Molecular Profiling in Carcinoma of Unknown Primary (CUP)
Results from the study, 'Biotheranostic profiling of CUP: paradigm shift in the management of CUP', show that tumour profiling can positively influence patient outcomes where the primary site of the patient's tumour is unknown by providing oncologists with critical new information to help them select optimal treatment.[1]
Using a number of different methods to assess the biomarkers associated with the potential for drug response, the researchers were able to find targets for which there are existing cancer drugs in 77% of the tumours profiled.[1]
Dr. Zoran Gatalica, MD, DSc, Executive Medical Director, Caris Life Sciences, Phoenix, Arizona, USA, and an Adjunct Professor of Pathology, Creighton University School of Medicine, reported that his team's research has shown that investigating the biology of a CUP patient's tumour is a highly effective way of developing an actionable treatment plan for most patients.
"Previous attempts to characterise cancer of unknown primary (CUP) have only managed to provide a statistical likelihood of a potential primary organ site, and for the most part have not addressed the question of which treatments are likely to be effective. We set out to do just that in a large group of over 1350 CUP patients. This is the largest group to date to have their tumour biomarker profiles characterised." said Dr Gatalica.
"We believe that our research, based on the Caris Molecular Intelligence(TM) service, signals a paradigm shift in the treatment of CUP. With this strategy, physicians can build a treatment plan based on changes in cancer cells which are known to be associated with the potential for benefit from specific drugs. We could be looking at the evolution of a new standard of care for these patients who badly need new options," added Dr Gatalica.
Cancer Research UK estimates that CUP accounted for 3% of all cancer cases and 7% of all cancer deaths in the UK in 2009 and 2010 respectively.[2]
"A CUP diagnosis is challenging for patient and clinician and a search for the primary site, to define treatment options, is often distressing and fruitless. Using predictive biomarker information directly from the tumour offers doctors powerful insights into the best treatment options for CUP patients. Where available, this new approach to treating patients diagnosed with CUP is very promising and demonstrates the value of embracing innovative profiling techniques," explains John Symons, Director of the CUP Foundation.
As recent advances in translational medicine and cancer molecular profiling have shown, different cancers may share the same molecular pathways, which provides the biological basis for using the same targeted therapy in different cancer types, irrespective of primary site.
Molecular Profiling in Rare Cancers and Cancers Refractory to Treatment
A second abstract presented at this year's meeting successfully showed the clinical application of the Caris Molecular Intelligence service in selecting treatment for 30 heavily pre-treated and 10 rare cancer patients. In this Australian cohort, tumour profiling-guided therapy resulted in clinical benefit for three quarters of patients with rare cancers and over half of heavily pre-treated patients, where complete response, partial response or stable disease was considered clinical benefit.[3]
Lead investigator Dr Andrew Dean from St John of God Hospital, Subiaco, and Sir Charles Gairdner Hospital, Nedlands, Western Australia concluded: "While requiring further clinical validation, these data lend support to the use of evidence-guided tumour profiling in identifying therapy options for patients with advanced refractory and rare solid tumours who have limited treatment options and poor prognosis."
About Caris Molecular Intelligence (MI)
Caris Molecular Intelligence(TM) is an evidence-based tumour profiling service, which aims to help physicians select the best available therapy for each patient. It examines a broad range of established biomarkers using the best available technologies and with the help of a proprietary database, associates drugs that are more or less likely to benefit each individual patient. Using the MI Profile(TM) report, physicians are able to more easily translate the results from published clinical studies into individualised treatment plans.
Most frequently, Caris Molecular Intelligence(TM) is used in metastatic disease and in unresectable primary tumours. It is most suitable for use when the patient has exhausted available treatment options; and in rare or aggressive tumours, where there is limited evidence to guide care.
Caris Molecular Intelligence(TM) is performed on paraffin-embedded tumour samples usually obtained from a recent biopsy or tumour resection. Archived specimens can also be used, although as cancer changes over time and with therapy, archived samples are not preferred.
The Caris MI Profile(TM) report provides oncologists with critical information to help them develop an individualised cancer treatment plan for each of their difficult to treat cancer patients. Tumour profiling with Caris MI has been shown to identify potentially clinically actionable targets in common and rare cancer types.[4]
Caris Molecular Intelligence has been available since 2005, and to date, over 50,000 cancer patients have received the Caris Molecular Intelligence service. In the UK, the service is available privately and negotiations with the NHS for more widespread adoption are ongoing.