We are leveraging ASCO’s unique ability to bring together a diverse group of collaborators to undertake something that’s never been done before, all while simplifying access to multiple cancer treatments across many tumor types.
—Richard L. Schilsky, MD, FASCO
ASCO announced its first-ever clinical trial, which will offer patients with advanced cancer access to molecularly targeted cancer drugs and collect “real-world” data on clinical outcomes, to help learn the best uses of these drugs outside of indications approved by the U.S. Food and Drug Administration (FDA). Plans for the Targeted Agent and Profiling Utilization Registry (TAPUR) study, including the participation of major pharmaceutical companies that will contribute free drugs, were discussed June 1 at the 2015 ASCO Annual Meeting in Chicago.
The ASCO-sponsored prospective, nonrandomized clinical trial will collect information on the antitumor activity and toxicity of commercially available, targeted cancer drugs in a range of cancer types, including any advanced solid tumor, multiple myeloma, or non-Hodgkin lymphoma, with a genomic variation known to be a drug target.
“Oncologists often use therapies approved for a specific cancer indication to treat people with other types of advanced cancer, but we very rarely learn from that experience to benefit other patients,” said ASCO Immediate Past President Peter Paul Yu, MD, FACP, FASCO. “TAPUR will document the real-world experience of patients who receive commercially available, targeted anticancer drugs and will describe the effectiveness and side effects of a range of targeted agents available in this study.”
ASCO will organize the operational aspects of the study, including the participation of multiple collaborators who are central to TAPUR’s success. TAPUR will involve not only patients and physicians, but also ASCO oversight committees, pharmaceutical companies, technology firms, and community-based study sites—representing a uniquely innovative and inclusive approach to studying the use of molecularly targeted cancer drugs.
“We are leveraging ASCO’s unique ability to bring together a diverse group of collaborators to undertake something that’s never been done before, all while simplifying access to multiple cancer treatments across many tumor types,” said ASCO Chief Medical Officer Richard L. Schilsky, MD, FASCO. “Perhaps even more importantly, TAPUR will involve community-based research programs, where the majority of cancer patients receive treatment, and will provide education and support to community oncologists to help them interpret complex genomic tests.”
Next Steps for TAPUR
In the coming months, an Institutional Review Board will review the study protocol and consent form. In addition, ASCO has established three oversight committees, each of which will include patient representatives, clinical oncologists, statisticians, and genomics specialists.
TAPUR is designed to include a broader patient population than is typically enrolled in clinical trials. It will accept patients who have any advanced solid tumor, multiple myeloma, or B-cell non-Hodgkin lymphoma who are no longer responding to standard anticancer treatment or for whom no acceptable treatment is available. Patients will be screened to determine if they are healthy enough to participate based on broad inclusion/exclusion criteria.
If and when a patient meets the defined trial criteria, their treating physician will select a drug from among those available in the TAPUR study protocol that targets the identified genomic variation in the patient’s tumor. If a relevant drug-target match is not described in the protocol, a physician may consult the Molecular Tumor Board, which will review the clinical and genomic features of the case and suggest potential therapies on or off the study. All patients who receive treatment through TAPUR will be monitored for standard toxicity and efficacy outcomes, including tumor response, progression-free and overall survival, and duration of treatment.
Patients participating in TAPUR will receive the anticancer drugs at no charge. It is expected that routine clinical care costs will be covered by the patient’s insurance plan.
ASCO has invited a number of pharmaceutical companies to provide marketed, targeted drugs and additional resources to support the development of the new study’s infrastructure. At the time of this announcement, ASCO reported that AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Company, Genentech, and Pfizer have signed memoranda of understanding, agreeing to participate in the TAPUR study.
“At least 13 drugs that target more than 15 unique genomic variants will be provided by these companies. We are extremely grateful for the generosity of these companies, without whose support TAPUR would not be possible,” said Dr. Yu. “We anticipate additional companies will sign on and are extremely encouraged with the level of interest we have received so far.”
ASCO will launch the TAPUR study at clinical sites that comprise the Michigan Cancer Research Consortium, the Cancer Research Consortium of West Michigan, and the Carolinas Healthcare System, with the ultimate goal of expanding nationally.
Two technology companies will provide key support to manage, analyze, and interpret the study data. Syapse will provide its Syapse Precision Medicine Platform to automate the study workflow and the Molecular Tumor Board process and capture structured data from participating practices. Illumina will provide its NextBio knowledge base platform to support and inform the case review by the Molecular Tumor Board, as well as to explore aggregate data analytics.
Finally, ASCO will collaborate and share data with the Netherlands Center for Personalized Cancer Treatment, which is conducting a clinical trial using a study protocol very similar to TAPUR.
“We are very fortunate that this leading cancer center has the same focus as TAPUR,” said Dr. Schilsky. “Technological advancements will allow us to pool our information in a seamless fashion and give us the ability to learn from the experience of a larger group of patients.”
Patient Advocates to Play a Key Role
Patient advocates will play a central role throughout the study, providing guidance and oversight support. Jane Perlmutter, PhD, a cancer survivor and nationally recognized patient advocate, is lending her expertise in trial development, and will help coordinate patient advocate recruitment and training for the study.
“TAPUR has enormous potential to improve our understanding of the effectiveness of currently available therapies in treating cancers with genomic variations, and to learn from patients who are treated with off-label drugs,” said Dr. Perlmutter. “I applaud ASCO for undertaking this important study and believe its findings will improve cancer care, especially for those with advanced cancer, for whom traditional therapies are no longer working.”
For more information about TAPUR, please visit www.asco.org/TAPUR. ■