On a recent trip out of town, I had a bit of a disagreement with my rental car. I wanted to find NPR and listen to the news. First I tried the preset buttons on the radio, which led me to talk show hosts yelling at each other and golden oldies – not what I was looking for. I then tried scanning up and down the dial, where I found mostly Justin Bieber and Katy Perry (I would not have known who the “artists” were without the help of the hyper-kinetic DJ). I eventually gave up.
In some ways, this inability to find what I was looking for on the radio reminded me of the current state of clinical cancer research. Many of the more exciting opportunities involve targeted therapies that are only appropriate for a small percentage of cancer patients who have very specific genetic abnormalities in their cancer. For trials of these new treatments, we currently first get consent from the patient so we can test for that particular abnormality in the biopsy of their cancer. More often than not, the patient’s cancer does not have that particular abnormality, and the patient is not eligible for that trial. If we don’t find what we want when we push a particular button, we move on to another approach.
As I reported in this blog a few weeks ago, we are now starting to test the genetics in a tumor up front to look at multiple possible genes. Once we have this information, we will be able to scan up and down the dial in hopes of finding the right treatment or clinical trial for that patient.
Given that each possible genetic abnormality is relatively rare, neither of these approaches is efficient. What we need is a large set of buttons in our clinical trials portfolio that allows us to use genetic findings to select the right drug and the right trial quickly and efficiently.
This is the goal of a new program being developed by the National Cancer Institute called “NCI MATCH” that we discussed last week in Washington, where I attended a meeting as a member of the NCI Clinical and Translational Research Advisory Committee or “CTAC.”
The idea of NCI MATCH is to test the genetics of a cancer and link this testing to a panel of clinical trials testing drugs, each designed to target a specific abnormality. Discussions are ongoing related to inclusion of more than 40 new drugs in NCI MATCH, each designed to target a specific, but relatively rare, genetic abnormality. Using made-up numbers to illustrate how this would work, if we estimate each drug is appropriate and would be helpful for an average of 2 percent of patients as determined by genetic testing of each cancer, overall this approach would cover 80 percent of cancer patients.
Being able to quickly find the right trial for the right patient, without randomly pushing buttons or scanning up and down the dial will be a major step forward. It would be the equivalent of having 40 preset buttons on the radio, and knowing where each one is, so we could quickly tune to NPR, talk radio, Justin Bieber, Golden Oldies or the Hawkeye game based on our needs.
This effort won’t be limited to any particular type of cancer (breast, prostate, lung, etc.) as we have traditionally defined them, since we now know that two cancers that come from the same organ can have different genetic causes, and cancer types from different organs can share the same genetic abnormality.
Since only a few percent of cancer patients will have each abnormality, this can’t be done well at a single cancer center – we need to do work on this together.
At our CTAC meeting, we discussed the logistics and costs of implementing the NCI MATCH program. Needless to say, it will be complex. Challenges include obtaining biopsies, genetic testing, arranging for access to the targeted drugs, design of specific arms of the trial for each targeted drug and obtaining institutional approval through the Internal Review Board of each trial to assure protection of the rights of the individual patients who participate.
Despite the complexity, this is an incredibly exciting direction, and we at Holden look forward to being part of the effort from design to implementation. I will keep you up to date periodically on the progress of this effort, so “Stay tuned!”