Clinical Utility of ctDNA in Detecting Resistance Mechanisms and Delivering Precision Medicine to Cancer Patients

Clinical Utility of ctDNA in Detecting Resistance Mechanisms and Delivering Precision Medicine: A Tumour Agnostic Study

ctDNA stands for circulating tumour DNA. As ctDNA is released by tumour cells into the blood stream, taking a blood sample and analysing it for ctDNA, can provide a lot of useful information about a patient's cancer. In certain situations, ctDNA can be used to screen for or detect cancer early, to aid clinical decisions about which treatment to give a patient, to provide information about if a cancer has become resistant to treatment, or provide information about how much cancer may be left after treatment (residual disease).

The aim of this trial is to establish the clinical utility of implementing ctDNA testing in cancer patients with a view to enhance the delivery of personalised care within the National Health Service in the United Kingdom (UK).

One hundred patients will be recruited, with 20 from each of the following cancer types:

• Non-small cell lung cancer
• Gastrointestinal stromal tumours
• Colorectal cancer
• Biliary tract cancer
• Ovarian cancer.

Patients must be aged 18 or over, must have had progressive disease whilst receiving anti-cancer treatment, and must be being treated at The Royal Marsden.

Patients will have a blood sample taken and analysed using the Marsden360 ctDNA test. The results of the test will be looked at by The Royal Marsden Genomic Tissue Advisory Board (GTAB), and for each individual patient, the GTAB will determine if having a ctDNA test helped to personalise their care by:

• Aiding the identification of a genomically-matched standard of care therapy
• Aiding the identification of a genomically-matched clinical trial (based in the UK)
• Offering additional prognostic information not otherwise available through standard of care testing
• Negating the need for a tissue biopsy.

Inclusion Criteria

All cohorts:

• Age ≥18 years old
• Ability to provide written informed consent
• Presence of metastatic or unresectable disease
• Being reviewed and treated through medical oncology service at Royal Marsden Hospital

Cohort 1: Locally Advanced/Metastatic NSCLC

• Oncogene-addicted NSCLC (i.e. ESCAT Tier 1 oncogenic drivers: EGFR/ALK/ROS1/RET/MET/BRAF/NTRK/HER2/KRAS), AND
• Progressive disease on targeted therapy (any line) within the 6 weeks prior to consent

Cohort 2: Locally Advanced/Metastatic GIST

• Locally advanced/metastatic gastrointestinal stromal tumour (GIST), AND
• Progressive disease on targeted therapy (any line) within the 6 weeks prior to consent

Cohort 3: Metastatic Colorectal Cancer

• Metastatic colorectal cancer, left sided, RAS wild type, HER2 any status, AND

• If HER2 negative or unknown: progressive disease on systemic anti-cancer therapy (SACT) with an anti-EGFR agent (e.g. cetuximab) within the 6 weeks prior to consent
• If HER2 positive: progressive disease on first line systemic anti-cancer therapy (SACT) +/- an anti-EGFR agent within the 6 weeks prior to consent

Cohort 4: Locally Advanced/Metastatic BTC

• Identified targetable mutation (IDH1 mutation/HER2 amplification/FGFR2 fusion or rearrangement/NTRK fusion/BRAF V600E mutation/MMR deficiency [dMMR]), AND
• Progressive disease on targeted therapy (any line) demonstrated within the 6 weeks prior to consent

Cohort 5: Advanced/Metastatic ovarian cancer

• Diagnosis of advanced/metastatic high-grade ovarian cancer, AND
• Known BRCA status, AND
• Progressive disease on a PARP-inhibitor (with or without bevacizumab) following platinum-based therapy in the 1st line maintenance setting, within the 6 weeks prior to consent

Exclusion Criteria

All cohorts:

• Medically unstable to commit to sampling required for the study
• ECOG performance status ≥3