A new trial to determine whether lung cancer DNA in patients’ blood can predict the risk of relapse after surgery has been announced, to be led by Professor Charlie Swanton’s team at the Francis Crick Institute and UCL Cancer Institute. Patient recruitment is due to start in the first half of 2019.
The trial will build on initial results from TRACERx, a major Cancer Research UK-funded study to track the evolution of lung tumours over time; specifically non-small cell lung cancers, which make up around 87% of all cases. In TRACERx, a retrospective analysis of blood samples from 24 patients accurately identified more than 90% of patients whose cancer would return.
In the new trial, sponsored by Bristol-Myers Squibb, Charlie’s team will test whether the technology can be used in real-time to predict patient outcomes after surgery and inform treatment decisions. Patients predicted to be at risk of relapse will be randomised so that some are given standard care while others also receive the cancer drug nivolumab.
“We’re aiming to find out whether the technique can predict relapse prospectively in the clinic, and then whether treating those patients early will improve their chances of being cured,” said Charlie. “The theory is that treating returning cancers when there aren’t many cancer cells in the body – before they’re big enough to show up on scans – could increase the chance of killing the cancer and curing the patient.”
Lung tumours are notoriously complex, making it difficult to predict their behaviour, and up to half of all patients relapse after surgery. Initial results from TRACERx represented a significant leap in scientific understanding, and the new phase 2 trial will test whether this can translate into real benefits to patients.
The trial will be the first of its kind in lung cancer, using a personalised approach to tailor each blood test to the patients’ own tumours. This uses a test called Signatera, from DNA testing company Natera, which involves genetically testing a patient’s tumour and then looking for that tumour’s DNA in the bloodstream.
“The phase 2 trial will be a proof-of-concept to find out whether this technique is suitable for informing clinical decisions on the ground,” said Dr Chris Abbosh, who leads circulating tumour DNA analyses in Charlie's group and designed the clinical protocol with Bristol-Myers Squibb. “We won’t know until the trial is over, but I’m excited to find out whether these approaches have the potential to improve the lives of cancer patients.”