Tara Lin, M.D., director of the adult leukemia program and the site principal investigator for myeloMATCH at The University of Kansas Cancer Center.
An aggressive cancer in which the bone marrow starts producing large numbers of abnormal blood cells, acute myeloid leukemia is the most common type of acute leukemia in adults. Unfortunately, the overall five-year survival rate for the disease is 30%.
MyeloMATCH is looking to change that. A precision-medicine initiative sponsored by the National Cancer Institute, myeloMATCH (Myeloid Malignancies Molecular Analysis for Therapy Choice) is an “umbrella trial,” a group of clinical substudies for people with acute myeloid leukemia or myelodysplastic syndrome. Myelodysplastic syndrome is another blood cancer characterized by cytopenia — a reduction in the number of one or more types of blood cells — that sometimes progresses to acute myeloid leukemia.
With more than 100 participating locations, myeloMATCH is the largest coordinated effort in the United States to address these myeloid cancers and includes treatment trials and protocols developed by the Alliance for Clinical Trials in Oncology, Canadian Cancer Trials Group, ECOG-ACRIN Cancer Research Group and SWOG Cancer Research Network.
“It took a long time to get here, and it’s really exciting to see that this is a national priority for the U.S. leukemia community,” said Tara Lin, M.D., director of the adult leukemia program and the site principal investigator for myeloMATCH at The University of Kansas Cancer Center.
The multisite trial opened at KU Cancer Center and member institutions of the Masonic Cancer Alliance this summer. MyeloMATCH is open to people ages 18 or over who are believed to have acute myeloid leukemia or myelodysplastic syndrome. Participants are screened at diagnosis for specific biomarkers in their blood and bone marrow — e.g., particular gene mutations or certain proteins — and based on those results, are assigned to a myeloMATCH substudy that targets these genetic or molecular characteristics.
In addition to ensuring that participants receive treatment based on their specific disease features, Lin noted that the diagnostic testing offered by myeloMATCH takes just 72 hours, instead of weeks. “This access to rapid diagnostic information, you really can't get through any other mechanism,” she said.
If no suitable substudy exists for a participant at the time of diagnosis, that participant receives standard-of-care treatment from their physician, but they will continue to be followed by myeloMATCH and may still be eligible for a trial at a later treatment stage for their disease.
Lin is the national co-leader, along with a researcher at the University of Utah, of one of the substudies currently offered under myeloMATCH. The substudy is for acute myeloid leukemia patients under age 60 with high-risk disease that is more difficult to treat and has a higher rate of recurrence. This trial will test newer experimental treatment regimens with additional drugs against the current standard-of-care and compare the results. The hope is to find a regimen that helps increase the rate of people reaching minimal residual disease (MDR) negativity, which means they have even fewer cancer cells left than the proportion indicating that a patient has gone into remission. “We know that MDR status really predicts somebody's long-term survival,” said Lin.
Another myeloMATCH substudy is looking at adding a new drug to the treatment of patients over age 60 who have the most common gene mutation in acute myeloid leukemia, a mutation in the FLT3 gene.
“This is the first time that we have made an effort like this (for this group of cancers) in the United States, to get together and do a trial at the same time with many institutions involved,” said Jesus Gonzalez Lugo, M.D., assistant professor of hematologic malignancies and cellular therapeutics at KU Medical Center and the principal investigator for the FLT3 trial at KU Cancer Center. Gonzalez Lugo said he believes that the opportunity to be screened and participate in MyeloMATCH will be “revolutionary for our patients.”
The number of substudies offered under the myeloMATCH umbrella will grow over time. “The purpose of myeloMATCH is to become an entire pipeline of trials,” said Lin. “The long-term, big picture goal would be that every person with a new diagnosis could enroll, get rapid diagnostic screening and get assigned to a treatment, and that the myeloMATCH platform could carry them through their whole treatment trajectory.”
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