The National Institutes of Health (NIH) has commenced the Myeloid Malignancies Molecular Analysis for Therapy Choice (myeloMATCH) trial, a proof-of-concept precision medicine clinical trial designed to evaluate novel treatment combinations that target specific genetic alterations in cancer cells of patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Funded by the NIH’s National Cancer Institute (NCI), the trial seeks to expedite the development of more personalized treatments for these aggressive blood and bone marrow cancers.
Precision Medicine Approach
myeloMATCH employs a strategy of rapid genetic testing of tumor samples from newly diagnosed AML or MDS patients. Based on the molecular profiles of their tumors, patients will be assigned to a substudy that tests a treatment tailored to the specific genetic changes and characteristics associated with their disease. If a suitable substudy is unavailable, patients will receive standard treatment.
If the initial treatment proves effective in reducing the patient's disease burden, further genetic testing will be conducted to match them with a subsequent substudy that tests a treatment appropriate for the specific genetic changes associated with any remaining disease. Investigators will use increasingly sensitive tools, such as biomarker assays, to identify appropriate treatments for any remaining cancer cells as the amount of disease decreases.
Trial Design and Objectives
The myeloMATCH trial intends to enroll several thousand participants within the first few years, with new substudies being introduced over time. Blood and bone marrow samples collected from participants during the trial will be used to develop and refine assays, as well as to understand what genetic changes might be associated with the development of resistance to a treatment. The trial is being conducted by the National Clinical Trials Network, with the participation of the NCI Community Oncology Research Program (NCORP).
Richard F. Little, M.D., of NCI’s Division of Cancer Treatment and Diagnosis, and the NCI coordinator for the myeloMATCH trial, stated, "The goal of myeloMATCH is to test combinations of drugs to treat the disease in a highly targeted way and to be able to start treatment quickly after diagnosis."
Broader Precision Medicine Initiatives
myeloMATCH is one of three next-generation precision medicine trials that NCI has under way. ComboMATCH is testing the effectiveness of treating adults and children who have relapsed solid tumours with new drug combinations that target specific tumour alterations. ImmunoMATCH has launched a pilot study to determine whether prospective characterization of the immune status of a tumour can be used to improve the response to targeted immunotherapy treatments, with plans to expand to larger studies in the future. All three trials are successors to NCI-MATCH, NCI’s groundbreaking precision medicine clinical trial, which showed that people with advanced cancer may benefit from genomic sequencing to help plan their treatment.
W. Kimryn Rathmell, M.D., Ph.D., director of NCI, noted, "NCI is uniquely positioned to conduct this type of study, which is one of a series of NCI precision medicine trials that are helping pave the way for more personalized treatment of cancer. By making these trials available to patients in communities around the country, we bring cutting edge science to people where they live and ensure that what we learn from our study participants can benefit patients like them in the future."
Impact on Cancer Treatment
This initiative is aligned with the Cancer Moonshot program, aiming to prevent more than 4 million cancer deaths by 2047 and improve the experience of individuals affected by cancer. Danielle Carnival, deputy assistant to the president for the Cancer Moonshot, emphasized the US government's commitment to expanding access to innovative trials and bringing targeted new treatments to patients.
