The American Society of Clinical Oncology and software/IT company CollabRx have formed a strategic partnership to help physicians and patients choose treatments targeted to a cancer patient’s particular molecular profile.
The partnership will focus, at first, on CollabRx’s Targeted Therapy Finder — Melanoma, a web application that allows physicians and patients to search for treatments based on the molecular characteristics of melanoma. Under the terms of the partnership, announced earlier this month, ASCO is providing CollabRx with access to its published content as base material for the company’s Melanoma Molecular Disease Model, or MMDM, a map of eight molecular subtypes that informs the TTF app.
ASCO has also made the TTF available to members through its website and to melanoma patients through the group’s patient information site cancer.net.
“[ASCO is] the preeminent channel for community oncologists in this country, both with respect to reach and reputation,” Gavin Gordon, CollabRx's vice president of business development, told PGx Reporter. “Their explicit endorsement and their content are both incredibly valuable.”
“We believe that this type of therapy finder, where you begin to link genetic testing with the appropriate drug or clinical trial, will be essential to the practice of high-quality oncology going forward,” Alan Lichter, ASCO’s CEO told PGx Reporter. “We hope to see this type of work expand over time so that it eventually covers the whole field from A to Z.”
The melanoma therapy finder is part of a larger CollabRx initiative called Cancer Commons, which aims to contribute to the development of new oncology drugs by enabling pharmaceutical companies to conduct faster and smarter clinical trials, and to reduce the number of late-stage drug failures by collecting and advancing information about the molecular heterogeneity of cancer.
TTF — Melanoma is the first application in this online hub, and is based on the MMDM, which classifies individual melanoma tumors into eight actionable molecular subtypes. CollabRx researchers in collaboration with melanoma experts published the model in March in PLoS One. But while the journal paper is static, the online description is intended to constantly evolve as a wiki-style reference, Gordon said.
A fluid resource, the model requires consistent and up-to-date access to research, along with informed curation by experts covering all wings of the field. According to Gordon, the ASCO partnership offers CollabRx enhanced and guided access to the group’s wide knowledge base and publications.
It also gives ASCO the chance to appoint one of its own members to the Cancer Commons editorial board. The society’s new voice on the board is Lynn Schuchter, a professor of medicine at the University of Pennsylvania and the editor of the melanoma section of ASCO’s cancer.net. Schucter joins 11 other scientists and clinicians on the volunteer melanoma editorial advisory board, which is responsible for curating the MMDM to date, and going forward.
“She is the window to identifying where in the ASCO knowledge database appropriate material lies and how to pull it in … in addition to contributing to editorial activities,” said Gordon.
The company intends to expand the melanoma model and similarly develop "targeted therapy finders" for other cancer types, as well. Hopefully, according to Gordon, lessons learned on melanoma can be applied to these future projects to save time and enhance accuracy.
For example, during the creation of the MMDM, researchers realized that only some of the melanoma subtypes the group identified were actionable with currently available drugs. Now the board can use that knowledge to streamline the process of identifying actionable subtypes of other cancers. (PGx Reporter 3/30/2011).
'Closing the Loop'
Currently, the MMDM reflects only the input of the melanoma board members. But the company’s plan is to build avenues for researchers, doctors, and even patients to eventually feed their experiences back into the community via new online tools.
“It would surprise me if somebody in the field didn’t look at this thing and say you forgot ‘X,’ despite the fact we tried to think of everything,” ASCO’s Lichter said.
“The biggest challenge for us right now is closing the loop,” said Gordon. "There is this paradigm, the circular system: educate, treat, capture outcomes, learn, educate, and so on. We’re very much focusing on one side of that loop right now, using the targeted therapy finder to help clinicians help their patients who are beyond the standard of care.”
The next steps will expand the other side of the circle, according to Gordon, by forming bridges between different patient discussion forums, doctors, and journal publishers who can feed their case reports back into the model. “That’s in the very near future, he said. “It is in the works.”
The company isn’t ready to announce its next steps, but Gordon said it plans to partner with an online science journal to create a system whereby physicians can rapidly publish their experiences and data, even for individual patients.
He said these small studies and anecdotal reports will still be peer reviewed, but on a significantly accelerated schedule — just a few days rather than the months involved in traditional peer-reviewed medical publishing.
More challenges arise when information comes from this wider variety of sources, Gordon said — namely, how to integrate evidence that varies widely in its reliability.
While the goal of Cancer Commons is to overcome the failure of randomized-controlled trials and address the molecularly heterogeneity of cancer, anecdotal evidence from single patients doesn’t carry the same evidentiary weight as a clinical trial. Integrating these other types of observation and testing into the initiative’s recommendations may be tricky.
“We believe this information needs to be collected and will form a vital part of how we evaluate therapies. Not so much for objective response rates, which are measured with sophisticated tests, but for many of the quality-of-life issues, patient reports are indispensable,” ASCO’s Lichter said.
According to Gordon, the paths for information to be incorporated back into the model will be routed through the editorial board in order to ensure that everything that goes into the TTF is evaluated by experts.
Describing what Cancer Commons will look like when these paths are in place, Gordon said, “anybody can post something to a forum or to a bulletin board. For example, if someone has an observation of a patient in a specific subtype, they can post that … But the model only gets updated when the moderators decide that there is enough evidence to do so, and decide how it should be modified.”
“Our goal with the therapy finder app is to allow patients to ask the right questions of their doctors — to go to the doctor and say, 'Hey look, these clinical experts told me based on this information I gave them that these are some of the drugs I should consider for my molecular subtype. What do you think?'”
In the end, getting pharmaceutical companies to take the findings from Cancer Commons and actually advance molecularly targeted drugs in genomically-defined patient subsets will be the rate limiting factor. In Gordon's view, if pharmaceutical companies were willing to pick up promising results reported by a single doctor and translate them into smaller, proof-of-concept trials, this would also offer a mechanism to evaluate and expand the evidence.
“They won’t pay for a study to evaluate whether their drug works in an off-label indication unless it’s in the formal mechanism," he noted. "However, if they see anecdotal evidence out there by named physicians, that’s an in." So far, CollabRx has not announced any formal partnerships with pharma.
The melanoma TTF was launched publicly in December and CollabRx began promoting it in January. Gordon estimates the company is probably reaching about ten percent of its target market — advanced melanoma patients — at this point.
“The response has been absolutely tremendous on the patient side, he said. “And on the physician side, with ASCO behind it, it’s really seen as seal of approval and it's really driven adoption by physicians.”
According to Gordon, the clearest sign that the TTF is impacting physicians and ASCO members in particular is that CollabRx is accelerating its application rollout plan with ASCO. He said the partners will have a "major announcement" in this regard at the end of May.
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