Castle Biosciences Posts Results of Collaborative Ocular Oncology Group Survey on the Management of Ocular Oncology Patients During the COVID-19 Pandemic

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Castle Biosciences, Inc. (Nasdaq: CSTL), a skin and eye cancer diagnostics company providing personalized genomic information to improve cancer treatment decisions, today posted to its website results from a survey performed by the Collaborative Ocular Oncology Group (COOG) for the purpose of providing a current practices survey for clinicians regarding management of patients diagnosed with uveal melanoma and other ocular tumors during the COVID-19 pandemic.

The Collaborative Ocular Oncology Group (COOG) represents most major ocular oncology centers in North America who manage patients with uveal melanoma and other ocular tumors. Twenty-three of twenty-five COOG members were able to complete the survey.

The COOG conducted an on-line survey study between March 25-26, 2020, in order to survey current management practices for patients with a range of eye tumors, including uveal melanoma, high risk choroidal nevus, retinoblastoma, intraocular metastasis, vitreoretinal lymphoma, benign intraocular tumors, conjunctival melanoma, conjunctival squamous cell carcinoma/ocular surface squamous neoplasia (OSSN), and conjunctival lymphoma.

Telemedicine is of limited value in patients with active intraocular cancers, due to the need for specialized ophthalmic imaging, whereas it may be of more benefit in patients with treated inactive tumors, and those with ocular surface conjunctival tumors, in which the patient can take photos of the eye with their smartphone, said J. William Harbour, M.D., the Mark J. Daily Endowed Professor of Ophthalmology, Vice Chairman for Translational Research, and Director of Ocular Oncology at Bascom Palmer Eye Institute, Associate Director for Basic Research at Sylvester Comprehensive Cancer Center, and chair of the COOG. Given these challenges, we conducted a survey of COOG investigators across North America to obtain a snapshot of current practices during the COVID-19 pandemic. Currently, most ocular oncology experts continue to promptly see new patients with eye cancers, such as uveal melanoma, retinoblastoma, intraocular metastasis and vitreoretinal lymphoma. In contrast, many experts would delay by at least a few weeks the return of established eye cancer patients who have been treated and are stable, and those with benign or low-grade tumors.

Summary results are attached, and detailed results are available on the Castle Biosciences DecisionDx-UM page: https://castlebiosciences.com/products/decisiondx-um/. The attached results were prepared by the COOG, and Castle Biosciences makes no representation or warranty as to their accuracy or completeness.

About DecisionDx-UM

DecisionDx-UM is a 15-gene expression profiling (GEP) test that uses an individual patients tumor biology to predict individual risk of metastasis. DecisionDx-UM is considered to be standard of care in the management of uveal melanoma in the majority of ocular oncology practices in the United States. Since 2009, the American Joint Committee on Cancer (AJCC; v7 and v8) Staging Manual for UM has specifically identified the GEP test as a prognostic factor that is recommended for collection as a part of clinical care. Further, the National Comprehensive Cancer Network (NCCN) guidelines for uveal melanoma include the DecisionDx-UM test result as a prognostic method for determining risk of metastasis and recommended differential surveillance regimens based on a Class 1A, 1B, and 2 result. DecisionDx-UM is the only prognostic test for uveal melanoma that has been validated in prospective, multi-center studies and it has been shown to be a superior predictor of metastasis compared to other prognostic factors such as chromosome 3 status, mutational status, AJCC stage, and cell type.

It is estimated that nearly 8 in 10 patients diagnosed with uveal melanoma in the U.S. receive the DecisionDx-UM test as part of their initial diagnostic workup. More information about the test and disease can be found at www.MyUvealMelanoma.com.

About Castle Biosciences

Castle Biosciences (Nasdaq: CSTL) is a commercial-stage dermatologic cancer company focused on providing physicians and their patients with personalized, clinically actionable genomic information to make more accurate treatment decisions. The Company currently offers tests for patients with cutaneous melanoma (DecisionDx-Melanoma, DecisionDx-CMSeq; www.SkinMelanoma.com) and uveal melanoma (DecisionDx-UM, DecisionDx-PRAME and DecisionDx-UMSeq; www.MyUvealMelanoma.com), with products in development for other underserved cancers, the two most advanced of which are focused on patients with cutaneous squamous cell carcinoma, and patients who have a difficult-to-diagnose pigmented lesion. Castle Biosciences is based in Friendswood, Texas (Houston), and has laboratory operations in Phoenix, Arizona. For more information, visit www.CastleBiosciences.com.

DecisionDx-Melanoma, DecisionDx-CMSeq, DecisionDx-UM, DecisionDx-PRAME and DecisionDx-UMSeq are trademarks of Castle Biosciences, Inc.

RESULTS OF SURVEY OF THE COLLABORATIVE OCULAR ONCOLOGY GROUP: MANAGEMENT OF OCULAR ONCOLOGY PATIENTS DURING THE COVID-19 PANDEMIC March 27, 2020

During this unprecedented COVID-19 event, there are unique challenges in the care of patients with intraocular and ocular surface tumors, recognizing that a delay in care may impact vision, eye preservation, and in some cases survival. This is complicated by the small number of ocular oncologists and the current mandate to see only urgent and emergent patients. We are also limited in our ability to examine patients with intraocular tumors by telemedicine.

As such, the Collaborative Ocular Oncology Group (COOG) is uniquely positioned to provide expert insights from our respective centers across North America.

The following survey was completed by 23/25 (92%) of COOG investigators within the past 24 hours. These are the directors of most major ocular oncology centers in North America, including hard hit cities such as New York City, Boston, Miami, Baltimore, Dallas, Houston, and others. We recognize that the situation is rapidly changing, and that case-by-case details may result in variations in care. However, we believe that this survey provides an informative and helpful snapshot that will be of value to others in the field around the world.

These questions were posed with the assumption that patients in question have no symptoms associated with COVID-19 and have not been in close contact with anyone who has tested positive.

Importantly, this is not a position statement and does not represent consensus management guidelines but is simply a snapshot of what COOG investigators are currently doing in their practices.

This survey may be conducting again in the future as the situation evolves.

We hope that this is of value to ocular oncology providers.

Thank you, J. William Harbour, MD on behalf of the COOG Executive Committee

OVERVIEW OF SURVEY FINDINGS

Retinoblastoma

Newly diagnosed patients and those in active treatment continue to be seen as usual. For patients who have been treated with no active disease for >3months, most would delay follow-up at least 4 weeks. Factors such as laterality, germline RB1 status, and age had little influence.

Uveal melanoma

Newly diagnosed patients continue to be evaluated promptly. Most would delay follow-up visits on recently treated patients by at least 4 weeks. For patients receiving regular intravitreal anti-VEGF injections for radiation complications, most would continue these as usual, with a significant minority delaying these 4 weeks or more.

Choroidal nevus with high risk features

Most would see new patients as usual, but most would delay follow-up visits by at least 4 weeks. Patients with symptoms would tend to be seen more promptly. Several would triage returning patients with telemedicine.

Intraocular metastasis

Newly diagnosed patients continue to be seen as usual. Follow-up visits on treated patients would tend to be delayed at least 4 weeks unless patient is having ocular pain.

Vitreoretinal lymphoma

Newly diagnosed patients and those in active treatment continue to be seen as usual unless confounding factors such as patient age >70 or pulmonary/immune compromise. Treated patients in remission would be delayed at least 4 weeks.

Benign intraocular tumors

Most would delay initial and follow-up visits by at least 4 weeks.

Conjunctival melanoma

New patients and those in active treatment, especially those with extensive and/or elevated disease, would be seen promptly. Treated patients with stable disease would be delayed at least 4 weeks.

Conjunctival squamous cell carcinoma/ocular surface squamous neoplasia (OSSN)

New patients and those in active treatment, especially those with extensive and/or elevated disease, would be seen promptly. Treated patients with stable disease would be delayed at least 4 weeks. Several would use telehealth to triage initial and returning patients.

Conjunctival lymphoma

Some would see newly diagnosed patients as usual, whereas most would delay by at least 4 weeks, with some using that time to obtain systemic imaging. Several would use telemedicine to triage initial visits. Stable follow-up patients would be delayed by at least 4 weeks.

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