- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03576937
Achieving Value in Cancer Diagnostics: Blood Versus Tissue Molecular Profiling - a Prospective Canadian Study (VALUE)
May 12, 2023 updated by: University Health Network, Toronto
Current guidelines in non-small cell lung cancer recommend genomic assessment for mutations in EGFR and BRAF, gene rearrangements in ALK and ROS1, and resistance mutations such as T790M upon progression during EGFR inhibitor therapy.
However, obtaining sufficient tumour tissue to test for these molecular alterations, as well as those with emerging targeted therapies, is challenging in lung cancer.
A promising method to improve molecular diagnostic testing in lung and other cancers is the use of circulating cell-free DNA (cfDNA) obtained from blood samples or liquid biopsies.
This multi-centre prospective study will compare blood-based profiling (using the GUARDANT360 assay) to standard of care tissue-based profiling within the Canadian system.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Observational
Enrollment (Actual)
207
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Alberta
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Calgary, Alberta, Canada
- Tom Baker Cancer Centre
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British Columbia
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Vancouver, British Columbia, Canada
- BC Cancer Agency
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Ontario
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Hamilton, Ontario, Canada
- Juravinski Cancer Centre
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Ottawa, Ontario, Canada
- Ottawa Hospital Regional Cancer Centre
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Toronto, Ontario, Canada
- Princess Margaret Cancer Centre
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Quebec
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Montreal, Quebec, Canada
- Jewish General Hospital
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Sampling Method
Non-Probability Sample
Study Population
Non-small cell lung cancer patients (Stage IIIB or IV not eligible for curative intent treatment, or relapsed/recurrent disease)
Description
Inclusion Criteria:
Patients with non-small cell lung cancer (NSCLC) with:
- Histologically-proven, advanced (Stage IIIB or IV not eligible for curative intent treatment, or relapsed/recurrent) disease;
- Non-squamous histology (mixed adenocarcinoma histology is allowed);
- Never smoking or light smoking history (≤10 pack years);
- Measureable disease by RECIST 1.1;
- Patients who have previously received curative therapy are eligible if primary treatment was completed at least 6 months prior to the development of advanced disease; for patients who received adjuvant systemic therapy, the last dose of treatment must have been given at least 6 weeks prior to enrollment;
- Age ≥ 18 years;
- Ability to provide written informed consent;
- Agreement to provide blood sample prior to starting systemic treatment;
- Eligibility for targeted therapy in the opinion of the investigator;
- Standard-of-care tissue genotyping ordered or planned. Patients with tissue deemed insufficient for genotyping are eligible.
- Cohort 2 only: evidence of disease progression on prior targeted tyrosine kinase inhibitor or other targeted therapy for EGFR including T790M, ALK, ROS-1 or BRAF-deranged advanced NSCLC. Patients progressing on 1st or 2nd generation EGFR TKI must have undergone SOC testing for EGFR T790M. If blood- or tissue-negative for T790M, the patient is eligible for this study. If T790M-positive, the patient must have progressed on a T790M inhibitor to be eligible. Intervening systemic therapy such as chemotherapy or immunotherapy is permitted.
Exclusion Criteria:
- Pregnancy;
- ≥10 pack year smoking history;
- Any other concurrent malignancy except for localized, non-melanoma, cutaneous cancer or non-invasive cervical cancer. Any prior cancer other than NSCLC must have occurred more than 2 years prior to study entry with no evidence of currently active disease;
- Prior resection of metastatic disease if the resected metastasis was the only site of measurable disease;
- Radiation of a metastatic lesion or residual disease if administered to the only site(s) of advanced disease;
- Cohort 1 only: Prior systemic treatment for metastatic NSCLC including but not limited to targeted therapy, chemotherapy, immunotherapy, or biologic therapy. Adjuvant therapy is permitted at least 6 weeks prior to enrollment.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Cohort 1
Patients with advanced (incurable stage IIIB or IV), histologically proven, non-squamous NSCLC who are never- or light-smokers (≤10 pack year smoking history) and are being considered for systemic therapy in the first line setting are eligible.
Blood will be collected prior to first line treatment for testing cfDNA with the GUARDANT360 assay.
Testing of available diagnostic tissue for genomic abnormalities will be performed in all patients per standard of care at the participating sites.
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GUARDANT360 is a validated cfDNA next-generation sequencing assay that identifies variants in 73 genes associated with several cancers.
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Cohort 2
Patients with advanced non-squamous NSCLC with known oncogenic drivers (such as EGFR, ALK, ROS-1, BRAF) that have failed tyrosine kinase inhibitor (TKI) therapy, and are being considered for subsequent therapy.
Blood will be collected from patients at time of progression on TKI therapy for cfDNA testing with the GUARDANT360 assay.
Testing of available diagnostic tissue for genomic abnormalities will be performed in all patients per standard of care at the participating sites.
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GUARDANT360 is a validated cfDNA next-generation sequencing assay that identifies variants in 73 genes associated with several cancers.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Response rate to first-line therapy
Time Frame: Up to 18 Months
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Measure best response to first-line therapy using investigator-assessed RECIST 1.1, including progression free survival and time to treatment failure, in patients with advanced lung adenocarcinoma using the cfDNA GUARDANT360 assay versus standard of care tissue genotyping.
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Up to 18 Months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patients receiving targeted therapy
Time Frame: Up to 18 Months
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Compare the proportion of patients receiving targeted therapy using the cfDNA GUARDANT360 assay versus standard of care tissue genotyping.
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Up to 18 Months
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Time to Treatment Initiation
Time Frame: Up to 18 Months
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The time to treatment initiation using both genotyping methods, will be calculated as the number of days from the date of pathologic or clinical stage IV NSCLC diagnosis until initiation of systemic treatment.
This will be compared to the turnaround time for GUARDANT360 results.
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Up to 18 Months
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Incremental number of actionable genomic alterations
Time Frame: Up to 18 Months
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Count the number of actionable genomic alterations identified in cfDNA that were not identified in tumour tissue standard of care testing.
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Up to 18 Months
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Turnaround time of cfDNA vs. tissue results
Time Frame: Up to 18 Months
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Calculate the time (in days) from the date of request for testing to the report date for both genotyping methods.
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Up to 18 Months
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Costs of cfDNA vs. tissue testing
Time Frame: Up to 18 Months
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Cost consequence analysis to examine incremental mean direct and indirect costs in Canadian dollars between the two approaches (cfDNA testing vs tumour tissue genotyping).
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Up to 18 Months
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Response rate to immunotherapy
Time Frame: Up to 18 Months
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Assess response rate in patients (Cohort 1) who received single agent or combination immunotherapy.
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Up to 18 Months
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Response duration to immunotherapy
Time Frame: Up to 18 Months
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Assess response duration in patients (Cohort 1) who received single agent or combination immunotherapy.
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Up to 18 Months
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Patient reported quality of life
Time Frame: Upon entry and 3 months following initiation of systemic therapy
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Patient quality of life will be measured using the EQ5D-5L, which will be administered upon entry to the study and 3 months after starting systemic therapy.
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Upon entry and 3 months following initiation of systemic therapy
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Patient willingness-to-pay
Time Frame: Within 30 days of study enrollment
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Evaluate patient willingness-to-pay for using a next generation sequencing assay, such as the GUARDANT360, using a validated patient survey.
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Within 30 days of study enrollment
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
February 12, 2019
Primary Completion (Actual)
October 30, 2020
Study Completion (Actual)
April 30, 2023
Study Registration Dates
First Submitted
June 22, 2018
First Submitted That Met QC Criteria
June 22, 2018
First Posted (Actual)
July 5, 2018
Study Record Updates
Last Update Posted (Actual)
May 15, 2023
Last Update Submitted That Met QC Criteria
May 12, 2023
Last Verified
May 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 18-5353
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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