Utilization of Genomic Information to Augment Chemotherapy Decision-making for People With Incurable Malignancies

Study Description

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Brief Summary:

Most systemic therapies are chosen on the basis of large randomized clinical trials; however, tumour heterogeneity means that cancers with similar histological features may have substantially different underlying biological drivers. The investigators propose that applying personal genomic information prospectively obtained in a clinically realistic timeframe to assist in chemotherapy decision-making could result in more effective and efficient cancer treatment. This study will investigate this approach in a cross section of advanced cancers to examine timeliness, deliverability, rate of actionable targets identified, and our ability to expand this approach into a larger clinical trial setting.

Condition or disease	Intervention/treatment	Phase
Advanced Incurable Cancers	Genetic: in depth genomic sequencing	Not Applicable

Detailed Description:

It is clear that carcinogenesis is an immensely complex process and that even within a histologic cancer subtype - such as adenocarcinoma of the lung or breast - there is significant heterogeneity in cancer behaviour and response to therapy. Recognizing genetic mutations that promote disease facilitates targeted treatment; this has been demonstrated in several small subgroups of cancers in which specific genetic mutations or translocations have been successfully treated with targeted chemotherapy agents.

Analyses of individual patients demonstrate unique molecular signatures for every cancer examined. Frequently, multiple different pathways are involved in disease growth and progression and the dominant process varies from person to person and perhaps even within different sites of disease within one person. As well these variations evolve in response to treatment. With many recognized mutations personalized evaluation of the genetic signature encoded in DNA and RNA may enable directed therapy to the appropriate oncologic pathway thereby providing information to help guide chemotherapy choices.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	100 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Official Title:	Utilization of Genomic Information to Augment Chemotherapy Decision-making for People With Incurable Malignancies
Study Start Date :	June 2012
Actual Primary Completion Date :	February 2015
Actual Study Completion Date :	February 2015

Arms and Interventions

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Arm	Intervention/treatment
Experimental: Sequenced patients; Patients enrolled on the study who have successful sequencing of their cancers will be closely monitored for: what chemotherapy agents are next used, what response and toxicity do they have, is there any early sign of response detected on PET-CT, overall did the genomic information change treatment decision-making.	Genetic: in depth genomic sequencing; Fresh tumour biopsies and matched normal specimens (blood and surrounding tissue) and when possible archival pretreatment specimens, will undergo in depth DNA and RNA sequencing and analysis on an oncogene panel.

Outcome Measures

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Primary Outcome Measures :

1. Frequency of actioanble genomic abnormalites detected that modify treatment [ Time Frame: up to 24 months ]
   What is the frequency of "actionable" results in this varied tumour population ?

Secondary Outcome Measures :

1. What is the frequency with which these actionable results actually result in a subject receiving a drug(s) related to this test [ Time Frame: up to 24 months ]
   What is the frequency with which these actionable results actually result in a subject receiving a drug(s) related to this test.

Eligibility Criteria

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Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

1. Subjects must have histologically or cytologically confirmed diagnosis of cancer
2. This cancer must be incurable, as defined by their treating oncologist (generally because of advanced stage).
3. Subjects must agree to provide archival tissue and agree to undergo a study specific biopsy and blood test for genetic analysis. All subjects would have a biopsy and blood samples at progression if it could be done safely.
4. ECOG PS 0 or 1.
5. Age > 18 years of age.
6. Subject consent must be obtained according to the BCCA requirements.
7. Subject must be accessible for treatment and follow-up. Subjects must be registered at the BCCA Vancouver site.

Exclusion Criteria:

1. Unable or unwilling to undergo tumour biopsy(s) and/or blood/skin samples for normal DNA.
2. Significant medical condition that in the opinion of the treating oncologist renders the subject not suitable for participation.

Contacts and Locations

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Locations

Canada, British Columbia
BC Cancer Agency
Vancouver, British Columbia, Canada

Sponsors and Collaborators

British Columbia Cancer Agency

BC Cancer Foundation

Investigators

Principal Investigator:	Janessa J. Laskin, MD FRCPC	British Columbia Cancer Agency
Principal Investigator:	Marco Marra, PhD FRSC	Genome Sciences Centre, BC Cancer Agency

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications:

Peixoto RD; Li Y; Pleasance E; Yip S; et al. A case of the utilization of genomic information in the management of metastatic colorectal cancer. J Clin Oncol 30: 2012 (suppl 34; abstr 444)

Responsible Party:	British Columbia Cancer Agency
ClinicalTrials.gov Identifier:	NCT01802905 History of Changes
Other Study ID Numbers:	BCCA POG 01
First Posted:	March 4, 2013
Last Update Posted:	February 5, 2015
Last Verified:	February 2013

Keywords provided by British Columbia Cancer Agency:

neoplasm; metastatic cancer; cancer genome; genomic analysis; adults