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Cancer & Immuno-oncology glossary & taxonomy
Evolving Terminologies for Emerging Technologies
Comments? Questions? Revisions?
Mary Chitty MSLS  mchitty@healthtech.com
Last revised January 09, 2020

SCOPE NOTE Cancer and oncology include immuno-oncology, liquid biopsies, CAR T Cell therapies, circulating tumor cells, neoantigen targeted therapies, NK Natural Killer Cells based cancer immunotherapies, cancer vaccines, oncolytic virus immunotherapies, tumor microenvironment. Categories include diagnostics, therapeutics and prognostics.

Every day, scientists and physicians dedicated to cancer research work to make discoveries that will advance new treatments and tools into the clinic. Patients participate in clinical trials with the hope of finding new options for themselves and producing better outcomes for future patients who will face the same disease. Their combined efforts—enabled by research funding—have led to new ways to prevent, detect, and treat cancer and a 25% decline in the rate of death from cancer over the past two decades. Despite this progress, more work remains.    Highlights of the NCI Annual Plan & Budget Proposal for Fiscal Year 2019  https://www.cancer.gov/about-nci/budget/plan/

Related glossaries include Biomarkers    Cancer & Immuno-Oncology overview     Clinical trials    Molecular Diagnostics testing      Molecular imaging    Molecular Medicine   Pharmacogenomics 

adoptive cell transfer:  the transfer of cells into a patient.[1] The cells may have originated from the patient or from another individual. The cells are most commonly derived from the immune system with the goal of improving immune functionality and characteristics. In autologous cancer immunotherapy, T cells are extracted from the patient, genetically modified and cultured in vitro and returned to the same patient.  Wikipedia accessed 2018 Dec 12 https://en.wikipedia.org/wiki/Adoptive_cell_transfer

Adoptive T Cell Therapy  August 11-12., 2020  Boston, MA  Efforts to engineer CAR Ts, NKs, TCRs, and TILs with greater precision, safety profiles, and efficacy are leading to the second generation of improved adoptive cell therapies. With multiple engineered receptors already making preclinical impact, many biotech and pharma companies are preparing for the next wave of clinical trials. The end goal is still the same: improved patient outcomes. However, there remain technical considerations and translational challenges relating to cell therapy development, manufacturing practicability, clinical trial approaches, cell quality and persistence, and patient management  https://www.immuno-oncologysummit.com/T-Cell/
 Adoptive T Cell Therapy : Development  August 10-14 , 2020  Boston, MA https://www.immuno-oncologysummit.com/Adoptive-T-Cell-Therapy-Development/ | In 2017, two CAR T cell therapies were approved by the Food and Drug Administration (FDA). With multiple engineered receptors making preclinical impact, many biotech and pharma companies are already entering other clinical trials in a race to get to market. Has this promising field finally reached a tipping point? Technical considerations and translational challenges relating to cell therapy development, manufacturing practicability, clinical trial approaches, cell quality and persistence, and patient management remain. 

antibodies cancer therapy: Antibodies for Cancer Therapy Driving Breakthrough Therapies May 4-5, 2020 Boston MA Program  Antibodies have become the most sought-after tools in drug discovery, with bispecific antibodies and cell engagers leading the pack of new constructs. New insights on the tumor microenvironment and the microbiome can determine how successful a therapeutic strategy will be, and new imaging tools will help improve delivery of antibody drugs   https://www.pegsummit.com/Cancer-Antibodies/

ANTIBODY DRUG CONJUGATES 2020 May 6-7 BOSTON MA A successful ADC requires the combination of the right target, right antibody, right linker and the right payload. Getting it right can create ADCs that have the potential to become a life-saving medicine for many diseases, especially cancer. https://www.pegsummit.com/Antibody-Drug-Conjugates/

 antimetabolites: Anticancer drugs that closely resemble substances needed by cells for normal growth. The rumor cells uses the drug instead and "starves" for lack of proper substance.  NCI National Cancer Institute, Young People with Cancer,  NIH Publication No. 93-2378  https://files.eric.ed.gov/fulltext/ED403715.pdf

Antineoplastic Agents, Immunological: Antineoplastic agents containing immunological agents (e.g. MAbs). These pharmacologic preparations inhibit or prevent the proliferation of NEOPLASMS. MeSH 2018   Related terms: Immuno-Oncology IO, immunotherapy

autoantibodies: A hallmark of both autoimmunity and cancer, represent an easily accessible surrogate for measuring adaptive immune responses to cancer. ... Serological analysis of arrays displaying the complete human proteome (seromics) represents a new era in cancer immunology, opening the way to defining the repertoire of the humoral immune response to cancer. Seromic profiling of ovarian and pancreatic cancer, Gnjatic S, et. al, Proc Natl Acad Sci U S A. 2010 Mar 16;107(11):5088-93. Epub 2010 Mar 1 http://www.ncbi.nlm.nih.gov/pubmed/20194765

basket trials: Clinical trials  Related term: umbrella trials

biological therapy: involves the use of living organisms, substances derived from living organisms, or laboratory-produced versions of such substances to treat disease. Some biological therapies for cancer use vaccines or bacteria to stimulate the body’s immune system to act against cancer cells. These types of biological therapy, which are sometimes referred to collectively as “immunotherapy” or “biological response modifier therapy,” do not target cancer cells directly. Other biological therapies, such as antibodies or segments of genetic material (RNA or DNA), do target cancer cells directly. Biological therapies that interfere with specific molecules involved in tumor growth and progression are also referred to as targeted therapies.  National Cancer Institute, Immunotherapy fact sheet
https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/bio-therapies-fact-sheet

biological tumor markers: Molecular products metabolized and secreted by neoplastic tissue and characterized biochemically in cells or body fluids. They are indicators of tumor stage and grade as well as useful for monitoring responses to treatment and predicting recurrence. Many chemical groups are represented including hormones, antigens, amino and nucleic acids, enzymes, polyamines, and specific cell membrane proteins and lipids. MeSH, 1988

Bispecific Antibodies to the Clinic for Oncology  Advancing Bispecific Antibodies and Combination Therapy to the Clinic Creating the Killer Combo May 6-7, 2020 BOSTON MA https://www.pegsummit.com/Bispecific-Antibodies-For-Oncology/ The development of bispecific antibodies is one of the hottest areas in biologic research at the moment and their advancement to preclinical and clinical development will determine what the future of this area will look like.   

Bispecific Antibodies for Cancer Immunotherapy  August 10-12 2020 Boston, MA | Engaging multiple receptors with bispecific biologics offers the potential to improve upon single-agent checkpoint blockade and promises to be the next generation of immunotherapy with preclinical, translational and clinical studies on using bispecific antibodies for dual blockade of checkpoint targets, T-cell-redirecting bispecific biologics, overcoming T-cell exhaustion, as well as strategies to improve efficacy and reduce toxicity, and engineer the next generation of bi- and multi-specific biologics.  https://www.immuno-oncologysummit.com/Bispecific-Antibodies-Immunotherapy/

cancer biomarker validation: NIST supports the National Cancer Institute (NCI) Early Detection Research Network (EDRN)  as a Biomarker Reference Laboratory by efficiently validating the measurement of potential biomarkers for early detection of cancer and for cancer risk .  By increasing the quality of the data produced at each of the stages in the biomarker discovery and validation processes, NIST and the EDRN are collaborating to reduce both the time and resources expended in developing successful biomarkers.  https://www.nist.gov/programs-projects/nistedrn-cancer-biomarker-collaboration

Cancer biomarkers may also be present in benign neoplastic disease, which careful longitudinal clinical study has shown does not proceed to malignancy (13)(14). A vitally important and humbling example is the demonstration that oncogene markers such as c-erbB-2, p53, and cyclin D1, commonly thought to be cancer biomarkers, are also present in patients with benign breast disease who have been followed clinically for 15 years or longer without neoplastic progression. ... Even after more than 150 years of cell science, it must be recognized that our conceptual framework of cancer biology remains inadequate to recognize the ideal or optimal biomarker for most cancers. Furthermore, even if, as expected, our perspectives will change over time, we need to understand what we are looking for before investments in the search and evaluation for cancer biomarkers will be effective. KP Pritzker, Cancer biomarkers: Easier said than done, Clinical Chemistry, 48 (8): 1147- 1150 Aug. 2002  http://www.clinchem.org/cgi/content/full/48/8/1147 
Cancer Biomarkers Study Section CBSS, NIH, Center for Scientific Review http://cms.csr.nih.gov/PeerReviewMeetings/CSRIRGDescription/ONCIRG/CBSS.htm  

cancer genomics: Cancer is a complex disease of genomic alteration, exploiting many different molecular mechanisms. Fighting cancer will ultimately require a comprehensive classification of cancers according to their genomic basis. Projects include: systematic studies of genome-wide loss and amplification; targeted resequencing to identify mutant genes in key pathways; and discovery of cancer-specific biomarkers. ... Cancer cells rely for their survival on the expression of a limited number of specific genes. Identifying these genes would yield, for the first time, a comprehensive catalog of the potential therapeutic targets for cancer. Projects include systematic use of RNA interference (RNAi) to identify such Achilles' heels of cancers. ... Genomic signatures provide a powerful way to recognize the effects of chemical compounds, both to understand cancer biology and to develop new therapeutics. Program activities include: Gene-Expression High-Throughput Screening (GE-HTS) to identify compounds that can induce specific developmental changes in cancer ... Other efforts include molecular pathology studies to map gene expression patterns to actual tumor architecture, integrating molecular signatures to predict cancer prognosis and treatment response, and developing robust computational biology tools to analyze and interpret the data generated across the large range of projects underway.  Broad Institute of MIT and Harvard 2010 http://www.broadinstitute.org/scientific-community/science/programs/cancer/cancer 

Herceptin is an example of a drug for which specific suitable patients can now be identified. Oncogenomics appears to be a synonym, but less frequently used than cancer genomics. (Glossary FAQ question # 3 outlines methodology.)  Related terms: CGAP Cancer Genome Anatomy Project, familial cancer, family history, germline mutations, oncogenomics, somatic cells, sporadic cancer   Narrower terms: cancer proteomics; familial cancer, family history, hereditary cancer, sporadic cancer.  

Cancer Immunome Atlas:  Innsbruck Medical University, Austria comprehensive immunogenomic analyses of next generation sequencing data (NGS) data for 20 solid cancers from The Cancer Genome Atlas (TCGA) and other datasources. https://tcia.at/home   Broader term: -Omes & -omics   immunome; Related terms: Expression gene & protein

cancer immunotherapies: Engineering Next-Generation Cancer Immunotherapies January 20-21, 2020 San Diego, CA New Protein Engineering Science and Technology to Support the Development of Novel Immunotherapeutics and Treatment Combinations Based on the clinical successes of checkpoint inhibitors, the industry is now directing its attention to combination treatments, single agent therapeutics with multiple modes of action, confronting resistance mechanisms, reducing toxicity and the persistent challenge of solid tumors.  https://www.chi-peptalk.com/cancer-immunotherapies

See also Biomarkers

Cancer Informatics April 21-23, 2020 • Boston, MA |  explores the important technology and informatics trends and challenges of applying computational biology to cancer research and care. Themes that will be covered include collaboration and network models, data access/management/integration strategies, and applications of biological interpretation to aid in research at the bench side or care at the bedside.Most clinical diagnoses involve the use of clinical testing, much of which is not standardized locally/nationally/internationally.  https://www.bio-itworldexpo.com/cancer-informatics

cancer proteomics: The use of DNA microarrays to study cancer is as established as the technology itself [5, 6]. Transcriptome data is not only used to classify different types of cancer, but to shed light on known and unknown cancer genes: proto- oncogenes, oncogenes, and tumor suppressor genes. Proteome data, on the other hand, is not as pervasive, largely due to technological limitations. However, with the steady advancements in the tools mentioned above, “cancer proteomics” is becoming a reality. James Kuo "Proteomics and its applications to cancer research" Molecular Biology & Biochemistry, Yale Univ. 2000  http://bioinfo.mbb.yale.edu/mbb452a/2000/projects/James--Kuo.html

cancer resources - for patients

cancer vaccines:  Vaccines or candidate vaccines designed to prevent or treat cancer. Vaccines are produced using the patient's own whole tumor cells as the source of antigens, or using tumor-specific antigens, often recombinantly produced. MeSH 1997

Cancer vaccines are designed to boost the body’s natural ability to protect itself, through the immune system, from dangers posed by damaged or abnormal cells such as cancer cells. The U.S. Food and Drug Administration (FDA) has approved two types of vaccines to prevent cancer: vaccines against the hepatitis B virus, which can cause liver cancer, and vaccines against human papillomavirus types 16 and 18, which are responsible for about 70 percent of cervical cancer cases. The FDA has approved one cancer treatment vaccine for certain men with metastatic prostate cancer. Researchers are developing treatment vaccines against many types of cancer and testing them in clinical trials. National Cancer Institute, Cancer Vaccines http://www.cancer.gov/cancertopics/factsheet/Therapy/cancer-vaccines 

While the common goal for cancer immunotherapeutics is to boost the immune system and thereby fight cancer in various stages, what is needed most for treating cancer successfully are more precisely-targeted therapies. The approaches vary widely and ideally it may be reached by using the patient’s own immune system or by inducing T-cells or “vaccines”  Broader term: cancer immunotherapeutics 

CAR T-cell therapy: A type of treatment in which a patient's T cells (a type of immune system cell) are changed in the laboratory so they will attack cancer cells. T cells are taken from a patient’s blood. Then the gene for a special receptor that binds to a certain protein on the patient’s cancer cells is added in the laboratory. The special receptor is called a chimeric antigen receptor (CAR). Large numbers of the CAR T cells are grown in the laboratory and given to the patient by infusion. CAR T-cell therapy is being studied in the treatment of some types of cancer. Also called chimeric antigen receptor T-cell therapy. NCI Dictionary of Cancer Terms https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=771302

Cell-Free Nucleic Acids: Nucleic acids (DNA or RNA) found circulating in SERUM; PLASMA; or other BODY FLUIDS. MeSH 2018 both tumor cells and fetal.

cellular oncogene (proto-oncogene): A normal gene that when mutated or improperly expressed contributes to the development of cancer. (See Oncogene.)  Molecular Cell Biology 4th edition https://www.ncbi.nlm.nih.gov/books/NBK21662/

checkpoint inhibitors: are used to treat cancers such as melanoma skin cancer and lung cancer. Researchers are also looking at them in clinical trials for other types of cancer.
Cancer Research UK, Checkpoint inhibitors https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/immunotherapy/types/checkpoint-inhibitors  See related immune checkpoint inhibitor

chemotherapy: Drug discovery & development  Often, but not necessarily cancer chemotherapy.

Circulating Tumor Cells  March 2-4, 2020 • San Francisco, CA  https://www.triconference.com/Circulating-Tumor-Cells | Circulating tumor cells and cell-free tumor DNA have dominated the headlines for the past decade and presently new liquid biopsy tests are entering the clinic. These will enable improved diagnosis of cancer, early detection, and a new era of companion diagnostics for therapy selection, monitoring, predicting outcomes, and measuring the risk of recurrence. New tools include methods to both isolate CTCs and destroy them with lasers, digital microfluidics, and epigenetic measurement to better diagnose, prognose, and treat disease.

Circulating Tumor Cells

Molecular characterization of tumour material will become increasingly important in selecting patients for clinical trials and offering appropriate treatment for patients in clinical practice. Recent advances in the field have indicated that the molecular characteristics of a tumour can be determined from circulating tumour cells and circulating tumour DNA; thus, a simple blood sample could provide these data in a simple, convenient and efficient manner. Circulating tumour-derived predictive biomarkers in oncology, Hodgson DR, Wellings R, Orr MC, McCormack R, Malone M, Board RE, Cantarini MV., AstraZeneca, Drug Discov Today. 2010 Feb;15(3-4):98-101. Epub 2010 Jan 4. http://www.ncbi.nlm.nih.gov/pubmed/20045486  

Related terms: cell free DNA, cell free nucleic acids, neoplastic cells circulating

Comparative Oncology Program COP:   In 2003, the National Cancer Institute's Center for Cancer Research (CCR) launched the Comparative Oncology Program (COP) to help researchers better understand the biology of cancer and to improve the assessment of novel treatments for humans by treating pet animals-primarily cats and dogs-with naturally occurring cancer, giving these animals the benefit of cutting-edge research and therapeutics. 
https://ccr.cancer.gov/Comparative-Oncology-Program/pet-owners/about

dominant (-acting) oncogene  A gene that stimulates cell proliferation and contributes to oncogenesis when present in a single copy. See oncogene [FAO glossary] 

driver mutations: Cancer genomes carry two classes of mutations: 'driver' mutations, which are positively selected because they are essential for tumour growth and development, and 'passenger' mutations, which are not subject to selection because they don't confer a growth advantage. Genomics: Beyond the usual suspects Nature Reviews Drug Discovery 6, 270-271 April 2007 doi:10.1038/nrd2301

early detection of cancer:  Methods to identify and characterize cancer in the early stages of disease and predict tumor behavior. MeSH 2009  

Emerging Immuno-Oncology Targets  August 11-12, 2020 Boston, MA | While cancer immunotherapy has made a giant leap in the past five years, the majority of therapies at advanced stages of development are clustered in a similar target space. The increased investment in immuno-oncology has created an urgent opportunity to discover and populate new target spaces that either present new classes of immunotherapies or can be used in combination with existing products. https://www.immuno-oncologysummit.com/Immuno-Oncology-Targets/

Engineering Next-Generation Cancer Immunotherapies January 20-21, 2020 • San Diego, CA  https://www.chi-peptalk.com/cancer-immunotherapies/  Based on the clinical successes of checkpoint inhibitors, the industry is now directing its attention to combination treatments, single agent therapeutics with multiple modes of action, confronting resistance mechanisms, reducing toxicity and the persistent challenge of solid tumors.

endpoints, cancer drug clinical trials:  Guidance for Industry, Clinical Trial Endpoints for the approval of cancer drugs and biologics, FDA 20207 http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071590.pdf 

familial cancer:  The expression 'familial cancer' is used by some as a synonym of hereditary cancer, however, many (including the authors of  this program) use it simply to refer to the familial occurrence of  cancer (> 1 case in a family), not necessarily due to an inherited cancer predisposition. Some proven hereditary disorders include the word ‘familial’ in their name. [Familial Cancer Database On-line Manual. R.H. Sijmons & G.T.N. Burger, Groningen, The Netherlands, 2000 http://facd.uicc.org/manual.shtml   Related terms: hereditary cancer, sporadic cancer

FDA Office of Hematology and Oncology Products OHOP:  http://www.fda.gov/aboutfda/centersoffices/officeofmedicalproductsandtobacco/cder/ucm091745.htm

Gleevec: An early example of a drug that targets a genetic change that is characteristic of the disease being treated ... approved for treatment of patients with chronic myeloid leukemia (CML). Gleevec inhibits Bcr- Abl tyrosine kinase, a protein that is created by the Philadelphia chromosome abnormality that is characteristic of CML. 
Gleevec.com http://www.gleevec.com/index.jsp

Herceptin: Herceptin.com, Genentech, US http://www.herceptin.com/ A preliminary (and promising) example of pharmacogenomics coming into clinical use.

hereditary cancer: The hallmark of hereditary cancer is that the associated germ- line mutation confers a high lifetime risk of cancer (often  >50 %, but no precise risk percentage has been defined in the literature). As a general rule, tumor development is a multi- step process in which in addition to the germline mutation in a gene, the normal ("wild type") copy of that gene and/ or other genes need to undergo somatic mutations before cancer develops. Familial Cancer Database On- line Manual. R.H. Simons & G.T.N. Burger, Groningen, The Netherlands, 2000 http://facd.uicc.org/manual.shtml     Related terms: familial cancer, sporadic cancer

immune checkpoint inhibitor: A type of drug that blocks certain proteins made by some types of immune system cells, such as T cells, and some cancer cells. These proteins help keep immune responses in check and can keep T cells from killing cancer cells. When these proteins are blocked, the “brakes” on the immune system are released and T cells are able to kill cancer cells better. Examples of checkpoint proteins found on T cells or cancer cells include PD-1/PD-L1 and CTLA-4/B7-1/B7-2. Some immune checkpoint inhibitors are used to treat cancer. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immune-checkpoint-inhibitor  See related checkpoint inhibitor

immuno-oncology IO:  As our understanding of tumor immunology has advanced, immuno-oncology has made unprecedented progress in improving the outcomes for cancer patients. Immuno-Oncology Summit 2020 Aug 10-14 https://www.immuno-oncologysummit.com/   

Immuno-Oncology Biomarkers & Companion Diagnostics Predicting Response and Guiding Patient Selection in IO Trials and Patient Care MARCH 2-4, 2020 San Francisco CA Recent advances in cancer immunotherapy have generated excitement across all fields of oncology. However, the field is still experiencing a lack of predictive biomarkers and patient selection remains difficult. Challenges in discovering predictive biomarkers for cancer immunotherapy involve multiple cell types, multiple mechanisms of T-cell regulation, genetic heterogeneity of tumors, immune components.  https://www.triconference.com/Preclinical-Immuno-Oncology-Biomarkers

Immuno-Oncology Summit Europe  March 9-12, 2020  South Quay London  https://www.immuno-oncologyeurope.com/ |  Harnessing the immune system for breakthrough therapies
Adoptive T-Cell Therapy  March 10-122, 2020  South Quay London  https://www.immuno-oncologyeurope.com/t-cell-therapy/ |  The therapeutic potential of adoptive cell therapy was first acknowledged a couple of decades ago, but it was only recently that we transformed adoptive cell therapy into a viable therapeutic option for patients by the two CAR T cell therapies approved by the FDA. Although this is a very exciting time for adoptive cell therapy, there is still much to be done to reach its full potential including other novel cell therapies beyond T cells.  
Biomarkers for Immuno-Oncology March 11-12, 2020  South Quay London Patient stratification and selection is a crucial step for those developing and providing immunotherapy. However, the heterogeneity of tumours makes it difficult to develop accurate predictive biomarkers for cancer patient populations. Thankfully there is a significant effort across academia and industry to do just this. Combining outputs from genomics, transcriptomics, proteomics and metabolomics, as well as looking into more discreet blood niches, such as circulating tumour cells and exosomes, may indeed provide the answers we need.  https://www.immuno-oncologyeurope.com/biomarkers-immuno-oncology
Combination Immunotherapy  March 11-12, 2020  South Quay London  |  Treating patients with an immunotherapy combination has become commonplace for many cancers. With an abundance of combinations to choose from and plenty more clinical trials ongoing, it is difficult to know which combinations will be most effective. Whether double immunotherapy combinations or immune checkpoint inhibitors combined with conventional cancer therapy, there are numerous factors that may influence therapeutic success, with varying degrees of supporting evidence. Predictive biomarkers, neoantigens, therapeutic mechanism, reducing toxicity and the immune response are all important considerations. https://www.immuno-oncologyeurope.com/combination-immunotherapy/
Immunomodulatory Approches  March 10-11 , 2020  South Quay London  |  With an abundance of immunotherapies and increasing biomarker availability, there are ever more choices for oncologists looking to employ the immune system in their treatment plans. The tumour microenvironment, and all its heterogeneity, represents a huge challenge in stratifying patient populations and selecting immunomodulatory therapies.we will discuss how immune cells and cytokines can be activated or suppressed to elicit a desired treatment response with a focus on T cell effectors, myeloid-derived suppressor cells and bispecific antibody Fc engagement. https://www.immuno-oncologyeurope.com/immunomodulatory-approaches 

immunotherapy: A type of biological therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection, and other diseases. Some types of immunotherapy only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG), and some monoclonal antibodies. NCI Dictionary of Cancer terms

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunotherapy 

Improving Immunotherapy Efficacy and Safety  May 4-5, 2020 Boston, MA  focuses on the latest innovations, science, novel targets, and modalities being adopted to improve immunotherapy efficacy and safety. Topics include: new approaches to immunity, the tumor microenvironment, novel IO targets and engineering strategies, emerging modalities, such as NK Cells and Gamma Deltas, immune tolerance, TREGs, plus effective strategies to mitigate toxicity. Examples will come from the world of checkpoint inhibitors, adoptive T cell therapy, combinations, cancer vaccines, oncolytic viruses, and novel immunotherapy approaches. https://www.pegsummit.com/Immunotherapy

imprecision medicine: “Fundamentally, this is still imprecision medicine,” said Dr. George Demetri, an oncologist and professor at the Dana-Farber Cancer Institute in Boston, referring to cancer immunotherapy. “We have great targets, but we still don’t know how to identify the right patients.”  Adam Feuerstein A humbling setback for an immune-revving cancer therapy underscores the many questions facing the field, Stat 2017  July
https://www.statnews.com/2017/07/27/immunotherapy-cancer-questions/ 

Interagency Council on Biomedical Imaging in Oncology: The Interagency Council on Biomedical Imaging (ICBIO) in Oncology brings together technology developers and representatives from the National Cancer Institute (NCI), Food and Drug Administration (FDA), and Centers for Medicare and Medicaid Services (CMS) to expedite the process of bringing new products to market, to provide advice from a multi-agency perspective on the spectrum of scientific, regulatory, and reimbursement issues related to developing imaging devices or technology. https://imaging.cancer.gov/programs_resources/specialized_initiatives/icbio/site.htm

liquid biopsy: June 15-17, 2019, Seattle WA https://www.liquidbiopsysummit.com/ Biofluids consist of circulating tumor cells (CTCs), infectious organisms, cell-free nucleic acid (cfNA), or extracellular vesicles (EVs) from multiple tissues or infectious agents within the body. The rapid development of highly sensitive and accurate analytical tools allows researchers to determine the role of these biomarkers in health, disease, and treatment response. Thus, precision medicine is increasingly expanding into the clinic as therapies based on these molecular profiles are actively being developed and used in patients. Of course, before the goal of high clinical utility can be achieved, liquid biopsies must pass rigorous analytic validation.

Obtaining material for pathological examination and analysis, from bodily fluids. Material retrieved includes CELL-FREE NUCLEIC ACIDS; CELL-DERIVED MICROPARTICLES; EXOSOMES; CIRCULATING NEOPLASM CELLS; and other circulating cells and CELLULAR STRUCTURES. MeSH Year introduced: 2018

Liquid biopsy enabling technologies  August 25-26, 2020 Washington, DC https://www.nextgenerationdx.com/circulating-tumor-cells/ | The technologies in the liquid biopsy field have been maturing rapidly and are on their path to revolutionize the management of cancer patients. However, in the increasingly crowded landscape of all the diagnostic approaches, it can be overwhelming to identify the key technologies that are showing promises and have potential to be implemented in clinical practices.

mathematical oncology: Clinical oncologists and tumour biologists possess virtually no comprehensive model to serve as a framework for understanding, organizing and applying their data... Fortunately, there are some signs of increasing acceptance of mathematical methods in experimental oncology. "Mathematical oncology: Cancer summed up" RA Gatenby, PK Maini, Nature 421 (6921): 321, Jan. 23, 2003  Related term: oncologic mathematics

Molecular Targets Program Recent advances and insights into the molecular pathogenesis of cancer provide unprecedented opportunities for discovery and development of novel, molecularly targeted diagnostic, therapeutic and preventative strategies and agents. The pivotal challenge to discovery and development of molecularly targeted prevention and therapeutics remains the definitive validation of human cancer-pertinent molecular targets for intervention. Such validation ultimately requires human clinical trials of specific molecularly targeted agents, and the demonstration that the desired clinical outcome is unequivocally the result of the corresponding molecular intervention. The critical foundation for the lead-discovery and preclinical research phase of molecular target validation is the basic research elucidating potential cancer-pertinent molecular targets. Within the NCI Center for Cancer Research (CCR), there are unique and extraordinary opportunities to advance molecularly targeted therapeutics and prevention of cancer, AIDS and other diseases. Rapid and efficient translation of basic scientific advances into new tools, reagents, and molecularly targeted leads for preclinical and clinical research and development based on scientific rationales and state-of-the-art technologies, optimally requires an interdisciplinary, collaborative, team-oriented approach.... The initial goal of the MTP is to facilitate the discovery of compounds that may serve as bioprobes for functional genomics, proteomics and molecular target validation research, as well as leads or candidates for drug development. Compounds of interest include not only classical, "drug-like" organic small-molecules, but also peptides, proteins, nucleic acids, lipids, carbohydrates and other bioactive chemical classes. Future implementation phases of the MTP concept may support preclinical and clinical development of promising new molecularly targeted investigational drugs.  National Cancer Institute, Molecular targets Program  https://ccrod.cancer.gov/confluence/display/CCRMTDPBeu/Introduction+to+MTP
Related terms:  molecularly targeted cancer therapies  See also Drug targets

myeloid cells: It is well established that cancer development ensues based on reciprocal interactions between genomically altered neoplastic cells and diverse populations of recruited “host” cells co-opted to support malignant progression. Among the host cells recruited into tumor microenvironments, several subtypes of myeloid cells, including macrophages, monocytes, dendritic cells, and granulocytes contribute to tumor development by providing tumor-promoting factors as well as a spectrum of molecules that suppress cytotoxic activities of T lymphocytes. Based on compelling preclinical data revealing that inhibition of critical myeloid-based programs leads to tumor suppression, novel immune-based therapies and approaches are now entering the clinic for evaluation.  Cotechini T, Medler TR, Coussens LM. Myeloid Cells as Targets for Therapy in Solid Tumors. Cancer J. 2015;21(4):343-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948591/

neoadjuvant therapy: Treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy. Definition of neoadjuvant therapy - NCI Dictionary of Cancer Terms ...  https://www.cancer.gov/publications/dictionaries/cancer-terms/def/neoadjuvant-therapy\

Neoantigen Targeted Therapies  August 13-14, 2020 Boston, MA | Fueled with advances in genomic technologies, personalized oncology promises to innovate cancer therapy and target previously undruggable space. Developments in NGS technology enabled systematic analysis of patient-specific mutanome and opens the door to developing personalized cancer vaccines and other therapies targeting neoantigens. https://www.immuno-oncologysummit.com/Neoantigen-Targeted-Therapies/

neoantigens: A neoantigenic determinant is an epitope on a neoantigen, which is a newly formed antigen that has not been previously recognized by the immune system.[1]Neoantigens are often associated with tumor antigens and are found in oncogenic cells.[2] Neoantigens and, by extension, neoantigenic determinants can be formed when a protein undergoes further modification within a biochemical pathway such as glycosylation, phosphorylation or proteolysis. This, by altering the structure of the protein, can produce new epitopes that are called neoantigenic determinants as they give rise to new antigenic determinants. https://en.wikipedia.org/wiki/Neoantigenic_determinant

The nature of the antigens that allow the immune system to distinguish cancer cells from noncancer cells has long remained obscure. Recent technological innovations have made it possible to dissect the immune response to patient-specific neoantigens that arise as a consequence of tumor-specific mutations, and emerging data suggest that recognition of such neoantigens is a major factor in the activity of clinical immunotherapies. These observations indicate that neoantigen load may form a biomarker in cancer immunotherapy and provide an incentive for the development of novel therapeutic approaches that selectively enhance T cell reactivity against this class of antigens. Neoantigens in cancer immunotherapy  Ton N. Schumacher1,*, Robert D. Schreiber2,*  Science  03 Apr 2015: Vol. 348, Issue 6230, pp. 69-74 DOI: 10.1126/science.aaa4971  http://science.sciencemag.org/content/348/6230/69 

Neoplastic Cells, Circulating:  Exfoliate neoplastic cells circulating in the blood and associated with metastasizing tumors. MeSH Year Introduced 2009   Related term: circulating tumor cells, cell free DNA

NK Natural Killer cells: are lymphocytes in the same family as T and B cells, coming from a common progenitor. However, as cells of the innate immune system, NK cells are classified as group I Innate Lymphocytes (ILCs) and respond quickly to a wide variety of pathological challenges. NK cells are best known for killing virally infected cells, and detecting and controlling early signs of cancer. As well as protecting against disease, specialized NK cells are also found in the placenta and may play an important role in pregnancy.  Philipp Eissmann, British Society for Immunology https://www.immunology.org/public-information/bitesized-immunology/cells/natural-killer-cells  

oncogene: A normal cellular gene which, when inappropriately expressed or mutated, can transform eukaryotic cells into tumour cells. IUPAC Medicinal Chemistry

Genes which can potentially induce neoplastic transformation. They include genes for growth factors, growth factor receptors, protein kinases, signal transducers, nuclear phosphoproteins, and transcription factors. When these genes are constitutively expressed after structural and/or regulatory changes, uncontrolled cell proliferation may result. Viral oncogenes have prefix "v-" before the gene symbol; cellular oncogenes (PROTO- ONCOGENES) have the prefix "c-" before the gene symbol. MeSH, 1983  Narrower terms: cellular oncogenes, dominant oncogene, immortalizing oncogene, proto-oncogene, recessive oncogene, viral oncogenes

oncogene proteins: Proteins coded by oncogenes. They include proteins resulting from the fusion of an oncogene and another gene (ONCOGENE PROTEINS, FUSION). MeSH, 1993

oncologic mathematics:  HYPOTHESIS: Mathematical methods and their derivatives have practical applications to oncology. They can be used to describe fundamental aspects of tumor behavior, such as loss of genetic stability, tumor growth, immunologic identity, genesis of diversity, and methods of prognosticating cancer. DATA SOURCES: Descriptive models and published literature in the fields of oncology and applied mathematics. DATA SYNTHESIS: Cancer does not conform to simple mathematical principles. Its irregular mode of carcinogenesis, erratic tumor growth, variable response to tumoricidal agents, and poorly understood metastatic patterns constitute highly variable clinical behavior. Defining this process requires an accurate understanding of the interactions between tumor cells and host tissues and ultimately determines prognosis. Applying time- tested and evolving mathematical methods to oncology may provide new tools with inherent advantages for the description of tumor behavior, selection of therapeutic modes, prediction of metastatic patterns, and providing an inclusive basis for prognostication. ... CONCLUSION: Experimentally testable, oncologic mathematics may provide a framework to determine clinical outcome on a patient- specific basis and increase the growing awareness that mathematical models help simplify seemingly complex and random tumor behavior. "Oncologic mathematics: evolution of a new specialty" RY Chandawarkar, DP Guyton, Archives of Surgery 137(12): 1428- 1434, Dec. 2002  Related term: mathematical oncology

oncolytic virotherapy:  August 10-11, 2020 Boston MA https://www.immuno-oncologysummit.com/Oncolytic-Virus-Immunotherapy/  The use of oncolytic viruses has expanded rapidly over the past five years with interest in the field at an all-time high following recent scientific breakthroughs and multi-million dollar investments from big pharma.

oncosomes: The major bottle neck for using exosomes in cancer research or clinical care is in obtaining enriched preparations of oncosomes from body fluids, where “oncosomes” are defined in this solicitation as exosomes that contain oncogenic cargo and/or unique signatures of the tumor cells from which they emanate.  Existing technologies are based on centrifugation, precipitation/centrifugation or affinity purification, which are labor intensive and time consuming.  Currently, we do not have effective technologies that can differentially isolate tissue-specific exosomes and tumor-derived oncosomes from the general population of exosomes in archived body fluids. Technologies for differential isolation of exosomes and oncosomes  NIH/NCI 359, August 2016,  SBIR Funding https://sbir.cancer.gov/funding/contracts/nihnci359

p53: Tumor suppressor genes located on the short arm of human chromosome 17 and coding for the phosphoprotein p53. MeSH, 1991  Broader term: tumor suppressor gene

passenger mutations: See under driver mutations

patient navigation: NCI addressed unequal patterns of standard health care access through CRCHD’s multisite Patient Navigation Research Program (PNRP). The PNRP focused on developing and testing interventions for follow-up and treatment initiation of four cancers with significant disparity: breast, cervical, prostate, and colorectal.

ness. These interventions are designed to decrease the time between a cancer-related abnormal finding, definitive diagnosis, and delivery of quality standard cancer care services. National Cancer Institute, NIH https://www.cancer.gov/about-nci/organization/crchd/disparities-research/pnrp

patient resources: cancer

precancerous:  There has been a lack of uniform terminology for the precancerous and non- invasive lesions. Reasons for this lack relate in part to changing concepts about the biology of these lesions, subjective interpretation of criteria, heterogeneity of the neoplastic cell population, less than optimal interobserver reproducibility, and even changes in treatment. Very often descriptive terms applied to these lesions contain a mixture of diagnostic and prognostic meanings. Classifying the precancers: A metadata approach Jules J Berman*1 and Donald E Henson2 BMC Medical Informatics and Decision Making 2003, 3:8 http://www.springerlink.com/content/2x6x4908206022vv/fulltext.pdf

Preclinical and Translational Immuno-Oncology August 11-12, 2020 Boston, MA | The recent advancements in immunotherapies, such as immune checkpoint modulators, bispecific antibodies, and adoptive T cell transfer, are shifting the way cancer patients are treated. Rapid development of novel immuno-oncology programs is creating the need for predictive preclinical models and translational strategies to understand combination immunotherapy, study responses and resistance to cancer immunotherapy, and identify novel biomarkers and targets. https://www.immuno-oncologysummit.com/Preclinical-Immuno-Oncology/

predictive oncology:  Essentially promotes primary cancer prevention by assessment of cancer susceptibility and control of genotoxic exposures and of the basic mechanisms that may lead to the development of neoplastic diseases. Predictive oncology incorporates also identification of cancer prone individuals and prognostic evaluation of tumor development and progression as well as lifestyle modification. Cancer Prediction and Prevention Online, International Society for Preventive Oncology http://www.cancerprev.org/ISPO/About/Definition

preventive oncology: For secondary prevention focuses on routine clinical and laboratory procedures for early detection and treatment of cancer, patient management and education, management of curable lesions, education and lifestyle modification. Involves: screening modalities and their cost effectiveness, methodological issues of cancer detection, public awareness and professional education, screening guidelines for cancer detection, clinical and laboratory aspects of cancer detection, management of patients with preneoplastic alterations, management of early curable neoplasms, novel therapeutic approaches. Cancer Prediction and Prevention Online, International Society for Preventive Oncology http://www.cancerprev.org/ISPO/About/Definition

proto-oncogene: See cellular oncogene

proto-oncogene proteins: Products of proto-oncogenes. Normally they do not have oncogenic or transforming properties, but are involved in the regulation or differentiation of cell growth. They often have protein kinase activity. MeSH, 1991

recessive oncogene; recessive-acting oncogene; anti-oncogene A single copy of this gene is sufficient to suppress cell proliferation; the loss of both copies of the gene contributes to cancer formation. See oncogene FAO glossary 

Small Molecules for Immunology and Oncology  APRIL 15-16, 2020 San Diego CA Evidence is mounting that autoimmunity/inflammation versus cancer can be considered two sides of the same coin. Inflammation arises when the immune system is overactive whereas cancer is largely a result of an underactive or subverted immune system. Hence medicinal chemists often design drugs against the same target for these seemingly opposite diseases: developing antagonists to inhibit autoimmunity/inflammation or agonists for the same molecular target to activate the immune system against cancer. We hope you can join fellow chemists at this event to share strategies, successes and challenges in discovering and optimizing drug candidates that have the potential to be orally bioavailable modulators of the immune system be it for cancer or other diseases.

https://www.drugdiscoverychemistry.com/Small-Molecule-Immunology

sporadic cancer: Cancer that occurs randomly and is not inherited from parents. Caused by DNA changes in one cell that grows and divides, spreading throughout the body. DOE  Related terms: familial cancer, family history, hereditary cancer

targeted cancer therapies:  Drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression. Because scientists often call these molecules “molecular targets,” targeted cancer therapies are sometimes called “molecularly targeted drugs,” “molecularly targeted therapies,” or other similar names. By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapies may be more effective than other types of treatment, including chemotherapy and radiotherapy, and less harmful to normal cells.  National Cancer Institute, Targeted Cancer Therapy   http://www.cancer.gov/cancertopics/factsheet/Therapy/targeted 

targeted therapy:  a type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells and limiting harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins, or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells or deliver toxic substances directly to cancer cells to kill them. This type of therapy may have fewer side effects than other types of cancer treatment. National Cancer Institute [NCI] Dictionary of Terms

therapy ladders: Sequential uses of combination protocols consisting of drugs that have been available for a long time (and are generically available in most cases) and are frequently also used for the treatment of solid tumors. 

Tumor antigen: an antigenic substance produced in tumor cells, i.e., it triggers an immune response in the host. Tumor antigens are useful tumor markers in identifying tumor cells with diagnostic tests and are potential candidates for use in cancer therapy. Wikipedia accessed 2018 August 8  https://en.wikipedia.org/wiki/Tumor_antigen

tumor markers: Tumor markers are substances produced by tumor cells or by other cells of the body in response to cancer or certain benign (noncancerous) conditions. These substances can be found in the blood, in the urine, in the tumor tissue, or in other tissues. Different tumor markers are found in different types of cancer, and levels of the same tumor marker can be altered in more than one type of cancer. In addition, tumor marker levels are not altered in all people with cancer, especially if the cancer is early stage. Some tumor marker levels can also be altered in patients with noncancerous conditions. Tumor Markers Q&A, National Cancer Institute https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-markers-fact-sheet

Tumor markers are substances, usually proteins, that are produced by the body in response to cancer growth or by the cancer tissue itself. Some tumor markers are specific for one type of cancer, while others are seen in several cancer types. Many of the well-known markers are seen in non-cancerous conditions as well as cancer. Consequently, these tumor markers are not diagnostic for cancer. Lab Tests Online, American Association for Clinical Chemistry in collaboration with ACLA, ASCLS, ASM, CLMA, ASH, AMP, ASCP, NCCLS, CAP, CSLMS, CSCC, CLAS, NACB and  ACB. https://labtestsonline.org/tests/tumor-markers

tumor microenvironment (TME):  Targeting the Tumour Microenvironment, Nov 18-19 2019, Lisbon Portugal   innovations for enhancing the immune anti-tumour response and overcoming inhibitory factors. It is becoming clear that many immunosuppressive mechanisms are at work. The checkpoint inhibitors are not living up to expectations, and for these and other antagonists to be effective, it is necessary to control Tregs and manipulate myeloid-derived and other suppressor cells in the tumour microenvironment (TME). The leaders in the field are also paying attention to the role of cytokines and the importance of Fc-engagement for effective targeting. https://www.pegsummiteurope.com/tumour-microenvironment

 Consists of cells, soluble factors, signaling molecules, extracellular matrix, and mechanical cues that can promote neoplastic transformation, support tumor growth and invasion, protect the tumor from host immunity, foster therapeutic resistance, and provide niches for dormant metastases to thrive. An American Association for Cancer Research (AACR) special conference held on November 3–6, 2011, addressed five emerging concepts in our understanding of the TME: its dynamic evolution, how it is educated by tumor cells, pathways of communication between stromal and tumor cells, immunomodulatory roles of the lymphatic system, and contribution of the intestinal microbiota.    Tumor Microenvironment Complexity: Emerging Roles in Cancer Therapy Melody A. Swartz 1, Noriho Iida 2, Edward W. Roberts 3, Sabina Sangaletti 4, Melissa H. Wong 5, Fiona E. Yull 6, Lisa M. Coussens 5 , and  Yves A. DeClerck 7 Cancer Res May 15, 2012 72; 2473 Published OnlineFirst March 13, 2012; doi: 10.1158/0008-5472.CAN-12- 0122   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653596/


Tumor Necrosis Factors A family of proteins that were originally identified by their ability to cause NECROSIS of NEOPLASMS. Their necrotic effect on cells is mediated through TUMOR NECROSIS FACTOR RECEPTORS which induce APOPTOSIS.  MeSH 2005

tumor suppressor gene: A protective gene that normally limits the growth of tumors. When a tumor suppressor is mutated, it may fail to keep a cancer from growing. BRCA1 and p53 are well- known tumor suppressor genes. NHGRI

Genes that inhibit expression of the tumorigenic phenotype. They are normally involved in holding cellular growth in check. When tumor suppressor genes are inactivated or lost, a barrier to normal proliferation is removed and unregulated growth is possible. MeSH, 2002

Ken Kinzler and Bert Vogelstein distinguish between "gatekeeper" tumor suppressor genes (classical) and "caretakers" (in DNA repair and genome integrity, whose action lies outside the pathway). KW Kinzler, B. Vogelstein "Cancer- susceptibility genes. Gatekeepers and caretakers" Nature 386 (6627): 761, 763 Apr. 24, 1997 Narrower terms: caretaker tumor suppressor genes, gatekeeper tumor suppressor genes, p53; Related term: Gene categories suppressor gene

tumor suppressor proteins: Proteins that are normally involved in holding cellular growth in check. Deficiencies or abnormalities in these proteins may lead to unregulated cell growth and tumor development. MeSH, 2002

tumoroid: Multicellular cancer “oids” (tumoroids, spheroids, organoids) provide models of intermediate complexity between standard two-dimensional culture systems and tumors in vivo. “Oids” exhibit physiologically relevant cell-cell and cell-matrix interactions, gene expression and signaling pathway profiles, heterogeneity and structural complexity that reflect in vivo tumors. When cultured properly, tumoroids form with relative ease and demonstrate the effectiveness, reproducibility, and robustness of this in vitro model system. 

An aggregate of cancer cells formed in vitro  Wiktionary https://en.wiktionary.org/wiki/tumoroid#English


umbrella trials (or studies): have many different treatment arms within one trial. People are assigned to a treatment arm of the trial based on their type of cancer and the specific molecular makeup of their cancer. ASCO American Society Clinical Oncology, Clinical trial Design and Methodology  https://www.asco.org/research-progress/clinical-trials/clinical-trial-resources/clinical-trial-design-and-methodology Related term: basket trials

Cancer Resources
IUPAC, Classification of carcinogenicity, IUPAC glossary of toxicology, 2007 http://sis.nlm.nih.gov/enviro/iupacglossary/annex3.html 
NCI National Cancer Institute, Dictionary of cancer terms, about 8,800 terms. http://www.cancer.gov/dictionary/
NCI Dictionary of Genetic terms https://www.cancer.gov/publications/dictionaries/genetics-dictionary
NCI Drug Dictionary https://www.cancer.gov/publications/dictionaries/cancer-drug
NCI Metathesaurus Browser, National Cancer Institute, NIH, US  http://ncimeta.nci.nih.gov/MetaServlet/  Maps 4,000,000 terms from more than 75 sources into 2,000,000 biomedical concepts.  
NCI, PDQ, Physicians Data Query,  http://www.cancer.gov/cancer_information/pdq/  Comprehensive cancer database, Cancer information summaries, clinical trials, links to other cancer resources
NCI Term Browser, National Cancer Institute http://nciterms.nci.nih.gov/ncitbrowser/pages/multiple_search.jsf be used to view and search the NCI Thesaurus and other biomedical vocabularies. 
OncoLink, University of Pennsylvania Medicine https://www.oncolink.org/  Comprehensive information about specific types of cancer, updates on cancer treatments and news about research advances. Updated every day,  information at various levels, from introductory  to in-depth.

Therapeutic indications Conferences: http://www.healthtech.com/conferences/upcoming.aspx?s=RXXS

Patient resources cancer
Cancer and statistics Stephen Jay Gould's essay "The Median isn't the Message" is a wonderful essay on interpreting statistics and the medical literature, and particularly useful for those of us who quickly head to a library and/ or the web with very specific and personal interest in a medical topic.  http://cancerguide.org/median_not_msg.html 

Robert Weinberg's Racing to the Beginning of the Road : The Search for the Origin of Cancer 1998 is a very readable account of top rate biomedical research, a good reminder that these "races" are marathons and not 100 yard dashes. The title is one of my favorite metaphors for the complexity of biology. This explanation of how nonlinear progress from lab to clinic can be is highly recommended. 

Welch, Gilbert H. Should I Be Tested for Cancer? Univ of California Press, 2004. http://www.ucpress.edu/books/pages/10079.html 

Support for college students with Cancer https://www.affordablecollegesonline.org/college-resource-center/students-with-cancer/

Other patient and disease related websites Molecular Diagnostics,     Patient resources

How to look for other unfamiliar  terms

IUPAC definitions are reprinted with the permission of the International Union of Pure and Applied Chemistry.

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