Community Oncology Molecular Profiling in Advanced Cancers Trial (COMPACT)
Implementation & Integration
COMPACT was the first program in Canada to provide next-generation DNA sequencing data to oncologists treating patients with advanced solid tumor malignancies. A total 836 patients from 31 Ontario hospitals and 105 community oncologists were enrolled over 3 years. Patients with clinically actionable mutations were treated in genotype-matched clinical trials. The experience gained through COMPACT helped transition NGS panel testing to standard care for lung cancer, melanoma and colon cancers and to launch an ongoing Ontario-wide study of targeted NGS testing across academic hospitals and community sites.
Objectives: The aims of this project were to: 1) provide access to molecular profiling to patients with selected advanced solid tumors; 2) identify patients with genomic alterations who may be candidates for clinical trials with new drug treatments, and; 3) uncover the challenges faced by community oncologists regarding the incorporation of genomic data into clinical care.
Methods: COMPACT was the first comprehensive molecular cancer screening program in Canada that sought to provide access to state-of-the-art molecular profiling for patients receiving cancer treatment across Ontario, by providing oncologists with specific cancer gene information to help tailor each patient’s treatment.
Results/Outcomes: A total 836 patients from 31 Ontario hospitals and 105 community oncologists were enrolled over 3 years. Molecular profiling was successfully completed for 727 patients (87%). Of these, 449 (62%) had one or more mutations identified in their cancers, and 93 (21%) of patients with mutation(s) were subsequently treated in therapeutic clinical trials at Princess Margaret Cancer Centre, including 34 (8%) who received treatment on genotype-matched clinical trials (Stockley et al Genome Medicine 2016). COMPACT broadened the infrastructure for clinical research through greater outreach and education to community oncology centres.
Potential for spread: As a result of the experience gained through this study, the University Health Network’s Advanced Molecular Diagnostic Laboratory (AMDL) transitioned targeted next generation sequencing (NGS) panels for routine clinical testing of patients with non-small cell lung, melanoma and colorectal cancers. Clinical and genomic data from the COMPACT were shared with the cancer research community through the first public release of the American Association for Cancer Research Project GENIE initiative (Cerami et al Cancer Discovery 2017).
Next Steps: The Ontario Cancer Targeted Nucleic Acid Evaluation (OCTANE) trial (NCT02906943) was launched at five academic hospitals across Ontario to enable targeted NGS testing for patients with advanced solid cancers and province-wide data sharing. Expansion to an additional 7 sites (including 5 community hospitals) is underway. Funding for this study is provided through the Ontario Institute for Cancer Research (OICR) and the Princess Margaret Cancer Foundation.