Nikos PARAGIOS — CentraleSupélec — Unlocking the full potential of cancer treatment

Unlocking the full potential of cancer treatment Professor Nikos Paragios, CEO

CANCER: CHALLENGE ST OF 21 CENTURY

30 million new cases with 15 million of predicted annual

deaths in 2030 Cancer diagnosis and treatment are changing through precision medicine & added value outcome reimbursement Choice of treatment, plan of treatment Optimize patienttreatment matching

Avoid predictably ineffective, toxic and costly treatments

Improve overall clinical outcomes

PRECISION MEDICINE Imaging in combination with other clinical data to predict treatment outcome Diagnose (imaging)

Radiomics Imaging Market to Exceed $30 Milliard in 2030 -

Diagnostic Radiology Clinical Trials & Drug Development

Decide (therapeutic strategy)

Treat

(image-guided)

Monitor

(added-value outcome)

Adjust

(assess and modify treatment)

OMICS CHALLENGES General Purpose Self Trained

Various pathologies & treatment objectives

Minimal investment from clinicians

Scalable

Out of the box

Studies involving few or too many samples

end-to-end (data management, radiomics extraction, automatic reasoning)

CLINICAL RELEVANCE  Leading cause of death in cancer, low life expectancy & survival rate  +10% increase of new cases and deaths between 2011 & 2015  Immunotherapy bring great promises in terms of treatment

Immunotherapy  Low response  Dangerous/deleterious for the patient  Highly expensive (100 k€ per patient)

ART-OMICS targets a response rate of 50% and elimination of treatment that are dangerous for the patient (25 m€ savings/year @France)

ART-OMICS / AI-DRIVEN RADIOMICS SOLUTIONS

Artificial Intelligence

Augmented Intelligence

Precision Medicine

RADIOMICS : SEEING THE INVISIBLE THROUGH INFORMATION FUSION AT MICRO AND MACRO SCALE

CLINICAL PARTNERSHIPS Cochin (clinical PI) is an internationally leading pole in thoracic oncology Multicentric clinical study bringing together national Numerous & mature collaborations between partners clinical, academic and industrial partners

CANCER: CHALLENGE ST OF 21 CENTURY 30 million new cases with 15 million of predicted annual deaths in 2030 Linear Accelerator

Radiation Therapy is the prevailing therapeutic strategy  Optimal compromise between effectiveness & cost  Successful clinical outcome (40% of the cured patients)  Affordable, accessible and most frequently used

Treatment Planning Software

Cancer :

Radiation therapy :

Challenge of 21st Century

60% Cancer patients

30M

New cases per year

15 million deaths

Over the last decade : Software

in 2030

(1,5BEU)

increasing importance

Hardware Linear Accelerator

Treatment Planning Software

(6,5B$)

10

Radiotherapy landscape Health system & regulations authorities Reimbursement structures

Safety rules

Market entry constraints

Flagship cancer centers Oncologists

H Patients

Public hospitals

Imaging & archiving hardware Toshiba, Siemens, GE

Physicians

Private clinics

Radiotherapy software

Radiotherapy hardware

Raysearch, Philips, Brainlab, Mirada,‌

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1 Planning Imaging + Physics + Optimization + Simulation

Radiation therapy today Painpoints

Facts

Time

Human 4-6 h human expertise required expertise

Tedious, time-consuming manual steps

2 Treatment Imaging + Positioning + Radiation

Expert bias Quality of treatment heavily depends on expertise

Anatomy’s evolution Lack of handling anatomy’s evolution

1

per patient

Unequal access to treatment Same patient treated by 2 different centers will see different clinical outcomes

Plan change 25% patients should see plan change but only 2% are updated during treatment

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Radiation therapy powered by AI @TheraPanacea

We bring in Time-saving Human expertise needed from hours to minutes

Advanced AI solutions

Automated alerts and simple adaptation of treatment plans

Optimal clinical outcomes Faster and more precise algorithms runs in clinic for the sake of patients

Benefits Treatment efficiency improved Less side effects Automation & Standardizati on Reduced healthcare expenses

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Art-suite : the unique AI suite for radiotherapy

Market entry

2018

Annotate

2019

2019

2020

2021

Automatic

Smart Dose

Plan

Monitor Dose

automatic re-

Replan

Adapt

annotation AI -

Optimization

accumulation

planning

on the fly

5-10 min for closed loop optimal plan selection

Real-time rigid and deformable registration

Planning

based

5-10 min for tumor organ annotation

Automatic generation of new plan when necessary

Dose optimization at each session

Dose accumulation while accounting for anatomical changes 14

Artificial intelligence and more @ TheraPanacea Artificial intelligence Deep learning Reinforcement learning

Applied Math Distributed Optimization Compressed Sensing

Medical physics

Medical imaging Deformable registration Multi-atlas segmentation

10 millions Euros of investment in research during the past decade (FR, EU)

Multi-scale/Multi-Physics Monte-Carlo High Performance Parallel Computing

5 international (EU, USA) patents (2 pending) with exclusive licence 15

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What can our AI actually do?

Plan preparation

1

Multi-modal, multi-organ organ segmentation through Unique combination of Deep and transfer learning Auto-identify organs at risks and tumors in patients anatomy in a few minutes with medical accuracy

2

Dose Optimization: Unique combination of

parallel multi-

objective Master-Slave optimization & reinforcement learning Produce the best possible treatment plan in minutes instead of hours /days, protecting 30% more organs at risk 16

UNLOCKING THE FULL POTENTIAL OF RADIATION THERAPY  Glioblastoma: most common and lethal primitive brain tumors in adults  Very low survival rate (median: 14 months), and almost no increase during the past decade  5 000 new cases/year in France treated with combination of drugs

Dose Paining  Personalized heterogeneous irradiation  Increase of tumor control probability  Major role of multi-modal imaging (PET, MRI, CT)

ART-OMICS targets personalized heterogeneous radiation with improved clinical outcomes and cost reduction of over 10m

CLINICAL PARTNERSHIP GR is an internationally leading pole in oncoradiotherapy Qualified clinical & research personnel Numerous & mature collaborations between clinical, academic and industrial partners

IMPACT OF AI IN MEDICINE (CO-DESIGN)  able to solve full-scale problems  where domain expertise is encoded into the solution  and continuous access to unique data is guaranteed  and algorithmic supremacy is part of the solution 19

CO-DESIGN What can AI do for you?

Or what can you do for AI?

OPEN ISSUES IN AI FOR MEDICINE Accountable AI: data-driven AI doesn’t necessarily adopt (human) reasoning and solutions lack of understanding the decisions process - that is present in the data - as well as ability to predict failures [handling life threatening decisions? …]

Small Data AI: the success of AI relies on crawling massive annotated examples – in many cases these data well never be available - [one-shot learning? transfer learning?]

Integrated AI: the success of sub-symbolic methods relies on answering a specific question or addressing a specific task [handling incoherent or multiple/plausible recommendations?]

Ethics AI: data-driven AI seeks to reproduce the underlying behavior of data, and eventually improves itself using its own recommendations [eliminating bias and discrimination]

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LOOKING TO THE FUTURE Mining On Multi-modal Data Diagnostic Radiology

LOOKING TO THE FUTURE Radiation Therapy powered by AI (treatment on the fly, dose painting)

Interventional Radiology / Computer Assisted Surgery

Contact:

Pioneering Cancer Treatment powered by Artificial Intelligence

Catherine HUYNH, COO c.huynh@therapanacea.eu Pr. Nikos Paragios, CEO n.paragios@therapanacea.eu