Advanced GC Multi-omic Characterization in EU and CELAC Populations (LEGACY-2)

Observational study (cohort type) of advanced GC patients that will be recruited prospectively to study biological factors associated with the disease and relevant clinical outcomes.

Study Overview

• Status: Completed
• Conditions: Gastric Cancer

Detailed Description

Despite of multiple attempts to improve treatment in recent decades, none strategies has improved prognosis in locally advanced stage III and IV GC. A therapeutic approach to GC based on current histological and image criteria (Tumour Node Metastasis -TNM- stage) is insufficient. Although multiple targeted agents are currently under investigation, so far, only trastuzumab and ramucirumab have demonstrated efficacy in advanced GC and have a regulatory approval. For this reason, the identification of specific targets that could be susceptible for drug inhibition, is an urgent requirement. Moreover, most studies and current international databases on late-stage/advanced GC are largely based on Asian populations, in sharp contrast tumour biology and genome of EU or CELAC populations remain poorly known.

The primary objective of this study are to:

1. Characterize a multi-centric cohort including EU and CELAC populations diagnosed with advanced GC through a multi-omic approach including proteomics, genomics, transcriptomics, microbiome and exposome analysis due to study the determinants of GC.
2. Identify the regional differences in EU and CELAC populations recruiting patients for this study for each omic characterization due to identify the high-risk group populations.
3. Identify and select from the multi-omic approach those biomarkers useful for the development of an algorithm to guide the therapeutic approach for advanced GC.

• Study Type: Observational
• Enrollment (Actual): 800

Contacts and Locations

Study Locations

• Argentina
  • Buenos Aires, Argentina, C1426ANZ
    • Instituto Alexander Fleming
• Chile
  • Santiago, Chile, 8331150
    • Pontificia Universidad Catolica de Chile
• Mexico
  • Mexico, Mexico, 01480
    • Instituto Nacional De Cancerologia de Mexico
• Netherlands
  • Amsterdam, Netherlands, 1081
    • VU Medical Centre
• Paraguay
  • Asunción, Paraguay
    • GenPat
• Portugal
  • Porto, Portugal, 4200 135
    • Institute of Pathology and Immunology of University of Porto
• Spain
  • Barcelona, Spain, 08035
    • Vall d'Hebron Institut d'Oncologia
  • Valencia, Spain, 46010
    • Hospital Clínico Univeristario de Valencia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A

• Sampling Method: Probability Sample

Study Population

• Subjects >18 years old, with high diagnostic suspicion of advanced GC diagnosis (Stage III and IV)
• Subjects >18 years old to whom a gastroscopy was indicated and confirmed absent of GC.

Description

Cases:

• Inclusion criteria:

  • Subjects ≥18 years old.
  • GC diagnosis stages III and IV (including gastroesophageal junction cancer) and/or a gastroscopy indication due to the high diagnostic suspicion of GC as part of the study of his disease.
  • Has given and signed the IC to participate in this study.

• Exclusion criteria:

  • Patients diagnosed with GC early disease (stage I and II) suitable for resectable strategy.

• Withdrawal criteria:

  • Patients initially recruited with high suspicion of GC diagnosis but not confirmed by the pathological report.

Controls:

• Inclusion criteria (only for microbiome analysis):

  • Subjects ≥18 years old.
  • Subjects to whom a gastroscopy is indicated within clinical care and is confirmed absent of GC in the same centres will be matched in age (+/- 10 years), gender and pertaining from the same region of the GC case.
  • Has given and signed the IC to participate in this study.

• Exclusion criteria:

  • Subjects from a different geographic area from the cases.
  • Patients with high suspicion of GC.
  • Patients with previous histopathologic diagnosis of peptic (gastric or duodenal) ulcer disease and/or atrophy or intestinal metaplasia.
  • Patients that have received antimicrobials during the 4 weeks period prior to the endoscopy.
  • Patients that have received proton pump inhibitors or H2-receptor antagonists, at least 2 weeks prior to the endoscopy

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Control; Patients with confirmed absent of GC
Cases; Patients with high diagnostic suspicion of advanced GC diagnosis

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Development of a new diagnostic algorithm for gastric cancer that includes molecular landscape, patient history, histopathological and environmental factors, personal microbiome and immune landscape	The project will look for an integrative diagnostic algorithm that incorporates multi-parameter inputs and apply artificial intelligence to provide more personalized risk estimates and which will form the basis for future development of a clinical tool	3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proteomic analysis of gastric cancer tissue	Determine the expression of certain proteins using ICH and ISH	3 years
Genomics (tumour next-generation sequencing)	Determine differences in the genetic mutational profile of different populations	3 years
Transcriptomics (Nanostring immune gene expression panel)	Determine differences in the genetic expression profile of different populations	3 years
Microbiota sequencing (including level of Epstein-Barr virus [EBV] DNA)	Determine differences in the microbiota profile of different populations	3 years
Dietary habits as assessed by a new study-specific questionnaire	Determine differences in dietary habits of different populations and its correlation with risk to develop gastric cancer	3 years
Biological risk factors as assessed through medical chart review	Determine differences in biological risk factors of different populations and its correlation with risk to develop gastric cancer	3 years
Daily routines as assessed by a new study-specific questionnaire	Determine differences daily routines of different populations and its correlation with risk to develop gastric cancer	3 years

Collaborators and Investigators

• Sponsor: Fundación para la Investigación del Hospital Clínico de Valencia
• Collaborators: Pontificia Universidad Catolica de Chile; Amsterdam UMC, location VUmc; Vall d'Hebron Institute of Oncology; Instituto Nacional de Cancerologia de Mexico; INSTITUTO ALEXANDER FLEMING; Hospital Central del IPS; IPATIMUP - Instituto De Patologia E Imunologia Molecular Da Universidade Do Porto

Publications and helpful links

General Publications

• van Schooten TS, Derks S, Jimenez-Marti E, Carneiro F, Figueiredo C, Ruiz E, Alsina M, Molero C, Garrido M, Riquelme A, Caballero C, Lezcano E, O'Connor JM, Esteso F, Farres J, Mas JM, Lordick F, Vogt J, Cardone A, Girvalaki C, Cervantes A, Fleitas T; members of LEGACy consortium. The LEGACy study: a European and Latin American consortium to identify risk factors and molecular phenotypes in gastric cancer to improve prevention strategies and personalized clinical decision making globally. BMC Cancer. 2022 Jun 13;22(1):646. doi: 10.1186/s12885-022-09689-9.

Study record dates

Study Major Dates

• Study Start (Actual): June 12, 2019
• Primary Completion (Actual): December 31, 2023
• Study Completion (Actual): December 31, 2023

Study Registration Dates

• First Submitted: June 5, 2019
• First Submitted That Met QC Criteria: July 10, 2019
• First Posted (Actual): July 11, 2019

Study Record Updates

• Last Update Posted (Actual): May 9, 2024
• Last Update Submitted That Met QC Criteria: May 8, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: Gastric Cancer; Oncology; Personalized medicine; Solid tumor; Primary Intervention
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Stomach Diseases; Stomach Neoplasms
• Other Study ID Numbers: LEGACY-2

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No