The iCat2, GAIN (Genomic Assessment Informs Novel Therapy) Consortium Study

Study Overview
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Brief Summary
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This research study is evaluating the use of specialized testing of solid tumors including sequencing. The process of performing these specialized tests is called tumor profiling. The tumor profiling may result in identifying changes in genes of the tumor that indicate that a particular therapy may have activity. This is called an individualized cancer therapy (iCat) recommendation. The results of the tumor profiling and, if applicable, the iCat recommendation will be returned.

Detailed Description
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Patients with extra-cranial (not in the brain) solid tumors that are either difficult to diagnose or more difficult to treat are eligible to participate in this study. All enrolled patients will have targeted sequencing of tumor performed. Sequencing results will be reviewed for clinically significant findings including determination of whether any mutations exist that suggest potential for activity of a targeted therapy (iCat recommendation). Results will be returned to the patient's oncologist and follow-up data will be collected. In this prospective multi-center cohort study, the primary objective is to describe the outcomes of pediatric patients with advanced solid tumors according to whether or not they received of targeted therapy matched to an iCat recommendation. The primary clinical outcome of interest is the endpoint of overall survival (OS), with progression-free survival and response rate (RR) as key secondary clinical outcome measures. To address this hypothesis, 825 patients will enroll from an anticipated 11 participating institutions over 3 years.

Official Title
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Multicenter Cohort Study To Evaluate Outcomes After Receipt of Targeted Therapy Matched to an Individualized Cancer Therapy (iCat) Recommendations in Children and Young Adults With Solid Tumors: The iCat2, GAIN Consortium Study

Conditions
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Pediatric Solid Tumor

Intervention / Treatment
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* Genetic: Genetic testing and GAIN report


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age -- Age ≤ 30 years at time of initial qualifying solid tumor diagnosis Diagnosis -- Histologic diagnosis of solid malignancy (excluding brain tumors and lymphoma) that meets at least one of the following criteria: Refractory, defined as tumor progression after initiation of standard first line therapy without having achieved a prior partial or complete remission OR Biopsy proven residual disease at the completion of planned standard initial front-line therapy. Recurrent, defined as tumor progression after achieving a prior partial or complete remission Newly diagnosed high risk disease, defined as having an expected event free survival of < 50% at 2 years. Lacks definitive diagnosis or classical genomic findings after histologic review and standard molecular testing (rare tumor group). Examples include (eligibility not limited to these examples): Histology typically associated with a fusion in which fusion is not detected. Ewing-like sarcoma Undifferentiated sarcoma Inflammatory myofibroblastic tumor without ALK fusion Infantile fibrosarcoma without NTRK fusion Specimen Samples Sufficient tumor specimen available to meet the minimum requirements for profiling from diagnosis or progression / recurrence --- OR Surgery / biopsy planned as part of clinical care that is anticipated to yield sufficient material to meet the minimum requirements for profiling; OR Patient has already had molecular profiling and patient has not yet started matched targeted therapy based on the report . Exclusion Criteria: No Therapy Planned -- Patients who have declined further anticancer therapy will be excluded. Performance Status -- Patients with Lansky (age < 16 years) or Karnofsky (age ≥16 years) score < 50 will be excluded. Life Expectancy -- Patients with anticipated life expectancy < 3 months will be excluded.

Ages Eligible for Study
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Maximum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Genetic testing and GAIN report<br>All enrolled patients will submit specimens for sequencing and analysis. | Genetic: Genetic testing and GAIN report<br>* All patients enrolled will submit specimens for genetic analysis. If successful the report will be reviewed to look for possible recommendations and a GAIN report will be generated regardless of possible recommendations.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Survival | In pediatric patients with recurrent or refractory solid tumors who undergo successful molecular profiling, a) to describe the overall survival of patients by treatment group (iCatM, iCatUM and UM); b) to identify demographic, clinical, and genomic factors associated with overall survival from the time of relapse/progression (OSr); and c)to store tumor material, derived cell lines / xenografts, and blood samples for general sample banking and potential future research. | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Identification of the patient, clinical, and medication access factors associated with a) having an iCat recommendation and b) with receipt of matched targeted therapy. |  | 2 Years | 
| Determination of factors associated with response and progression-free survival time by treatment group for patients with recurrent/refractory disease and measurable/evaluable disease. |  | 2 Years | 
| Description of the frequency and range of molecular alterations in pediatric solid tumors at diagnosis and at relapse including a comparison of potentially targetable variants in paired tumor samples obtained from relapse and at initial diagnosis. |  | 2 Years | 
| Determination of whether participation in a genomics study provides psychological well-being and whether that is associated with level of genomic comprehension and with receipt of an iCat recommendation. |  | 2 Years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pediatric Solid Tumor