The Molecular Analysis for Therapy Choice (NCI-MATCH) Trial: Lessons for Genomic Trial Design.

Abstract

BACKGROUND:

The proportion of tumors of various histologies that may respond to drugs targeted to molecular alterations is unknown. NCI-MATCH, a collaboration between ECOG-ACRIN Cancer Research Group and the National Cancer Institute, was initiated to find efficacy signals by matching patients with refractory malignancies to treatment targeted to potential tumor molecular drivers regardless of cancer histology.

METHODS:

Trial development required assumptions about molecular target prevalence, accrual rates, treatment eligibility, and enrollment rates as well as consideration of logistical requirements. Central tumor profiling was performed with an investigational next-generation DNA-targeted sequencing assay of alterations in 143 genes, and protein expression of protein expression of phosphatase and tensin homolog, mutL homolog 1, mutS homolog 2, and RB transcriptional corepressor 1. Treatments were allocated with a validated computational platform (MATCHBOX). A preplanned interim analysis evaluated assumptions and feasibility in this novel trial.

RESULTS:

At interim analysis, accrual was robust, tumor biopsies were safe (<1% severe events), and profiling success was 87.3%. Actionable molecular alteration frequency met expectations, but assignment and enrollment lagged due to histology exclusions and mismatch of resources to demand. To address this lag, we revised estimates of mutation frequencies, increased screening sample size, added treatments, and improved assay throughput and efficiency (93.9% completion and 14-day turnaround).

CONCLUSIONS:

The experiences in the design and implementation of the NCI-MATCH trial suggest that profiling from fresh tumor biopsies and assigning treatment can be performed efficiently in a large national network trial. The success of such trials necessitates a broad screening approach and many treatment options easily accessible to patients.

• Authors: Keith T Flaherty, Robert Gray, Alice Chen, Shuli Li, David Patton, Stanley R Hamilton, Paul M Williams, Edith P Mitchell, A John Iafrate, Jeffrey Sklar, Lyndsay N Harris, Lisa M McShane, Larry V Rubinstein, David J Sims, Mark Routbort, Brent Coffey, Tony Fu, James A Zwiebel, Richard F Little, Donna Marinucci, Robert Catalano, Rick Magnan, Warren Kibbe, Carol Weil, James V Tricoli, Brian Alexander, Shaji Kumar, Gary K Schwartz, Funda Meric-Bernstam, Chih-Jian Lih, Worta McCaskill-Stevens, Paolo Caimi, Naoko Takebe, Vivekananda Datta, Carlos L Arteaga, Jeffrey S Abrams, Robert Comis, Peter J O'Dwyer, Barbara A Conley, NCI-MATCH Team
• Journal: Journal of the National Cancer Institute (J Natl Cancer Inst) Vol. 112 Issue 10 Pg. 1021-1029 (10 01 2020) ISSN: 1460-2105 [Electronic] United States
• PMID: 31922567 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2019. Published by Oxford University Press.

Chemical References

• Antineoplastic Agents

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (administration & dosage)
• Biopsy
• Clinical Trial Protocols as Topic
• Clinical Trials, Phase II as Topic
• Female
• High-Throughput Nucleotide Sequencing
• Humans
• Male
• Middle Aged
• Molecular Targeted Therapy
• Neoplasms (drug therapy, genetics, pathology)
• Precision Medicine
• Young Adult