High Tech + High Touch Healthcare Series Explores Revolutionizing Patient Care

Business as Usual continues its partnership with the Jewish Healthcare Foundation for the next installment of High Tech + High Touch Healthcare.

We will welcome Nicole Lambert, President of Myriad Genetic Laboratories, to discuss how Myriad is revolutionizing patient care through the discovery, development and marketing of transformative molecular diagnostic tests that address pressing clinical needs across multiple medical specialties.

Prior to her current position, Nicole served as general manager for Myriad's Oncology and Urology business units and vice president of Dermatology. Prior to joining Myriad, she was a genetic counselor at LabCorp. Nicole received her bachelor’s degree in Biology and Sociology from Boston College and she earned her master’s in genetic counseling from Mt. Sinai School of Medicine at New York University.

So good afternoon, everyone. This is Audrey Russo, President and CEO of the Pittsburgh Technology Council kicking off a Monday with our partners at the Jewish health care foundation. And I'm pretty excited about today because we're titling today, high tech and high touch. And for those people who have been around Pittsburgh for a long time, the Pittsburgh tech council used to be called the high tech Council. So when I saw that I was like, whoo, we have had a flashback. But today is definitely going to be a great, great conversation, I want to give people appreciation to Huntington bank, because they have believed in us right from the onset, Jonathan Kersting, is with us. He's Vice President, all things media and marketing. He keeps his eyes on the chat and make sure that there's opportunities for us to stay connected in terms of the dialogue that we'll have with our guests. So I really want to also think 40 by 80. That's a wholly owned subsidiary of the Pittsburgh tech Council. And that's our charitable arm, we focus on education and entrepreneurship. And you can hear a little bit about our apprenticeships as they move forward. So we this is all about our guests today, this is not an opportunity to sell your wares. This is an opportunity for us to just, you know, shine the light on the work of our guests who is Nicole Lambert. And we are pretty thrilled about having a partnership with the Jewish health care foundation. Because of their work. If you don't know them, you can see that there's a link that's called lift off PGH. That's actually the name of the series. But the Jewish health care foundation itself does a tremendous amount of work in making sure that really the world is the safe place for all the things that happen in health care, but that they're also thought leaders in terms of innovation and solving problems of today and tomorrow. So we want this to be interactive. And I am very excited to jump in and introduce Nicole Lambert. She is the group president of myriad oncology, myriad women's health, and Miriam International. That's a lot. And I'm very excited to be able to peel that back a little bit. And talk with her about who she is what her journey has been. So good morning, Nicole, welcome to the program. Thank you for joining us, this is a little early, but not too early, because she's out in Utah. And we were talking about mountain zone. So she's two hours behind us in eastern standard time. But no matter she took the time to join us, and I'm thrilled for that. So before we start Nicole, what I really like to do is just take a few minutes to learn more about you. So you've been with the company for a significant portion of your own career. But can you talk about your journey a little bit like before the company, your academic, anything that you would like to share with us? Sure. Absolutely.

And thanks so much for having me, Audrey. It's so great to be here and to see everyone. Yeah, absolutely. I will have been with Marriott 20 years next month, actually. So it is a very significant portion of my career. I can tell you a little bit you know, starting out I when I was in college, I you know, as biology, sociology, women's health major, I always knew that I wanted to do something in healthcare, but I didn't know exactly what and so I started out working in a, you know, academic research laboratory doing, you know, bench work, like I think many of us in the life science industry have started out. So I had a really good knowledge of molecular biology. That was when DNA sequencing was first becoming a thing, right? So we're running those gel electrophoresis. And putting them on the, you know, X ray films and whatnot, was quite a while ago, but it was really rewarding. But I knew that I wanted something more out of my career in terms of, you know, how does this actually matter to patients? How can I use all the insights that I gained in the laboratory to actually impact patients. And so after college, I took a couple years off, and I worked for a private company, and I'm like their biology research lab. But I went back to graduate school to be a genetic counselor to get more of that clinical perspective that, yeah, I know exactly how to sequence DNA, but I want to be there at the intersection of how that impacts patient care. And I thought that genetic counseling was a great field to be able to do that. So I went back to Mount Sinai, I actually had a great experience being, you know, embedded in a medical school, first of all, but second of all, you know, the Jewish community has such a robust carrier screening program, that they really were on the forefront of getting genetic testing done and that patients were demanding genetic testing, and so it was a really exciting place to start out my career and to get trained on it. I became a clinical genetic counselor actually in the Texas Medical Center after that, and I counseled on a wide variety of conditions it was, you know, genetics was very early in its evolution. So you didn't have as much specialization, as you might see in genetic counselors. Today, we sort of all counseled about everything. So I saw, you know, pediatric patients, prenatal patients, people at risk for adult onset diseases, like cancer, or Alzheimer's disease, or something like that. But I really loved the breast cancer space. And so when there was an opportunity to join myriad, I took it right away, they were the company that was known for discovering the BRCA one and two genes. And I always thought that they were innovative and cutting edge and obviously, forward thinking but also that they were responsible and that they weren't looking to they were, look, their goal really was to make the test available to all women. And so it was it was a fun opportunity. And I joined the company 20 years ago next month, as sort of a medical science liaison type of role. And so, you know, my job was to help providers understand how to offer genetic testing for breast cancer in their clinical practice. You know, at the time, it was mostly large academic centers, it was MD Anderson, and Memorial Sloan Kettering and those types of institutions. But it grew from there. And I took on a variety of different roles. Throughout myriad more commercial roles, I went into sales and marketing, and, you know, ran some of our new business units, product launches, and things like that. And so I helped launch our dermatology product or urology business unit, and then came back to oncology where it's just, you know, kind of the heart and soul of Mariette and eventually worked my way up to being the president. So it's a very long journey, but a very rewarding one.

Yeah, that's really amazing. I was just trying to remember, like, where things were at that point in time. So you definitely see the change of some of those genetic tests are actually required. These days are deeply encouraged, I would say like, particularly for those like tie sacks and, and things like that. So it just sort of took me through my own child birth period of time. And those tests were at the beginning. That was I can't believe that's 30 years ago. But in 1991, let's talk about this nearly a decade before the human genome was actually mapped. Marion genetics was formed. Right. So they've been around 10 years, more than you've been there. So startup, so can you talk about the company's early history a little bit, even though it was right before your time?

Yes, absolutely. And it was, it was a company that I definitely had followed even before I joined as an employee because they were doing such groundbreaking work. And so in those early days, in the early 90s, we really were a rapid DNA sequencing company, we're, you know, looking for, and especially, I think we had the opportunity being in Utah to research many adult onset disorders, because the population of Utah, you know, they're very healthy, they live a long time. They have large families, and they keep excellent family history records. And so we really had an opportunity. And we had, you know, a lot of DNA sequencing capacity for what it was at the time. So we had an opportunity to research adult onset disorders. And breast cancer was one that we you know, had a large collection of families and we're able to really zero in on where might be the breast, the breast cancer gene, right. We only sort of knew or thought that there might be one, but we were able to find BRCA one. And then a few years later, BRCA two, so we were able to sort of map those genes very early. And what I thought was was fun about that time is, you know, in the early days, everything, all of our employees were scientists, everyone was sequencing DNA, we had a small number of employees, and they were all PhD molecular biologists, once we had sort of, you know, cloned and patented those jeans, we know how to real obligation to bring them to patients and to make them accessible. So that right around the time that I joined, the company was making a really hard pivot to, okay, now we have a lot of work to do to get payers to pay for this testing for women, to educate providers about this, to help the public feel comfortable with this. We worked a lot with legislators on non discrimination laws and things like that there was just so much to do, because it was, you know, really one of the earlier you know, genes that genetic testing was available for so there wasn't really a foundation or you know, payers didn't have the vernacular. Even a lot of physicians didn't have the vernacular to understand this stuff. So there was a ton of work to do. around education, market access, etc. That's the shift that myriad was making, when I joined.

Wow, that's really exciting. So you were really at the beginning of all this. So you know that your company isn't just at the forefront of genetics, but you're also a leader in the fields of personalized medicine. So from a maturity standpoint, where do you think we are in the world in terms of our progress towards more personalized medicine?

Yeah, still still very early. I think, you know, we saw in the early days of genetic testing, you know, people were afraid that patients wouldn't want it or wouldn't know what to do with it. And it took a really active patient community. And honestly, it was a lot of, you know, Jewish women who wanted prenatal testing that really push the field forward. And I think that's kind of where we are with personalized medicine. And if we think about something like you know, mental health, one of our you know, more broadly used a personalized medicine test is called gene site, it's for antidepressants, and how patients will respond to antidepressants. And right now, the way that it is used is primarily for what they call treatment resistant depression. So these are patients that have failed three lines of therapy, three antidepressants, before they will order a gene site test, and then prescribe an antidepressant that falls into, they kind of come into green, yellow, and red buckets of how you would use them how you would dose them, etc. And that's really a shame, I think you know, that there are many, many patients who will go through multiple lines of antidepressants, they will fail multiple lines. And this takes months and months at a time, right? Because it may take a month for an antidepressant to come to full efficacy. And then you've got to be on it for a month or two to realize or think about whether it's really working or not, then you may stop that one, there may be a washout period, or you may, you know, wait a little bit before you try another one. So now you're talking about months and months and months of someone that has a clinically diagnosed depression, that is not getting the medication that we know will work for them. So we I think, have to go through that same cycle of pushing the healthcare field to say, why are we allowing people to fail three lines of therapy? Why wouldn't we just order this test up front and get the patient the right medicine the first time?

And I would imagine for cancer treatments as well probably falls all across the spectrum.

Yes, exactly. We have one of our companion diagnostics is for PARP inhibitor use in primarily ovarian cancer, but is now being studied and and used in prostate cancer, breast cancer etc. And same thing your your sometimes it's the clinical practice falls a little bit behind where the data is. And so getting physicians to change their routine and their habits to order this test up front and prescribe PARP inhibitor or choose a different type of therapy upfront, you know, has been, again, another really big effort on market access, physician education, patient outreach, et cetera.

Well, the same thing happens. And in just regular technology, the change management process is really the key thing. So when you have those kinds of services and supports in in your teams that lead change, right? We do. So well. Let's talk about myriad women's health. There's so many areas to cover. So I feel like I'm jumping from topic to topic that I want everyone to get, you know, sort of a sense of how wide you are. Can you talk about the insights that your company can offer to women through genetics, so maybe just dig a little bit deeper? Because you talked about that, you know, the braca, you talked about, you know, the other genetic testing for maternal health? What are all the things that you offer? Sure, absolutely. I

would say, you know, right now, our goals of providing services really fall into kind of three buckets. The first one is around pregnancy and prenatal decision making. The second one is around, you know, cancer, both risk for cancer and if you're diagnosed, which treatments will work for you. And the third is around mental health. So in the pregnancy space, we offer carrier screening, and that so again, you you mentioned earlier in the interview about Tay Sachs disease, right. So you know, back when I first started out as a genetic counselor, it was population specific, you know, it was it was most of the Jewish community that was screened for Tay Sachs disease. And that was really the only disease that they were screened for. And that is a recessive condition, you're looking to see if both the mother and the father are carriers, or if they are, there's a one in four chance that the child will have that disease. What we see now there's been so much advance in carrier screening that first of all, it's it's pan ethnic, we offer carrier screening to know all ethnicities and it includes, you know, genetic diseases that are common in all different ethnic groups because we see especially in America, there's a lot more blending of different you know, couples but Also, people may not know their family history as well, if you ask about their ethnicity, they may or may not get it right, we see a big difference in patient reported ancestry versus what we find when we do a test like risk score that, you know, looks at different snips and can also tell what ancestry people are coming from. So offering carrier screening that is now we offer almost 200 different conditions, and we offer them to everybody. So if you don't know your exact answers to your ethnicity, or if there's mixed ancestry, you're covered, right, we offer almost 200 conditions, you can get screened for sort of everything that we know is clinically actionable, that might affect that pregnancy. And also, as you mentioned, earlier, standard of care and guidelines have changed right now, where it used to be, you know, you waited until you were, you know, certainly you were pregnant and you tested, you know, one parent, then you might test another parent, we're now at the place where guidelines can recommend carrier screening, even before pregnancy, so you can get all of this stuff straightened out, before you even get into a pregnancy when I was a genetic counselor. You know, many times people didn't get carrier screening till they were already 20 weeks pregnant. And then by the time you know, it takes a couple of weeks for results. And then it might take a couple of weeks, if they wanted to do an amnio or something, you could be very far along in the pregnancy, before you realize what this risk was. So it's fantastic to have these wider panels and to do testing much earlier for women. The second category of pregnancy related testing that we do is non invasive, non invasive prenatal screening for chromosome disorders. So again, people used to go through invasive procedures, like amniocentesis carry a risk to the pregnancy, we now can do these tests, non invasively. And we continue to upgrade those tests so that we make sure that we reduce test failures, and more and more and more women will get early results as early as 10 weeks pregnancy for these things. So that's kind of the first

shift. Yeah, yep. So how available is this? So I mean, obviously, I haven't been pregnant in a while. But just, you know, how available is this? Is this considered standard practice and standard of care? It really is.

Yes. And a cog has been an ACM G has been very progressive about, you know, putting out guidelines that these tests are appropriate for, you know, all women, regardless of their age, or their baseline risk. These tests can be ordered by ob gens in the community practice, you know, it used to be that you had to go into a maternal fetal specialist or genetic counselor to get these tests. And now they're all, you know, very widely available and very widely covered by insurance.

Are we seeing more and more of these being covered by insurance? I mean, when you're 20 years, can you? Yes, yes. A little bit.

Yes, absolutely. In fact, you know, when I joined myriad, you know, we used to offer patients, you know, ways to pay cash or to finance things people often wanted to pay with their American Express, just because, you know, they were worried about genetic discrimination. And now, you know, it's very rare for a patient to have to pay out of pocket. And it's, it's, you know, extremely rare for anyone to get tested anonymously, it's become much more mainstream.

Well, you talked a little bit about mental health, right. And so I know that you've developed some tests to improve the outcomes for psychiatric treatments. Can you can you talk about that even more?

Yes, absolutely. That's our gene site test. And it is for antidepressants, as I mentioned earlier, it will tell you it as I said, it separates the different antidepressants into green, yellow and red, green being, you know, use as prescribed as directed, you can use them norm according to the normal, you know, package insert, essentially, with the other categories, what they're what we're looking for is genetic changes that actually affect how patients metabolize antidepressants. So it doesn't tell you, you know, if you're predisposed to depression, it tells you how your metabolism is working, how the genes in your, that affect your metabolism of these drugs work, in that if a medication is in the yellow or red bin, it could be that you're a fast metabolizer and that you may need a lower dose because you're metabolizing these drugs very, very quickly, or you have an increased risk for side effects from these medications. And then there may be other medications that you have a very difficult time metabolizing and so they may not work for you.

So you know, you mentioned something earlier, the reason that you're in Utah is one of the mean, you know, essentially you said a few reasons, because data collection, healthiness and what else You mentioned something else in terms of why you're there.

People live a long time and they have large families, right?

People have large families and live longer. Is that still the case? Is that still the the trajectory? And what the demographic reports? Because here we are in Pennsylvania, we have different demographics we have we do have people who live long, and the age and the age in place, but we have an aging population. Is that the same case in Utah? Or is there an influx of, of younger people as well? It's still

I would say largely that family sizes are fairly large in Utah, and people live, you know, very healthy, active, outdoor lifestyles. And so yeah, so I would say largely, that is still the case in Utah.

Wow, I wonder how many what's the average size family there? Oh, gosh, I

don't know. That's okay.

That's okay. That's okay. I know that most in the US, it's now like 1.6, in terms of children.

So no, it's very, very common in Utah to have four children, six children, even sometimes larger families. So

that's great. So what about the company and the commitment to r&d? What what are some of the key breakthrough areas that you're targeting today?

Sure, absolutely. We do have a very strong commitment to r&d. And I would say that, you know, hereditary cancer and cancer risk is really at the core of what we do. And we continue to work on that question. And as I mentioned, the company was really founded when we identified the BRCA one and BRCA two genes. But we didn't stop there. You know, we didn't stop doing research, we continue to discover additional hereditary cancer genes, we continue to expand our offering. So when I started with mariadb, we routinely tested for two genes for BRCA one and BRCA two, we currently test for 35 genes routinely. So we offer larger panels of, of, you know, cancer testing to our patients clinically, but also we really looked at risk modification and other factors that might influence a person's risk. So many patients will undergo hereditary cancer testing. They might have a large family history of disease, but they will test negative for BRCA one and BRCA two, what we did is we discovered we did additional research to discover a personalized risk or element where we look at snips. These are just small snippets of DNA across the genome that have been shown to increase risk for breast cancer. And so we now offer that test along with our hereditary cancer testing. So if you test negative for BRCA one BRCA two and some of the you know, really well known high penetrance breast cancer genes, we will also run this personalized risk score algorithm and this molecular test that will give you your residual risk to develop breast cancer. So instead of just being told, Nope, sorry, your negative, we will take into account these other genetic factors. And also lifestyle factors, right, we calculate what's called a tire Cusick model as well, that incorporates, you know, your sort of lifestyle choices and things like that into this algorithm, and will give you a precise risk estimate. So, you know, we can tell you, you have a 36% chance to develop breast cancer or a 5% chance, right, so we'll give you a very precise risk estimate. But also, I think, what's different about this test is, people would often ask me as a genetic counselor, well, I know I have this high risk, but when when am I going to develop breast cancer. And we always used to speak in terms of lifetime risk. So if you had a B, one mutation, we would say you have up to an 87% chance to develop breast cancer by the time you're 70. Well, if you're 30, or 35, and you're a young working mom, and you're too busy to, you know, deal with a lot of this stuff, you people would always ask, well, is this something I need to do something about today? Or can I wait? What do I do with this information? So the difference with risk score is you get a five year risk as well as a lifetime risk.

And so are the interventions as well becoming more progressive in terms of the interventions? Because I know people who have been identified with the bracket one or two, and the interventions are quite severe? Are we seeing any changes?

Yes, I mean, fundamentally, I would say the, the interventions are the same, but the quality of outcomes is much, much better and always improving. So for instance, when I started if someone tested positive for BRCA one or two mutation, they were offered increased surveillance, more mammograms, they were offered, you know, maybe tamoxifen or some type of chemo prevention or surgery and surgery largely was, you know, just mastectomy was fairly barbaric. You might do reconstruction at a later date, but it was a long process and if you look Get the options. Now, we still largely have those three buckets, but you're seeing a lot of advances in breast MRI. And these patients often will do a mammogram and a breast MRI alternating every six months. So surveillances, I think come a long way, and is much more precise than it used to be. And then on the surgical side, you know, options for reconstruction have come a long, long, long, long way. And so patients are able to have their cystectomy and reconstruction in the same surgery, often with autologous tissue for, you know, much more natural and desirable cosmetic outcome.

Wow. Yeah, we have come a long way, just from people that I know. So that's good. So Jonathan, there's a question I believe out there.

This is an interesting one here. Good to have you on the show today, Nicole, on center health wants to know, tell me more about Vectra test. And is it useful in targeting treatment for rheumatory? arthritis?

Sure, yes. So So that's, that's our autoimmune business unit. So it's not actually my business unit. But let me see if I can give you a little bit of background information on that test. So yes, basically, that test is measuring progression of disease and whether or not treatments are working, or whether you might want to switch treatments. It has been proven effective in a number of clinical studies. But as I said, it's not my area of expertise. So I probably would defer you to some of the clinical papers that are on our website.

That's great. We're gonna put your website out there. What What is it?

What's the website? www.neerja.com?

Okay, excellent. And so you have this business unit? How big? How many people work at your company? Until

about 2700.

Really? Okay. And are they all located in Utah? No, absolutely

not. We have about 1000 1200 that are located in Utah. We have laboratories here in Salt Lake City, where our hereditary cancer and our autoimmune testing is performed. We have a laboratory out in South San Francisco, where our prenatal testing is performed. And we have a lab in Ohio where our mental health our gene site testing is performed.

Okay. And then in your business units, all that you cover, Are you hiring?

Yes. We're always hiring. Yeah,

you know, we're gonna pull you to Pittsburgh. So we're gonna fill you to Pittsburgh.

Yes. We're always hiring. And we, you know, we always have a variety of roles. If you're, you know, just coming out of college and you're looking for an entry level, laboratory tech position or marketing position. You know, we're almost always hiring for those, as it many, many people come in through the genetic counseling route. We're one of the largest employers of genetic counselors for your visit, who that do a wide variety of roles, physician, education, patient education, summer in sales, or marketing or market access. So yes, overall, tech people do often find a home here.

And listen to you oversee a lot of really interesting things. And my hat's off to you for doing the work that you do and living in beautiful Utah. Do you think there's anything that maybe you wish I would have asked that I didn't ask you?

Um, no, I think that, you know, I love I always love being able to talk about the great work that we do, providing, you know, both insights clinically for women that are making decisions today, but also our commitment to research. We're just presenting actually, in a couple of weeks at ASCO, the validation of our risk score for all ancestry. So we will be the first and only company that is able to provide that risk score for people across the globe. And we're very, very pleased and excited about that. If anyone's going to ask go, I hope you'll check it out.

Wow, that's interesting. I can tell you that I just did my little 23andme a few years ago. And I was surprised. I mean, I realized that the you know, it's only as strong as the people who are, are submitting the data in that database. But it was definitely interesting in terms of some of the genetic propensities that that you could see across the different groups of what were in my background. And to be alert for whether it was statistically significant or true or not. At least it raises the awareness, which I think is is what your company actually delivers. Yeah,

I really

wanted to do so. I really, I can't thank you enough. I think Wait, is there another Thank you. You got some thank yous out here. We if people want to get in touch with you, is there a good way to reach you?

And Lambert at miria? Calm or Nicole Lambert on LinkedIn. Oh, that's

awesome. You've been just a delight.

Thank you so much for having me. It's always a pleasure.

It's great. Keep up the great work. Thank you so much, and appreciate you taking the time and getting up a little bit early and spending time with us really love it. So that was Nicole Lambert, you will you can find her@marissa.com and I know we just touched the tip of the iceberg in terms of all the work that they did. But once again, great female leader rocking it and can't thank you enough and thanks, lift off PGH for the work that they do, and trying to make sure that all of us understand the kind of work that's occurring for the future, as well as some of the opportunities for now. So thanks, Jonathan. Is there anything else?

Well, tomorrow's gonna be very exciting. Audrey, we have Casey minlan. He's the executive director of the stem at coding lab right in our neck of the woods on the north side should be a lot of fun.

I love it. I learned each and every day, our topics just go far and wide. So thanks, everyone, for joining. Thank you, Nicole. Really appreciate your time. Keep up doing the great work that you're doing and leading.

Thank you. Have a great day, everyone. All right. Thanks

again.

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