Keith T Flaherty 1 , Robert Gray 2 , Alice Chen 3 , Shuli Li 2 , David Patton 4 , Stanley R Hamilton 5 , Paul M Williams 6 , Edith P Mitchell 7 , A John Iafrate 8 , Jeffrey Sklar 9 , Lyndsay N Harris 3 , Lisa M McShane 3 , Larry V Rubinstein 3 , David J Sims 6 , Mark Routbort 5 , Brent Coffey 10 , Tony Fu 6 , James A Zwiebel 3 , Richard F Little 3 , Donna Marinucci 11 , Robert Catalano 11 , Rick Magnan 12 , Warren Kibbe 4 , Carol Weil 3 , James V Tricoli 3 , Brian Alexander 13 , Shaji Kumar 14 , Gary K Schwartz 15 , Funda Meric-Bernstam 5 , Chih-Jian Lih 6 , Worta McCaskill-Stevens 16 , Paolo Caimi 17 , Naoko Takebe 3 , Vivekananda Datta 6 , Carlos L Arteaga 18 , Jeffrey S Abrams 3 , Robert Comis 11 , Peter J O’Dwyer 19 , Barbara A Conley 3 , NCI-MATCH Team
January 10 2020
January 10 2020
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 (ECOG-ACRIN) and the National Cancer Institute (NCI), was initiated to find efficacy signals by matching patients with refractory malignancies to treatment targeted to potential tumor molecular drivers regardless of cancer histology.
Trial development required assumptions about molecular target prevalence, accrual rates, treatment eligibility, enrollment rates, as well as consideration of logistical requirements. Central tumor profiling was performed with an investigational Next Generation DNA targeted Sequencing assay (NGS) of alterations in 143 genes, and protein expression of PTEN, MLH1, MSH2 and Rb. Treatments were allocated with a validated computational platform (MATCHBOX). A pre-planned interim analysis evaluated assumptions and feasibility in this novel trial.
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).
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.