The Molecular Analysis for Therapy Choice (NCI-MATCH) Trial: Lessons for Genomic Trial Design

Abstract

Background: The proportion of tumors of various histologies that may respond to drugs targeted to molecular alterations is unknown. NCI-MATCH, a collaboration between ECOG-ACRIN Cancer Research Group and the National Cancer Institute, was initiated to find efficacy signals by matching patients with refractory malignancies to treatment targeted to potential tumor molecular drivers regardless of cancer histology.

Methods: Trial development required assumptions about molecular target prevalence, accrual rates, treatment eligibility, and enrollment rates as well as consideration of logistical requirements. Central tumor profiling was performed with an investigational next-generation DNA-targeted sequencing assay of alterations in 143 genes, and protein expression of protein expression of phosphatase and tensin homolog, mutL homolog 1, mutS homolog 2, and RB transcriptional corepressor 1. Treatments were allocated with a validated computational platform (MATCHBOX). A preplanned interim analysis evaluated assumptions and feasibility in this novel trial.

Results: At interim analysis, accrual was robust, tumor biopsies were safe (<1% severe events), and profiling success was 87.3%. Actionable molecular alteration frequency met expectations, but assignment and enrollment lagged due to histology exclusions and mismatch of resources to demand. To address this lag, we revised estimates of mutation frequencies, increased screening sample size, added treatments, and improved assay throughput and efficiency (93.9% completion and 14-day turnaround).

Conclusions: The experiences in the design and implementation of the NCI-MATCH trial suggest that profiling from fresh tumor biopsies and assigning treatment can be performed efficiently in a large national network trial. The success of such trials necessitates a broad screening approach and many treatment options easily accessible to patients.

Figure 1.

National Cancer Institute (NCI)-MATCH design and patient entry procedures. A) NCI -MATCH design (a type of platform trial with features of both umbrella and basket design). B) NCI -MATCH procedures for trial entry. IHC = immunohistochemistry; PD = progressive disease.

Figure 2.

Subprotocol activation timeline for National Cancer Institute (NCI)-MATCH. EGFR = epidermal growth factor receptor; HER2 = human epidermal growth factor receptor 2; ALK = anaplastic lymphoma kinase; ROS = proto-oncogene tyrosine-protein kinase ROS; BRAF = B-Raf proto-oncogene, serine/threonine kinase; NF2 = neurofibromatosis type 2; KIT = KIT proto-oncogene, receptor tyrosine kinase; PIK3CA = phosphatidylinositol 3-kinase catalytic subunit; PTEN = Phosphatase and tensin homolog; NF1 = neurofibromatosis type 1; GNAQ = G protein subunit alpha q; GNA11 = Guanine nucleotide-binding protein subunit alpha-11; PTCH1 = Patched1; SMO = Smoothened; DDR2 = DNA damage response 2; NRAS = Rat sarcoma virus GTPase, neuroblastoma; CCN = cyclin; MLH1 = mutL homolog 1; MSH2 = mutS homolog 2; MET = Mesenchymal Epithelial Transition, receptor tyrosine kinase; FGFR = Fibroblast Growth Factor Receptor; AKT = V-Akt Murine Thymoma Viral Oncogene Homolog.