Ontario-wide Cancer TArgeted Nucleic Acid Evaluation
Substantial progress has been made in the treatment of cancer through the use of targeted
therapies, but what works for one patient might not work for another patient. Certain drugs
are now being developed that target specific molecules in the body that are believed to be
part of the disease.
Biomarkers are specific characteristics of the cancer that may help provide prognostic
information (e.g. how well patients will be regardless of the treatments given) or help
predict sensitivity or resistance to a specific treatment.
The study will collect archival tumour samples (previously collected biopsy or surgical tumour
samples) to provide biomarker data about a patient's cancer, which may help their physicians
to identify which clinical trials of new drug treatments may be most appropriate for the
patient in the future and may also guide the use of approved treatments that may potentially
benefit the patient.
Another goal of this study is to develop a province-wide registry of targeted gene
sequencing testing results that will be made available to cancer researchers. Additional
tumour tissue and blood samples collected from all study participants will also be stored in
a biobank at the Ontario Institute for Cancer Research for future research.
The study will also look at linking data from this study to other health care databases to
further collect information about the health care the patients received, including medical
tests, clinic visits, or procedures both before and after participating in this study.
Having more information about patient health to relate to the DNA sequences may provide new
insights into cancer and its treatment.
- Number of patients included in a province-wide registry of NGS panel-based testing results
- Change in use of NGS panel-based testing in Ontario clinical genetic testing laboratories
- Number of patients included in province-wide repository of genomically-characterized tumour tissue and blood samples and their utilization rates for future research
- Change in rates of genomics based clinical research in Ontario
- Utilization rates of province-wide genomically-characterized and clinically-annotated patient base in enrollment into specific research initiatives
- Utilization rates of molecular profiling information provided to treating physicians in guiding future treatment decisions
- Percentage of successful linkages between transferred study data and administrative databases
- Concordance between administrative data and clinically abstracted data comparing variables using 2x2 concordance tables
A recent survey of clinical genetic testing laboratories for cancer diagnostics by the
Molecular Oncology Advisory Committee for Cancer Care Ontario identified disparities in
access and use patterns for next generation sequencing (NGS) across the province of Ontario.
All fourteen responding laboratories indicated that NGS instruments were either currently
being used for clinical testing, were in the validation stage, or that they were planning to
purchase NGS instruments within the near future. Respondents were uncertain about what tests
should be performed, how costing and reimbursement would be addressed by the provincial
funding agency (e.g. individual tests vs. panels), and how to deal with informatics issues
from NGS testing, such as storage, variant interpretation, and utilization over the long
Given the increasing use of multi-gene somatic mutation testing in routine clinical cancer
care (e.g. KRAS, NRAS, BRAF mutations in colorectal cancer, EGFR mutation and ALK
translocation in non-small cell lung cancer, and BRAF, NRAS, and cKIT mutations in malignant
melanoma), there is a need to expand the infrastructure for NGS panel testing in clinical
laboratories. With a single payer provincial health care system, there is also an
opportunity to develop a provincial-wide registry of NGS panel-based testing results and
repository of genomically-characterized and clinically-annotated tumour tissues and blood
samples to accelerate the development of additional "omic"-based tests for clinical use.
This study will enroll patients with advanced, incurable solid tumours at selected Ontario
hospitals receiving standard palliative treatment(s). Archival formalin-fixed paraffin
embedded (FFPE) tumour tissue will be requested and undergo targeted panel sequencing. An
additional FFPE tissue sample will be requested at the same time for future research
purposes. Patients will also be asked to provide blood samples for future research. A
selected number of genes will be annotated in a research report provided to their treating
oncologist. In addition to the clinically reported variants, targeted NGS testing results
for all tested genes will be captured in a clinical research database that can be accessed
by the treating oncologist in a secure web-based portal.
Following the reporting of targeted DNA sequencing results into the web-portal, remaining
tumour DNA will be stored in the clinical testing laboratories. Blood samples collected at
the time of consent and additional FFPE research blocks or slides collected for research
will be transferred to a centralized biorepository maintained by the Ontario Tumour Bank
(OTB) for more comprehensive analysis at the Princess Margaret (PM)-Ontario Institute for
Cancer Research (OICR) Translational Genomics Laboratory (TGL). Blood will undergo standard
germline DNA extraction and plasma processing for future circulating tumour DNA (ctDNA) and
RNA (ctRNA) isolation at the PM-OICR TGL. Selected patient samples will be further
characterized at the PM-OICR TGL for test development, additional sequencing, or discovery
All patients will be asked to provide permission for data-sharing with other cancer
researchers. The consent will also include a provision for review of patient health records
through review of patient charts or administrative databases (i.e. Cancer Care Ontario New
Drug Funding Program, Provincial Cancer Registry, etc.) to obtain addition information about
time on drug treatments and survival.
View this trial on ClinicalTrials.gov