Clinical trial NCT05846594: A Study to Evaluate the Impact of Liquid Biopsy in Participants With a Clinical Diagnosis of Advanced Cancer
Official title: An International Prospective Study to Evaluate the Impact of Liquid Biopsy in Participants With a Clinical Diagnosis of Advanced Cancer (L1ST)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Metastatic Lung Cancer
Metastatic Gastrointestinal Cancer
Lead sponsor: Hoffmann-La Roche
Sponsor class: INDUSTRY
Collaborators: name: Foundation Medicine
First posted: 2023-05-06
Enrollment: 466
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: DIAGNOSTIC

Brief summary: This is an international, prospective study to assess the impact of concomitant early use of liquid biopsy (FoundationOne® Liquid CDx) within the diagnostic pathway, compared with the standard of care diagnostic pathway, on the timing of routine cancer care in treatment-naïve participants presenting with a clinical diagnosis of advanced cancer, where the pathologic diagnosis has not yet been confirmed. Participants with one of the following two clinical presentations will be included: participants with evidence of de novo metastatic lung cancer or participants with evidence of de novo metastatic gastrointestinal cancer.

Participants may have undergone different levels of diagnostic workup prior to enrollment. Participants who have not had tissue biopsy performed prior to enrollment will be classified as 'basic workup' and those who have had tissue biopsy performed prior to enrollment will be classified as 'extended workup'.

During the diagnosis period, eligible participants will undergo liquid biopsy (FoundationOne® Liquid CDx assay; as per label) on blood samples. Blood samples will be tested using the FoundationOne® Liquid CDx assay at a central laboratory. In parallel, participants will undergo the standard of care diagnostic pathway, including tissue biopsy and histology workup, if not already done before enrollment, and molecular workup according to ESMO guidelines or national guidelines for each tumor type included in this study.

Once a complete pathologic diagnosis has been made, the investigator (or multidisciplinary team) can complete an anti-cancer treatment recommendation assessment. Anti-cancer treatment recommendation should follow current practice and professional guidelines based on the results provided by either liquid biopsy (as per label) or tissue biopsy/standard of care.


Eligibility criteria: Inclusion Criteria:

* Participants presenting with a clinical diagnosis of advanced cancer, falling into one of the following two clinical presentations:

  i) De novo metastatic lung cancer as evidenced by imaging demonstrating a lung nodule/mass and objective evidence of a metastatic process; OR, ii) De novo metastatic gastrointestinal cancer as evidenced by imaging demonstrating a metastatic process in the abdomen/pelvis
* Participants who are treatment naïve for the metastatic setting under study
* Ability to comply with the study protocol
* Participants must either:

  i) Have a tissue biopsy intended/planned to confirm malignant disease and histology; OR, ii) Have a tissue biopsy already performed but pathology has not yet been finalized.

If a tissue biopsy has already been performed prior to ICF signature, then the subtyping of primary tumor may have already been assessed (i.e., for lung cancer TTF1, p40, and napsin A IHC staining may have already been performed).

Exclusion Criteria:

* Participants deemed not fit for treatment with systemic therapy
* Participants deemed not fit for tissue biopsy
* Participants with hematological neoplasm
* Participants with primary malignant neoplasm of the brain
* Participants with any previous molecular testing (NGS or other methods) e.g., all immunohistochemistry staining recommended by ESMO aiming to define the treatment decision (i.e., for lung cancer ALK, EGFR, and PD-L1 IHC staining must not have already been performed). Participants in which tissue biopsy and primary histotyping have been performed can be included in the study.
* Prior treatment for metastatic cancer with the exception of participants who have already been diagnosed and treated for cancer, other than the cancer type under study, who have no evidence of relapse
* History of malignancy within 5 years prior to screening, with the exception of the cancer under investigation in this study and malignancies with a negligible risk of metastasis or death (e.g., 5-year overall survival rate \> 90%), such as adequately treated carcinoma in situ of the cervix, non-melanoma skin carcinoma, localized prostate cancer, ductal carcinoma in situ, or Stage I uterine cancer

Primary outcomes:
measure: Median Time to Diagnosis
timeFrame: From the date of first request for biopsy (tissue or blood) by a healthcare professional to the date of complete pathologic diagnosis (up to 12 weeks)
Secondary outcomes:
measure: Median Time to Treatment Recommendation
timeFrame: From the date of first request for biopsy (tissue or blood) by a healthcare professional to the date of investigator's anticancer treatment recommendation (up to 12 weeks)
measure: Number of Molecular Testing Failures
timeFrame: Up to 12 weeks
measure: Percentage of Participants in Which Comprehensive Genomic Profiling (CGP) Led to a Molecularly Guided Treatment Option (MGTO) Recommendation
timeFrame: Up to 12 weeks
measure: Percentage of Participants Diagnosed with an Actionable Driver Mutation Who Did Not Receive a MGTO Because Anticancer Treatment Needed to Begin Before the CGP Results Were Available
timeFrame: Up to 12 weeks
measure: Percentage of Participants With Concordant CGP Results Between the Liquid Biopsy and the Standard of Care Diagnostic Pathway on the Gene Alteration Level
timeFrame: Up to 12 weeks
measure: Percentage of Participants in Which Treatment Recommendation Based on Molecular Data from the Liquid Biopsy Were the Same as That Based on the Standard of Care Diagnostic Pathway
timeFrame: Up to 12 weeks
measure: Percentage of Participants in Which the MGTO Recommendation Issued Was Discordant Between the Liquid Biopsy Results and the Standard of Care Diagnostic Pathway Results
timeFrame: Up to 12 weeks
measure: Incidence and Severity of Liquid Biopsy Sample Collection-Related Adverse Events
timeFrame: Up to 17 weeks
Other outcomes:
Locations:
city: Avignon
country: France
facility: Institut Sainte Catherine;Recherche Clinique
city: Le Plessis Robinson
country: France
facility: Hopital Marie Lannelongue
city: Lille
country: France
facility: Centre Oscar Lambret; Chir Cancerologie General
city: Rennes
country: France
facility: Centre Eugène Marquis
city: Strasbourg
country: France
facility: CHU Strasbourg - Nouvel Hopital Civil
city: Villejuif
country: France
facility: Gustave Roussy
city: Gauting
country: Germany
facility: Asklepios Klinik Gauting; Onkologisches Studienzentrum
city: Hamburg
country: Germany
facility: Universitätsklinikum Hamburg-Eppendorf Onkologisches Zentrum Medizinische Klinik II
city: Hannover
country: Germany
facility: Med. Hochschule Hannover
city: Mannheim
country: Germany
facility: Universität Mannheim; Personalisierte Onkologie
city: München
country: Germany
facility: Klinikum der LMU München, Campus Großhadern, Krebszentrum München; Comprehensive Cancer Center LMU
city: Stuttgart
country: Germany
facility: Klinikum Stuttgart - Katharinenhospital
city: Napoli
country: Italy
facility: Università degli Studi della Campania Luigi Vanvitelli; Divsione Di Oncologia Medica
state: Campania
city: Udine
country: Italy
facility: Azienda Ospedaliero-Universitaria Dipartimento Interaziendale Di Oncologia
state: Friuli-Venezia Giulia
city: Messina
country: Italy
facility: Ospedale Papardo- Piemonte;Oncologia Medica
state: Sicilia
city: Verona
country: Italy
facility: Azienda Ospedaliera Universitaria Integrata Verona; UOC Oncologia
state: Veneto
city: Córdoba
country: Spain
facility: Hospital Universitario Reina Sofia; Servicio de Oncologia
state: Cordoba
city: Palma De Mallorca
country: Spain
facility: Hospital Universitario Son Espases; Servicio de Oncologia
state: Islas Baleares
city: Madrid
country: Spain
facility: Clinica Universidad de Navarra Madrid; Servicio de Oncología
Study officials:
affiliation: Hoffmann-La Roche
name: Clinical Trials
role: STUDY_DIRECTOR
References: