Todd Knepper, PharmD

Cancer Focus:
Breast Cancer, Leukemia, Melanoma, Merkel Cell Carcinoma, Myelodysplastic Syndromes (MDS), Pancreatic Cancer, Skin Cancer (Nonmelanoma)

Dr. Todd Knepper is an Associate Member in the Department of Pathology at Moffitt Cancer Center. He graduated with his PharmD degree from the University of North Carolina - Eshelman School of Pharmacy, completed a Personalized Cancer Medicine Fellowship at Moffitt Cancer Center, and gained regulatory experience as an ORISE fellow at the US FDA with the Genomics and Targeted Therapy group. At Moffitt, he has been a key part of the creation and development of the Precision Medicine Program, bringing cancer genomics into the clinic through the molecular tumor board (MTB) and Precision Medicine Clinical Service. He also serves on the ASCO TAPUR trial MTB and is a precision oncology expert for a nationwide SWOG Precision Medicine trial focused on the clinical utility of MTBs in community oncology practices. As an Attending on the clinical service at Moffitt, he provides clinically meaningful interpretations of tumor next-generation sequencing results for patients with hematologic malignancies and solid tumors and is Precision Medicine Clinical Service rotation leader for 2^nd-year heme-onc fellows. He has co-authored over thirty scientific manuscripts, including in high-impact journals such as the Journal of Clinical Oncology, Blood, Clinical Cancer Research, Lancet, and Nature.

Education & Training

Fellowship:

• Moffitt Cancer Center - Precision Oncology

• Drekolias D, Knepper TC, Lovette Q, Sallman DA. Case of KRAS G12C-Mutated AML Treated With Sotorasib. JCO Precis Oncol. 2025 Jul.9:e2500368. Pubmedid: 40712108.
• Harris EJ, Karaoglu DA, Sukhanova M, Abaza Y, Karantanos T, Eisfeld AK, Anderson C, Lin C, Moreno Vanegas YA, Badar T, Coltoff A, Knepper TC, Ozkaya N, Youshanlouei HR, Cetin S, Patel AA, DuVall AS, Drazer MW, Wang P, Tjota M, Segal JP, Venkataraman G, Gurbuxani S, Cheng JX, Arber DA, Larson RA, Odenike O, Webster J, Shah B, Stock W, Saygin C. Clinical and molecular characterization of TP53-mutant acute lymphoblastic leukemia in adults. Blood Cancer J. 2025 Aug.15(1):138. Pubmedid: 40813576. Pmcid: PMC12354737.
• Lloyd MR, Chica-Parrado R, Weipert CM, Knepper TC, Podany EL, Napolitano F, Ye D, Lin CC, Uemoto Y, Liao J, Wegrzyn C, Walko CM, Ryan LY, Keenan JC, Medford AJ, Liu SA, Wulf GM, Clifton KK, Ma CX, Han HS, Zhang N, Ellisen LW, Bardia A, Arteaga CL, Hanker AB, Wander SA. A bedside-to-bench translational analysis of NF1 alterations and CDK4/6 inhibitor resistance in hormone receptor-positive metastatic breast cancer. EBioMedicine. 2025 Aug.118:105828. Pubmedid: 40578027. Pmcid: PMC12266523.
• Yu J, Park R, Miao R, Imanirad I, Shahzad M, Laborde JM, Knepper TC, Walko CM, Kim R. Blood Tumor Mutational Burden Alone Is Not a Good Predictive Biomarker for Response to Immune Checkpoint Inhibitors in Patients With Gastrointestinal Tumors. J Immunother. 2024 Nov.47(9):378-383. Pubmedid: 39012081.
• Saygin C, Zhang P, Stauber J, Aldoss I, Sperling AS, Weeks LD, Luskin MR, Knepper TC, Wanjari P, Wang P, Lager AM, Fitzpatrick C, Segal JP, Gharghabi M, Gurbuxani S, Venkataraman G, Cheng JX, Eisfelder BJ, Bohorquez O, Patel AA, Umesh Nagalakshmi S, Jayaram S, Odenike OM, Larson RA, Godley LA, Arber DA, Gibson CJ, Munshi NC, Marcucci G, Ebert BL, Greally JM, Steidl U, Lapalombella R, Shah BD, Stock W. Acute Lymphoblastic Leukemia with Myeloid Mutations Is a High-Risk Disease Associated with Clonal Hematopoiesis. Blood Cancer Discov. 2024 May.5(3):164-179. Pubmedid: 38150184. Pmcid: PMC11061587.
• Berry DK, Gillis N, Padron E, Moore C, Barton LV, Gewandter KR, Haskins CG, Knepper TC. Interpretation of ambiguous TP53 test results: Mosaicism, clonal hematopoiesis, and variants of uncertain significance. J Genet Couns. 2024 Aug.33(4):916-926. Pubmedid: 37715966.
• Baker SD, Bates SE, Brooks GA, Dahut WL, Diasio RB, El-Deiry WS, Evans WE, Figg WD, Hertz DL, Hicks JK, Kamath S, Kasi PM, Knepper TC, McLeod HL, O'Donnell PH, Relling MV, Rudek MA, Sissung TM, Smith DM, Sparreboom A, Swain SM, Walko CM. DPYD Testing: Time to Put Patient Safety First. J Clin Oncol. 2023 May.41(15):2701-2705. Pubmedid: 36821823.
• Zhang Y, Nguyen L, Lu CM, Wang E, Lauw MIS, Ball S, Dong N, Moscinski L, Chan O, Yun S, Sallman D, Sokol L, Shah B, Knepper T, Lancet J, Komrokji R, Padron E, Kuykendall A, Zhang L. Clinical Response to Upfront Targeted Tyrosine Kinase Inhibitors among Patients with Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Gene Fusion. Clin Lymphoma Myeloma Leuk. 2023 Mar.23(3):e150-e163. Pubmedid: 36624015.
• Meng L, Thapa R, Delgado MG, Gomez MF, Ji R, Knepper TC, Hubbard JM, Wang X, Permuth JB, Kim RD, Laber DA, Xie H. Association of Age With Treatment-Related Adverse Events and Survival in Patients With Metastatic Colorectal Cancer. JAMA Netw Open. 2023 Jun.6(6):e2320035. Pubmedid: 37358854. Pmcid: PMC10293914.
• Shah NN, Castillo-Tokumori F, Whiting J, Boulware D, Sandoval-Sus J, Knepper TC, Hussaini M, Tao J, Chavez JC, Isenalumhe L, Gaballa S, Saeed H, Bello C, Sokol L, Pinilla-Ibarz J, Shah BD. Frontline treatment approaches in TP53-aberrant mantle cell lymphoma. Leuk Lymphoma. 2023 Jan.64(1):230-233. Pubmedid: 36301721.
• Knepper TC, Boyle TA, Hicks JK, Walko CM. Pharmacist-Driven Precision Medicine: A Ferry to Cross the Chasm of Interpreting Biomarker Testing Reports. JCO Oncol Pract. 2023 Aug.19(8):679-680. Pubmedid: 37335971.
• Kim S, Wuthrick E, Blakaj D, Eroglu Z, Verschraegen C, Thapa R, Mills M, Dibs K, Liveringhouse C, Russell J, Caudell JJ, Tarhini A, Markowitz J, Kendra K, Wu R, Chen DT, Berglund A, Michael L, Aoki M, Wang MH, Hamaidi I, Cheng P, de la Iglesia J, Slebos RJ, Chung CH, Knepper TC, Moran-Segura CM, Nguyen JV, Perez BA, Rose T, Harrison L, Messina JL, Sondak VK, Tsai KY, Khushalani NI, Brohl AS. Combined nivolumab and ipilimumab with or without stereotactic body radiation therapy for advanced Merkel cell carcinoma: a randomised, open label, phase 2 trial. Lancet. 2022 Sep.400(10357):1008-1019. Pubmedid: 36108657. Pmcid: PMC9533323.
• Ball S, Knepper TC, Deutsch YE, Samra W, Watts JM, Bradley TJ, Chan O, Hussaini MO, Zhang L, Sweet KL, Kuykendall AT, Talati C, Padron E, Komrokji RS, Lancet JE, Sallman DA. Molecular annotation of extramedullary acute myeloid leukemia identifies high prevalence of targetable mutations. Cancer. 2022 Nov.128(21):3880-3887. Pubmedid: 36107670.
• Tan ES, Fan W, Knepper TC, Schell MJ, Sahin IH, Fleming JB, Xie H. Prognostic and Predictive Value of PIK3CA Mutations in Metastatic Colorectal Cancer. Target Oncol. 2022 Jul.17(4):483-492. Pubmedid: 35767139.
• Fusco MJ, Knepper TC, Balliu J, Del Cueto A, Laborde JM, Hooda SM, Brohl AS, Bui MM, Hicks JK. Evaluation of Targeted Next-Generation Sequencing for the Management of Patients Diagnosed with a Cancer of Unknown Primary. Oncologist. 2022 Feb.27(1):e9-e17. Pubmedid: 35305098. Pmcid: PMC8842368.
• Karan C, Tan E, Sarfraz H, Knepper TC, Walko CM, Felder S, Kim R, Sahin IH. Human Epidermal Growth Factor Receptor 2-Targeting Approaches for Colorectal Cancer: Clinical Implications of Novel Treatments and Future Therapeutic Avenues. JCO Oncol Pract. 2022 Aug.18(8):545-554. Pubmedid: 35613416.
• Tan ES, Knepper TC, Wang X, Permuth JB, Wang L, Fleming JB, Xie H. Copy Number Alterations as Novel Biomarkers and Therapeutic Targets in Colorectal Cancer. Cancers (Basel). 2022 Apr.14(9). Pubmedid: 35565354. Pmcid: PMC9101426.
• Tan E, Whiting J, Knepper T, Xie H, Imanirad I, Carballido E, Felder S, Frakes J, Mo Q, Permuth JB, Somerer K, Kim R, Anaya DA, Fleming JB, Walko C, Sahin IH. Core Homologous Recombination Mutations and Improved Survival in Nonpancreatic GI Cancers. Am J Clin Oncol. 2022 Apr.45(4):137-141. Pubmedid: 35320814.
• Knepper TC, Panchaud RA, Muradova E, Cohen L, DeCaprio JA, Khushalani NI, Tsai KY, Brohl AS. An analysis of the use of targeted therapies in patients with advanced Merkel cell carcinoma and an evaluation of genomic correlates of response. Cancer Med. 2021 Sep.10(17):5889-5896. Pubmedid: 34269527. Pmcid: PMC8419775.
• Wenning L, Pillai GC, Knepper TC, Ilic K, Ali AM, Hibma JE. Clinical Pharmacology Worldwide: A Global Health Perspective. Clin Pharmacol Ther. 2021 Oct.110(4):946-951. Pubmedid: 33893656.
• Dong N, Castillo Tokumori F, Isenalumhe L, Zhang Y, Tandon A, Knepper TC, Mo Q, Shao H, Zhang L, Sokol L. Large granular lymphocytic leukemia - A retrospective study of 319 cases. Am J Hematol. 2021 Jul.96(7):772-780. Pubmedid: 33819354.
• Fusco MJ, Saeed-Vafa D, Carballido EM, Boyle TA, Malafa M, Blue KL, Teer JK, Walko CM, McLeod HL, Hicks JK, Extermann M, Fleming JB, Knepper TC, Kim DW. Identification of Targetable Gene Fusions and Structural Rearrangements to Foster Precision Medicine in KRAS Wild-Type Pancreatic Cancer. JCO Precis Oncol. 2021 Jan.5. Pubmedid: 34250383. Pmcid: PMC8232071.
• Seligson ND, Knepper TC, Ragg S, Walko CM. Developing Drugs for Tissue-Agnostic Indications: A Paradigm Shift in Leveraging Cancer Biology for Precision Medicine. Clin Pharmacol Ther. 2021 Feb.109(2):334-342. Pubmedid: 32535906. Pmcid: PMC7891377.
• Knepper TC, Montesion M, Russell JS, Sokol ES, Frampton GM, Miller VA, Albacker LA, McLeod HL, Eroglu Z, Khushalani NI, Sondak VK, Messina JL, Schell MJ, DeCaprio JA, Tsai KY, Brohl AS. The Genomic Landscape of Merkel Cell Carcinoma and Clinicogenomic Biomarkers of Response to Immune Checkpoint Inhibitor Therapy. Clin Cancer Res. 2019 Oct.25(19):5961-5971. Pubmedid: 31399473. Pmcid: PMC6774882.
• Liao P, Jia F, Teer JK, Knepper TC, Zhou HH, He YJ, McLeod HL. Geographic variation in molecular subtype for gastric adenocarcinoma. Gut. 2019 Jul.68(7):1340-1341. Pubmedid: 29960981.
• Knepper TC. Editorial Comment. J Urol. 2019 Aug.202(2):390-391. Pubmedid: 31107159.
• Ramamoorthy A, Knepper TC, Merenda C, Mendoza M, McLeod HL, Bull J, Zhang L, Pacanowski M. Demographic Composition of Select Oncologic New Molecular Entities Approved by the FDA Between 2008 and 2017. Clin Pharmacol Ther. 2018 Nov.104(5):940-948. Pubmedid: 30218447. Pmcid: PMC6220929.
• Knepper TC, McLeod HL. When will clinical trials finally reflect diversity?. Nature. 2018 May.557(7704):157-159. Pubmedid: 29743700.
• Yun S, Zhang L, Patel MR, Knepper TC, Chavez JC, Pinilla-Ibarz J. Transformation of chronic lymphocytic leukemia into B-cell acute lymphoblastic leukemia. Blood. 2018 Mar.131(11):1258-1261. Pubmedid: 29437555.
• Wang W, Wang K, Chen Z, Chen L, Guo W, Liao P, Rotroff D, Knepper TC, Liu Z, Zhang W, Mcleod HL, He Y. Immunoclassification characterized by CD8 and PD-L1 expression is associated with the clinical outcome of gastric cancer patients. Oncotarget. 2018 Feb.9(15):12164-12173. Pubmedid: 29552300. Pmcid: PMC5844736.
• Coombs CC, Gillis NK, Tan X, Berg JS, Ball MC, Balasis ME, Montgomery ND, Bolton K, Parker JS, Mesa TE, Yoder SJ, Hayward MC, Patel NM, Richards KL, Walko CM, Knepper TC, Soper JT, Weiss J, Grilley-Olson JE, Kim WY, Earp S, Levine R, Papaemmanuil E, Zehir A, Hayes DN, Padron E. Identification of Clonal Hematopoiesis Mutations in Solid Tumor Patients Undergoing Unpaired Next-Generation Sequencing Assays. Clin Cancer Res. 2018 Dec.24(23):5918-5924. Pubmedid: 29866652. Pmcid: PMC6812550.
• Vela CM, Knepper TC, Gillis NK, Walko CM, McLeod HL, Hicks JK. Quantitation of Targetable Somatic Mutations Among Patients Evaluated by a Personalized Medicine Clinical Service: Considerations for Off-Label Drug Use. Pharmacotherapy. 2017 Sep.37(9):1043-1051. Pubmedid: 28235141.
• Knepper TC, Freeman ML, Gibney GT, McLeod HL, Russell JS. Clinical Response to Pazopanib in a Patient With KDR-Mutated Metastatic Basal Cell Carcinoma. JAMA Dermatol. 2017 Jun.153(6):607-609. Pubmedid: 28384659.
• Knepper TC, Bell GC, Hicks JK, Padron E, Teer JK, Vo TT, Gillis NK, Mason NT, McLeod HL, Walko CM. Key Lessons Learned from Moffitt's Molecular Tumor Board: The Clinical Genomics Action Committee Experience. Oncologist. 2017 Feb.22(2):144-151. Pubmedid: 28179575. Pmcid: PMC5330702.
• Knepper TC, Saller J, Walko CM. Novel and Expanded Oncology Drug Approvals of 2016-PART 1: New Options in Solid Tumor Management. Oncology (Williston Park). 2017 Feb.31(2):110-121. Pubmedid: 28205191.
• Shen H, Zhong M, Wang W, Liao P, Yin X, Rotroff D, Knepper TC, Mcleod HL, Zhou C, Xie S, Li W, Xu B, He Y. EBV infection and MSI status significantly influence the clinical outcomes of gastric cancer patients. Clin Chim Acta. 2017 Aug.471:216-221. Pubmedid: 28601671.
• Jia F, Teer JK, Knepper TC, Lee JK, Zhou HH, He YJ, McLeod HL. Discordance of Somatic Mutations Between Asian and Caucasian Patient Populations with Gastric Cancer. Mol Diagn Ther. 2017 Apr.21(2):179-185. Pubmedid: 28039579. Pmcid: PMC5357153.
• Zhou C, Chen X, Zeng W, Peng C, Huang G, Li X, Ouyang Z, Luo Y, Xu X, Xu B, Wang W, He R, Zhang X, Zhang L, Liu J, Knepper TC, He Y, McLeod HL. Propranolol induced G0/G1/S phase arrest and apoptosis in melanoma cells via AKT/MAPK pathway. Oncotarget. 2016 Oct.7(42):68314-68327. Pubmedid: 27582542. Pmcid: PMC5356557.
• Zhao Y, Chen W, Zhu W, Li J, Su J, Zhao S, Chen M, Zhang J, Guo A, Yan S, Zhou X, Kuang X, Liu Z, Luo D, Knepper TC, He Y, Chen X. Tandem repeats of TSER significantly influence the efficacy of 5-fluorouracil in the treatment of plantar warts. Per Med. 2016 May.13(3):233-240. Pubmedid: 29767611.
• Knepper TC, McLeod HL. Heritage-specific mechanisms for cancer adverse reactions: one gene does not explain the world. J Clin Oncol. 2015 Apr.33(11):1230-1231. Pubmedid: 25753435.