NCI-MATCH Trial Interim Analysis Results and Status Update
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Interim Analysis Results
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Massachusetts General Hospital, Boston, MA;
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National Cancer Institute (NCI), Division of Cancer
Treatment and Diagnosis, Bethesda, MD;
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University of Pennsylvania, Philadelphia, PA;
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MD Anderson
Cancer Center, Houston, TX;
5
NCI Frederick National Laboratory for Cancer Research, Frederick, MD;
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Dana-Farber Cancer Institute, Boston, MA;
7
NCI Cancer Imaging Program, Rockville, MD
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Case
Western Reserve University, Cleveland, OH,
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TNorthwestern University, Chicago, IL,
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Thomas
Jefferson University, Philadelphia, PA
05/06/2016
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Due to the uniqueness of the trial, early scientific review
was built into the protocol design
•
From the protocol:
“Given a number of unknown aspects about this study
(e.g. prevalence of specific alterations), after 500
patients are screened the design will be reassessed to
assure its appropriateness. An analysis of the
distributions of actionable alterations and of tumor
types, both overall and within treatment subprotocols,
will be performed….”
•
Data as of March 9, 2016, are included in this analysis
2
05/06/2016
•
Trial opened on Aug 12, 2015, with 10 treatment arms
–
And plan to add at least 14 more arms in coming months
•
Initial goal of 3,000 patients for tumor gene testing
–
Estimated mutation matching rate of up to 30% when all arms
open
–
But 10% estimated matching rate for first 10 arms
•
Registration of
new
patients was paused on Nov 11, 2015
•
Pause allowed for a planned interim analysis
–
After first 500 patients had undergone tumor testing
•
Due to extremely rapid pace of accrual, it was not possible to pause
enrollment at a precise cut-off
•
By the time 500 patients had undergone tumor testing, several
hundred more had begun the initial screening process
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795 patients enrolled for screening in the first 3 months
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Far surpassing original estimate
of 50/month
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05/06/2016
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Overall 9% mutation match rate for first ten arms
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Expected 10%
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05/06/2016
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Overall 9% mutation match rate for first ten arms (56/645)
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Expected 10%
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05/06/2016
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Salivary Gland = 3
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Uterine Carcinosarcoma = 7
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NOS = 18, Pancreas = 6, Carcinoid = 3
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Key Other Types: Lymphoma = 9, Brain Tumor = 9, Melanoma = 9
8
05/06/2016
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05/06/2016
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*Pending approval
05/06/2016
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Trial size will increase to 5,000 patients for screening
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795 already registered; 4,205 more patients can
register
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Tumor testing completion rate will be 87%
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Mutation prevalence rates will be the same as in
patients enrolled to date
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65% of patients with treatment assignments will enroll
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There will be one treatment arm assignment per patient
(some may have more than one matching mutation)
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05/06/2016
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Expected Overall Match Rate = 23%
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05/06/2016
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Increase enrollment of pre-screened patients by:
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Increasing the participation of cancer centers currently
performing next-generation sequencing (NGS) in people
with advanced cases of cancer
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Developing communication plans with commercial NGS
lab to notify ordering physicians of relevant NCI-MATCH
treatment arms for their patients who have matching
mutations
05/06/2016
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Projected 50
Cases/Month
at Start
Gradual
Ramp-up in
Year 1
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Most samples received by Nov 22
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Averaged 80 samples/week from Oct 12 to Nov 15
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Median days for sample submission from sites to central lab: 7
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05/06/2016
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Rate is well within industry standard (≥80%)
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Sample quality major reason for 94 cases not analyzed
739 Cases with Samples Submitted
+33
Cases Requiring 2
nd
Biopsy
772 Total Samples Submitted
* Reason linked to individual sample sets
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05/06/2016
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Optional needle aspirate specimens submitted: 179/739 (24%)
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Cytology specimens with tumor present: 173/179 (97%)
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Patient cases where cytology was used for analysis when core
was unusable: 19
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Predicted contribution if all patients had cytology exam:
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84 more patients (based upon salvage of 86% of 94 cases
not able to be analyzed)
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Complete tumor testing for 729/739 (98.6%)
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Rather than 645/739 (87%)
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Biopsy data
submitted for
659 cases
AEs reported
for 17 cases
(2.6%)
No grade 4 or
grade 5 AEs
05/06/2016
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TAT ≤ 14 days
Ticketing & Tracking
Software
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Main changes:
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Increase in screening goal to 5,000 patients
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Increase in number of arms (24 by late May, planned already)
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Match rate expected to be 23% overall
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Greater focus on communication to influence patient selection
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Expansion of analytical capacity to accelerate return of results
for patients
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Other changes:
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Mandating needle aspiration in all cases
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Allowance of tumor samples obtained up to six months prior to
registration
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Allowance of data from other genetic platforms
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1.
A trial of therapy based on genetic characteristics of the
tumor is feasible on a national scale in the NCI-sponsored
networks
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Unprecedented with registration higher than for any
other NCTN trial to date
2.
The whole process of tumor characterization from accrual
to biology read-out is feasible, having been accomplished
in 87% of patients
3.
A high proportion of less common malignancies in this early
analysis opens options for advances in these cancers
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05/06/2016
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The interim analysis that was applied early in the trial
permitted implementation of several enhancements to the
structure of the study
5.
The trial’s early analysis permits planning for the realistic
needs of additional trials/drugs that can be analyzed in
specific gene abnormalities
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05/06/2016
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Patients and their physicians
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NCI National Clinical Trials Network
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NCI Community Oncology Research Program
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Network groups
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Alliance for Clinical Trials in Oncology
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Children’s Oncology Group
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ECOG-ACRIN Cancer Research Group
•
150+ scientists, physicians, laboratory experts and patient advocates
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Subprotocol PIs
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Steering committee and working groups
•
Agents and Gene Selection
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Correlative Proposals
•
Imaging
•
Informatics
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Protocol Logistics
25
05/06/2016
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Samples and Sequencing
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Site Participation and Education
•
Patient Advocate
•
Public Relations
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NRG Oncology
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SWOG
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Main Webpages:
cancer.gov/nci-match
ecog-acrin.org/nci-match-eay131
Protocol Documents:
ctsu.org
(password required)
Spanish:
cancer.gov/espanol/nci-match
Email Inquiries:
match@jimmy.harvard.edu
NCI’s Cancer Information Service:
1-800-4-CANCER and
cancer.gov/contact
05/06/2016
26
This is a presentation of the first interim analysis of the NCI-MATCH trial, a phase two precision medicine trial that seeks to determine whether matching certain drugs or drug combinations in adults whose tumors have specific gene abnormalities will effectively treat their cancer, regardless of their cancer type. This trial was co-developed by the ECOG-ACRIN Cancer Research Group and the National Cancer Institute, and its broad leadership spans all of the cooperative groups of the NCI National Clinical Trials Network, as shown here. This interim analysis was presented at the annual meeting of the American Association for Cancer Research in New Orleans, Louisiana, in April 2016. Dr. Barbara Conley presented a poster and Dr. Peter O’Dwyer spoke as an invited guests at a special session on precision medicine. Their two presentations are combined here in the slides that you are about to view.
NCI-MATCH is a groundbreaking clinical trial aiming to match tumor gene alterations with targeted therapies. The interim analysis results revealed impressive patient enrollment and site participation exceeding expectations. Despite challenges with pausing new patient registrations for the analysis, the trial continues to progress with high mutation matching rates and significant patient involvement. The trial opened in August 2015 with 10 treatment arms and plans for additional arms, aiming to enroll 3,000 patients for tumor gene testing. The rapid pace of accrual demonstrated the importance and success of this precision medicine approach in cancer treatment.
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NCI-Molecular Analysis for Therapy Choice (NCI-MATCH or EAY131) Interim Analysis Results Study Chairs: Keith T. Flaherty1, Alice P. Chen2, Peter J. O'Dwyer3, Barbara A. Conley2, Stanley R. Hamilton4, Mickey Williams5, Robert J. Gray6, Shuli Li6, Lisa M. McShane6, Lawrence V. Rubinstein2, Susanna I. Lee1, Frank I. Lin7, Paolo F. Caimi8, Albert A. Nemcek, Jr.,9 Edith P. Mitchell10, James A. Zwiebel2 1Massachusetts General Hospital, Boston, MA; 2National Cancer Institute (NCI), Division of Cancer Treatment and Diagnosis, Bethesda, MD; 3University of Pennsylvania, Philadelphia, PA; 4MD Anderson Cancer Center, Houston, TX; 5 NCI Frederick National Laboratory for Cancer Research, Frederick, MD; 6Dana-Farber Cancer Institute, Boston, MA; 7NCI Cancer Imaging Program, Rockville, MD 8Case Western Reserve University, Cleveland, OH, 9TNorthwestern University, Chicago, IL, 10Thomas Jefferson University, Philadelphia, PA 05/06/2016
NCI-MATCH Interim Analysis Due to the uniqueness of the trial, early scientific review was built into the protocol design From the protocol: Given a number of unknown aspects about this study (e.g. prevalence of specific alterations), after 500 patients are screened the design will be reassessed to assure its appropriateness. An analysis of the distributions of actionable alterations and of tumor types, both overall and within treatment subprotocols, will be performed . Data as of March 9, 2016, are included in this analysis 05/06/2016 2
NCI-MATCH Trial Status Trial opened on Aug 12, 2015, with 10 treatment arms And plan to add at least 14 more arms in coming months Initial goal of 3,000 patients for tumor gene testing Estimated mutation matching rate of up to 30% when all arms open But 10% estimated matching rate for first 10 arms Registration of new patients was paused on Nov 11, 2015 Pause allowed for a planned interim analysis After first 500 patients had undergone tumor testing Due to extremely rapid pace of accrual, it was not possible to pause enrollment at a precise cut-off By the time 500 patients had undergone tumor testing, several hundred more had begun the initial screening process 05/06/2016 3
NCI-MATCH Patients and Sites 795 patients enrolled for screening in the first 3 months Far surpassing original estimate of 50/month 192 active sites (at least 1 patient) 2/3 community 1/3 academic 796 approved sites 05/06/2016 4
NCI-MATCH Accrual Summary Activated 08/12/15; paused 11/11/15: 92 days Patient cases registered for screening Cases with samples submitted Cases where labs were able to complete tumor testing Cases with mutation matching 1 of 10 available treatment arms Patients matching specific eligibility criteria for, and assigned to, a treatment arm Patients who entered 7 of 10 available treatment arms 795 739 645 87% (N=739) 56 9% (N=645) 33 5% (N=645) 2.5% (N=645) 16 Overall 9% mutation match rate for first ten arms Expected 10% 05/06/2016 5
NCI-MATCH Accrual Demographics Enrolled for Screening (N=795) 63 (Range 24-93) 305 (38%) 490 (62%) 646 (81%) 88 (11%) 27 (3%) 4 (1%) 1 (0%) 29 (4%) 36 (5%) Assigned to Rx (N=33) 68 (Range 40-82) 16 (48%) 17 (52%) 29 (88%) 1 (3%) 2 (6%) -- -- 1 (3%) -- Median Age Male Female White Black Asian Native American Native Hawaiian Race Not Reported Hispanic Ethnicity 05/06/2016 6
NCI-MATCH First Ten Arms and Mutation Prevalence Rates Per Arm (Actual vs Estimated) Overall 9% mutation match rate for first ten arms (56/645) Expected 10% Estimated Prevalence Rate (%) Actual MATCH Rate (%) Q: Ado-trastuzumab emtansine in HER2 amplifications U: Defactinib in NF2 loss B: Afatinib in HER2 mutations H: Dabrafenib+Trametinib in BRAF V600 R: Trametinib in BRAF non-V600 E: AZD9291 in EGFR T790M F: Crizotinib in ALK translocation V: Sunitinib in cKIT mutations A: Afatinib in EGFR mutations G: Crizotinib in ROS1 translocation 1.7 5 1.1 0.8 0.8 0.3 0.2 0.2 0.2 0 0 2 2-6 7 2.8 1-2 <2 2 1-4 <2 05/06/2016 7
NCI-MATCH Primary Disease Sites Enrolled for Screening (N=795) 104 (13.1%) 96 (12.1%) 62 (7.8%) 20 (2.5%) 282 (35.47%) Assigned to Rx (N=33) 6 (18.2%) 2 (6.1%) 5 (15.2%) 1 (3.0%) 14 (42.42%) Common Cancers Screened (N=645) Colorectal Breast Non-Small Cell Lung Prostate 84 (13.0%) 84 (13.0%) 48 (7.4%) 17 (2.6%) 233 (36.12%) Common Cancers Subtotal Uncommon Cancers Ovarian Pancreas (Adeno/NOS) Head and Neck1 Endometrial/Uterine (Non-Sarcoma) Esophageal/GE Junction/Gastric Neuroendocrine2 Cholangio Bladder/Urinary Tract Endometrial/Uterine Sarcoma3 Small Cell Lung Other4 Primary Site Not Specified Uncommon Cancers Subtotal 89 (11.2%) 43 (5.4%) 38 (4.8%) 34 (4.3%) 31 (3.9%) 27 (3.4%) 24 (3.0%) 21 (2.6%) 20 (2.5%) 16 (2.0%) 151 (19.0%) 19 (2.4%) 513 (64.53%) 72 (11.2%) 34 (5.3%) 34 (5.3%) 27 (4.2%) 28 (4.3%) 20 (3.1%) 22 (3.4%) 14 (2.2%) 16 (2.5%) 14 (2.2%) 116 (18.0%) 15 (2.3%) 412 (63.87%) 6 (18.2%) -- -- -- 4 (12.1%) 2 (6.1%) 1 (3.0%) 1 (3.0%) -- -- 3 (9.1%) 2 (6.1%) 19 (57.57%) 1 Salivary Gland = 3 2 NOS = 18, Pancreas = 6, Carcinoid = 3 3 Uterine Carcinosarcoma = 7 4 Key Other Types: Lymphoma = 9, Brain Tumor = 9, Melanoma = 9 05/06/2016 8
NCI-MATCH Enrollment Status of Patients with Treatment Assignments to First Ten Arms No Longer Met Overall Study Eligibility Progressed/ Deteriorating Condition/ Started Other Rx Assigned to Rx (N-33) Enrolled for Rx (N=16) Ineligible for Arm Died Q: Ado-trastuzumab emtansine in HER2 amplifications U: Defactinib in NF2 loss 11 3 2 6 7 2 1 1 1 2 B: Afatinib in HER2 mutations 5 1 1 3 H: Dabrafenib+Trametinib in BRAF V600 R: Trametinib in BRAF non-V600 5 1 2 2 2 1 1 E: AZD9291 in EGFR T790M 1 1 F: Crizotinib in ALK translocations V: Sunitinib in cKIT mutations 1 1 1 1 A: Afatinib in EGFR mutations G: Crizotinib in ROS1 translocations Total 33 5 5 3 4 16 05/06/2016 9
NCI-MATCH Treatment Assignments to First Ten Arms, by Arm, Cancer Type Assigned to Rx Uncommon Cancers Common Cancers Adeno Esophageal (2) Ovarian (3) Cholangio (1) TCC Urothelium (1) Mesothelioma (2) Ovarian (2) Pancreas/Adeno NOS (1) Gastric Adeno (1) Adeno Esophageal (1) Q: Ado-trastuzumab emtansine in HER2 amplifications Colon Adeno (3) Colon NOS (1) 11 Colon Adeno (1) Lung Adeno (1) U: Defactinib in NF2 loss 7 Breast (2) Prostate (1) Lung Adeno (3) Lung Adeno w. BAF (1) B: Afatinib in HER2 mutations 5 H: Dabrafenib+Trametinib in BRAF V600 R: Trametinib in BRAF non- V600 E: AZD9291 in EGFR T790M 5 Neuroendocrine (1) 2 Ovarian (1) Colon Adeno (1) 1 Neuroendocrine NOS (1) -- F: Crizotinib in ALK translocations V: Sunitinib in cKIT mutations A: Afatinib in EGFR mutations G: Crizotinib in ROS1 translocations 1 1 -- Mets to Peritoneum NOS (1) Thymoma (1) -- -- -- -- -- -- -- Total 33 19 (58%) 14 (42%) 05/06/2016 10
NCI-MATCH Expanding to 24 Arms in Late May 2016 Arm / Target Drug(s) Arm / Target Drugs(s) R BRAF nonV600 Trametinib A EGFR mut Afatinib S1 NF1 mut Trametinib B HER2 mut Afatinib S2 GNAQ/GNA11 Trametinib C1 MET amp Crizotinib* T SMO/PTCH1 Vismodegib C2 MET ex 14 sk Crizotinib* U NF2 loss Defactinib E EGFR T790M AZD9291 V cKIT mut Sunitinib F ALK transloc G ROS1 transloc Crizotinib Crizotinib W FGFR1/2/3 AZD 4547* X DDR2 mut Dasatinib Dabrafenib+trametinib H BRAF V600 Y AKT1 mut AZD 5363* I PIK3CA mut Taselisib Z1A NRAS mut Binimetinib* N PTEN mut GSK2636771 Z1B CCND1,2,3 amp Palbociclib* P PTEN loss GSK2636771 Z1D dMMR Nivolumab* Q HER 2 amp Ado-trastuzumab emtansine *Pending approval 05/06/2016 11
NCI-MATCH Assumptions for Enrollment Projections Across 24 Treatment Arms Trial size will increase to 5,000 patients for screening 795 already registered; 4,205 more patients can register Tumor testing completion rate will be 87% Mutation prevalence rates will be the same as in patients enrolled to date 65% of patients with treatment assignments will enroll There will be one treatment arm assignment per patient (some may have more than one matching mutation) 05/06/2016 12
NCI-MATCH Projected Match Rates and Enrollments for 24 Treatment Arms (N=5,000 Screened) Expected Overall Match Rate = 23% Arm / Target Expected Match Rate % Expected Enroll- ment Arm / Target Expected Match Rate % Expected Enroll- ment I PIK3CA mut 4.0 89 B ERBB2 mut 0.8 20 Z1B CCND1 amp 3.6 79 H BRAF V600 0.8 19 W FGFR1/2/3 2.9 65 T SMO/PTCH1 0.6 14 P PTEN loss 2.5 55 R BRAF non V600 0.3 8 Q ERBB2 amp 1.7 44 E EGFR T790M 0.2 4 S1 NF1 mut 1.9 41 F ALK transloc 0.2 4 Z1C CDK4/6 amp 1.7 38 V cKIT mut 0.2 3 Y AKT1 mut 1.2 28 A EGFR mut 0 0 Z1A NRAS mut 1.2 28 G ROS1 transloc 0 0 U NF2 loss 1.1 26 S2 GNAQ/GNA11 0 0 N PTEN mut 1.1 24 C2 MET ex 14 sk No Data Not Known C1 MET amp 0.9 21 Z1D dMMR No Data Not Known 05/06/2016 13
NCI-MATCH Enrichment Strategies for Rare Mutations Increase enrollment of pre-screened patients by: Increasing the participation of cancer centers currently performing next-generation sequencing (NGS) in people with advanced cases of cancer Developing communication plans with commercial NGS lab to notify ordering physicians of relevant NCI-MATCH treatment arms for their patients who have matching mutations 05/06/2016 14
NCI-MATCH Weekly Accrual Far Exceeded Projections Cumulative Accrual Projected Cumulative Accrual 900 800 795 722 700 619 600 Projected 50 Cases/Month at Start 531 500 449 400 370 314 300 234 200 Gradual Ramp-up in Year 1 168 107 100 74 38 15 0 05/06/2016 15
NCI-MATCH Sample Processing Turn-around Times Extended with Increased Registration Rates Over Time Period # Days 38 28 -- # Samples 162 274 336 772 Median (Days) 14 23 36 Aug 21 to Sep 27 Sep 28 to Oct 25 After Oct 26 Total Most samples received by Nov 22 Averaged 80 samples/week from Oct 12 to Nov 15 Median days for sample submission from sites to central lab: 7 05/06/2016 16
NCI-MATCH Laboratories Analyzed 87% of Cases Rate is well within industry standard ( 80%) Sample quality major reason for 94 cases not analyzed # Samples Not Analyzed % Samples (N=127) Total % of Samples (N=772) Reason No Viable Tumor 61 48.0% 8.2% Insufficient DNA/RNA 44 34.6% 5.9% Insufficient Tumor % or No Tissue 10 7.8% 1.3% Tumor Gene Testing QC 9 7.0% 1.2% Sample Did Not Meet Protocol Req s 3 2.3% 0.4% Total 127* 739 Cases with Samples Submitted +33 Cases Requiring 2nd Biopsy 772 Total Samples Submitted * Reason linked to individual sample sets 05/06/2016 17
NCI-MATCH Patient Cases Benefiting from Cytology Optional needle aspirate specimens submitted: 179/739 (24%) Cytology specimens with tumor present: 173/179 (97%) Patient cases where cytology was used for analysis when core was unusable: 19 Predicted contribution if all patients had cytology exam: 84 more patients (based upon salvage of 86% of 94 cases not able to be analyzed) Complete tumor testing for 729/739 (98.6%) Rather than 645/739 (87%) 05/06/2016 18
NCI-MATCH Biopsy-related Adverse Events (AE) Grade Biopsy data submitted for 659 cases 1 2 0 1 1 0 0 1 0 0 1 4 1 0 9 2 0 0 0 0 0 0 0 1 0 0 2 0 0 3 3 1 1 0 0 1 1 0 0 1 0 1 0 1 5 Abdominal pain Anemia Bleeding, post biopsy Bloating Duodenal obstruction Dyspnea Hematoma Hepatic pain Hypertension Pain of skin Pneumothorax Postoperative hemorrhage Supraventricular tachycardia Worst degree AEs reported for 17 cases (2.6%) No grade 4 or grade 5 AEs 05/06/2016 19
NCI-MATCH Laboratory Bottleneck Caused by High Accrual Staffed for 4 Patient Cases/Day; Received > 20 Cases/Day Lack of Automated Extractors 1 Tumor Sample/ Sequencing Chip Avg 80 Samples/Week - by Week 8 Bottleneck Turn-around Times > 14 Days 05/06/2016 20
NCI-MATCH Laboratory Expansion to Handle Expected Demand and Improve Turn-around Times (TAT) ThermoFisher Ion S5TM -- 12 Tumor Samples/Chip and 2-3 Runs/Day QIAcube Automated Extractors Validated H&E Microdissection Adequate Staffing Calls from Sequencing Labs TAT 14 days Calls from Clinical Sites Ticketing & Tracking Software CALL CENTER 05/06/2016 21
NCI-MATCH Changes Underway Main changes: Increase in screening goal to 5,000 patients Increase in number of arms (24 by late May, planned already) Match rate expected to be 23% overall Greater focus on communication to influence patient selection Expansion of analytical capacity to accelerate return of results for patients Other changes: Mandating needle aspiration in all cases Allowance of tumor samples obtained up to six months prior to registration Allowance of data from other genetic platforms 05/06/2016 22
NCI-MATCH Conclusions from the Interim Analysis 1. A trial of therapy based on genetic characteristics of the tumor is feasible on a national scale in the NCI-sponsored networks Unprecedented with registration higher than for any other NCTN trial to date 2. The whole process of tumor characterization from accrual to biology read-out is feasible, having been accomplished in 87% of patients 3. A high proportion of less common malignancies in this early analysis opens options for advances in these cancers 05/06/2016 23
NCI-MATCH Conclusions Contd 4. The interim analysis that was applied early in the trial permitted implementation of several enhancements to the structure of the study 5. The trial s early analysis permits planning for the realistic needs of additional trials/drugs that can be analyzed in specific gene abnormalities 05/06/2016 24
Acknowledgements Patients and their physicians NCI National Clinical Trials Network NCI Community Oncology Research Program Network groups Alliance for Clinical Trials in Oncology Children s Oncology Group ECOG-ACRIN Cancer Research Group 150+ scientists, physicians, laboratory experts and patient advocates Subprotocol PIs Steering committee and working groups Agents and Gene Selection Correlative Proposals Imaging Informatics Protocol Logistics NRG Oncology SWOG Samples and Sequencing Site Participation and Education Patient Advocate Public Relations 05/06/2016 25
Resources for NCI-MATCH Main Webpages: cancer.gov/nci-match ecog-acrin.org/nci-match-eay131 Protocol Documents: ctsu.org (password required) Spanish: cancer.gov/espanol/nci-match Email Inquiries: match@jimmy.harvard.edu NCI s Cancer Information Service: 1-800-4-CANCER and cancer.gov/contact 05/06/2016 26
