IMPaCT reveals translational challenges


Pancreatic cancer trial reveals challenges in fast translation of new discoveries into treatment for patients

Advances in genetic testing have made it possible to identify characteristics of individual tumors that make them susceptible to available treatments. However, such personalised treatment has been found to have practical challenges when it comes to delivering the treatment.

Individualized Molecular Pancreatic Cancer Therapy (IMPaCT) is a bench-to-bedside translational research study using genome sequencing of pancreatic cancer. The trial experience has just been presented by Professor Andrew Biankin and Dr Lorraine Chantrill to an international cancer. Professor Biankin said 'The science is the easy part. The science will work out. But the clinical systems just aren't there to do this properly'.

IMPaCT screened tumours for three molecular targets: HER2 amplification, which can be treated with trastuzumab and gemcitabine; KRAS wildtype, which can be treated with erlotinib and gemcitabine; and mutations in DNA damage repair pathways (BRCA1, BRCA2, PALB2, ATM), which can be treated with platinum-based chemotherapy. While patients waited for the molecular analysis results, they could start standard chemotherapy treatment.

Of 93 patients whose tumours were examined, 22 patients were eligible to participate in the trial because their cancer cells contained one of the three molecules. Unfortunately, none of the eligible patients went on to receive their targeted treatment.

'It became very clear to us that patients with advanced pancreas cancer can't afford to wait protracted periods of time for sequencing results before they start treatment', said Dr Chantrill.

Professor John Simes, director of Sydney Catalyst, director of the CTC, and an IMPaCT investigator, says:

'This study is showing that we need new approaches to the way clinical trials are conducted, and also the way health care is delivered.

'When people with advanced cancer are being considered for targeted therapy, we have to be able to work very quickly and in a coordinated way. The processes of obtaining consent, acquiring and analysing tumour samples, and discussing options of treatment etc. can be even more challenging when we are still evaluating the benefit of these new approaches in a clincal trial. This requires collaboration by several groups  in science and health care systems.'

 

The trial is a Sydney Catalyst study, sponsored by the Australasian Gastro-Intestinal Trials Group and coordinated by CTC, in partnership with the Garvan Institute of Medical Research and the Australian Pancreatic Cancer Genome Initiative.  It is supported by the National Health and Medical Research Council (NHMRC), Cancer Council NSW, the Cancer Institute NSW, Queensland Government (NIRAP), Institute of Molecular Bioscience at the University of Queensland; the Avner Nahmani Pancreatic Cancer Foundation, and Jane Hemstritch in memory of Philip Hemstritch.

The study was presented at the American Association for Cancer Research (AACR) meeting in Philadelphia and has been published in Clinical Cancer Research.

23 April 2015