To try and avoid this Cancer Research UK (CRUK) has set up the Stratified Medicine Programme, in partnership with pharma companies and the governments Technology Strategy Board, to push towards centralised, standardised testing and quality of access for patients.
“Were trying to make sure we have one system thats got rigorous QC and QA, and that we open that system up to as many patients as possible right across the UK,” says Rowena Sharpe, CRUKs head of precision medicine, who leads the programme. “We have about 70 NHS trusts that have sent patients and samples in, and three centralised labs that do the testing.
“Those tests determine whether a patient is eligible for a large 21-arm clinical trial called the Lung Matrix Trial, which tests various combinations of biomarkers and drugs. Thats teaching us a lot about how to do genomic screening. Weve also got initiatives in colorectal cancer and breast cancer.”
One of the reasons for setting up the Stratified Medicine Programme was to demonstrate the advantages of national prescreening over local labs.
“If you run a study in just a single centre its easier to control the process and quality,” says Sharpe, “but your referral network to that centre will be severely limited, and therefore the patients that get access to it is reduced.
“If you have a larger network then you get more patients in and you retain the high quality of testing. You have a limited number of labs, they just have a large number of samples coming to them.
“We want to have multi-centre studies and make our studies as equitable as possible. One of the reasons for developing the Stratified Medicine Programme is that when our targeted therapies first came on the market we didnt have equity of access, and that gap still remains to a certain extent, but the NHS is working hard to provide the funding and support to make sure that there is access to the test for patients who need it.”
Sharpe adds that the programme has taught CRUK a lot about how to communicate with patients about precision treatments.
“We need to make sure that we inform our patients at the start of the process so that they understand fully what they are signing up to. The more that our patients understand, the better.
“Its also really important that we only give them the information that they need to hear and thats relevant to them at that point in the process. Because weve added in this extra testing step which may be followed by lots of different trial interventions depending on the patients genomic makeup, weve taken the approach of splitting that consent into two phases.
“First we approach the patient and say We will test a bit of your tumour, are you happy for us to do that?. If they go on to have a positive result they will be approached again by the clinical team to say, This is your result and it makes you eligible for this targeted therapy. Then they can talk through that intervention in more detail rather than saying up front You could go into one of 21 arms of a clinical trial. Thats just too much information.”
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