Doctors consider change in how to group cancers

CHICAGO — The National Cancer Institute announced Monday the launch of a nationwide research study that will sort patients into treatment groups based on genetic mutations in their tumors, rather than by cancer type.

The precision medicine study seeks to take advantage of progress in the last decade at identifying molecular abnormalities in cancers to determine whether drugs are more effective when targeted at those changes, rather than at long-standing labels of cancer types.

A patient with a kidney tumor might be assigned to a group that is being treated with a drug traditionally used for another form of cancer if DNA tests showed a likelihood that the drug might work on his tumor’s makeup.

The project is part of the institute’s “precision medicine” efforts and a larger shift in the field toward designing cancer trials that are faster and more efficient and that better match drugs with patients most likely to benefit from them.

“We are truly in a paradigm change,” said James Doroshow, director of the division of cancer treatment and diagnosis at the National Cancer Institute. He said that the research is asking: “When is histology (the microscopic structure of cancers) important, and when isn’t it?”

He said at a news briefing Monday that the effort is “the largest and most rigorous precision oncology trial that’s ever been attempted.” He estimated the current cost, which could change as the project continues over a number of years, at $30 million to $40 million.

The American Society of Clinical Oncology announced the launch of a separate project at its annual meeting here Monday that will provide patients with drugs targeted at similar molecular abnormalities and collect the data from oncologists providing their care, to better understand the effectiveness of the treatments.

D. Neil Hayes, an associate professor at the University of North Carolina’s School of Medicine who is not part of the National Cancer Institute’s project, said it represents the future of cancer research. It no longer makes sense to categorize and treat cancer based on the site in the body where it originates when we know it is a disease of DNA mutations that modern technology allows us to understand, he said.

The National Cancer Institute’s project will begin screening patients for eligibility July 1. About 3,000 will be tested at 2,400 sites around the country to find about 1,000 who meet the eligibility criteria. They will be sorted into approximately 20 treatment “arms” of 30 to 35 patients. Each group will receive a different drug provided by pharmaceutical companies that are part of the effort. Drugs may be added to or dropped from the research as the project continues.