ONCOGRAM: study protocol for the evaluation of therapeutic response and survival of metastatic colorectal cancer patients treated according to the guidelines of a chemosensitivity assay, the Oncogramme®
Authors: Mathonnet Muriel , Vanderstraete Mathieu , Bounaix Morand du Puch Christophe , Giraud Stéphanie , Lautrette Christophe , Ouaissi Mehdi , Tabchouri Nicolas , Taïbi Abdelkader , Martin Renaud , Herafa Isabelle , Tchalla Achille , Christou Niki ,   The ONCOGRAM trial investigators, Marin B. , Bouvier S. , Durand-Fontanier S. , Fabre A. , Valleix D. , Rivaille T. , Fredon F. , Derbal S. , Carrier P. , Lonfo R. Daloko , Legros R. , Lavau-Denes S. , Lebrun-Ly V. , Thuillier F. , Engel P. , Chaunavel A. , Pradel M. , Pezet D. , Dubois A. , Pétorin C. , Antomarchi O. , Aboukassem A. , Vimal-Baguet A. , Gillet B. , Mathieu B. , Joubert-Zakeyh J. , Evrard S. , Becouarn Y. , Béchade D. , Fonk M. , Desolneux G. , Dauriat N. , Agbo M. , Louty M. , Borie F. , Lyubimova S. , Phoutthasang V. , Brunaud-Gagniard B. , Benadjaoud Y. , Rolland N. , Letournoux L. , Roger P. , Chen L. , Amadou Z. , Christopoulous C. , Nakahl G. , Souliman Y. , Cirt M. N. , Ducoux D. , Boisseau P. A. , Pardies P. , Mesturoux L. , Vayre L. , Abdeh A. , Teboul F. , Landraud R. , Ouaissi M. , Salamé E. , Tabchouri N. , Lecomte T. , Proutheau G. , Guyetant S. , Tougeron D. , de Singly A. , Ferru A. , El Fadel R. , Courvoisier T. , Junca A. , Frouin E. , Rouleau L. , Rafaert S. , Rocher A. , Regimbeau J-M , Sabbagh C. , Dumange E. , Chive E. , Lignier D. , Siembida N. , Chauffert B. , Hautefeuille V. , Chatelain D. , Rivkine E. 
Published: August 2021

Abstract
Background
Colorectal cancer is a major public concern, being the second deadliest cancer in the world. Whereas survival is high for localized forms, metastatic colorectal cancer has showed poor prognosis, with a 5-year survival barely surpassing 11%. Conventional chemotherapies against this disease proved their efficiency and remain essential in first-line treatment. However, the large number of authorized protocols complexifies treatment decision. In common practice, such decision is made on an empirical basis, by assessing benefits and risks for the patient. In other words, there is currently no efficient means of predicting the efficacy of any chemotherapy protocol for metastatic colorectal cancer.

Methods/design
The use of a chemosensitivity assay, the Oncogramme®, should help clinicians administer the best chemotherapy regimen to their patients. We hypothesize it would ultimately improve their survival. In this multicentred, prospective trial (ONCOGRAM), eligible patients with metastatic colorectal cancer are randomized to determine whether they will receive an Oncogramme®. For clinicians whose patients benefited from the assay (arm A), results are used as a decision support tool. Patients not undergoing the Oncogramme® procedure are treated according to current practice, without the assistance of the assay (arm B). Primary outcome is 1-year progression-free survival. Secondary outcomes include response rates, as well as 6-month and 1-year survival rates.

Discussion
This study aims at investigating the clinical utility of the Oncogramme® as a decision support tool for the treatment of patients with metastatic colorectal cancer. If the Oncogramme® positively influenced patient overall survival and/or progression-free survival, it would be of great value for clinicians to implement this assay within the current landscape of personalized medicine tools, which include genomics and biomarker assays.

Trial registration
ClinicalTrials.gov identifier NCT03133273. Registered on April 28, 2017.