In an effort to give pancreatic cancer patients more treatment options, a patient advocacy organization is testing the idea that individuals should be given different choices based on the genetic characteristics of their tumors.
The study, called Precision Promise, will help provide much-needed evidence about the value of precision medicine and, in particular, the value of sequencing tumors as a way of prescribing the most effective treatment. Some 41,780 Americans die from pancreatic cancer every year, and the survival rate over five years is just 8 percent. Current treatment options include surgery, radiation, and chemotherapy, but these have varying success rates. What's unknown is how patients with different mutations in their tumors will respond to new types of treatment that are more tailored to individual patients than these traditional approaches.
Patients who enroll in the trial, run by the Pancreatic Cancer Action Network, will have samples of their tumors collected through a biopsy. Investigators will then perform DNA sequencing on the tumor samples, a technique that will be able to reveal mutations that may be responsible for the cancer. On the basis of that information, patients will be divided into different treatment groups, says Lynn Matrisian, chief research officer at the cancer organization.
For example, patients harboring mutations in BRCA, a gene involved in DNA repair that has also been linked to breast and ovarian cancer, will be given a treatment to repair that mutation. Another treatment will target patients with high levels of a molecule called hyaluronan around their tumors. For patients whose tumors don’t fit in those categories, a third approach is available—immunotherapy to kill cancer cells.
When the trial opens in spring 2017, it will initially offer these three treatment options. But investigators plan to add additional treatment arms once more patients join. That way, if one treatment doesn’t work for someone, that patient can quickly move to another. The trial will eventually enroll thousands of patients at 12 sites around the country.
The National Cancer Institute’s MATCH trial, a bigger precision-medicine project, is trying to answer some of the same questions for a variety of cancer types. The trial, which launched in August 2015, is conducting genomic testing on 5,000 study participants to guide them into treatments that match their genetic profile.
Robert Comis, cochair of the ECOG-ACRIN Cancer Research Group, which designed the MATCH trial with the National Cancer Institute, says investigators are looking for genetic mutations that are present in different cancer types and trying to determine whether those mutations can be treated the same way regardless of tumors’ location in the body.
Comis thinks we’re likely to see more such trials in the future as drug developers take advantage of cheaper and faster sequencing technology to help them find new drug targets. But he acknowledges that there are substantial costs involved.