Clinical trials on the way to secure the translational and clinical efficacy

Abstract

Position of the problem: To date only 10% of NSCLC patients are detected in stage I, at a stage when the disease is curable by surgery alone (90% of patients are alive at 5 years). Most of the patients, over 60%, are unfortunately detected in late metastatic stage IV and remain incurable, with a median survival of 12 months, and less than 5% of patients alive at 5 years. The lecture will present WIN Consortium efforts to significantly improve the clinical outcome of lung cancer patients: A major portion is international collaboration to improve molecular profiling and data management and design of innovative trials, driven by new biomarker based platforms, tools and strategies.Combination of targeted therapies: The key feature of future therapies in metastatic NSCLC, is switching from current monotherapies to combinatorial modes, as only way to fight against secondary resistance that occurs in all patients. This switch will need the identification and validation of new tools to match individually the patient's tumor biology profile to the most appropriate combination of therapies.The main limitations of current biomarker and mainly companion diagnostics (Cdx) are:a)multiplicity of drugs that require a large number of tests (and different technologies) to be performed on limited amount of biological samples.b)inability to prioritize the best therapeutic options for each individual patient.The lecture will present the Simplified Interventional Mapping System (SIMS), a Systems Biology based novel generation of multiplex combinatorial Cdx which provides biological support to prioritize and to select the classes of drugs that are predicted to be most effective at the individual patient level. The example used is metastatic Non-Small Cell Lung Carcinoma (NSCLC), but the method applies to any solid tumor. SIMS is based on the use of dual biopsies in order to compare tumor with its histologically matched normal tissue from the same patients. SIMS algorithm integrates data of DNA sequencing, CNV, and the differential expression of mRNA and miRNA between tumor and matched normal tissue from 121 NSCLC patients. SIMS converts thousands of genomic and transcriptomic measurements into a simple and actionable result (a 1 to 10 score) that may be usable by physicians to select the optimal drug or drugs' combinations therapy. One of the most interesting hypothesis being the tri-therapy approaches, following the historical success in AIDS. Comparing tumor and normal tissue biopsies has proven feasible in the ongoing WINTHER trial (NCT01856296) SIMS outlines novel therapeutic possibilities by focusing on pertinent classes of targeted biotherapeutics to be used in appropriate combinations, and is a novel generation of combinatorial multiplex companion test enabling to match patients to drugs.