Ahead of our virtual panel discussion on the promises and pitfalls of precision medicine trials: now and in the future next week, we caught up with Maria Cerone and Donald White from Cancer Research UK, two of the panellists speaking.
Can you give us a brief introduction of yourself and the work that you do?
Maria Cerone: I am Maria and I am the research programme manager for Precision Medicine at CRUK. My role is to support and coordinate the Precision Medicine initiatives funded by the charity as well as help develop new initiatives in other cancer types of unmet need to offer more treatments to all cancer patients.
Don White: I am Don, the programme manager in Stratified Medicine at CRUK. My team coordinates and manages a national molecular testing programme for assigning patients to a UK-wide non-small cell lung cancer precision medicine trial.
As technology is moving forward, many people think that we can just sequence the entire genome of patients and use this wealth of information for clinical trials. Why would you choose to do panel sequencing over WGS?
Maria: The two approaches have different applications and strengths. From a clinical perspective, panel sequencing can give all the information needed for patient stratification at a very good depth of reading. It is also cheaper and less labour intensive to do, and can use FFPE (Formalin-fixed paraffin-embedded) samples from left over diagnostic biopsies. From a research perspective, WGS gives more comprehensive information that can be used to increase the knowledge and understanding of the disease.
Don: Panel sequencing gives us the depth we require when we need confidence in calling genes harbouring no aberrations, as in the case of molecular exclusion for trial arms. As it is less labour intensive, it is a good option for some trials.
We have heard a lot on how COVID-19 has affected cancer care, from people not showing up to appointments to appointments going virtual. How has COVID-19 affected the clinical trial space?
Don: COVID-19 resulted in a near complete pause in testing and enrolment of patients onto trials. It will be interesting to see how the mechanisms and regulatory processes behind setting up a trial will be impacted in the future from lessons we learned in expediting COVID-19 trials due to the urgency.
Maria: Yes, COVID-19 has affected most clinical trials which were either paused by the sponsors or locally at the recruiting NHS hospitals due to both safety reasons and due to lack of available NHS staff deployed to COVID-19 care. In the UK, the reduction of the activity in the clinical trial space has been extensive (over 90%); however, data in other countries have shown that clinical trial activity has been affected less, suggesting an over-cautious approach taken in the UK. Hopefully the lessons from this pause and from other countries will help avoid a total block in the event of another wave of the pandemic. The process of restarting all clinical trial activity will require a massive coordinated effort and a long time, with negative consequences for cancer patients.
Not all oncologists are keen to integrate genomics in cancer care, what do you think is needed in order to change their perceptions?
Don: I think we need more engagement and education of all of the oncology community, as well as positive results coming out of trials to help change their attitudes on genomics in cancer care.
Maria: I agree, we definitely need more training in genomics for the clinical community. Also, we need to highlight the positive impact of using genomics for patients’ treatment to ensure buy-in from the oncology community.
What are you most excited about that is coming in the precision oncology space?
Don: For me, it will be the ease of access to testing, such as with liquid biopsies, as well as advances in machine learning algorithms to help find new biomarkers of treatment response and toxicity. I think this is going to make a big impact to cancer research and patient care.
Join the discussion:
Sign up to join Don and Maria in an interactive discussion alongside oncology experts, where they discuss optimising clinical trials:
Gary Middleton, Professor, University of Birmingham
Pauline Rehal, Principal Clinical Scientist, West Midlands Regional Genetics Laboratory
Alastair Greystoke, Clinical Senior Lecturer/ Hon Consultant, Newcastle University Hospital