Next-generation sequencing and targeted cancer therapies have shown remarkable promise in treating cancer, but their use in the clinic is not yet widespread.
A large-scale study called Ontario-wide Cancer Targeted Nucleic Acid Evaluation (OCTANE) has been working since 2016 to propel advanced genomic testing out of the lab and into the clinic. OICR and five major Ontario cancer centres — Juravinski Cancer Centre, Kingston Health Sciences Centre, London Health Sciences Centre, Princess Margaret Cancer Centre (PM) and The Ottawa Hospital Cancer Centre – are conducting NGS of patients’ cancers and helping match them with therapies by looking at the unique genomic details of their disease.
Since OCTANE’s launch, more than 2,700 Ontario patients with advanced solid tumours have enrolled in the program, bringing these cutting-edge technologies to the clinic and providing a better chance of successful treatment.
NGS has long been used in research settings to dig into the genomic details of cancers, in an effort to understand what caused tumours to develop and their potential vulnerabilities. At the centre of OCTANE is the effort to bring NGS testing to patients, screening cancerous tissue samples in hospital labs against a panel of 50 to 163 genes to provide a comprehensive picture of which mutations can be targeted with treatments.
“Whenever you introduce a new technology into a hospital setting there are always challenges and it is not always a guarantee that things will work as planned,” explains Dr. Philippe Bedard, Medical Oncologist at PM and Co-Principal Investigator for OCTANE. “In our case, we were adding this new technology to not just one cancer centre but to five, each with their own established workflows and procedures. So, for the OCTANE team, at the outset a big question was whether results would be consistent across the participating sites.”
A recent OCTANE effort to study this question returned outstanding results: it found 100 per cent technical concordance between the five participating centres, providing a critical indication of success in translating this testing to the clinic.
But OCTANE is about much more than just moving NGS testing into clinical labs – it is also driving the development of a massive database of clinical and genomic information. The purpose of this database is two-fold: It can help clinicians find either approved or experimental treatments for OCTANE patients and it also serves as a resource for cancer researchers, providing the starting point for new studies or the development of novel targeted therapies and biomarkers. This past year a new feature was rolled out in the database that ‘flags’ gene mutations detected by NGS that are being targeted in a clinical trial, better assisting clinicians in directing patients to trials that may benefit them.
We have introduced features into our system that can aid oncologists, and in turn their patients, in making decisions about treatment - Dr. Lillian Siu
Introducing advanced genomic testing is only step one in bringing precision medicine to patients – the next step is figuring out what to do with the wealth of data that this testing provides. “Just looking at the results will not always provide an obvious path forward for treatment,” says Dr. Lillian Siu, Director of the Phase I Program at PM and Co-Principal Investigator for OCTANE. “We have introduced features into our system that can aid oncologists, and in turn their patients, in making decisions about treatment.” An important part of this is identifying clinical trials that may benefit those patients who have run out of standard treatment options.
Patients that enroll in OCTANE are also contributing to future research projects by donating their data, blood and tissue samples to research. These samples are stored at OICR by the Ontario Tumour Bank and undergo additional sequencing for research purposes at the OICR-PM Translational Genomics Laboratory.
The OCTANE study and its participants are providing the starting point for the next wave of precision medicine and enabling that research in Ontario - Dr. Philippe Bedard
“The gift that these individuals are providing is so valuable to cancer research. By looking at thousands of cases we can get a birds-eye view of what’s driving specific subtypes of cancer and how we can best treat them,” says Bedard. “The OCTANE study and its participants are providing the starting point for the next wave of precision medicine and enabling that research in Ontario.”
Research use of the OCTANE database has been strong, with several cancer research groups now using the data to inform their studies. The reach of OCTANE’s benefits to research grew in 2017 when a subset of genomic and clinical data was added to the American Association for Cancer Research’s Genomics Evidence Neoplasia Information Exchange (GENIE) project, a global research consortium of 18 leading cancer centres.
OCTANE has grown since its launch in 2016 and will continue to do so with the addition of new clinical sites in the coming year and the use of a larger panel of genes for testing at all participating sites.
“This will give more Ontarians access to precision medicine and allow us to provide their doctors with even more robust genomic data to help guide treatment,” says Bedard. “Together, with our patients, OCTANE has found success in making the precision treatment of cancer more accessible in Ontario and we are charting a course to make even bigger impacts in the future.”