Exceptional Responders Pilot Study: Molecular Profiling of Tumors From Cancer Patients Who Are Exceptional Responders
Overview
- Phase
- Not Applicable
- Intervention
- Laboratory Biomarker Analysis
- Conditions
- Malignant Neoplasm
- Sponsor
- National Cancer Institute (NCI)
- Enrollment
- 170
- Locations
- 137
- Primary Endpoint
- Percentage of identified potential cases confirmed to be exceptional responders
- Status
- Active, not recruiting
- Last Updated
- 15 days ago
Overview
Brief Summary
This pilot research trial studies molecular profiling in tissue samples from patients with cancer who got better with treatment that didn't work for most other patients with the same disease. Studying samples of tissue from patients with cancer in the laboratory may help doctors learn more about changes that occur in deoxyribonucleic acid (DNA) and identify biomarkers related to how well patients respond to treatment.
Detailed Description
PRIMARY OBJECTIVES: I. To identify molecular indicators in malignant tissues from patients who were exceptional responders on clinical trials or standard systemic treatments using whole exome and/or targeted deep sequencing, as well as potentially other sequencing and other molecular characterization methods (if adequate tissue exists). II. To explore associations between the identified molecular indicators and the putative mechanism of action of the treatment received by the patient. III. To test the feasibility of identifying "exceptional responders", obtaining the relevant tumor and normal tissue and clinical data, and performing whole exome and/or targeted deep sequencing on these samples. OUTLINE: Previously collected tissue samples are analyzed via whole exome sequencing and/or targeted next generation sequencing (NGS) assay deep sequencing. Cases for which sufficient nucleic acid amounts are available will undergo additional analyses including whole genome sequencing, messenger ribonucleic acid (RNA) (mRNA)-sequencing, micro (miRNA) sequencing, promoter methylation analysis, and single nucleotide polymorphism (SNP) analysis.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Documented exceptional response, defined as patients meeting the following criteria:
- •Complete response to a regimen in which complete response is expected in \< 10% of similarly treated patients
- •Partial response (PR) \> 6 months in a regimen in which PRs \> 6 months are expected in \< 10% of patients with similar disease treated with same or similar regimen
- •Complete response (CR) or PR of unusual duration, such that the internal review committee considers it to be an exceptional response; examples below:
- •PR of duration \> 3 x the median expected PR duration (in cases where PR is expected in \> 10% of patients with the same disease treated with the same regimen)
- •CR or duration \> 3 x the median expected CR duration (in cases where CR may be seen in \> 10% of patients with same disease treated with same regimen)
- •The observed duration of CR (or PR) is longer than expected for 90% of patients with same disease treated with same regimen
- •Note: it is not required that the patient be enrolled on a clinical trial when the exceptional response was observed
- •Reports of radiologic scans or other evidence documenting response will be submitted for review; cases where response is not assessable (e.g. adjuvant treatment) will not be eligible because the outcome can not be attributed to a specific treatment
- •Treatment history must be available, for prior treatment and for the drug to which the exceptional response occurred
Exclusion Criteria
- •Patient's response did not meet criteria for an exceptional response
- •Patient's treatment regimen is expected to lead to CR or durable PR in \> 10% of patients
- •Patient's duration of response is not \> 3 x expected median length of response
- •Response not evaluable or not able to be attributed to systemic treatment (e.g. adjuvant treatment)
- •Patient refused consent for use of tissue for research activities included in the exceptional responders study
- •Tumor sample from prior to the exceptional response is not available, or does not meet quality metrics
Arms & Interventions
Ancillary-Correlative (molecular profiling)
Previously collected tissue samples are analyzed via whole exome sequencing and/or targeted NGS assay deep sequencing. Cases for which sufficient nucleic acid amounts are available will undergo additional analyses including whole genome sequencing, mRNA-sequencing, miRNA sequencing, promoter methylation analysis, and SNP analysis.
Intervention: Laboratory Biomarker Analysis
Outcomes
Primary Outcomes
Percentage of identified potential cases confirmed to be exceptional responders
Time Frame: Baseline
Statistical analyses will be primarily descriptive.
Percentage of molecularly characterized cases for which a Molecular Characterization report identified (without reference to the drug received by the patient) at least one feature judged to have potential therapeutic relevance
Time Frame: Baseline
Promising discoveries will be summarized for the group of cases for which the minimum molecular characterization was successfully obtained. For each such case, molecular data will be reviewed by an expert panel ("Panel") to identify interesting features. All estimated proportions will be accompanied by exact 95% confidence intervals.
Putative mechanisms of action of the treatments that the patients received when they experienced their exceptional responses
Time Frame: Baseline
The associations between identified molecular features and the putative mechanisms of action of the treatments that the patients received when they experienced their exceptional responses will be explored. Statistical analyses will be primarily descriptive.
Number of cases identified as potential exceptional responders
Time Frame: Baseline
Statistical analyses will be primarily descriptive.
Percentage of cases with >= 1 feature that correlates with the mechanism of action of the specific grant to which the exceptional response occurred that was found after further analyzing the molecular profile data for relevant molecular abnormalities
Time Frame: Baseline
Promising discoveries will be summarized for the group of cases for which the minimum molecular characterization was successfully obtained. For each such case, molecular data will be reviewed by the Panel to identify interesting features. All estimated proportions will be accompanied by exact 95% confidence intervals.
Molecular features in tissue samples from patients who were exceptional responders
Time Frame: Baseline
The molecular features of the tumors in the patients will be discernible as distinct to the tumor by comparison to (i) samples from normal tissue in the same patient and (ii) databases of similar data for normal and other tumor types.
Percentage of confirmed exceptional responders for which adequate tissue with appropriate informed consent is acquired
Time Frame: Baseline
Statistical analyses will be primarily descriptive.
Percentage of acquired cases with tissue for which at least the minimum molecular characterization is successfully obtained
Time Frame: Baseline
Statistical analyses will be primarily descriptive.
Percentage of cases with >= 1 feature on Molecular Characterization report that was judged to have potential therapeutic relevance to the specific class of drug the patient actually received when the exceptional response was experienced
Time Frame: Baseline
Promising discoveries will be summarized for the group of cases for which the minimum molecular characterization was successfully obtained. For each such case, molecular data will be reviewed by the Panel to identify interesting features. All estimated proportions will be accompanied by exact 95% confidence intervals.