Utilization of Genomic Information to Augment Chemotherapy Decision-making for People With Incurable Malignancies

Utilization of Genomic Information to Augment Chemotherapy Decision-making for People With Incurable Malignancies

Most systemic therapies are chosen on the basis of large randomized clinical trials; however, tumour heterogeneity means that cancers with similar histological features may have substantially different underlying biological drivers. The investigators propose that applying personal genomic information prospectively obtained in a clinically realistic timeframe to assist in chemotherapy decision-making could result in more effective and efficient cancer treatment. This study will investigate this approach in a cross section of advanced cancers to examine timeliness, deliverability, rate of actionable targets identified, and our ability to expand this approach into a larger clinical trial setting.

It is clear that carcinogenesis is an immensely complex process and that even within a histologic cancer subtype - such as adenocarcinoma of the lung or breast - there is significant heterogeneity in cancer behaviour and response to therapy. Recognizing genetic mutations that promote disease facilitates targeted treatment; this has been demonstrated in several small subgroups of cancers in which specific genetic mutations or translocations have been successfully treated with targeted chemotherapy agents.

Analyses of individual patients demonstrate unique molecular signatures for every cancer examined. Frequently, multiple different pathways are involved in disease growth and progression and the dominant process varies from person to person and perhaps even within different sites of disease within one person. As well these variations evolve in response to treatment. With many recognized mutations personalized evaluation of the genetic signature encoded in DNA and RNA may enable directed therapy to the appropriate oncologic pathway thereby providing information to help guide chemotherapy choices.

Inclusion Criteria:

1. Subjects must have histologically or cytologically confirmed diagnosis of cancer
2. This cancer must be incurable, as defined by their treating oncologist (generally because of advanced stage).
3. Subjects must agree to provide archival tissue and agree to undergo a study specific biopsy and blood test for genetic analysis. All subjects would have a biopsy and blood samples at progression if it could be done safely.
4. ECOG PS 0 or 1.
5. Age > 18 years of age.
6. Subject consent must be obtained according to the BCCA requirements.
7. Subject must be accessible for treatment and follow-up. Subjects must be registered at the BCCA Vancouver site.

Exclusion Criteria:

1. Unable or unwilling to undergo tumour biopsy(s) and/or blood/skin samples for normal DNA.
2. Significant medical condition that in the opinion of the treating oncologist renders the subject not suitable for participation.