PRecision Oncology Evidence Development in Cancer Treatment - Liquid

Official Title

PRecision Oncology Evidence Development in Cancer Treatment - Liquid AKA the Real World Clinical Utility of ctDNA Analysis for Decision Making and Access to Precision Therapy for Advanced Cancer Patients in BC: The RAPTor Sub-study


The current standard of care for molecular characterization of tumours is tissue based next generation sequencing (NGS) panel. Liquid biopsies (ie blood) are of increasing interest and have been implemented as a diagnostic tool in some countries. This study compares tissue based and liquid based testing to evaluate the detection rate and cost consequence of using this new tool in BC.

Trial Description

Primary Outcome:

  • Simultaneous: 12-month health resource utilization
  • Sequential: Proportion of patients with an actionable sequencing result following uninformative standard care oncopanel results, treated at BC Cancer, outside Vancouver Centre.
Secondary Outcome:
  • Simultaneous: 18 and 24-month health resource utilization
  • Simultaneous: Clinical utility
  • Simultaneous: Diagnostic pathway impact
  • Simultaneous: Quality of Life
  • Sequential: Clinical utility
  • Sequential: Proportion of patients with insufficient tissue for molecular characterization
Part A - Simultaneous
  • Patients will be randomized 1:1 to FoundationOne liquid CDx or no additional testing simultaneously at initiation of request for standard based tissue based next generation sequencing (NGS) panel testing. The objective of Part A is to evaluate the cost-consequence of the liquid ctDNA biopsy technology, FoundationOne liquid CDx, for first line molecular characterization of advanced colorectal cancer, gastrointestinal stromal tumour (GIST), melanoma, non small cell lung cancer (NSCLC) and ovarian cancer with simultaneous molecular characterization by tissue based NGS panel, at BC Cancer's Vancouver Centre.
Part B - Sequential
  • Patients will undergo standard tissue based NGS panel testing and if there are no somatic tier 1 variant of strong clinical significance identified the patients will then be eligible for FoundationOne liquid CDx. The objective of Part B is to determine the benefit of a sequential approach with molecular characterization by tissue based NGS panel testing followed by liquid based FoundationOne liquid CDx for patients who do not have an actionable tissue based oncogenic driver, across British Columbia.
The development and access to next generation sequencing (NGS) technologies on tumour tissue and blood allows the ability to profile the genomic landscape of the tumour within reasonable turn-around times and costs. The promise of precision oncology is the ability to 'match the right drug to the right patient at the right time'. Despite considerable excitement at the prospect of genome-informed therapy to improve oncologic outcomes, there has been little empirical assessment of its benefit from an overall population perspective and its true impact on cancer care delivery in 'real-world' scenarios.

While the enthusiasm for liquid biopsies has increased, the understanding of the cost implications lags behind. We propose to assess the true clinical impact on both individual patients and on a population-based cancer system of precision oncology via ctDNA analyses in metastatic solid tumours in a real-world scenario.

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Canadian Cancer Society

These resources are provided in partnership with the Canadian Cancer Society