“It isn’t just about matching patients to therapy, it is also about avoiding therapies that will not work.”— Warren Kibbe, PhD
“PRECISION MEDICINE will lead to fundamental understanding of the complex interplay among genetics, epigenetics, nutrition, environment and clinical presentation, and direct effective, evidence-based prevention and treatment. We can’t measure all that all at once right now, but we are starting to make real progress,” National Cancer Institute Acting Deputy Director Warren Kibbe, PhD, reported at the inaugural OncoSET Symposium: Emerging Approaches to Precision Medicine.
Sponsored by the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, the symposium, which focused on translating advances in precision medicine to clinical practice, drew more than 250 physicians and other health-care professionals. Dr. Kibbe, the keynote speaker, updated participants on the National Cancer Institute (NCI) programs aimed at advancing precision medicine.1
Phenomenal Accrual Rate
“ACCRUAL HAS BEEN PHENOMENAL” for the NCI-MATCH clinical trial, a precision medicine trial that explores treating patients based on the molecular profiles of their tumors, Dr. Kibbe reported. “It is the fastest accruing trial that NCI has ever been a part of, accruing between 100 and 150 patients every week.” The trial is available at 1,500 sites, and community practices have been responsible for about two-thirds of the accrual, “pointing to a very different future for clinical trials and precision medicine,” Dr. Kibbe commented.
The trial is open to adults with solid tumors (including rare tumors), lymphoma, and tumors that no longer respond to standard treatment. Patients are screened with a tumor biopsy, and those with a gene abnormality targeted by a study drug are eligible. The match rate currently is about 20%. “Patients with tumors that share the same genetic abnormality, regardless of tumor type, will receive the drug that targets that abnormality,” Dr. Kibbe explained. “But it isn’t just about matching patients to therapy, it is also about avoiding therapies that will not work.”
Beau Biden Cancer Moonshot
THE BEAU BIDEN CANCER MOONSHOT “is a unique opportunity to enhance cancer research in specific areas that are poised for acceleration,” Dr. Kibbe stated. The projects provide an “express lane” to do in 5 years what it would normally take 10 years.
A Blue Ribbon Panel of scientific experts created to advise the National Cancer Advisory Board “made 10 bold, yet feasible, recommendations that will fast-track initiatives if infused with Moonshot funding,” Dr. Kibbe reported. He highlighted two of those recommendations: establish a network for direct patient involvement by encouraging patients to contribute their comprehensive tumor profile data and build a national cancer data ecosystem for sharing and analyzing cancer data. “Sharing data is all about improving outcome,” Dr. Kibbe said.
Genomic Data Commons
THE NCI GENOMIC DATA COMMONS, aligned with the Cancer Moonshot, “gives us a framework for getting people to share data and, just as important, to share software, to share expertise, to share communications, and to learn from each other’s experience with technology,” Dr. Kibbe said. It advances the goal of “making everything discoverable.”
The Genomic Data Commons “went live on June 6, 2016, with approximately 4.1 PB [petabytes] of data,” Dr. Kibbe stated. Data are derived from 17 different experimental strategies, with the major ones being RNA sequencing, whole-exome sequencing, whole-genome sequencing, microRNA sequencing, genotyping array, and expression array. At the Cancer Moonshot Summit, Foundation Medicine announced the release of 18,000 genomic profiles to the Genomic Data Commons.
“The Genomic Data Commons sits in a data center at the University of Chicago,” Dr. Kibbe said, and currently “data primarily have to be downloaded. We want to experiment with how we can take the same data and move them into a commercial cloud. The whole idea is to democratize data, so you don’t have to download them,” which can take a long time and use up a lot of computer space.
There are three NCI Cancer Genomic Cloud pilots. The Broad Institute and Institute for Systems Biology pilots use Google Cloud, and the Seven Bridges Genomics uses Amazon Web services. “Integrated data sets, interoperable resources, and harmonized data are necessary to develop biologically informed cancer computational predictive models,” Dr. Kibbe explained. “It is really important for researchers to put their own data up against reference data sets like the Genomic Data Commons and be able to cross analyze and decide whether to make them public or not.”
Combining Proteomics and Genomics
A NEW MOONSHOT project called Apollo involves “taking specimens from patients who have cancer and doing both proteomic and genomic analyses,” Dr. Kibbe said. The goal is “to understand how those two things inform us better, when they correlate, and when they don’t correlate.”
The project “has been opened up across the country, and we have 10 different countries that are interested in contributing data. All that data will be accessible to the whole community, so everyone can learn from those data,” Dr. Kibbe stated. He noted, however, that at this point, proteomics does not provide nearly as much information as genomics. ■
DISCLOSURE: Dr. Kibbe reported no conflicts of interest.
IN RESPONSE to a question during the Lurie Cancer Center OncoSET Symposium about sharing clinical data, Warren Kibbe, PhD, Acting Deputy Director of the National Cancer Institute, acknowledged “it is still very problematic,” but “there is an opportunity for meaningful use.” He said that the...