you are continuing for cancer patients and you know we'll speak in just a little bit with Krista Johnston our Chief Nursing Officer just a little bit about finding those clinical trials and how massive bio can help with that as well but you're right. You know, I'm sure it's definitely taken a huge impact on everyone within research. So now for patients out there who are already receiving treatment or have received treatment in the past if they have a history of chemotherapy or radiation. Does that raise their risk for developing a serious illness from COVID-19?

Dr. Arturo Loaiza-Bonilla: The answer of course is not as straightforward, it's more nuanced than that. So, as we all know every cancer is different and every treatment is unique, the chemotherapy drugs are not the same for most patients. And we use it as a blanket statement I mean you know that already but just for the audience to understand that it when you talk about chemotherapy is not the same drug for everyone, even if you have the same cancer, or at the same stage. Everyone could have much different regimens and much different outcomes based on that or side effects. In some cases, for example, electrical malignancies Some people have leukemia, lymphomas, myeloma. They are, by default, an increased risk of complications from infection, because their immune system is compromised, to some extent, upfront just by the disease. So, after that the use of the drugs and agents that fight the disease which can compromise the immune system further. You can add you know anybody who need it. That's the way you can, you know, get rid of the cancer so it's a risk, patients pursue and of course we support as much as possible but still put them at risk. If you happen to contract COVID during that period of time of vulnerability, then certainly the outcome to be concerning and, and that's what we had seen mostly on that when we go through registries and different collaboration efforts that have been underway for example there's one from ASCO there's the COVID-19 and cancer consortium which I'm a member of as well we publish a number of papers already on that. In general, oncology and other outlets. We have found that of course patient with cancer, there are a higher risk of complications with COVID-19 the hospitalization rate is higher mortality unfortunately is higher too, and you have a compromise not only his system but maybe lung function that can certainly affect those cases and there's also some traumatic complications that happen from COVID that means that you are more prone to develop firings in certain parts like the blood becomes thicker, quote unquote, and that can make it complicated because you may develop things that are already prone to happen in cancer. And that can add to the morbidity and mortality of the disease. As I mentioned also, you know, COVID-19 is not a walk in the park so some patients do perfectly fine and get, you know, overcome the infection and, as if not happen or so that are those asymptomatic ones, very mild cases, which are the you know the lucky ones, but some others even a young patients or with abilities they end up in hospital they innovated I mean, even if you overcome all these who wants to be in the hospital with the tracheal tube on their ventilator. I don't see who wouldn't have had that in that. Also, the aftermath of that you know what the recovery phase, it could be challenging any for the patient. So, I think that's part of the whole equation that that is key to understand so the answer is yes, there's a higher risk of complications for COVID-19. But it's also not only the complications, but you know, all the other things around it that are important as well.

Stephanie Tran: Right, right. Yeah, it's really hard to know, sometimes with COVID-19 and you know what it's going to do. Actually, I think that's really helpful to our audience today, to understand that, you know, there truly will be, you know, some, some additional complications. For these patients. So, in your opinion, you know, is it safe for cancer patients or current cancer patients or even previous cancer patients to get a COVID-19 vaccine?

Dr. Arturo Loaiza-Bonilla: Yes. I was mentioning a little bit earlier today about the glimpse of hope. Right, so the light at the end of the tunnel is that vaccine. Right. So, the way to go for us beyond the current measures we're doing is, you know, overcoming not the cancer but the COVID-19 itself. By making us immune. In some people would say well there's two natural infection and getting our cells infected well I don't necessarily agree with that statement because as we just mentioned a second ago a patient with cancer could be severely compromised, a patient over the age of 65, who may otherwise be fine. Now, may end up in the hospital or may die from the disease. So, running out. We even though we let the COVID-19 just run rampant as a country. Unfortunately, now we're seeing new variants right that are concerning, and we need to continue our measures of you know wear a mask and social distancing and take care of each other. But also, even in those cases we have been already a year almost into the pandemic, and we haven't reached the numbers that we even need to get to any level of herd immunity which is the ability of the, you know, are we as, as a community of humans to overcome an infection because there's enough of us immune to it that we do not transmit any further effectively. So, we become more like a cold or something that you know we don't catch colds all the time. We only get it through some seasons and that's why, eventually COVID-19 may become as we’re able to isolate everyone. That's my aspiration, but until that happens, we need to be careful. So once again the vaccination. We have now. Two vaccines approved in the United States for major immunization, which are the Moderna and Pfizer ones. I have been fortunate because I'm a health care provider to get that vaccine already so I already have it so long as I can lead by example. Hopefully, we can get many others to that so I'm looking forward to actually to get my patients access to those vaccines as soon as possible. That's my goal is to offer to any of those because they're increased risk as I mentioned, and that's the way we're going to be able not only to protect ourselves but others, right. So, if anything has shown us in this time and age, is that we need to be, you know, mindful of each other, and careful that's not, that's an act of love itself. Even though it's all the stuff that you're getting yourself. Right.

Stephanie Tran: Yeah, absolutely. And you know I think it goes back to you in our beginning statement we're all in this together. And there are a lot of unknowns, but it's comforting to hear that from you as a you know a Berlin and you've gotten the vaccine yourself. I think that's very important for our cancer patients and just everyone to hear. So, I do want to take just a moment. We've gotten a few questions in. So, I want to just ask a couple of questions to you while you know while we have your, your time here. Okay, so you've mentioned you mentioned the Pfizer vaccine and the Moderna vaccine. One of the questions that we've received is, what is the difference between the two between the Pfizer vaccine and the Moderna vaccine?

Dr. Arturo Loaiza-Bonilla: Right. And that's a very, very common question and one that I had to solve myself as I was reading about them, I mean I became very passionate about reading vaccinations, in all different modalities. When, even when I started but now of course even more relevant now that we have improved. So, they're both novel vaccine preventable the mechanism of action like we had seen how these vaccines work in the past, but we never had a need to use these technologies. Right. So, this is not just happened overnight, none of this happens overnight. We are building up on, you know, the knowledge and things that have happened in the many years already, from the initial efforts for example we have the SARS, Ebola, all of those vaccines were in development but, you know, they were put to a halt because of pandemics or the epidemic system led up to happen, so people you know they once again resource allocation so let's focus on that but I think this is something that is going to develop into new vaccines, hopefully fight. Many other diseases. So, this is a prime of these if any silver lining comes from COVID-19. So, the Moderna vaccine. It was a vaccine developed to be given through the, you know, into muscle is basically on the deltoid the shoulder you just get a shot. And it's given every four weeks, times two, so you get two shots, four weeks apart. The most common side effects that were noted are very mild in terms of fatigue or how to diagnose some headaches. Every single patient for both vaccines required to be 15 minutes sitting down while they're getting in so just to make sure that they don't have any allergic reactions, which is still, you know we have vaccinated over 2 million people now, and we have seen less than 200 complications and the most common ones is lightheadedness, so now there's some of course random things that happen you know as things happen in life you may be allergic to something, but none of them have been lethal none of them have ended up in the hospital they just get treated that day, similar to when people are allergic to peanuts or to. They just come in and the things you have then you get the reaction. The same happens in those cases so that's one of the things that I want to reassure the audience. The other one is the Pfizer one, this is given every three weeks basically times two again. There's some questions now, if we should get one or two studies to phase two clinical trials that led to the approval that had the most data actually worked on using the two dosages so I think I will do that myself, why would I want to cut myself short, and maybe I may not get a strong immune reaction, patients who are with cancer or immunocompromised, they may not be able to mount the response they supposed to do it, with just one dose. So those are the ones also that I will 100% recommend them to get the full immunization schedule. Some of the things that I always get from patients and others is like, well, that's this is like RNA base vaccines are they safe. Are they going to you know mutate into an X-men or something like that? Well, it's not that RNA is basically you know it's not the recipe book which is the DNA is the translation of that right so it's already the instructions to make a protein. And it's also basically they're just telling the cell, hey, you know, do you make ice cream here right? Yes, we do ice chemical flavors. Alright, so I want to give you the recipe here. Can you just do this, vanilla ice cream flavor that I like and have ingredients, just do this for me please. You've never seen these ice cream before, but you know in the future when someone else asked for the ice cream to have the recipe ready. So that's kind of like the way it's done so it's basically the, the code for the instructions to make the spike protein which is a protein that is unique to this virus to replicate and is the one that he will recognize it. Next time or when the virus tries to attack us, then we really recognize it as foreign, and we don't allow the virus to take over it doesn't protect you from COVID. 100 percent because nothing is 100 percent except for paying taxes and being alive. But, in the whole spectrum, it really protects you from being in the hospital, and transmitting to others. So, it doesn't change your DNA, it doesn't do anything but just give your body the instructions to recognize and protect the future. And it's, you know, pretty innovative way of doing this and I can guarantee you, we're going to be hearing more on novel developments of these technologies, I'm hopeful that we can use it for cancer or for cure of infectious diseases.

Stephanie Tran: Great, great. Thank you, Dr. Arturo, sorry it broke up just a little bit there at the end but great analogies that was, that was fantastic and thank you for that helped me to understand that a bit better, so I appreciate that. I think we have time for one more question. Okay, so we've kind of approached this a little bit about you know cancer patients and maybe they have a past history of treatment if, is there a serious illness risk by one of these questions is our cancer patients truly at a higher risk of serious illness, from COVID-19.

Dr. Arturo Loaiza-Bonilla: Yeah, and I think it just to emphasize a few of the points that we made earlier in the conversation. The answer is yes, we have a higher risk of patients in the hospital, we have a higher risk for patients, requiring mechanical ventilation, and also the aftermath itself could be the fact that if the patient has COVID then they cannot get treatment. Right and they’re already fighting cancer so now we have to add this you know you know injury. Overall, so now we're making it worse and delaying cancer care for who knows how long, and we have, unfortunately, a few patients that they were sick from COVID that they couldn't get treatment for three months. So, that's a lot of time to start their treatment for metastatic cancer for three months, unless it's voluntary. Very few will sign up for it. Because now we had to catch up and try to figure it out. I mean, you know, all the challenges we're already facing. So, that's a challenge. And hopefully we can help patients with that.

Stephanie Tran: Yeah, and it kind of goes back to the importance of getting the COVID-19 vaccine. You made a great point you know if a patient gets COVID during their treatment period or, you know, whatever the case may be, it's even more important to get a vaccine and try to prevent it as much as possible, so. Great. All right. Well Dr Arturo, again, we really appreciate you taking the time out and speaking with our audience and just giving us a lot of great information. This is very informative. I think it's very important, especially in a time like these during the COVID-19 pandemic. And really speaking to our cancer patients, their families, even their physician team out there. So, thank you again for taking the time to be with us and, you know, we look forward to talking with you again.

Dr. Arturo Loaiza-Bonilla: Likewise, take care and stay safe.

Stephanie Tran: Thank you, you too. Bye bye.
Well, that was incredibly informative and he answered a lot of my own questions there as well. So, I hope that was just as informative for all of you out there. I do want to just know we see a lot of questions coming in from our audience, some very specific. So, please, please know, we will absolutely get back with you and how to answer any questions that we can after the event if we don't answer it you know within the rest of the event today, but we do see you we see those questions coming in, and we will absolutely follow up. So, I hope that piece, the Interview with Dr. Arturo was very helpful for you. But let's keep the information going you know our next guest is Kristin Johnston, so we're really excited to talk to her a little bit more, just about, you know, how massive bio might be able to help, and just more of a perspective of clinical trials and COVID-19. So, like I said, Kristin Johnston, is the Chief Nursing Officer here at Massive Bio. Hi Kristin, how are you?

Kristin Johnston: Hi Steph, I'm good. How are you?

Stephanie Tran: I'm doing really well thank you, thank you so much for joining us today for this COVID-19 presentation and our key cancer patients out there so happy to be here. Yeah, absolutely. So, let's just kind of jump in. You know I have a few questions for you that I think will be really beneficial to our audience to our cancer patients and anyone else who's tuning in. So, when it comes to cancer patients right now. You know how, how can Massive Bio help cancer patients right now at a time like this in the middle of the COVID-19 pandemic?

Kristin Johnston: Sure Steph, that's a good question. You know Massive Bio has always been and continues to support cancer patients during this time. You know we have and will continue to provide virtual assistance to patients through our call center, and our case management team. We also continue to provide quicker and more streamlined access to clinical trials, through our clinical trial matching system and enrollment support which is all done virtually without the need for in person visits, until of course the time of consent and screening for trial, which I do feel is what patients are really looking for now with the stress of COVID and everything else going on, so they would they appreciate being able to do all of this from the comfort of their home. And then once it comes time, go, and enroll into that trial.

Stephanie Tran: Wow, okay that is great. So, you are saying so any interaction that patients or their family has with Massive Bio. It is truly, you know the interaction with Massive Bio in general is virtual to get to get started and actually identify those trials.

Kristin Johnston: Exactly, exactly. It is all done virtually, we will review patient's records, upload them into our clinical trial matching system and run that matching against over 125 parameters, based on the inclusion and exclusion criteria from the clinical trial. So, when a patient goes to enroll into that trial. We are about 95 to 99% positive that the patient will be eligible and able to enroll. Now that other five to 1%. It is really testing that we need to be done at the site before the trial enrollment such as labs and EKG possibly an echocardiogram whatever the trial requires, and we can't tell those until they're actually done. But based off of previous exams, we are pretty certain that the patients would be eligible.

Stephanie Tran: Of course, of course that is understandable, but I mean that's huge. I am sure that saves patients, a lot of time in their family, if any, you know travel is required and even the providers and their team to assist in even identifying these trials or getting the patients there It saves a lot of time, it sounds like so.

Kristin Johnston: Absolutely, absolutely.

Stephanie Tran: So that is what it leads to my next question so as far as travel goes. You know how much travel is required when using Massive Bio services?

Kristin Johnston: Sure, but really that is up to the patient and their caregiver or family if they are involved in the patient's care. So Massive Bio's clinical trial matching services can be tailored to the patient's needs really, if a patient, say would like to stay within 50 mile radius of their home, then the system will only search for trials within that radius, However if for some reason we're unable to find a trial within that mileage or that radius which of course does happen, depending on the patient's cancer type, stage and other factors, then we would absolutely discuss increasing the radius with the patient before moving forward. However, if a patient is able and willing to travel a greater distance, we can always increase the search and tailor it of course to the patient's request.

Stephanie Tran: Great. Okay. So really, the patient kind of lets us know how far you know they would essentially be willing to travel. If we were to identify a trial for them.

Kristin Johnston: Absolutely. And we you know we at Massive Bio understand that time, funding, everything like that all is has to be taken into consideration when there is enrollment consideration for trial. So, you know, every patient is different, and we recognize that, so we really try to tailor it to each patient's needs.

Stephanie Tran: Wonderful, wonderful, that is great. So, as far as patients getting enrolled into these clinical trials, right now, during a you know the COVID-19 pandemic. Should they feel safe or, you know, what would you suggest there and just advice to patients, trying to enroll in a clinical trial right now?

Kristin Johnston: Sure, absolutely, I absolutely feel that it is safe. In my opinion, there's really no better time than now to enroll into a clinical trial, all necessary and required precautions are absolutely being taken to ensure that every patient is able to receive their treatment and study drugs in an extremely safe environment, were some trials put on hold due to COVID until the safest precautions and measures could be taken? Yes. Yes, they were. But many have restarted after evaluating the safest and most effective way of administering treatment or being able to keep a watchful eye. We do have to remember it is so important that clinical trials cannot continue, and patients cannot receive a study drug, unless it is safe. So, patients, always receive increased observation and attention while on a clinical trial which has helped to make patients feel safer during this time of COVID.

Stephanie Tran: Gotcha, gotcha. Yeah, we hear a lot about the precautions, and everything being taken at health facilities in general, I know with clinical trials. You know, it is very specific as to, you know, the precautions that are taken in general for the battles and you know there's a lot of attention given to these patients and their health and safety in general so I'm sure it's only even more days to write everything is heightened now everybody is much more aware, even more so than before which, which is amazing I mean patients absolutely should feel safe. Great, great. So, how has the clinical trial enrollment process, has not changed at all since COVID-19 or what does that look like.

Kristin Johnston: You know I would not say that a great deal has changed. Some studies depending on the treatment type are now requiring a waiting period between when and if a patient receives the COVID vaccine. And when they receive their next dose of treatment. So, this washout period which we call it can be anywhere from two to three weeks. Additionally, patient symptoms are being watched much more closely, for instance, fever, cough etc. are not being considered symptoms of the patient's cancer or treatment, until after a full workup has been performed and everything else, including COVID has been rolled out.

Stephanie Tran: Gotcha. That is great to know, really because, you know, it's tough sometimes to say if it is COVID or reaction or their cancer that's causing that. Yeah, so that is very reassuring. You know especially right now. During these unknown times.

Kristin Johnston: Absolutely so many symptoms can be the same and patients just don't know so the healthcare teams and healthcare professionals are really taking over precautions to make sure that everybody is safe.

Stephanie Tran: Right, right. Yeah, and it's important to remember that you know these are professionals and this is what they do, and part of their responsibility is the safety of the patient. So, absolutely. Absolutely. Okay, well so one of my final questions for you. You know, how can, so Massive Bio has, a virtual tumor board option how can our virtual tumor board actually help cancer patients during this COVID-19 pandemic? You know where second opinions are hard to come by sometimes.

Kristin Johnston: Absolutely. So, the good news is that massive bio really not much has changed with our virtual tumor board during the time of COVID. Virtual tumor board, which of course is comprised of a team of experts specializing in each individual patient's specific cancer type. We'll carefully analyze each patient's records and devise a specialized treatment plan that is specific to each patient's preferences past treatment medical history and then any other needs that should be taken into consideration. So, the beauty of the virtual tumor board is that it's all done virtually, and it always has been. So, it eliminates any added stress and risk of exposure to COVID which is a huge concern now for many patients. And there's no need for travel, or to relocate for a second opinion, which many times that does happen for a patient, so Massive Bio's case managers and dedicated oncologists will also work with the patient's physician to ensure that the best treatment is given, so really, Massive Bio, what we have always wanted and still want now in a time of COVID is to become an extended part of the care team for our patients so we want to be there to support both the patient and their physician during this time and throughout their journey.

Stephanie Tran: Absolutely, absolutely. That is incredibly important I know to all of us here at Massive Bio it's great to know that you know we have, we have even more options than you know the clinical trial is and isn't necessarily the right step for them the virtual tumor board option is there as well, you know, to help like you said both the patients and their physicians and the physician, so that's wonderful and again it's right in the name of a virtual tumor board so again there's no charge for that right.

Kristin Johnston: Absolutely, absolutely.

Stephanie Tran: Great, great. Well, this is fantastic. Kristin, I really appreciate you taking the time to be with us today and just give our patients and their families and their physicians, you know, even more information about how Massive Bio can help these cancer patients during great COVID-19 so this was incredibly beneficial.

Kristin Johnston: Absolutely, thank you so much for having me.

Stephanie Tran: Absolutely yes thank you Kristin, have a good day.

Kristin Johnston: You too, Bye.

Stephanie Tran: Wow. So, that was great, so much great information from Dr. Arturo and from Kristin. Again, definitely appreciate the time they took to talk to our audience today, I know I learned a lot. I appreciate learning something new every day and today was one of those days. So, hopefully, this was very helpful for our audience out there. This does wrap up our session for today. But like I said, we see your questions, we will absolutely follow up with you if you know someone from our clinical staff may need to follow up with a more specific question, but we see those questions coming in, and we will absolutely get back with you, either through the comments or by direct message so please know, we do see those. We hope you enjoyed the session today and hopefully it may be brought some peace of mind and answered any questions that you have. So, the next screen is going to just list our contact information. Please do not hesitate to reach out, reach out to us by phone, email, or you can visit our website at massivebio.com, but please know it's truly been a pleasure to be hostess for everyone out there and know that the Massive Bio family is always here for you when you need us. Thanks, everyone, and have a great day.

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