ASCO 2015

Medically under-represented populations: Refining the calculation of accrual targets

Dr Robert Comis - ECOG-ACRIN Cancer Research Group, Philadelphia, USA

Everybody has been talking about individualising cancer therapy for a long time and the emergence of genetic characteristics or mutations or factors has been regarded as pretty important but pretty confusing as well. What are you trying to do with MATCH and what is MATCH?

MATCH is a study where we are going to screen 3,000 patients with a panel of genes, about 147 genes and 4,000 variants, and assign them to genetic buckets independent of their disease status. So they will be treated, solid tumours and lymphoma patients who are refractory to treatment will be treated according to their genetic mutations with drugs that are either commercially available or investigational.

Let me get this right, you’re concerned about which mutations they have rather than which sort of cancer they have?

Absolutely. This is the great paradigm shift which is starting, at least, in cancer where we are starting to characterise cancer not as an anatomic site but as a biological entity.

This is such a complex task that you have to be extremely well organised and you’ve got a network of laboratories, haven’t you?

Yes, so ECOG-ACRIN is part of the National Cancer Institute’s clinical trials network and so there are going to be over 2,000 sites in the country that are going to be doing it. It’s one of the largest ever done. But most importantly we’ve established a network of laboratories that have shared samples doing the genetic tests and we’ve shown that the reproducibility and concordance is over 95%. So when we call a mutation it’s going to be a mutation, it’s going to be a variant that we can action, act upon. So the precision, you can’t have precision medicine without precision diagnostics, so we have both.

How sure are you, how much data are there, about the effectiveness of targeting your therapy to the mutation rather than to a particular cancer?

We really won’t know until we get into this. We know that it’s very variable. For instance with BRAF we know that melanoma responds with B600 mutations but colon does not respond. So we are going to learn from studying these patients in over twenty phase II studies based on their genetics who responds and who doesn’t. And it may be that there might be combinations of mutations or combinations of drugs which are required.

You’re getting doctors to collaborate, centres to collaborate, what do you want cancer doctors all over the planet to know about right now?

I think it’s important to understand that this is an evolving field, that we have hints from individual diseases that this might work. But the question is, can we redefine cancer and its treatment based on molecular information?

In the past, President Kennedy wanted to get the moon, President Nixon wanted to beat cancer, are you going to beat cancer with this new approach? Will it make the paradigm shift that you’re looking for?

I think when one looks down the road that there will be very… we know already that there are very important niches for this type of treatment. I don’t think that it’s going to be a global type of approach, it’s going to be a highly specific and highly centred approach, but I do think that this approach combined with what’s happening in immunology and immunotherapy really introduces an entirely new approach to cancer in the world. All of us throughout the world are doing this in one way or another. In the States this is the biggest ever we’ve done.

So what’s your advice to busy cancer doctors, briefly then, what should they take away from this?

I think that participating in studies like MATCH, and there may be others in Europe and in other parts of the world, is very, very important if they have that opportunity. If they’re going to treat patients based upon tests that are done they need to make sure of the quality of the tests being performed so that you can guide patients to the right treatment.