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Richman SD, Hemmings G, Roberts H, Gallop N, Dodds R, Wilkinson L, Davis J, White R, Yates E, Jasani B, Brown L, Maughan TS, Butler R, Quirke P, Adams R. FOCUS4 biomarker laboratories: from the benefits to the practical and logistical issues faced during 6 years of centralised testing. J Clin Pathol 2023; 76:548-554. [PMID: 35256486 PMCID: PMC7614788 DOI: 10.1136/jclinpath-2022-208233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/03/2022]
Abstract
AIMS FOCUS4 was a phase II/III umbrella trial, recruiting patients with advanced or metastatic colorectal cancer, between 2014 and 2020. Molecular profiling of patients' formalin-fixed, paraffin-embedded tumour blocks was undertaken at two centralised biomarker laboratories (Leeds and Cardiff), and the results fed directly to the Medical Research Council Clinical Trials Unit, and used for subsequent randomisation. Here the laboratories discuss their experiences. METHODS Following successful tumour content assessment, blocks were sectioned for DNA extraction and immunohistochemistry (IHC). Pyrosequencing was initially used to determine tumour mutation status (KRAS, NRAS, BRAF and PIK3CA), then from 2018 onwards, next-generation sequencing was employed to allow the inclusion of TP53. Protein expression of MLH1, MSH2, MSH6, PMS2 and pTEN was determined by IHC. An interlaboratory comparison programme was initiated, allowing sample exchanges, to ensure continued assay robustness. RESULTS 1291 tumour samples were successfully analysed. Assay failure rates were very low; 1.9%-3.3% for DNA sequencing and 0.9%-1.3% for IHC. Concordance rates of >98% were seen for the interlaboratory comparisons, where a result was obtained by both laboratories. CONCLUSIONS Practical and logistical problems were identified, including poor sample quality and difficulties with sample anonymisation. The often last-minute receipt of a sample for testing and a lack of integration with National Health Service mutation analysis services were challenging. The laboratories benefitted from both pretrial validations and interlaboratory comparisons, resulting in robust assay development and provided confidence during the implementation of new sequencing technologies. We conclude that our centralised approach to biomarker testing in FOCUS4 was effective and successful.
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Affiliation(s)
- Susan D Richman
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Gemma Hemmings
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Helen Roberts
- All Wales Molecular Genetics Laboratory, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | - Niall Gallop
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Rachel Dodds
- All Wales Molecular Genetics Laboratory, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | | | - Jonathan Davis
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Rhian White
- All Wales Molecular Genetics Laboratory, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | - Emma Yates
- MRC Clinical Trials Unit at UCL, London, UK
| | | | | | - Tim S Maughan
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Rachel Butler
- All Wales Molecular Genetics Laboratory, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | - Philip Quirke
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Richard Adams
- Velindre Cancer Centre, Cardiff University, Cardiff, UK
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Huang K, Zhang Y, Gong H, Qiao Z, Wang T, Zhao W, Huang L, Zhou X. Inferring evolutionary trajectories from cross-sectional transcriptomic data to mirror lung adenocarcinoma progression. PLoS Comput Biol 2023; 19:e1011122. [PMID: 37228122 DOI: 10.1371/journal.pcbi.1011122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Lung adenocarcinoma (LUAD) is a deadly tumor with dynamic evolutionary process. Although much endeavors have been made in identifying the temporal patterns of cancer progression, it remains challenging to infer and interpret the molecular alterations associated with cancer development and progression. To this end, we developed a computational approach to infer the progression trajectory based on cross-sectional transcriptomic data. Analysis of the LUAD data using our approach revealed a linear trajectory with three different branches for malignant progression, and the results showed consistency in three independent cohorts. We used the progression model to elucidate the potential molecular events in LUAD progression. Further analysis showed that overexpression of BUB1B, BUB1 and BUB3 promoted tumor cell proliferation and metastases by disturbing the spindle assembly checkpoint (SAC) in the mitosis. Aberrant mitotic spindle checkpoint signaling appeared to be one of the key factors promoting LUAD progression. We found the inferred cancer trajectory allows to identify LUAD susceptibility genetic variations using genome-wide association analysis. This result shows the opportunity for combining analysis of candidate genetic factors with disease progression. Furthermore, the trajectory showed clear evident mutation accumulation and clonal expansion along with the LUAD progression. Understanding how tumors evolve and identifying mutated genes will help guide cancer management. We investigated the clonal architectures and identified distinct clones and subclones in different LUAD branches. Validation of the model in multiple independent data sets and correlation analysis with clinical results demonstrate that our method is effective and unbiased.
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Affiliation(s)
- Kexin Huang
- School of Life Science and Technology, Xidian University, Xi'an, China
- West China Biomedical Big Data Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Yun Zhang
- School of Life Science and Technology, Xidian University, Xi'an, China
| | - Haoran Gong
- West China Biomedical Big Data Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Zhengzheng Qiao
- School of Life Science and Technology, Xidian University, Xi'an, China
| | - Tiangang Wang
- School of Life Science and Technology, Xidian University, Xi'an, China
| | - Weiling Zhao
- Center for Computational Systems Medicine, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Liyu Huang
- School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xiaobo Zhou
- Center for Computational Systems Medicine, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
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Parashar D. Unlocking multidimensional cancer therapeutics using geometric data science. Sci Rep 2023; 13:8255. [PMID: 37217528 DOI: 10.1038/s41598-023-34853-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Personalised approaches to cancer therapeutics primarily involve identification of patient sub-populations most likely to benefit from targeted drugs. Such a stratification has led to plethora of designs of clinical trials that are often too complex due to the need for incorporating biomarkers and tissue types. Many statistical methods have been developed to address these issues; however, by the time such methodology is available research in cancer has moved on to new challenges and therefore in order to avoid playing catch-up it is necessary to develop new analytic tools alongside. One of the challenges facing cancer therapy is to effectively and appropriately target multiple therapies for sensitive patient population based on a panel of biomarkers across multiple cancer types, and matched future trial designs. We present novel geometric methods (mathematical theory of hypersurfaces) to visualise complex cancer therapeutics data as multidimensional, as well as geometric representation of oncology trial design space in higher dimensions. The hypersurfaces are used to describe master protocols, with application to a specific example of a basket trial design for melanoma, and thus setup a framework for further incorporating multi-omics data as multidimensional therapeutics.
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Affiliation(s)
- Deepak Parashar
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
- Warwick Cancer Research Centre, University of Warwick, Coventry, UK.
- The Alan Turing Institute for Data Science and Artificial Intelligence, The British Library, London, UK.
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Zhu HD, Li HL, Huang MS, Yang WZ, Yin GW, Zhong BY, Sun JH, Jin ZC, Chen JJ, Ge NJ, Ding WB, Li WH, Huang JH, Mu W, Gu SZ, Li JP, Zhao H, Wen SW, Lei YM, Song YS, Yuan CW, Wang WD, Huang M, Zhao W, Wu JB, Wang S, Zhu X, Han JJ, Ren WX, Lu ZM, Xing WG, Fan Y, Lin HL, Zhang ZS, Xu GH, Hu WH, Tu Q, Su HY, Zheng CS, Chen Y, Zhao XY, Fang ZT, Wang Q, Zhao JW, Xu AB, Xu J, Wu QH, Niu HZ, Wang J, Dai F, Feng DP, Li QD, Shi RS, Li JR, Yang G, Shi HB, Ji JS, Liu YE, Cai Z, Yang P, Zhao Y, Zhu XL, Lu LG, Teng GJ. Transarterial chemoembolization with PD-(L)1 inhibitors plus molecular targeted therapies for hepatocellular carcinoma (CHANCE001). Signal Transduct Target Ther 2023; 8:58. [PMID: 36750721 PMCID: PMC9905571 DOI: 10.1038/s41392-022-01235-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/24/2022] [Accepted: 10/17/2022] [Indexed: 02/09/2023] Open
Abstract
There is considerable potential for integrating transarterial chemoembolization (TACE), programmed death-(ligand)1 (PD-[L]1) inhibitors, and molecular targeted treatments (MTT) in hepatocellular carcinoma (HCC). It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations. In this nationwide, retrospective, cohort study, 826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT (combination group, n = 376) or TACE monotherapy (monotherapy group, n = 450) were included from January 2018 to May 2021. The primary endpoint was progression-free survival (PFS) according to modified RECIST. The secondary outcomes included overall survival (OS), objective response rate (ORR), and safety. We performed propensity score matching approaches to reduce bias between two groups. After matching, 228 pairs were included with a predominantly advanced disease population. Median PFS in combination group was 9.5 months (95% confidence interval [CI], 8.4-11.0) versus 8.0 months (95% CI, 6.6-9.5) (adjusted hazard ratio [HR], 0.70, P = 0.002). OS and ORR were also significantly higher in combination group (median OS, 19.2 [16.1-27.3] vs. 15.7 months [13.0-20.2]; adjusted HR, 0.63, P = 0.001; ORR, 60.1% vs. 32.0%; P < 0.001). Grade 3/4 adverse events were observed at a rate of 15.8% and 7.5% in combination and monotherapy groups, respectively. Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS, OS, and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice, with an acceptable safety profile.
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Affiliation(s)
- Hai-Dong Zhu
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, China
| | - Hai-Liang Li
- Department of Minimally invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Ming-Sheng Huang
- Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Wei-Zhu Yang
- Department of Interventional Radiology, Union Hospital of Fujian Medical University, Fuzhou, 350001, China
| | - Guo-Wen Yin
- Department of Interventional Radiology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Bin-Yan Zhong
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, 215006, China
| | - Jun-Hui Sun
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Zhi-Cheng Jin
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, China
| | - Jian-Jian Chen
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, China
| | - Nai-Jian Ge
- Department of Interventional Radiology, Eastern Hospital of Hepatobiliary Surgery, Navy Medical University (Second Military Medical University), Shanghai, 200438, China
| | - Wen-Bin Ding
- Department of Interventional Radiology, Nantong First People's Hospital, Nantong, 226001, China
| | - Wen-Hui Li
- Department of Interventional Radiology, Yancheng Third People's Hospital, Yancheng, 224008, China
| | - Jin-Hua Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Wei Mu
- Department of Vascular Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Shan-Zhi Gu
- Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, 410031, China
| | - Jia-Ping Li
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Hui Zhao
- Department of Interventional Radiology, The Hospital of Nantong University, Nantong, 226001, China
| | - Shu-Wei Wen
- Department of Interventional Therapy, Shanxi Tumor Hospital, Taiyuan, 030001, China
| | - Yan-Ming Lei
- Department of Interventional Radiology, Tibet Autonomous Region People's Hospital, Lhasa, 850000, China
| | - Yu-Sheng Song
- Department of Interventional Radiology, Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Chun-Wang Yuan
- Center of Interventional Oncology and Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Wei-Dong Wang
- Department of Interventional Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Ming Huang
- Department of Minimally Invasive Interventional Therapy, Yunnan Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Wei Zhao
- Department of Radiology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Jian-Bing Wu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Song Wang
- Department of Interventional Radiology, Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Xu Zhu
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China
| | - Jian-Jun Han
- Department of Interventional Radiology, Affiliated Cancer Hospital of Shandong First Medical University, Jinan, 250117, China
| | - Wei-Xin Ren
- Interventional Therapy Center, The first Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Zai-Ming Lu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 830011, China
| | - Wen-Ge Xing
- Department of Interventional Oncology, Tianjin Medical University Cancer Hospital, Tianjin, 300060, China
| | - Yong Fan
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Hai-Lan Lin
- Department of Tumor Interventional Therapy, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Zi-Shu Zhang
- Department of Radiology, The Second Xiangya Hospital, Changsha, 410011, China
| | - Guo-Hui Xu
- Department of Interventional Radiology, Sichuan Cancer Hospital and Institute, Chengdu, 610041, China
| | - Wen-Hao Hu
- Department of Interventional Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Qiang Tu
- Department of Hepatobiliary Oncology Surgery, Department of Interventional Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, 330029, China
| | - Hong-Ying Su
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Chuan-Sheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 110001, China
| | - Yong Chen
- Department of Interventional Radiology, General hospital of Ningxia Medical University, Yinchuan, 110001, China
| | - Xu-Ya Zhao
- Department of Interventional Radiology, Guizhou Cancer Hospital, Guiyang, 550000, China
| | - Zhu-Ting Fang
- Department of Interventional Radiology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Qi Wang
- Department of Interventional Radiology, Third Affiliated Hospital of Soochow University, Changzhou First Hospital, Changzhou, 213004, China
| | - Jin-Wei Zhao
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, China
| | - Ai-Bing Xu
- Department of Interventional Therapy, Nantong Tumor Hospital, Nantong, 226006, China
| | - Jian Xu
- Department of Interventional Therapy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, 210002, China
| | - Qing-Hua Wu
- Department of Interventional Radiology, Affiliated Hospital of Jiangnan University, Wuxi, 214122, China
| | - Huan-Zhang Niu
- Department of Interventional Radiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China
| | - Jian Wang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Feng Dai
- Department of Interventional Radiology, The Second Hospital of Nanjing, Nanjing, 210000, China
| | - Dui-Ping Feng
- Department of Oncology and Vascular Intervention, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Qing-Dong Li
- Vascular and Interventional Department, Chongqing University Cancer Hospital, Chongqing, 400000, China
| | - Rong-Shu Shi
- Department of Interventional Radiology, The Affiliated Hospital of Zunyi Medical College, Zunyi, 563000, China
| | - Jia-Rui Li
- Department of Interventional Therapy, The First Hospital of Jilin University, Changchun, 130000, China
| | - Guang Yang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jian-Song Ji
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - Yu-E Liu
- Department of Interventional Radiology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Zheng Cai
- Department of Interventional Medicine, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Po Yang
- Department of Interventional & Vascular Surgery, The Fourth Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yang Zhao
- Department of Biostatistics, Nanjing Medical University, Nanjing, 211166, China
| | - Xiao-Li Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, 215006, China.
| | - Li-Gong Lu
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000, China.
| | - Gao-Jun Teng
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, China.
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Ouma LO, Wason JMS, Zheng H, Wilson N, Grayling M. Design and analysis of umbrella trials: Where do we stand? Front Med (Lausanne) 2022; 9:1037439. [PMID: 36313987 PMCID: PMC9596938 DOI: 10.3389/fmed.2022.1037439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The efficiencies that master protocol designs can bring to modern drug development have seen their increased utilization in oncology. Growing interest has also resulted in their consideration in non-oncology settings. Umbrella trials are one class of master protocol design that evaluates multiple targeted therapies in a single disease setting. Despite the existence of several reviews of master protocols, the statistical considerations of umbrella trials have received more limited attention. Methods We conduct a systematic review of the literature on umbrella trials, examining both the statistical methods that are available for their design and analysis, and also their use in practice. We pay particular attention to considerations for umbrella designs applied outside of oncology. Findings We identified 38 umbrella trials. To date, most umbrella trials have been conducted in early phase settings (73.7%, 28/38) and in oncology (92.1%, 35/38). The quality of statistical information available about conducted umbrella trials to date is poor; for example, it was impossible to ascertain how sample size was determined in the majority of trials (55.3%, 21/38). The literature on statistical methods for umbrella trials is currently sparse. Conclusions Umbrella trials have potentially great utility to expedite drug development, including outside of oncology. However, to enable lessons to be effectively learned from early use of such designs, there is a need for higher-quality reporting of umbrella trials. Furthermore, if the potential of umbrella trials is to be realized, further methodological research is required.
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Affiliation(s)
- Luke O. Ouma
- Biostatistics Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - James M. S. Wason
- Biostatistics Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Haiyan Zheng
- Medical Research Council (MRC) Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Nina Wilson
- Biostatistics Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Grayling
- Biostatistics Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Lyu D, Liu B, Lan B, Sun X, Li L, Zhai J, Qian H, Ma F. Clinical value of next-generation sequencing in guiding decisions regarding endocrine therapy for advanced HR-positive/HER-2-negative breast cancer. Chin J Cancer Res 2022; 34:343-352. [PMID: 36199538 PMCID: PMC9468016 DOI: 10.21147/j.issn.1000-9604.2022.04.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/13/2022] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVE The mechanism of acquired gene mutation plays a major role in resistance to endocrine therapy in hormone receptor (HR)-positive advanced breast cancer. Circulating tumor DNA (ctDNA) has been allowed for the assessment of the genomic profiles of patients with advanced cancer. We performed this study to search for molecular markers of endocrine therapy efficacy and to explore the clinical value of ctDNA to guide precise endocrine therapy for HR-positive/human epidermal growth factor receptor-2 (HER-2)-negative metastatic breast cancer patients. METHODS In this open-label, multicohort, prospective study, patients were assigned to four parallel cohorts and matched according to mutations identified in ctDNA: 1) activation of the phosphatidylinositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) signaling pathway preferred mTOR inhibitor combined with endocrine therapy; 2) estrogen receptor 1 (ESR1) mutation preferred fulvestrant; 3) HER-2 mutations preferred pyrotinib; and 4) no actionable mutations received treatment according to the clinical situation. In all cohorts, patients were divided into compliance group and violation group. The primary outcome measure was progression-free survival (PFS), and the secondary outcome measure was overall survival (OS). RESULTS In all cohorts, the combined median PFS was 4.9 months, and median PFS for the compliance and violation groups was 6.0 and 3.0 months, respectively [P=0.022, hazard ratio (HR)=0.57]. Multivariate Cox regression model showed the risk of disease progression was lower in compliance group than in violation group (P=0.023, HR=0.55). Among the patients with HER-2 mutations, the median PFS was 11.1 months in the compliance group and 2.2 months in the violation group (P=0.011, HR=0.20). There was no significant difference in the median PFS between patients who did and did not comply with the treatment protocol in patients with activation of the PI3K/AKT/mTOR or ESR1 mutation. CONCLUSIONS The results suggest that ctDNA may help to guide the optimal endocrine therapy strategy for metastatic breast cancer patients and to achieve a better PFS. Next-generation sequencing (NGS) detection could aid in distinguishing patients with HER-2 mutation and developing new treatment strategies.
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Affiliation(s)
- Dan Lyu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Binliang Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Department of Breast Cancer Medical Oncology, Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Bo Lan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiaoying Sun
- Department of Medical Oncology, Cancer Hospital of Huanxing Chaoyang District, Beijing 100122, China
| | - Lixi Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jingtong Zhai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Haili Qian
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Osarogiagbon RU, Vega DM, Fashoyin-Aje L, Wedam S, Ison G, Atienza S, De Porre P, Biswas T, Holloway JN, Hong DS, Wempe MM, Schilsky RL, Kim ES, Wade JL. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the ASCO-Friends of Cancer Research Prior Therapies Work Group. Clin Cancer Res 2021; 27:2408-2415. [PMID: 33563637 PMCID: PMC8170959 DOI: 10.1158/1078-0432.ccr-20-3854] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/25/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Restrictive eligibility criteria induce differences between clinical trial and "real-world" treatment populations. Restrictions based on prior therapies are common; minimizing them when appropriate may increase patient participation in clinical trials. EXPERIMENTAL DESIGN A multi-stakeholder working group developed a conceptual framework to guide evaluation of prevailing practices with respect to using prior treatment as selection criteria for clinical trials. The working group made recommendations to minimize restrictions based on prior therapies within the boundaries of scientific validity, patient centeredness, distributive justice, and beneficence. RECOMMENDATIONS (i) Patients are eligible for clinical trials regardless of the number or type of prior therapies and without requiring a specific therapy prior to enrollment unless a scientific or clinically based rationale is provided as justification. (ii) Prior therapy (either limits on number and type of prior therapies or requirements for specific therapies before enrollment) could be used to determine eligibility in the following cases: a) the agents being studied target a specific mechanism or pathway that could potentially interact with a prior therapy; b) the study design requires that all patients begin protocol-specified treatment at the same point in the disease trajectory; and c) in randomized clinical studies, if the therapy in the control arm is not appropriate for the patient due to previous therapies received. (iii) Trial designers should consider conducting evaluation separately from the primary endpoint analysis for participants who have received prior therapies. CONCLUSIONS Clinical trial sponsors and regulators should thoughtfully reexamine the use of prior therapy exposure as selection criteria to maximize clinical trial participation.See related commentary by Giantonio, p. 2369.
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Affiliation(s)
| | | | | | - Suparna Wedam
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Gwynn Ison
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sol Atienza
- Advocate Aurora Health, Milwaukee, Wisconsin
| | | | - Tithi Biswas
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | | | | | | | | | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - James L Wade
- Cancer Care Specialists of Central Illinois, Decatur, Illinois
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8
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Agrawal S, Maity S, AlRaawi Z, Al-Ameer M, Kumar TKS. Targeting Drugs Against Fibroblast Growth Factor(s)-Induced Cell Signaling. Curr Drug Targets 2021; 22:214-240. [PMID: 33045958 DOI: 10.2174/1389450121999201012201926] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The fibroblast growth factor (FGF) family is comprised of 23 highly regulated monomeric proteins that regulate a plethora of developmental and pathophysiological processes, including tissue repair, wound healing, angiogenesis, and embryonic development. Binding of FGF to fibroblast growth factor receptor (FGFR), a tyrosine kinase receptor, is facilitated by a glycosaminoglycan, heparin. Activated FGFRs phosphorylate the tyrosine kinase residues that mediate induction of downstream signaling pathways, such as RAS-MAPK, PI3K-AKT, PLCγ, and STAT. Dysregulation of the FGF/FGFR signaling occurs frequently in cancer due to gene amplification, FGF activating mutations, chromosomal rearrangements, integration, and oncogenic fusions. Aberrant FGFR signaling also affects organogenesis, embryonic development, tissue homeostasis, and has been associated with cell proliferation, angiogenesis, cancer, and other pathophysiological changes. OBJECTIVE This comprehensive review will discuss the biology, chemistry, and functions of FGFs, and its current applications toward wound healing, diabetes, repair and regeneration of tissues, and fatty liver diseases. In addition, specific aberrations in FGFR signaling and drugs that target FGFR and aid in mitigating various disorders, such as cancer, are also discussed in detail. CONCLUSION Inhibitors of FGFR signaling are promising drugs in the treatment of several types of cancers. The clinical benefits of FGF/FGFR targeting therapies are impeded due to the activation of other RTK signaling mechanisms or due to the mutations that abolish the drug inhibitory activity on FGFR. Thus, the development of drugs with a different mechanism of action for FGF/FGFR targeting therapies is the recent focus of several preclinical and clinical studies.
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Affiliation(s)
- Shilpi Agrawal
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, Arkansas, United States
| | - Sanhita Maity
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, Arkansas, United States
| | - Zeina AlRaawi
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, Arkansas, United States
| | - Musaab Al-Ameer
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, Arkansas, United States
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9
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Lazzari C, Bulotta A, Cangi MG, Bucci G, Pecciarini L, Bonfiglio S, Lorusso V, Ippati S, Arrigoni G, Grassini G, Doglioni C, Gregorc V. Next Generation Sequencing in Non-Small Cell Lung Cancer: Pitfalls and Opportunities. Diagnostics (Basel) 2020; 10:E1092. [PMID: 33333743 PMCID: PMC7765222 DOI: 10.3390/diagnostics10121092] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/19/2022] Open
Abstract
Lung cancer remains the first cause of cancer-related deaths worldwide. Thanks to the improvement in the knowledge of the biology of non-small cell lung cancer (NSCLC), patients' survival has significantly improved. A growing number of targetable molecular alterations have been identified. Next-generation sequencing (NGS) has become one of the methodologies entered in clinical practice and was recently recommended by the European society for medical oncology (ESMO) to perform a comprehensive molecular characterization in patients with cancer. The current review provides an overview of the clinical trials that have explored the impact of NGS in patients with cancer, its limits, and advantages.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Maria Giulia Cangi
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Gabriele Bucci
- Center for Omics Science, IRCCS San Raffaele, 20132 Milan, Italy; (G.B.); (S.B.)
| | - Lorenza Pecciarini
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Silvia Bonfiglio
- Center for Omics Science, IRCCS San Raffaele, 20132 Milan, Italy; (G.B.); (S.B.)
| | - Vincenza Lorusso
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Stefania Ippati
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Gianluigi Arrigoni
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Greta Grassini
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Claudio Doglioni
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Vanesa Gregorc
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
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10
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Yao H, Liang Q, Qian X, Wang J, Sham PC, Li MJ. Methods and resources to access mutation-dependent effects on cancer drug treatment. Brief Bioinform 2020; 21:1886-1903. [PMID: 31750520 DOI: 10.1093/bib/bbz109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
In clinical cancer treatment, genomic alterations would often affect the response of patients to anticancer drugs. Studies have shown that molecular features of tumors could be biomarkers predictive of sensitivity or resistance to anticancer agents, but the identification of actionable mutations are often constrained by the incomplete understanding of cancer genomes. Recent progresses of next-generation sequencing technology greatly facilitate the extensive molecular characterization of tumors and promote precision medicine in cancers. More and more clinical studies, cancer cell lines studies, CRISPR screening studies as well as patient-derived model studies were performed to identify potential actionable mutations predictive of drug response, which provide rich resources of molecularly and pharmacologically profiled cancer samples at different levels. Such abundance of data also enables the development of various computational models and algorithms to solve the problem of drug sensitivity prediction, biomarker identification and in silico drug prioritization by the integration of multiomics data. Here, we review the recent development of methods and resources that identifies mutation-dependent effects for cancer treatment in clinical studies, functional genomics studies and computational studies and discuss the remaining gaps and future directions in this area.
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Affiliation(s)
- Hongcheng Yao
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Qian Liang
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Xinyi Qian
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Junwen Wang
- Department of Health Sciences Research & Center for Individualized Medicine, Mayo Clinic, Scottsdale, USA
| | - Pak Chung Sham
- Center for Genomic Sciences, The University of Hong Kong, Hong Kong SAR, China.,Departments of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mulin Jun Li
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.,Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
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11
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Biomarker-driven therapies for previously treated squamous non-small-cell lung cancer (Lung-MAP SWOG S1400): a biomarker-driven master protocol. Lancet Oncol 2020; 21:1589-1601. [PMID: 33125909 DOI: 10.1016/s1470-2045(20)30475-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Lung Cancer Master Protocol (Lung-MAP; S1400) is a completed biomarker-driven master protocol designed to address an unmet need for better therapies for squamous non-small-cell lung cancer. Lung-MAP (S1400) was created to establish an infrastructure for biomarker screening and rapid regulatory intent evaluation of targeted therapies and was the first biomarker-driven master protocol initiated with the US National Cancer Institute (NCI). METHODS Lung-MAP (S1400) was done within the National Clinical Trials Network of the NCI using a public-private partnership. Eligible patients were aged 18 years or older, had stage IV or recurrent squamous non-small-cell lung cancer, had previously been treated with platinum-based chemotherapy, and had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. The study included a screening component using the FoundationOne assay (Foundation Medicine, Cambridge, MA, USA) for next-generation sequencing, and a clinical trial component with biomarker-driven substudies and non-match substudies for patients who were ineligible for biomarker-driven substudies. Patients were pre-screened and received their substudy assignment upon progression, or they were screened at progression and received their substudy assignment upon completion of testing. Patients could enrol onto additional substudies after progression on a substudy. The study is registered with ClinicalTrials.gov, NCT02154490, and all research related to Lung-MAP (S1400) is completed. FINDINGS Between June 16, 2014, and Jan 28, 2019, 1864 patients enrolled and 1841 (98·9%) submitted tissue. 1674 (90·9%) of 1841 patients had biomarker results, and 1404 (83·9%) of 1674 patients received a substudy assignment. Of the assigned patients, 655 (46·7%) registered to a substudy. The biomarker-driven substudies evaluated taselisib (targeting PIK3CA alterations), palbociclib (cell cycle gene alterations), AZD4547 (FGFR alteration), rilotumumab plus erlotinib (MET), talazoparib (homologous recombination repair deficiency), and telisotuzumab vedotin (MET). The non-match substudies evaluated durvalumab, and nivolumab plus ipilimumab for anti-PD-1 or anti-PD-L1-naive disease, and durvalumab plus tremelimumab for anti-PD-1 or anti-PD-L1 relapsed disease. Combining data from the substudies, ten (7·0%) of 143 patients responded to targeted therapy, 53 (16·8%) of 315 patients responded to anti-PD-1 or anti-PD-L1 therapy for immunotherapy-naive disease, and three (5·4%) of 56 responded to docetaxel in the second line of therapy. Median overall survival was 5·9 months (95% CI 4·8-7·8) for the targeted therapy groups, 7·7 months (6·7-9·2) for the docetaxel groups, and 10·8 months (9·4-12·3) for the anti-PD-1 or anti-PD-L1-containing groups. Median progression-free survival was 2·5 months (95% CI 1·7-2·8) for the targeted therapy groups, 2·7 months (1·9-2·9) for the docetaxel groups, and 3·0 months (2·7-3·9) for the anti-PD-1 or anti-PD-L1-containing groups. INTERPRETATION Lung-MAP (S1400) met its goal to quickly address biomarker-driven therapy questions in squamous non-small-cell lung cancer. In early 2019, a new screening protocol was implemented expanding to all histological types of non-small-cell lung cancer and to add focus on immunotherapy combinations for anti-PD-1 and anti-PD-L1 therapy-relapsed disease. With these changes, Lung-MAP continues to meet its goal to focus on unmet needs in the treatment of advanced lung cancers. FUNDING US National Institutes of Health, and AbbVie, Amgen, AstraZeneca, Bristol Myers Squibb, Genentech, and Pfizer through the Foundation for the National Institutes of Health.
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12
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The Evolution of Master Protocol Clinical Trial Designs: A Systematic Literature Review. Clin Ther 2020; 42:1330-1360. [DOI: 10.1016/j.clinthera.2020.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/10/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
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13
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Ryan EG, Brock K, Gates S, Slade D. Do we need to adjust for interim analyses in a Bayesian adaptive trial design? BMC Med Res Methodol 2020; 20:150. [PMID: 32522284 PMCID: PMC7288484 DOI: 10.1186/s12874-020-01042-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/04/2020] [Indexed: 01/30/2023] Open
Abstract
Background Bayesian adaptive methods are increasingly being used to design clinical trials and offer several advantages over traditional approaches. Decisions at analysis points are usually based on the posterior distribution of the treatment effect. However, there is some confusion as to whether control of type I error is required for Bayesian designs as this is a frequentist concept. Methods We discuss the arguments for and against adjusting for multiplicities in Bayesian trials with interim analyses. With two case studies we illustrate the effect of including interim analyses on type I/II error rates in Bayesian clinical trials where no adjustments for multiplicities are made. We propose several approaches to control type I error, and also alternative methods for decision-making in Bayesian clinical trials. Results In both case studies we demonstrated that the type I error was inflated in the Bayesian adaptive designs through incorporation of interim analyses that allowed early stopping for efficacy and without adjustments to account for multiplicity. Incorporation of early stopping for efficacy also increased the power in some instances. An increase in the number of interim analyses that only allowed early stopping for futility decreased the type I error, but also decreased power. An increase in the number of interim analyses that allowed for either early stopping for efficacy or futility generally increased type I error and decreased power. Conclusions Currently, regulators require demonstration of control of type I error for both frequentist and Bayesian adaptive designs, particularly for late-phase trials. To demonstrate control of type I error in Bayesian adaptive designs, adjustments to the stopping boundaries are usually required for designs that allow for early stopping for efficacy as the number of analyses increase. If the designs only allow for early stopping for futility then adjustments to the stopping boundaries are not needed to control type I error. If one instead uses a strict Bayesian approach, which is currently more accepted in the design and analysis of exploratory trials, then type I errors could be ignored and the designs could instead focus on the posterior probabilities of treatment effects of clinically-relevant values.
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Affiliation(s)
- Elizabeth G Ryan
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Kristian Brock
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Daniel Slade
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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14
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van Tilburg CM, Witt R, Heiss M, Pajtler KW, Plass C, Poschke I, Platten M, Harting I, Sedlaczek O, Freitag A, Meyrath D, Taylor L, Balasubramanian GP, Jäger N, Pfaff E, Jones BC, Milde T, Pfister SM, Jones DTW, Kopp-Schneider A, Witt O. INFORM2 NivEnt: The first trial of the INFORM2 biomarker driven phase I/II trial series: the combination of nivolumab and entinostat in children and adolescents with refractory high-risk malignancies. BMC Cancer 2020; 20:523. [PMID: 32503469 PMCID: PMC7275428 DOI: 10.1186/s12885-020-07008-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pediatric patients with relapsed or refractory disease represent a population with a desperate medical need. The aim of the INFORM (INdividualized Therapy FOr Relapsed Malignancies in Childhood) program is to translate next generation molecular diagnostics into a biomarker driven treatment strategy. The program consists of two major foundations: the INFORM registry providing a molecular screening platform and the INFORM2 series of biomarker driven phase I/II trials. The INFORM2 NivEnt trial aims to determine the recommended phase 2 dose (RP2D) of the combination treatment of nivolumab and entinostat (phase I) and to evaluate activity and safety (phase II). Methods This is an exploratory non-randomized, open-label, multinational and multicenter seamless phase I/II trial in children and adolescents with relapsed / refractory or progressive high-risk solid tumors and CNS tumors. The phase I is divided in 2 age cohorts: 12–21 years and 6–11 years and follows a 3 + 3 design with two dose levels for entinostat (2 mg/m2 and 4 mg/m2 once per week) and fixed dose nivolumab (3 mg/kg every 2 weeks). Patients entering the trial on RP2D can seamlessly enter phase II which consists of a biomarker defined four group basket trial: high mutational load (group A), high PD-L1 mRNA expression (group B), focal MYC(N) amplification (group C), low mutational load and low PD-L1 mRNA expression and no MYC(N) amplification (group D). A Bayesian adaptive design will be used to early stop cohorts that fail to show evidence of activity. The maximum number of patients is 128. Discussion This trial intends to exploit the immune enhancing effects of entinostat on nivolumab using an innovative biomarker driven approach in order to maximize the chance of detecting signs of activity. It prevents exposure to unnecessary risks by applying the Bayesian adaptive design for early stopping for futility. The adaptive biomarker driven design provides an innovative approach accelerating drug development and reducing exposure to investigational treatments in these vulnerable children at the same time. Trial registration ClinicalTrials.gov, NCT03838042. Registered on 12 February 2019.
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Affiliation(s)
- Cornelis M van Tilburg
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. .,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany. .,Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Ruth Witt
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Melanie Heiss
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Kristian W Pajtler
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Christoph Plass
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Isabel Poschke
- DKTK Immune Monitoring Unit, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Michael Platten
- DKTK Immune Monitoring Unit, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,DKTK CCU Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Inga Harting
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Sedlaczek
- Radiology Cooperation Uni/DKFZ, Division of Radiology, NCT, Heidelberg, Germany
| | - Angelika Freitag
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Meyrath
- Pharmacy Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Lenka Taylor
- Pharmacy Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Gnana Prakash Balasubramanian
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Natalie Jäger
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Elke Pfaff
- Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Barbara C Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Till Milde
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - David T W Jones
- Pediatric Glioma Research Group, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | - Olaf Witt
- KiTZ Clinical Trial Unit, Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
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15
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Pestinger V, Smith M, Sillo T, Findlay JM, Laes JF, Martin G, Middleton G, Taniere P, Beggs AD. Use of an Integrated Pan-Cancer Oncology Enrichment Next-Generation Sequencing Assay to Measure Tumour Mutational Burden and Detect Clinically Actionable Variants. Mol Diagn Ther 2020; 24:339-349. [PMID: 32306292 PMCID: PMC7264086 DOI: 10.1007/s40291-020-00462-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The identification of tumour mutational burden (TMB) as a biomarker of response to programmed cell death protein 1 (PD-1) immunotherapy has necessitated the development of genomic assays to measure this. We carried out comprehensive molecular profiling of cancers using the Illumina TruSight Oncology 500 (TSO500) panel and compared these to whole-genome sequencing (WGS). METHODS Cancer samples derived from formalin-fixed material were profiled on the TSO500 panel, sequenced on an Illumina NextSeq 500 instrument and processed through the TSO500 Docker pipeline. Either FASTQ files (PierianDx) or vcf files (OncoKDM) were processed to understand clinical actionability. RESULTS In total, 108 samples (a mixture of colorectal, lung, oesophageal and control samples) were processed via the DNA panel. There was good correlation between TMB, single-nucleotide variants (SNVs), indels and copy-number variations as predicted by TSO500 and WGS (R2 > 0.9) and good reproducibility, with less than 5% variability between repeated controls. For the RNA panel, 13 samples were processed, with all known fusions observed via orthogonal techniques. For clinical actionability, 72 tier 1 variants and 297 tier 2 variants were detected, with clinical trials identified for all patients. CONCLUSIONS The TSO500 assay accurately measures TMB, microsatellite instability, SNVs, indels, copy-number/structural variation and gene fusions when compared to WGS and orthogonal technologies. Coupled with a clinical annotation pipeline, this provides a powerful methodology for identification of clinically actionable variants.
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Affiliation(s)
- Valerie Pestinger
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK
| | | | - Toju Sillo
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK
| | | | | | | | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Andrew D Beggs
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK.
- Queen Elizabeth Hospital Birmingham, Birmingham, UK.
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16
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Blagden SP, Billingham L, Brown LC, Buckland SW, Cooper AM, Ellis S, Fisher W, Hughes H, Keatley DA, Maignen FM, Morozov A, Navaie W, Pearson S, Shaaban A, Wydenbach K, Kearns PR. Effective delivery of Complex Innovative Design (CID) cancer trials-A consensus statement. Br J Cancer 2020; 122:473-482. [PMID: 31907370 PMCID: PMC7028941 DOI: 10.1038/s41416-019-0653-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 01/13/2023] Open
Abstract
The traditional cancer drug development pathway is increasingly being superseded by trials that address multiple clinical questions. These are collectively termed Complex Innovative Design (CID) trials. CID trials not only assess the safety and toxicity of novel anticancer medicines but also their efficacy in biomarker-selected patients, specific cancer cohorts or in combination with other agents. They can be adapted to include new cohorts and test additional agents within a single protocol. Whilst CID trials can speed up the traditional route to drug licencing, they can be challenging to design, conduct and interpret. The Experimental Cancer Medicine Centres (ECMC) network, funded by the National Institute for Health Research (NIHR), Cancer Research UK (CRUK) and the Health Boards of Wales, Northern Ireland and Scotland, formed a working group with relevant stakeholders from clinical trials units, the pharmaceutical industry, funding bodies, regulators and patients to identify the main challenges of CID trials. The working group generated ten consensus recommendations. These aim to improve the conduct, quality and acceptability of oncology CID trials in clinical research and, importantly, to expedite the process by which effective treatments can reach cancer patients.
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Affiliation(s)
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
| | - Louise C Brown
- Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK
| | | | - Alison M Cooper
- The Association of the British Pharmaceutical Industry (ABPI), London, UK
| | | | | | - Helen Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Debbie A Keatley
- Independent Cancer Patients' Voice, National Cancer Research Institute (NCRI), London, UK
| | | | | | | | - Sarah Pearson
- Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - Abeer Shaaban
- Queen Elizabeth Hospital Birmingham and the University of Birmingham, Birmingham, UK
| | - Kirsty Wydenbach
- Medicines and Healthcare products Regulatory Agency (MHRA), London, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
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Antoniou M, Kolamunnage-Dona R, Wason J, Bathia R, Billingham C, Bliss J, Brown L, Gillman A, Paul J, Jorgensen A. Biomarker-guided trials: Challenges in practice. Contemp Clin Trials Commun 2019; 16:100493. [PMID: 31788574 PMCID: PMC6879976 DOI: 10.1016/j.conctc.2019.100493] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 12/14/2022] Open
Abstract
Biomarker-guided trials have drawn considerable attention as they promise to lead to improvements in the benefit-risk ratio of treatments and enhanced opportunities for drug development. A variety of such designs have been proposed in the literature, many of which have been adopted in practice. Implementing such trial designs in practice can be challenging, and identifying those challenges was the main objective of a workshop organised by the MRC Hubs for Trials Methodology Research Network's Stratified Medicine Working Group in March 2017. Participants reflected on completed and ongoing biomarker-guided trials to identify the practical challenges encountered. Here, the key challenges identified during the workshop including those related to funding, ethical and regulatory issues, recruitment, monitoring of samples and laboratories, biomarker assessment, and data sharing and resources, are discussed. Despite the complexities often associated with biomarker-guided trials, the workshop concluded that they can play an important role in advancing the field of personalised medicine. Therefore, it is important that the practical challenges surrounding their implementation are acknowledged and addressed.
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Affiliation(s)
| | | | - J. Wason
- Newcastle University and MRC Biostatistics Unit, Cambridge, UK
| | | | | | - J.M. Bliss
- Institute of Cancer Research, London, UK
| | | | - A. Gillman
- Institute of Cancer Research, London, UK
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18
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Galot R, Le Tourneau C, Guigay J, Licitra L, Tinhofer I, Kong A, Caballero C, Fortpied C, Bogaerts J, Govaerts AS, Staelens D, Raveloarivahy T, Rodegher L, Laes JF, Saada-Bouzid E, Machiels JP. Personalized biomarker-based treatment strategy for patients with squamous cell carcinoma of the head and neck: EORTC position and approach. Ann Oncol 2019; 29:2313-2327. [PMID: 30307465 DOI: 10.1093/annonc/mdy452] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The molecular landscape of squamous cell carcinoma of the head and the neck (SCCHN) has been characterized and actionable or targetable genomic alterations have been identified. However, targeted therapies have very limited activity in unselected SCCHN, and the current treatment strategy is still based on tumor location and disease stage and not on tumor biology. Trying to select upfront the patients who will benefit from a specific treatment might be a way to improve patients' outcome. With the objective of optimizing the activity of targeted therapies and immunotherapy, we have designed an umbrella biomarker-driven study dedicated to recurrent and/or metastatic SCCHN patients (EORTC-1559-HNCG, NCT03088059). In this article, we review not only the different trial designs for biomarker-driven studies with their respective advantages and opportunities but also the potential pitfalls that led to the design of the EORTC-1559-HNCG protocol. We also discuss the scientific and logistic challenges of biomarker-driven trials.
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Affiliation(s)
- R Galot
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Belgium; Institute for Clinical and Experimental Research (POLE MIRO), Université Catholique de Louvain, Brussels, Belgium
| | - C Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris & Saint-Cloud, Paris, France; INSERM U900 Research Unit, Saint-Cloud, France; Versailles-Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - J Guigay
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - L Licitra
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS "Istituto Nazionale dei Tumori", Milan; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - I Tinhofer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin; Department of Radiooncology and Radiotherapy, Berlin Institute of Health, Berlin, Germany
| | - A Kong
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - C Caballero
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - C Fortpied
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - J Bogaerts
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - A-S Govaerts
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - D Staelens
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - T Raveloarivahy
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - L Rodegher
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | | | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - J-P Machiels
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Belgium; Institute for Clinical and Experimental Research (POLE MIRO), Université Catholique de Louvain, Brussels, Belgium.
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George SL, Izquierdo E, Campbell J, Koutroumanidou E, Proszek P, Jamal S, Hughes D, Yuan L, Marshall LV, Carceller F, Chisholm JC, Vaidya S, Mandeville H, Angelini P, Wasti A, Bexelius T, Thway K, Gatz SA, Clarke M, Al-Lazikani B, Barone G, Anderson J, Tweddle DA, Gonzalez D, Walker BA, Barton J, Depani S, Eze J, Ahmed SW, Moreno L, Pearson A, Shipley J, Jones C, Hargrave D, Jacques TS, Hubank M, Chesler L. A tailored molecular profiling programme for children with cancer to identify clinically actionable genetic alterations. Eur J Cancer 2019; 121:224-235. [PMID: 31543384 PMCID: PMC6839402 DOI: 10.1016/j.ejca.2019.07.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/27/2019] [Accepted: 07/23/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND For children with cancer, the clinical integration of precision medicine to enable predictive biomarker-based therapeutic stratification is urgently needed. METHODS We have developed a hybrid-capture next-generation sequencing (NGS) panel, specifically designed to detect genetic alterations in paediatric solid tumours, which gives reliable results from as little as 50 ng of DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissue. In this study, we offered an NGS panel, with clinical reporting via a molecular tumour board for children with solid tumours. Furthermore, for a cohort of 12 patients, we used a circulating tumour DNA (ctDNA)-specific panel to sequence ctDNA from matched plasma samples and compared plasma and tumour findings. RESULTS A total of 255 samples were submitted from 223 patients for the NGS panel. Using FFPE tissue, 82% of all submitted samples passed quality control for clinical reporting. At least one genetic alteration was detected in 70% of sequenced samples. The overall detection rate of clinically actionable alterations, defined by modified OncoKB criteria, for all sequenced samples was 51%. A total of 8 patients were sequenced at different stages of treatment. In 6 of these, there were differences in the genetic alterations detected between time points. Sequencing of matched ctDNA in a cohort of extracranial paediatric solid tumours also identified a high detection rate of somatic alterations in plasma. CONCLUSION We demonstrate that tailored clinical molecular profiling of both tumour DNA and plasma-derived ctDNA is feasible for children with solid tumours. Furthermore, we show that a targeted NGS panel-based approach can identify actionable genetic alterations in a high proportion of patients.
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Affiliation(s)
- Sally L George
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Elisa Izquierdo
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK; Glioma Team, Division of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - James Campbell
- Bioinformatics Core Facility, The Institute of Cancer Research, London, UK
| | - Eleni Koutroumanidou
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Paula Proszek
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Sabri Jamal
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Deborah Hughes
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Lina Yuan
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Lynley V Marshall
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Fernando Carceller
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Julia C Chisholm
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Sucheta Vaidya
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Henry Mandeville
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Paola Angelini
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Ajla Wasti
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Tomas Bexelius
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Khin Thway
- Pathology Department, Royal Marsden NHS Foundation Trust, London, UK
| | - Susanne A Gatz
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK; Sarcoma Molecular Pathology Team, Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK; Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Matthew Clarke
- Glioma Team, Division of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - Bissan Al-Lazikani
- Bioinformatics Core Facility, The Institute of Cancer Research, London, UK
| | - Giuseppe Barone
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - John Anderson
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Developmental Biology and Cancer Programme, UCL GOS Institute of Child Health, London, UK
| | - Deborah A Tweddle
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - David Gonzalez
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK; Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, UK
| | - Brian A Walker
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK; Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jack Barton
- Developmental Biology and Cancer Programme, UCL GOS Institute of Child Health, London, UK
| | - Sarita Depani
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jessica Eze
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Department of Histology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Saira W Ahmed
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Department of Histology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucas Moreno
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK; HNJ-CNIO Clinical Research Unit, Hospital Universitario Nino Jesus, Madrid, Spain; Paediatric Oncology & Haematology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrew Pearson
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Janet Shipley
- Sarcoma Molecular Pathology Team, Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - Chris Jones
- Glioma Team, Division of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - Darren Hargrave
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas S Jacques
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Department of Histology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michael Hubank
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, UK
| | - Louis Chesler
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, London, UK; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK
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Abstract
PURPOSE OF REVIEW Contemporary advances in the understanding of the molecular and immunologic basis of metastatic lung cancer have firmly changed its treatment paradigm to a personalized, biomarker-driven approach. However, the majority of lung-cancer patients [especially lung squamous cell carcinoma (LUSC)] still do not have effective targeted therapeutic options. Master protocols, such as Lung-MAP, represent an innovative clinical trial approach designed to accelerate evaluation of novel biomarker-driven therapies. RECENT FINDINGS Lung-MAP is an umbrella trial for advanced LUSC and has been active since 2014. Cumulative experience from this overarching, multi-institution master protocol has demonstrated that centralized, real-time biomarker screening is feasible and substudy modularity is essential for protocol adaptability in a rapidly changing treatment landscape. In addition, screening and efficacy results from Lung-MAP affirm that LUSC has several putative drivers but remains difficult to effectively treat with targeted therapy. SUMMARY Master protocols are a feasible and efficient approach for evaluating biomarker-driven therapies in lung cancer. As we begin to target less common genomic and immunotherapy subtypes, centrally coordinated clinical trial designs such as Lung-MAP are necessary to rapidly deliver effective therapies to patients, whereas also maximizing the quality of research data obtained.
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21
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Stallard N, Todd S, Parashar D, Kimani PK, Renfro LA. On the need to adjust for multiplicity in confirmatory clinical trials with master protocols. Ann Oncol 2019; 30:506-509. [PMID: 30715156 PMCID: PMC6503623 DOI: 10.1093/annonc/mdz038] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Stallard
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry.
| | - S Todd
- Department of Mathematics and Statistics, University of Reading, Reading
| | - D Parashar
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry; The Alan Turing Institute, London; Warwick Cancer Research Centre, University of Warwick, Coventry, UK
| | - P K Kimani
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry
| | - L A Renfro
- Division of Biostatistics, University of Southern California, Los Angeles, USA
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22
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Rees G, Salto‐Tellez M, Lee JL, Oien K, Verrill C, Freeman A, Mirabile I, West NP. Training and accreditation standards for pathologists undertaking clinical trial work. J Pathol Clin Res 2019; 5:100-107. [PMID: 30680942 PMCID: PMC6463859 DOI: 10.1002/cjp2.124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/08/2019] [Accepted: 01/20/2019] [Indexed: 12/21/2022]
Abstract
Clinical trials rely on multidisciplinary teams for successful delivery. Pathologists should be involved in clinical trial design from the outset to ensure that protocols are optimised to deliver maximum data collection and translational research opportunities. Clinical trials must be performed according to the principles of Good Clinical Practice (GCP) and the trial sponsor has an obligation to ensure that all of the personnel involved in the trial have undergone training relevant to their role. Pathologists who are involved in the delivery of clinical trials are often required to undergo formal GCP training and may additionally undergo Good Clinical Laboratory Practice training if they are involved in the laboratory analysis of trials samples. Further training can be provided via trial-specific investigator meetings, which may be either multidisciplinary or discipline-specific events. Pathologists should also ensure that they undertake External Quality Assurance schemes relevant to the area of diagnostic practice required in the trial. The level of engagement of pathologists in academia and clinical trials research has declined in the United Kingdom over recent years. This paper recommends the optimal training and accreditation for pathologists undertaking clinical trials activities with the aim of facilitating increased engagement. Clinical trials training should ideally be provided to all pathologists through centrally organised educational events, with additional training provided to pathologists in training through local postgraduate teaching. Pathologists in training should also be strongly encouraged to undertake GCP training. It is hoped that these recommendations will increase the number of pathologists who take part in clinical trials research in order to ensure a high level and standard of data collection and to maximise the translational research opportunities.
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Affiliation(s)
- Gabrielle Rees
- Department of Cellular PathologyJohn Radcliffe HospitalOxfordUK
| | - Manuel Salto‐Tellez
- Northern Ireland Molecular Pathology LaboratoryCentre for Cancer Research and Cell Biology, Queens UniversityBelfastUK
| | - Jessica L Lee
- Strategy and InitiativesNational Cancer Research InstituteLondonUK
| | - Karin Oien
- Institute of Cancer Sciences – PathologyUniversity of GlasgowGlasgowUK
| | - Clare Verrill
- Nuffield Department of Surgical SciencesUniversity of Oxford, and Oxford NIHR Biomedical Research CentreOxfordUK
| | - Alex Freeman
- Department of PathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Ilaria Mirabile
- ECMC Programme Office, Experimental Cancer Medicine Centres (ECMCs) NetworkLondonUK
| | - Nicholas P West
- Pathology and Data AnalyticsLeeds Institute of Medical Research at St. James's, University of LeedsLeedsUK
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Moore DA, Kushnir M, Mak G, Winter H, Curiel T, Voskoboynik M, Moschetta M, Rozumna-Martynyuk N, Balbi K, Bennett P, Forster M, Kulkarni A, Haynes D, Swanton C, Arkenau HT. Prospective analysis of 895 patients on a UK Genomics Review Board. ESMO Open 2019; 4:e000469. [PMID: 31245058 PMCID: PMC6557082 DOI: 10.1136/esmoopen-2018-000469] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The increasing frequency and complexity of cancer genomic profiling represents a challenge for the oncology community. Results from next-generation sequencing-based clinical tests require expert review to determine their clinical relevance and to ensure patients are stratified appropriately to established therapies or clinical trials. METHODS The Sarah Cannon Research Institute UK/UCL Genomics Review Board (GRB) was established in 2014 and represents a multidisciplinary team with expertise in molecular oncology, clinical trials, clinical cancer genetics and molecular pathology. Prospective data from this board were collated. RESULTS To date, 895 patients have been reviewed by the GRB, of whom 180 (20%) were referred for clinical trial screening and 62 (7%) received trial therapy. For a further 106, a clinical trial recommendation was given. CONCLUSIONS Numerous challenges are faced in implementing a GRB, including the identification of potential germline variants, the interpretation of variants of uncertain significance and consideration of the technical limitations of pathology material when interpreting results. These challenges are likely to be encountered with increasing frequency in routine practice. This GRB experience provides a model for the multidisciplinary review of molecular profiling data and for the linking of molecular analysis to clinical trial networks.
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Affiliation(s)
- David Allan Moore
- Department of Pathology, University College London Cancer Institute, London, UK
- Sarah Cannon Molecular Diagnostics, London, UK
| | - Marina Kushnir
- Medical Oncology, Sarah Cannon Research Institute UK, London, UK
| | - Gabriel Mak
- University of New South Wales Adult Cancer Program, Sydney, New South Wales, Australia
| | - Helen Winter
- Medical Oncology, Sarah Cannon Research Institute UK, London, UK
| | - Teresa Curiel
- Medical Oncology, Sarah Cannon Research Institute UK, London, UK
| | - Mark Voskoboynik
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michele Moschetta
- Early Clinical Development, AstraZeneca UK Ltd, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Kevin Balbi
- Sarah Cannon Molecular Diagnostics, London, UK
| | | | | | | | - Debra Haynes
- Medical Oncology, Sarah Cannon Research Institute UK, London, UK
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Verweij J, Hendriks H, Zwierzina H, Hanauske, Wacheck V, Collignon O, Bruzzi P, Gross J, Riehl T, Bretz F, Dollins, Radtke I. Innovation in oncology clinical trial design. Cancer Treat Rev 2019; 74:15-20. [DOI: 10.1016/j.ctrv.2019.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/01/2019] [Indexed: 12/11/2022]
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Abstract
Precision medicine, aka stratified/personalized medicine, is becoming more pronounced in the medical field due to advancement in computational ability to learn about patient genomic backgrounds. A biomaker, i.e. a type of biological process indicator, is often used in precision medicine to classify patient population into several subgroups. The aim of precision medicine is to tailor treatment regimes for different patient subgroups who suffer from the same disease. A multi-arm design could be conducted to explore the effect of treatment regimes on different biomarker subgroups. However, if treatments work only on certain subgroups, which is often the case, enrolling all patient subgroups in a confirmatory trial would increase the burden of a study. Having observed a phase II trial, we propose a design framework for finding an optimal design that could be implemented in a phase III study or a confirmatory trial. We consider two elements in our approach: Bayesian data analysis of observed data, and design of experiments. The first tool selects subgroups and treatments to be enrolled in the future trial whereas the second tool provides an optimal treatment randomization scheme for each selected/enrolled subgroups. Considering two independent treatments and two independent biomarkers, we illustrate our approach using simulation studies. We demonstrate efficiency gain, i.e. high probability of recommending truly effective treatments in the right subgroup, of the optimal design found by our framework over a randomized controlled trial and a biomarker–treatment linked trial. A classical randomized controlled trial fails to identify subgroup treatment effect. Standard enriched designs may miss out potential patient subgroups. A standard multi-arm design could be inefficient for a trial of precision medicine. A data-driven design framework could provide efficient designs for future trials.
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26
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Adderley H, Blackhall FH, Lindsay CR. KRAS-mutant non-small cell lung cancer: Converging small molecules and immune checkpoint inhibition. EBioMedicine 2019; 41:711-716. [PMID: 30852159 PMCID: PMC6444074 DOI: 10.1016/j.ebiom.2019.02.049] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 02/06/2023] Open
Abstract
KRAS is the most frequent oncogene in non-small cell lung cancer (NSCLC), a molecular subset characterized by historical disappointments in targeted treatment approaches such as farnesyl transferase inhibition, downstream MEK inhibition, and synthetic lethality screens. Unlike other important mutational subtypes of NSCLC, preclinical work supports the hypothesis that KRAS mutations may be vulnerable to immunotherapy approaches, an efficacy associated in particular with TP53 co-mutation. In this review we detail reasons for previous failures in KRAS-mutant NSCLC, evidence to suggest that KRAS mutation is a genetic marker of benefit from immune checkpoint inhibition, and emerging direct inhibitors of K-Ras which will soon be combined with immunotherapy during clinical development. With signs of real progress in this subgroup of unmet need, we anticipate that KRAS mutant NSCLC will be the most important molecular subset of cancer to evaluate the combination of small molecules and immune checkpoint inhibitors (CPI).
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27
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Lindsay CR, Shaw EC, Blackhall F, Blyth KG, Brenton JD, Chaturvedi A, Clarke N, Dick C, Evans TRJ, Hall G, Hanby AM, Harrison DJ, Johnston SRD, Mason MD, Morton D, Newton-Bishop J, Nicholson AG, Oien KA, Popat S, Rassl D, Sharpe R, Taniere P, Walker I, Wallace WA, West NP, Butler R, Gonzalez de Castro D, Griffiths M, Johnson PWM. Somatic cancer genetics in the UK: real-world data from phase I of the Cancer Research UK Stratified Medicine Programme. ESMO Open 2018; 3:e000408. [PMID: 30233821 PMCID: PMC6135448 DOI: 10.1136/esmoopen-2018-000408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Phase I of the Cancer Research UK Stratified Medicine Programme (SMP1) was designed to roll out molecular pathology testing nationwide at the point of cancer diagnosis, as well as facilitate an infrastructure where surplus cancer tissue could be used for research. It offered a non-trial setting to examine common UK cancer genetics in a real-world context. METHODS A total of 26 sites in England, Wales and Scotland, recruited samples from 7814 patients for genetic examination between 2011 and 2013. Tumour types involved were breast, colorectal, lung, prostate, ovarian cancer and malignant melanoma. Centralised molecular testing of surplus material from resections or biopsies of primary/metastatic tissue was performed, with samples examined for 3-5 genetic alterations deemed to be of key interest in site-specific cancers by the National Cancer Research Institute Clinical Study groups. RESULTS 10 754 patients (98% of those approached) consented to participate, from which 7814 tumour samples were genetically analysed. In total, 53% had at least one genetic aberration detected. From 1885 patients with lung cancer, KRAS mutation was noted to be highly prevalent in adenocarcinoma (37%). In breast cancer (1873 patients), there was a striking contrast in TP53 mutation incidence between patients with ductal cancer (27.3%) and lobular cancer (3.4%). Vast inter-tumour heterogeneity of colorectal cancer (1550 patients) was observed, including myriad double and triple combinations of genetic aberrations. Significant losses of important clinical information included smoking status in lung cancer and loss of distinction between low-grade and high-grade serous ovarian cancers. CONCLUSION Nationwide molecular pathology testing in a non-trial setting is feasible. The experience with SMP1 has been used to inform ongoing CRUK flagship programmes such as the CRUK National Lung MATRIX trial and TRACERx.
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Affiliation(s)
- Colin R Lindsay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Manchester Experimental Cancer Medicine Centre, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | - Emily C Shaw
- Cancer Research UK, London, UK
- Southampton Experimental Cancer Medicine Centre, Southampton, UK
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Manchester Experimental Cancer Medicine Centre, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | - Kevin G Blyth
- Glasgow Experimental Cancer Medicine Centre, Glasgow, UK
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Institute ofInfection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - James D Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre and Cambridge Experimental Cancer Medicine Centre, Cambridge, UK
- Addenbrooke'sHospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Anshuman Chaturvedi
- Department of Histopathology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Noel Clarke
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Craig Dick
- Glasgow Experimental Cancer Medicine Centre, Glasgow, UK
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Thomas R J Evans
- Glasgow Experimental Cancer Medicine Centre, Glasgow, UK
- Cancer Research UK Beatson Institute, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Geoff Hall
- Leeds Experimental Cancer Medicine Centre, Leeds, UK
- St James's University Hospital, Cancer Research UK Clinical Cancer Centre, Leeds, UK
| | - Andrew M Hanby
- Leeds Experimental Cancer Medicine Centre, Leeds, UK
- Department of Cellular Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - David J Harrison
- School of Medicine, University of St Andrews, St Andrews, UK
- Edinburgh Experimental Cancer Medicine Centre, Edinburgh, UK
| | - Stephen R D Johnston
- Department of Medical Oncology, Royal Marsden Hospital, London, UK
- Institute of Cancer Research Experimental Cancer Medicine Centre, London, UK
| | - Malcolm D Mason
- Velindre Hospital, Cardiff University, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
- Cardiff Experimental Cancer Medicine Centre, Cardiff, UK
| | - Dion Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
- Birmingham Experimental Cancer Medicine Centre, Birmingham, UK
| | - Julia Newton-Bishop
- Leeds Experimental Cancer Medicine Centre, Leeds, UK
- Section of Biostatistics and Epidemiology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Andrew G Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Karin A Oien
- Glasgow Experimental Cancer Medicine Centre, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Sanjay Popat
- Institute of Cancer Research Experimental Cancer Medicine Centre, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Lung Unit, Royal Marsden Hospital, London, UK
| | - Doris Rassl
- Cancer Research UK Cambridge Centre and Cambridge Experimental Cancer Medicine Centre, Cambridge, UK
- Department of Histopathology, Papworth Hospital, Cambridge, UK
| | | | - Phillipe Taniere
- Birmingham Experimental Cancer Medicine Centre, Birmingham, UK
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - William A Wallace
- Edinburgh Experimental Cancer Medicine Centre, Edinburgh, UK
- Department of Pathology, Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas P West
- Leeds Experimental Cancer Medicine Centre, Leeds, UK
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - David Gonzalez de Castro
- Genomic Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Mike Griffiths
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Peter W M Johnson
- Cancer Research UK, London, UK
- Southampton Experimental Cancer Medicine Centre, Southampton, UK
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Le-Rademacher J, Dahlberg S, Lee JJ, Adjei AA, Mandrekar SJ. Biomarker Clinical Trials in Lung Cancer: Design, Logistics, Challenges, and Practical Considerations. J Thorac Oncol 2018; 13:1625-1637. [PMID: 30194034 DOI: 10.1016/j.jtho.2018.08.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/10/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
Treatment for lung cancer has evolved in the past 3 decades starting with platinum-based chemotherapy as the standard of care, regardless of histology, in the early 1990s to the current age of biomarker-driven therapy. Consequently, clinical trials in lung cancer have evolved in response to this new shift of paradigm, leading to novel approaches that simultaneously shorten the development process and allow evaluation of multiple patient cohorts. Herein, we provide an overview of the landscape of lung cancer clinical trials in the era of targeted therapies, precision medicine, and biomarkers. Specific trials are given as examples to illustrate the design paradigms. The paper is organized by drug development phases starting with early-phase biomarker discovery to proof-of-concept trials to definitive trials. We also present some thoughts on future directions.
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Affiliation(s)
| | | | - J Jack Lee
- MD Anderson Cancer Institute, Houston, Texas
| | - Alex A Adjei
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
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29
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Lindsay CR, Jamal-Hanjani M, Forster M, Blackhall F. KRAS: Reasons for optimism in lung cancer. Eur J Cancer 2018; 99:20-27. [PMID: 29894909 DOI: 10.1016/j.ejca.2018.05.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/21/2018] [Accepted: 05/13/2018] [Indexed: 01/07/2023]
Abstract
Despite being the most frequent gain-of-function genetic alteration in human cancer, KRAS mutation has to date offered only limited potential as a prognostic and predictive biomarker. Results from the phase III SELECT-1 trial in non-small cell lung cancer (NSCLC) recently added to a number of historical and more contemporary disappointments in targeting KRAS mutant disease, including farnesyl transferase inhibition and synthetic lethality partners such as STK33. This narrative review uses the context of these previous failures to demonstrate how the knowledge gained from these experiences can be used as a platform for exciting advances in NSCLC on the horizon. It now seems clear that mutational subtype (most commonly G12C) of individual mutations is of greater relevance than the categorical evaluation of KRAS mutation presence or otherwise. A number of direct small molecules targeted to these subtypes are in development and have shown promising biological activity, with some in the late stages of preclinical validation.
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Affiliation(s)
- C R Lindsay
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK; Cancer Research UK Lung Cancer Centre of Excellence, London and Manchester, UK.
| | - M Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, London and Manchester, UK; Department of Oncology, University College of London Hospital and UCL Cancer Institute, London, UK
| | - M Forster
- Cancer Research UK Lung Cancer Centre of Excellence, London and Manchester, UK; Department of Oncology, University College of London Hospital and UCL Cancer Institute, London, UK
| | - F Blackhall
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK; Cancer Research UK Lung Cancer Centre of Excellence, London and Manchester, UK
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30
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Hirsch FR, Kerr KM, Bunn PA, Kim ES, Obasaju C, Pérol M, Bonomi P, Bradley JD, Gandara D, Jett JR, Langer CJ, Natale RB, Novello S, Paz-Ares L, Ramalingam SS, Reck M, Reynolds CH, Smit EF, Socinski MA, Spigel DR, Stinchcombe TE, Vansteenkiste JF, Wakelee H, Thatcher N. Molecular and Immune Biomarker Testing in Squamous-Cell Lung Cancer: Effect of Current and Future Therapies and Technologies. Clin Lung Cancer 2018; 19:331-339. [PMID: 29773328 DOI: 10.1016/j.cllc.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/18/2022]
Abstract
Patients with non-small-cell lung cancer, including squamous-cell lung cancer (SqCLC), typically present at an advanced stage. The current treatment landscape, which includes chemotherapy, radiotherapy, surgery, immunotherapy, and targeted agents, is rapidly evolving, including for patients with SqCLC. Prompt molecular and immune biomarker testing can serve to guide optimal treatment choices, and immune biomarker testing is becoming more important for this patient population. In this review we provide an overview of current and emerging practices and technologies for molecular and immune biomarker testing in advanced non-small-cell lung cancer, with a focus on SqCLC.
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Affiliation(s)
- Fred R Hirsch
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO.
| | - Keith M Kerr
- Department of Pathology, University of Aberdeen School of Medicine and Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - Paul A Bunn
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO
| | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | | | - Maurice Pérol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Philip Bonomi
- Department of Hematology and Oncology, Rush University Medical Center, Chicago, IL
| | - Jeffrey D Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - David Gandara
- Department of Hematology and Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - James R Jett
- Department of Oncology, formerly of National Jewish Health, Denver, CO
| | - Corey J Langer
- Department of Thoracic Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Ronald B Natale
- Cedars-Sinai Comprehensive Cancer Center, West Hollywood, CA
| | - Silvia Novello
- Department of Oncology, University of Turin, Turin, Italy
| | - Luis Paz-Ares
- Department of Medical Oncology, Hospital Universitario Doce de Octubre, Universidad Complutense, CIBERONC and CNIO, Madrid, Spain
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | | | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Johan F Vansteenkiste
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium
| | - Heather Wakelee
- Department of Medicine (Oncology), Stanford Cancer Institute and Stanford University School of Medicine, Stanford, CA
| | - Nick Thatcher
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
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31
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Moorcraft SY, Gonzalez de Castro D, Cunningham D, Jones T, Walker BA, Peckitt C, Yuan LC, Frampton M, Begum R, Eltahir Z, Wotherspoon A, Teixeira Mendes LS, Hulkki Wilson S, Gillbanks A, Baratelli C, Fotiadis N, Patel A, Braconi C, Valeri N, Gerlinger M, Rao S, Watkins D, Chau I, Starling N. Investigating the feasibility of tumour molecular profiling in gastrointestinal malignancies in routine clinical practice. Ann Oncol 2018; 29:230-236. [PMID: 29361134 DOI: 10.1093/annonc/mdx631] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Targeted capture sequencing can potentially facilitate precision medicine, but the feasibility of this approach in gastrointestinal (GI) malignancies is unknown. Patients and methods The FOrMAT (Feasibility of a Molecular Characterisation Approach to Treatment) study was a feasibility study enrolling patients with advanced GI malignancies from February 2014 to November 2015. Targeted capture sequencing (mainly using archival formalin-fixed paraffin-embedded diagnostic/resection samples) was carried out to detect mutations, copy number variations and translocations in up to 46 genes which had prognostic/predictive significance or were targets in current/upcoming clinical trials. Results Of the 222 patients recruited, 215 patients (96.8%) had available tissue samples, 125 patients (56.3%) had ≥16 genes successfully sequenced and 136 patients (61.2%) had ≥1 genes successfully sequenced. Sample characteristics influenced the proportion of successfully sequenced samples, e.g. tumour type (colorectal 70.9%, biliary 52.6%, oesophagogastric 50.7%, pancreas 27.3%, P = 0.002), tumour cellularity (high versus low: 78.3% versus 13.3%, P ≤ 0.001), tumour content (high versus low: 78.6% versus 27.3%, P = 0.001) and type of sample (resection versus biopsy: 82.4% versus 47.6%, P ≤ 0.001). Currently, actionable alterations were detected in 90 (40.5%) of the 222 patients recruited (66% of the 136 patients sequenced) and 2 patients subsequently received a targeted therapy. The most frequently detected currently actionable alterations were mutations in KRAS, BRAF, TP53 and PIK3CA. For the 205 patients with archival samples, the median time to obtain sequencing results was 18.9 weeks, including a median of 4.9 weeks for sample retrieval and 5.1 weeks for sequencing. Conclusions Targeted sequencing detected actionable alterations in formalin-fixed paraffin-embedded samples, but tissue characteristics are of critical importance in determining sequencing success. Routine molecular profiling of GI tumours outside of clinical trials is not an effective use of healthcare resources unless more targeted drugs become available. ClinicalTrials.gov identifier NCT02112357.
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Affiliation(s)
- S Y Moorcraft
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - D Gonzalez de Castro
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - D Cunningham
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - T Jones
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - B A Walker
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - C Peckitt
- Department of Statistics, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - L C Yuan
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - M Frampton
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - R Begum
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - Z Eltahir
- Department of Pathology, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - A Wotherspoon
- Department of Pathology, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - L S Teixeira Mendes
- Department of Pathology, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - S Hulkki Wilson
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - A Gillbanks
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - C Baratelli
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - N Fotiadis
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - A Patel
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - C Braconi
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
- The Institute of Cancer Research, London and Sutton, UK
| | - N Valeri
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
- The Institute of Cancer Research, London and Sutton, UK
| | - M Gerlinger
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
- The Institute of Cancer Research, London and Sutton, UK
| | - S Rao
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - D Watkins
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - I Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - N Starling
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, UK
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32
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Izquierdo E, Yuan L, George S, Hubank M, Jones C, Proszek P, Shipley J, Gatz SA, Stinson C, Moore AS, Clifford SC, Hicks D, Lindsey JC, Hill RM, Jacques TS, Chalker J, Thway K, O’Connor S, Marshall L, Moreno L, Pearson A, Chesler L, Walker BA, De Castro DG. Development of a targeted sequencing approach to identify prognostic, predictive and diagnostic markers in paediatric solid tumours. Oncotarget 2017; 8:112036-112050. [PMID: 29340109 PMCID: PMC5762377 DOI: 10.18632/oncotarget.23000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/16/2017] [Indexed: 01/22/2023] Open
Abstract
The implementation of personalised medicine in childhood cancers has been limited by a lack of clinically validated multi-target sequencing approaches specific for paediatric solid tumours. In order to support innovative clinical trials in high-risk patients with unmet need, we have developed a clinically relevant targeted sequencing panel spanning 311 kb and comprising 78 genes involved in childhood cancers. A total of 132 samples were used for the validation of the panel, including Horizon Discovery cell blends (n=4), cell lines (n=15), formalin-fixed paraffin embedded (FFPE, n=83) and fresh frozen tissue (FF, n=30) patient samples. Cell blends containing known single nucleotide variants (SNVs, n=528) and small insertion-deletions (indels n=108) were used to define panel sensitivities of ≥98% for SNVs and ≥83% for indels [95% CI] and panel specificity of ≥98% [95% CI] for SNVs. FFPE samples performed comparably to FF samples (n=15 paired). Of 95 well-characterised genetic abnormalities in 33 clinical specimens and 13 cell lines (including SNVs, indels, amplifications, rearrangements and chromosome losses), 94 (98.9%) were detected by our approach. We have validated a robust and practical methodology to guide clinical management of children with solid tumours based on their molecular profiles. Our work demonstrates the value of targeted gene sequencing in the development of precision medicine strategies in paediatric oncology.
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Affiliation(s)
- Elisa Izquierdo
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, United Kingdom
- Glioma Team, Division of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Lina Yuan
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, United Kingdom
| | - Sally George
- Paediatric Tumour Biology, Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
- Paediatric Drug Development Team, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Michael Hubank
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, United Kingdom
| | - Chris Jones
- Glioma Team, Division of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Paula Proszek
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, United Kingdom
| | - Janet Shipley
- Sarcoma Molecular Pathology Team, Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Susanne A. Gatz
- Paediatric Drug Development Team, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
- Sarcoma Molecular Pathology Team, Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Caedyn Stinson
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - Andrew S. Moore
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
- Oncology Service, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Steven C. Clifford
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Debbie Hicks
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Janet C. Lindsey
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Rebecca M. Hill
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Thomas S. Jacques
- Department of Histology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Developmental Biology and Cancer Programme, UCL GOS Institute of Child Health, London, United Kingdom
| | - Jane Chalker
- Haematology, Cellular and Molecular Diagnostics Service, UCL GOS Institute of Child Health, London, United Kingdom
| | - Khin Thway
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Simon O’Connor
- Haemato-Oncology Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lynley Marshall
- Paediatric Drug Development Team, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lucas Moreno
- Paediatric Drug Development Team, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
- HNJ-CNIO Clinical Research Unit and Hospital Universitario Niño Jesus, Madrid, Spain
| | - Andrew Pearson
- Paediatric Drug Development Team, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Louis Chesler
- Paediatric Tumour Biology, Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
- Paediatric Drug Development Team, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Brian A. Walker
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, United Kingdom
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - David Gonzalez De Castro
- Molecular Diagnostics Department, The Institute of Cancer Research and Clinical Genomics, The Royal Marsden NHS Foundation, London, United Kingdom
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
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Tsoulos N, Papadopoulou E, Metaxa-Mariatou V, Tsaousis G, Efstathiadou C, Tounta G, Scapeti A, Bourkoula E, Zarogoulidis P, Pentheroudakis G, Kakolyris S, Boukovinas I, Papakotoulas P, Athanasiadis E, Floros T, Koumarianou A, Barbounis V, Dinischiotu A, Nasioulas G. Tumor molecular profiling of NSCLC patients using next generation sequencing. Oncol Rep 2017; 38:3419-3429. [PMID: 29130105 PMCID: PMC5783588 DOI: 10.3892/or.2017.6051] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 10/05/2017] [Indexed: 01/10/2023] Open
Abstract
Non‑small cell lung cancer (NSCLC) is the most common type of lung cancer and a tumor with a broad spectrum of targeted therapies already available or in clinical trials. Thus, molecular characterization of the tumor using next generation sequencing (NGS) technology, has become a key tool for facilitating treatment decisions and the clinical management of NSCLC patients. The performance of a custom 23 gene multiplex amplification hot spot panel, based on Ion AmpliSeq™ technology, was evaluated for the analysis of tumor DNA extracted from formalin-fixed and paraffin-embedded (FFPE) tissues. Furthermore, the Ion AmpliSeq™ RNA Fusion Lung Cancer Research Panel was used for fusion RNA transcript analysis. The mutation spectrum of the tumors was determined in a cohort of 502 patients with NSCLC using the aforementioned targeted gene panels. The panel used for tumor DNA analysis in this study exhibited high rates (100%) of sensitivity, specificity and reproducibility at a mutation allelic frequency of 3%. At least one DNA mutation was detected in 374 patients (74.5%) and an RNA fusion was identified in 16 patients, (3.2%). In total, alterations in a cancer-driver gene were identified (including point mutations, gene rearrangements and MET amplifications) in 77.6% of the tumors tested. Among the NSCLC patients, 23% presented a mutation in a gene associated with approved or emerging targeted therapy. More specifically, 13.5% (68/502) presented a mutation in a gene with approved targeted therapy (EGFR, ALK, ROS1) and 9.4% (47/502) had an alteration in a gene related to emerging targeted therapies (ERBB2, BRAF, MET and RET). Furthermore, 51.6% of the patients had a mutation in a gene that could be related to an off label therapy or indicative for access to a clinical trial. Thus, the targeted NGS panel used in this study is a reliable approach for tumor molecular profiling and can be applied in personalized treatment decision making for NSCLC patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pavlos Zarogoulidis
- Pulmonary Department, Oncology Unit, ‘G. Papanikolaou’ General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - George Pentheroudakis
- Department of Medical Oncology, University Hospital of Ioannina, Ioannina 45500, Greece
| | - Stylianos Kakolyris
- Department of Medical Oncology, University General Hospital of Alexandroupoli, Alexandroupoli 68100, Greece
| | - Ioannis Boukovinas
- Medical Oncology, ‘Bioclinic’ of Thessaloniki, Thessaloniki 54622, Greece
| | - Pavlos Papakotoulas
- Second Department of Medical Oncology, Theagenion Anticancer Hospital of Thessaloniki, Thessaloniki 54639, Greece
| | | | | | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Vasileios Barbounis
- Third Medical Oncology Department, ‘Metropolitan’ Hospital, Pireas 18547, Greece
| | - Anca Dinischiotu
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Bucharest, Bucharest 0050095, Romania
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Planchard D, Remon J, Nowak F, Soria JC. Future Genetic/Genomic Biomarker Testing in Non-Small Cell Lung Cancer. Am Soc Clin Oncol Educ Book 2017; 37:12-17. [PMID: 28561640 DOI: 10.1200/edbk_100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- David Planchard
- From the Department of Oncology Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Department of Oncology Medicine, Hospital de la Vall d'Hebron, Barcelona, Spain; Institut National du Cancer, Boulogne-Billancourt, France; University Paris-Sud and Gustave Roussy Cancer Campus, Villejuif, France
| | - Jordi Remon
- From the Department of Oncology Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Department of Oncology Medicine, Hospital de la Vall d'Hebron, Barcelona, Spain; Institut National du Cancer, Boulogne-Billancourt, France; University Paris-Sud and Gustave Roussy Cancer Campus, Villejuif, France
| | - Frédérique Nowak
- From the Department of Oncology Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Department of Oncology Medicine, Hospital de la Vall d'Hebron, Barcelona, Spain; Institut National du Cancer, Boulogne-Billancourt, France; University Paris-Sud and Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Charles Soria
- From the Department of Oncology Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Department of Oncology Medicine, Hospital de la Vall d'Hebron, Barcelona, Spain; Institut National du Cancer, Boulogne-Billancourt, France; University Paris-Sud and Gustave Roussy Cancer Campus, Villejuif, France
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35
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Sundar R, Chénard-Poirier M, Collins DC, Yap TA. Imprecision in the Era of Precision Medicine in Non-Small Cell Lung Cancer. Front Med (Lausanne) 2017; 4:39. [PMID: 28443282 PMCID: PMC5385461 DOI: 10.3389/fmed.2017.00039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/22/2017] [Indexed: 12/29/2022] Open
Abstract
Over the past decade, major advances have been made in the management of advanced non-small cell lung cancer (NSCLC). There has been a particular focus on the identification and targeting of putative driver aberrations, which has propelled NSCLC to the forefront of precision medicine. Several novel molecularly targeted agents have now achieved regulatory approval, while many others are currently in late-phase clinical trial testing. These antitumor therapies have significantly impacted the clinical outcomes of advanced NSCLC and provided patients with much hope for the future. Despite this, multiple deficiencies still exist in our knowledge of this complex disease, and further research is urgently required to overcome these critical issues. This review traces the path undertaken by the different therapeutics assessed in NSCLC and the impact of precision medicine in this disease. We also discuss the areas of "imprecision" that still exist in NSCLC and the modern hypothesis-testing studies being conducted to address these key challenges.
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Affiliation(s)
- Raghav Sundar
- Royal Marsden Hospital, London, UK
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore, Singapore
| | | | | | - Timothy A. Yap
- Royal Marsden Hospital, London, UK
- The Institute of Cancer Research, London, UK
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36
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Wilhelm-Benartzi CS, Mt-Isa S, Fiorentino F, Brown R, Ashby D. Challenges and methodology in the incorporation of biomarkers in cancer clinical trials. Crit Rev Oncol Hematol 2017; 110:49-61. [PMID: 28109405 DOI: 10.1016/j.critrevonc.2016.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/28/2016] [Accepted: 12/12/2016] [Indexed: 12/14/2022] Open
Abstract
Biomarkers can be used to establish more homogeneous groups using the genetic makeup of the tumour to inform the selection of treatment for each individual patient. However, proper preclinical work and stringent validation are needed before taking forward biomarkers into confirmatory studies. Despite the challenges, incorporation of biomarkers into clinical trials could better target appropriate patients, and potentially be lifesaving. The authors conducted a systematic review to describe marker-based and adaptive design methodology for their integration in clinical trials, and to further describe the associated practical challenges. Studies published between 1990 to November 2015 were searched on PubMed. Titles, abstracts and full text articles were reviewed to identify relevant studies. Of the 4438 studies examined, 57 studies were included. The authors conclude that the proposed approaches may readily help researchers to design biomarker trials, but novel approaches are still needed.
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Affiliation(s)
- Charlotte S Wilhelm-Benartzi
- CRUK Imperial Centre, Department of Surgery and Cancer, Imperial College London, UK; Imperial Clinical Trials Unit, School of Public Health, Imperial College London, UK.
| | - Shahrul Mt-Isa
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, UK
| | - Francesca Fiorentino
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, UK
| | - Robert Brown
- Epigenetics Unit, Department of Surgery and Cancer, Imperial College London, UK
| | - Deborah Ashby
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, UK
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Tissue-based next generation sequencing: application in a universal healthcare system. Br J Cancer 2017; 116:553-560. [PMID: 28103613 PMCID: PMC5344287 DOI: 10.1038/bjc.2016.452] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/17/2016] [Accepted: 11/30/2016] [Indexed: 02/07/2023] Open
Abstract
In the context of solid tumours, the evolution of cancer therapies to more targeted and nuanced approaches has led to the impetus for personalised medicine. The targets for these therapies are largely based on the driving genetic mutations of the tumours. To track these multiple driving mutations the use of next generation sequencing (NGS) coupled with a morphomolecular approach to tumours, has the potential to deliver on the promises of personalised medicine. A review of NGS and its application in a universal healthcare (UHC) setting is undertaken as the technology has a wide appeal and utility in diagnostic, clinical trial and research paradigms. Furthermore, we suggest that these can be accommodated with a unified integromic approach. Challenges remain in bringing NGS to routine clinical use and these include validation, handling of the large amounts of information flow and production of a clinically useful report. These challenges are particularly acute in the setting of UHC where tests are not reimbursed and there are finite resources available. It is our opinion that the challenges faced in applying NGS in a UHC setting are surmountable and we outline our approach for its routine application in diagnostic, clinical trial and research paradigms.
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Tumour Heterogeneity: The Key Advantages of Single-Cell Analysis. Int J Mol Sci 2016; 17:ijms17122142. [PMID: 27999407 PMCID: PMC5187942 DOI: 10.3390/ijms17122142] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 01/06/2023] Open
Abstract
Tumour heterogeneity refers to the fact that different tumour cells can show distinct morphological and phenotypic profiles, including cellular morphology, gene expression, metabolism, motility, proliferation and metastatic potential. This phenomenon occurs both between tumours (inter-tumour heterogeneity) and within tumours (intra-tumour heterogeneity), and it is caused by genetic and non-genetic factors. The heterogeneity of cancer cells introduces significant challenges in using molecular prognostic markers as well as for classifying patients that might benefit from specific therapies. Thus, research efforts for characterizing heterogeneity would be useful for a better understanding of the causes and progression of disease. It has been suggested that the study of heterogeneity within Circulating Tumour Cells (CTCs) could also reflect the full spectrum of mutations of the disease more accurately than a single biopsy of a primary or metastatic tumour. In previous years, many high throughput methodologies have raised for the study of heterogeneity at different levels (i.e., RNA, DNA, protein and epigenetic events). The aim of the current review is to stress clinical implications of tumour heterogeneity, as well as current available methodologies for their study, paying specific attention to those able to assess heterogeneity at the single cell level.
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Sun H, Bretz F, Gerke O, Vach W. Comparing a stratified treatment strategy with the standard treatment in randomized clinical trials. Stat Med 2016; 35:5325-5337. [PMID: 27666738 DOI: 10.1002/sim.7091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/07/2022]
Abstract
The increasing emergence of predictive markers for different treatments in the same patient population allows us to define stratified treatment strategies. We consider randomized clinical trials that compare a standard treatment with a new stratified treatment strategy that divides the study population into subgroups receiving different treatments. Because the new strategy may not be beneficial in all subgroups, we consider in this paper an intermediate approach that establishes a treatment effect in a subset of patients built by joining several subgroups. The approach is based on the simple idea of selecting the subset with minimal p-value when testing the subset-specific treatment effects. We present a framework to compare this approach with other approaches to select subsets by introducing three performance measures. The results of a comprehensive simulation study are presented, and the relative merits of the various approaches are discussed. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hong Sun
- Clinical Epidemiology, Institute for Medical Biometry and Statistics, Faculty of Medicine, Medical Center - University of Freiburg, Germany
| | | | - Oke Gerke
- Nuclear Medicine, Odense University Hospital, Denmark
| | - Werner Vach
- Clinical Epidemiology, Institute for Medical Biometry and Statistics, Faculty of Medicine, Medical Center - University of Freiburg, Germany
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Rozenblum AB, Ilouze M, Dudnik E, Dvir A, Soussan-Gutman L, Geva S, Peled N. Clinical Impact of Hybrid Capture-Based Next-Generation Sequencing on Changes in Treatment Decisions in Lung Cancer. J Thorac Oncol 2016; 12:258-268. [PMID: 27865871 DOI: 10.1016/j.jtho.2016.10.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 09/23/2016] [Accepted: 10/17/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Targeted therapy significantly prolongs survival in lung adenocarcinoma. Current diagnostic guidelines include only EGFR and anaplastic lymphoma receptor tyrosine kinase gene (ALK) testing. Next-generation sequencing (NGS) reveals more actionable genomic alterations than do standard diagnostic methods. Data on the influence of hybrid capture (HC)-based NGS on treatment are limited, and we investigated its impact on treatment decisions and clinical outcomes. METHODS This retrospective study included patients with advanced lung cancer on whom HC-based NGS was performed between November 2011 and October 2015. Demographic and clinicopathologic characteristics, treatments, and outcome data were collected. RESULTS A total of 101 patients were included (median age 63 years [53% females, 45% never-smokers, and 85% with adenocarcinoma]). HC-based NGS was performed upfront and after EGFR/ALK testing yielded negative or inconclusive results in 15% and 85% of patients, respectively. In 51.5% of patients, HC-based NGS was performed before first-line therapy, and in 48.5%, it was performed after treatment failure. HC-based NGS identified clinically actionable genomic alterations in 50% of patients, most frequently in EGFR (18%), Ret proto-oncogene (RET) (9%), ALK (8%), Mesenchymal-epithelial transition factor (MET) receptor tyrosine kinase gene (6%), and erb-b2 receptor tyrosine kinase 2 gene (ERBB2) (5%). In 15 patients, it identified EGFR/ALK aberrations after negative results of prior standard testing. Treatment strategy was changed for 43 patients (42.6%). The overall response rate in these patients was 65% (complete response 14.7%, partial response 50%). Median survival was not reached. Immunotherapy was administered in 33 patients, mostly without an actionable driver, with a presenting disease control rate of 32%, and with an association with tumor mutation burden. CONCLUSIONS HC-based NGS influenced treatment decisions in close to half of the patients with lung adenocarcinoma and was associated with an overall response rate of 65%, which may translate into a survival benefit.
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Affiliation(s)
- Anna Belilovski Rozenblum
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Ilouze
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Elizabeth Dudnik
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Addie Dvir
- Teva Pharmaceutical Industries Ltd., Shoam, Israel
| | | | - Smadar Geva
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Nir Peled
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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41
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Hiley CT, Le Quesne J, Santis G, Sharpe R, de Castro DG, Middleton G, Swanton C. Challenges in molecular testing in non-small-cell lung cancer patients with advanced disease. Lancet 2016; 388:1002-11. [PMID: 27598680 DOI: 10.1016/s0140-6736(16)31340-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/15/2016] [Accepted: 07/25/2016] [Indexed: 12/18/2022]
Abstract
Lung cancer diagnostics have progressed greatly in the previous decade. Development of molecular testing to identify an increasing number of potentially clinically actionable genetic variants, using smaller samples obtained via minimally invasive techniques, is a huge challenge. Tumour heterogeneity and cancer evolution in response to therapy means that repeat biopsies or circulating biomarkers are likely to be increasingly useful to adapt treatment as resistance develops. We highlight some of the current challenges faced in clinical practice for molecular testing of EGFR, ALK, and new biomarkers such as PDL1. Implementation of next generation sequencing platforms for molecular diagnostics in non-small-cell lung cancer is increasingly common, allowing testing of multiple genetic variants from a single sample. The use of next generation sequencing to recruit for molecularly stratified clinical trials is discussed in the context of the UK Stratified Medicine Programme and The UK National Lung Matrix Trial.
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Affiliation(s)
- Crispin T Hiley
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK; Division of Cancer Studies, King's College London, London, UK
| | - John Le Quesne
- Department of Cancer Studies, University of Leicester, Leicester, UK
| | - George Santis
- Department of Respiratory Medicine and Allergy, King's College London, UK
| | | | - David Gonzalez de Castro
- Centre for Molecular Pathology, Royal Marsden Hospital, Sutton, UK; School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Charles Swanton
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK; CRUK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK.
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Pearson ADJ, Herold R, Rousseau R, Copland C, Bradley-Garelik B, Binner D, Capdeville R, Caron H, Carleer J, Chesler L, Geoerger B, Kearns P, Marshall LV, Pfister SM, Schleiermacher G, Skolnik J, Spadoni C, Sterba J, van den Berg H, Uttenreuther-Fischer M, Witt O, Norga K, Vassal G. Implementation of mechanism of action biology-driven early drug development for children with cancer. Eur J Cancer 2016; 62:124-31. [PMID: 27258969 DOI: 10.1016/j.ejca.2016.04.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/04/2016] [Indexed: 01/08/2023]
Abstract
An urgent need remains for new paediatric oncology drugs to cure children who die from cancer and to reduce drug-related sequelae in survivors. In 2007, the European Paediatric Regulation came into law requiring industry to create paediatric drug (all types of medicinal products) development programmes alongside those for adults. Unfortunately, paediatric drug development is still largely centred on adult conditions and not a mechanism of action (MoA)-based model, even though this would be more logical for childhood tumours as these have much fewer non-synonymous coding mutations than adult malignancies. Recent large-scale sequencing by International Genome Consortium and Paediatric Cancer Genome Project has further shown that the genetic and epigenetic repertoire of driver mutations in specific childhood malignancies differs from more common adult-type malignancies. To bring about much needed change, a Paediatric Platform, ACCELERATE, was proposed in 2013 by the Cancer Drug Development Forum, Innovative Therapies for Children with Cancer, the European Network for Cancer Research in Children and Adolescents and the European Society for Paediatric Oncology. The Platform, comprising multiple stakeholders in paediatric oncology, has three working groups, one with responsibility for promoting and developing high-quality MoA-informed paediatric drug development programmes, including specific measures for adolescents. Key is the establishment of a freely accessible aggregated database of paediatric biological tumour drug targets to be aligned with an aggregated pipeline of drugs. This will enable prioritisation and conduct of early phase clinical paediatric trials to evaluate these drugs against promising therapeutic targets and to generate clinical paediatric efficacy and safety data in an accelerated time frame. Through this work, the Platform seeks to ensure that potentially effective drugs, where the MoA is known and thought to be relevant to paediatric malignancies, are evaluated in early phase clinical trials, and that this approach to generate pre-clinical and clinical data is systematically pursued by academia, sponsors, industry, and regulatory bodies to bring new paediatric oncology drugs to front-line therapy more rapidly.
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Affiliation(s)
- Andrew D J Pearson
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, London, UK.
| | - Ralf Herold
- Product Development Scientific Support Department, European Medicines Agency, Canary Wharf, London, UK
| | | | - Chris Copland
- Centre for English Language Teaching, University of York, UK
| | | | - Debbie Binner
- Create for Chloe and UK representative for aPODD, UK
| | | | - Hubert Caron
- Hoffman-La Roche, Basel, Switzerland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Jacqueline Carleer
- Belgian Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Louis Chesler
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, France
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Lynley V Marshall
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, London, UK; Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Stefan M Pfister
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), and Heidelberg University Hospital, Heidelberg 69120, Germany
| | - Gudrun Schleiermacher
- U830 INSERM, Recherche Translationelle en Oncologie Pédiatrique (RTOP) and Department of Pediatric Oncology, Institut Curie, Paris, France
| | | | | | - Jaroslav Sterba
- Department of Paediatric Oncology, Faculty of Medicine, University Hospital Brno and Masaryk University, Brno, Czech Republic; Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, ICRC Brno, Brno, Czech Republic
| | - Hendrick van den Berg
- Product Development Scientific Support Department, European Medicines Agency, Canary Wharf, London, UK
| | | | - Olaf Witt
- Clinical Cooperation Unit Pediatric Oncology (G340), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Koen Norga
- Paediatric Haematology/Oncology Unit, Antwerp University Hospital, Antwerp University, Belgium
| | - Gilles Vassal
- Department of Clinical Research, Institut Gustave Roussy, Paris-Sud University, Paris, France
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43
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O'Hara MH, Hamilton SR, O'Dwyer PJ. Molecular Triage Trials in Colorectal Cancer. Cancer J 2016; 22:218-22. [PMID: 27341602 DOI: 10.1097/ppo.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advances in the understanding of genomic alterations in cancer, and the various therapies targeted to these alterations have permitted the design of trials directed to bringing this science to the clinic, with the ultimate goal of tailoring therapy to the individual. There is a high need for advances in targeted therapy in colorectal cancer, a disease in which only 2 classes of targeted therapies are approved for use in colorectal cancer, despite the majority of colorectal cancers containing a potentially targetable mutation. Here we outline the key elements to the design of these clinical trials and summarize the current active molecular triage trials in colorectal cancer.
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Affiliation(s)
- Mark H O'Hara
- From the *Abramson Cancer Center at University of Pennsylvania, Philadelphia, PA; and †The University of Texas MD Anderson Cancer Center, Houston, TX
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Schmidt KT, Chau CH, Price DK, Figg WD. Precision Oncology Medicine: The Clinical Relevance of Patient-Specific Biomarkers Used to Optimize Cancer Treatment. J Clin Pharmacol 2016; 56:1484-1499. [PMID: 27197880 DOI: 10.1002/jcph.765] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 12/22/2022]
Abstract
Precision medicine in oncology is the result of an increasing awareness of patient-specific clinical features coupled with the development of genomic-based diagnostics and targeted therapeutics. Companion diagnostics designed for specific drug-target pairs were the first to widely utilize clinically applicable tumor biomarkers (eg, HER2, EGFR), directing treatment for patients whose tumors exhibit a mutation susceptible to an FDA-approved targeted therapy (eg, trastuzumab, erlotinib). Clinically relevant germline mutations in drug-metabolizing enzymes and transporters (eg, TPMT, DPYD) have been shown to impact drug response, providing a rationale for individualized dosing to optimize treatment. The use of multigene expression-based assays to analyze an array of prognostic biomarkers has been shown to help direct treatment decisions, especially in breast cancer (eg, Oncotype DX). More recently, the use of next-generation sequencing to detect many potential "actionable" cancer molecular alterations is further shifting the 1 gene-1 drug paradigm toward a more comprehensive, multigene approach. Currently, many clinical trials (eg, NCI-MATCH, NCI-MPACT) are assessing novel diagnostic tools with a combination of different targeted therapeutics while also examining tumor biomarkers that were previously unexplored in a variety of cancer histologies. Results from ongoing trials such as the NCI-MATCH will help determine the clinical utility and future development of the precision-medicine approach.
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Affiliation(s)
- Keith T Schmidt
- Clinical Pharmacology Program, Office of the Clinical Director, NIH, Bethesda, MD, USA
| | - Cindy H Chau
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Douglas K Price
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - William D Figg
- Clinical Pharmacology Program, Office of the Clinical Director, NIH, Bethesda, MD, USA
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
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45
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Zhang C, Guan Y, Sun Y, Ai D, Guo Q. Tumor heterogeneity and circulating tumor cells. Cancer Lett 2016; 374:216-23. [DOI: 10.1016/j.canlet.2016.02.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 12/15/2022]
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46
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Carr TH, McEwen R, Dougherty B, Johnson JH, Dry JR, Lai Z, Ghazoui Z, Laing NM, Hodgson DR, Cruzalegui F, Hollingsworth SJ, Barrett JC. Defining actionable mutations for oncology therapeutic development. Nat Rev Cancer 2016; 16:319-29. [PMID: 27112209 DOI: 10.1038/nrc.2016.35] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Genomic profiling of tumours in patients in clinical trials enables rapid testing of multiple hypotheses to confirm which genomic events determine likely responder groups for targeted agents. A key challenge of this new capability is defining which specific genomic events should be classified as 'actionable' (that is, potentially responsive to a targeted therapy), especially when looking for early indications of patient subgroups likely to be responsive to new drugs. This Opinion article discusses some of the different approaches being taken in early clinical development to define actionable mutations, and describes our strategy to address this challenge in early-stage exploratory clinical trials.
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Affiliation(s)
- T Hedley Carr
- Oncology IMED, AstraZeneca, Darwin Building, Cambridge Science Park, Cambridge CB4 0WG, UK
| | - Robert McEwen
- Oncology IMED, AstraZeneca, Darwin Building, Cambridge Science Park, Cambridge CB4 0WG, UK
| | - Brian Dougherty
- Oncology IMED, AstraZeneca, Waltham, Massachusetts 02451, USA
| | | | - Jonathan R Dry
- Oncology IMED, AstraZeneca, Waltham, Massachusetts 02451, USA
| | - Zhongwu Lai
- Oncology IMED, AstraZeneca, Waltham, Massachusetts 02451, USA
| | - Zara Ghazoui
- Oncology IMED, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK
| | - Naomi M Laing
- Oncology IMED, AstraZeneca, Waltham, Massachusetts 02451, USA
| | - Darren R Hodgson
- Oncology IMED, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK
| | | | - Simon J Hollingsworth
- Oncology IMED, AstraZeneca, Darwin Building, Cambridge Science Park, Cambridge CB4 0WG, UK
| | - J Carl Barrett
- Oncology IMED, AstraZeneca, Waltham, Massachusetts 02451, USA
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