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Genetic Testing in Screening Patients With Stage IB-IIIA Non-Small Cell Lung Cancer That Has Been or Will Be Removed by Surgery (The ALCHEMIST Screening Trial)

This study is currently recruiting participants. (see Contacts and Locations)
Verified January 2017 by National Cancer Institute (NCI)
Information provided by (Responsible Party):
National Cancer Institute (NCI) Identifier:
First received: July 16, 2014
Last updated: January 19, 2017
Last verified: January 2017
This research trial studies genetic testing in screening patients with stage IB-IIIA non-small cell lung cancer that has been or will be removed by surgery. Studying the genes in a patient's tumor cells may help doctors select the best treatment for patients that have certain genetic changes.

Condition Intervention
Large Cell Lung Carcinoma
Lung Adenocarcinoma
Stage IB Non-Small Cell Lung Carcinoma
Stage IB Squamous Cell Lung Carcinoma
Stage IIA Non-Small Cell Lung Carcinoma
Stage IIA Squamous Cell Lung Carcinoma
Stage IIB Non-Small Cell Lung Carcinoma
Stage IIB Squamous Cell Lung Carcinoma
Stage IIIA Non-Small Cell Lung Cancer
Stage IIIA Squamous Cell Lung Carcinoma
Other: Cytology Specimen Collection Procedure
Other: Laboratory Biomarker Analysis

Study Type: Observational
Official Title: Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trial (ALCHEMIST)

Resource links provided by NLM:

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Central clinical genotyping to facilitate accrual to the adjuvant Intergroup studies, E4512 and A081105, as measured by rate of accrual [ Time Frame: Up to 4 years ]
  • Feasibility of research grade formalin-fixed, paraffin-embedded tissue collection for CCG analysis, as measured by adequate specimens collected per month [ Time Frame: Up to 4 years ]

Secondary Outcome Measures:
  • Agreement of local genotyping methods (direct sequencing of EGFR, ALK FISH) with central Clinical Laboratory Improvement Amendments genotyping [ Time Frame: Up to 5 years ]
    For each locally used assay, agreement will be defined as the proportion of patients deemed mutant (or wild-type) by local and central assessment divided by the number of evaluable patients, where an evaluable patient is one who has a local assessment result and has submitted tissue for central assessment. An agreement rate of 90% or higher between the local assay and the central assessment will be deemed acceptable.

  • Disease free survival (DFS) rate for lung cancers which are wild-type for EGFR and ALK [ Time Frame: Time from resection to the earliest of documented disease recurrence confirmed by biopsy, development of a new lung cancer confirmed by biopsy, or death from any cause, assessed at 2 years ]
    Using genomics performed at CCG, DFS rate will be calculated for each genotype-defined population constituting greater than 1% of the study cohort.

Other Outcome Measures:
  • Proportions of patients who decline to enroll [ Time Frame: Up to 5 years ]
    Reasons behind why potentially eligible ALK-rearranged/EGFR mutant patients decline to enroll onto the adjuvant trials will be summarized. Concern with randomization, or not needing further therapy versus those who become otherwise ineligible due to recurrent disease or missing the enrollment window will be catalogued.

  • Spectrum of new mutations identified at recurrence [ Time Frame: Up to 5 years ]
    Genomic analysis will be performed on tissue collected at time of recurrence and compared to baseline genomics. New mutations in key oncogenes and tumor suppressor genes (phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha and phosphatase and tensin homolog, etc) will be quantified.

Estimated Enrollment: 8300
Study Start Date: August 2014
Estimated Primary Completion Date: June 2021 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Ancillary-Correlative (marker identification and sequencing)
Patients undergo collection of blood and tissue samples for EGFR and ALK testing via direct sequencing and FISH. Patients that have had surgery prior to pre-registration will submit samples from the previous surgery for testing.
Other: Cytology Specimen Collection Procedure
Undergo collection of blood and tissue
Other Name: Cytologic Sampling
Other: Laboratory Biomarker Analysis
Undergo laboratory analysis via direct sequencing and FISH

Detailed Description:


I. To centrally test resected non-small cell lung cancer (NSCLC) for genetic mutations to facilitate accrual to randomized adjuvant studies.

II. To obtain clinically annotated tumor tissue and patient-matched non-malignant deoxyribonucleic acid (DNA) from peripheral blood, as well as detailed epidemiologic and clinical follow-up data, to allow clinically annotated advanced genomic analyses in concert with the National Cancer Institute (NCI) Center for Cancer Genomics (CCG).


I. To characterize the natural history of molecularly characterized NSCLC to allow subsequent development of targeted therapies against genotype-defined subpopulations in the adjuvant and recurrent settings.

II. To cross-validate local genotyping assays for epidermal growth factor receptor (EGFR) and anaplastic lymphoma receptor tyrosine kinase (ALK) with a central reference standard.


I. To study the genomic evolution of lung cancers by comparing genomic characteristics at resection and at recurrence.

II. To understand reasons behind lack of enrollment to adjuvant targeted therapy studies for potentially eligible patients.


Patients undergo collection of blood and tissue samples for EGFR, ALK, and programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1)/cytotoxic t-lymphocyte-associated protein 4 (CTLA-4) testing via direct sequencing, fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC). Patients that have had surgery prior to pre-registration will submit samples from the previous surgery for testing.

After completion of study, patients that are not enrolled on either A081105, E4512, or EA5142 are followed up every 6 months for 5 years.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample

Inclusion Criteria:

  • For pre-surgical patients

    • Suspected diagnosis of resectable non-small cell lung cancer; patients with squamous cell carcinoma are eligible only if the registering site has EA5142 institutional review board (IRB) approved
    • Suspected clinical stage of IIIA, II or large IB (defined as size >= 4cm)
  • For post-surgical patients

    • Completely resected non-small cell lung cancer; patients with squamous cell carcinoma are eligible only if the registering site has EA5142 IRB approved
    • Pathologic stage IIIA, II or IB (defined as size >= 4 cm)
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-1
  • No patients who have received neoadjuvant therapy (chemo- or radio-therapy) for this lung cancer
  • No prior or concurrent malignancies within 5 years, except non-melanoma skin carcinoma or in situ carcinomas; a secondary primary lung cancer is considered a concurrent malignancy and would make a patient ineligible for A151216
  • No prior treatment with agents targeting EGFR mutation, ALK rearrangement, and PD-1/PD-L1/CTLA-4
  • No patients known to be pregnant or lactating
  • Patients who have had local genotyping are eligible, regardless of the local result
  • No patients with recurrence of lung cancer after prior resection
  • Note: Post-surgical patients should proceed to registration immediately following preregistration
  • Completely resected NSCLC; patients with squamous cell carcinoma are eligible only if the registering site has EA5142 IRB approved
  • Pathologic stage IIIA, II, or large IB (defined as size >= 4 cm)
  • Tissue available for the required analyses
  • In order to allow for time for central genotyping and eligibility for the ALCHEMIST treatment trial, patients must register within the following eligibility windows, depending on the adjuvant treatment approach:

    • If no adjuvant therapy, register patient within 75 days following surgery
    • If adjuvant chemotherapy only, register patient within 225 days following surgery
    • If adjuvant chemotherapy and radiation, register patient within 285 days following surgery
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT02194738

  Show 1148 Study Locations
Sponsors and Collaborators
National Cancer Institute (NCI)
Principal Investigator: Geoffrey Oxnard Alliance for Clinical Trials in Oncology
  More Information

Responsible Party: National Cancer Institute (NCI) Identifier: NCT02194738     History of Changes
Obsolete Identifiers: NCT02200497
Other Study ID Numbers: NCI-2014-01509  NCI-2014-01509  A151216  A151216  U10CA180821  U10CA031946 
Study First Received: July 16, 2014
Last Updated: January 19, 2017

Additional relevant MeSH terms:
Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Lung Diseases
Respiratory Tract Diseases
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Carcinoma, Bronchogenic
Bronchial Neoplasms processed this record on February 20, 2017