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J Natl Compr Canc Netw. 2016 Jan;14(1):8-17.

A Distributed Network for Intensive Longitudinal Monitoring in Metastatic Triple-Negative Breast Cancer.

Author information

1
From the Center for Cancer Innovation, University of Washington, Seattle, Washington; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington; Department of Medicine/Hematology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington; RareCyte Inc., Seattle, Washington; Northwest Medical Specialities, Puyallup and Tacoma, Washington; Department of Laboratory Medicine, University of Washington, Seattle, Washington; Department of Pathology, University of Washington, Seattle, Washington; Quellos High Throughput Screening Core, Institute for Stem Cell & Regenerative Medicine, University of Washington, Seattle, Washington; Trialomics LLC, Seattle, Washington; University of California at Santa Cruz, Santa Cruz, California; Covance/LabCorp Inc., Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; School of Computer Science and Engineering, University of Washington, Seattle, Washington; and Data4Cure Inc., La Jolla, California. From the Center for Cancer Innovation, University of Washington, Seattle, Washington; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington; Department of Medicine/Hematology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington; RareCyte Inc., Seattle, Washington; Northwest Medical Specialities, Puyallup and Tacoma, Washington; Department of Laboratory Medicine, University of Washington, Seattle, Washington; Department of Pathology, University of Washington, Seattle, Washington; Quellos High Throughput Screening Core, Institute for Stem Cell & Regenerative Medicine, University of Washington, Seattle, Washington; Trialomics LLC, Seattle, Washington; University of California at Santa Cruz, Santa Cruz, California; Covance/LabCorp Inc., Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; School of Computer Science and Engineerin
2
From the Center for Cancer Innovation, University of Washington, Seattle, Washington; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington; Department of Medicine/Hematology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington; RareCyte Inc., Seattle, Washington; Northwest Medical Specialities, Puyallup and Tacoma, Washington; Department of Laboratory Medicine, University of Washington, Seattle, Washington; Department of Pathology, University of Washington, Seattle, Washington; Quellos High Throughput Screening Core, Institute for Stem Cell & Regenerative Medicine, University of Washington, Seattle, Washington; Trialomics LLC, Seattle, Washington; University of California at Santa Cruz, Santa Cruz, California; Covance/LabCorp Inc., Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; School of Computer Science and Engineering, University of Washington, Seattle, Washington; and Data4Cure Inc., La Jolla, California.

Abstract

Accelerating cancer research is expected to require new types of clinical trials. This report describes the Intensive Trial of OMics in Cancer (ITOMIC) and a participant with triple-negative breast cancer metastatic to bone, who had markedly elevated circulating tumor cells (CTCs) that were monitored 48 times over 9 months. A total of 32 researchers from 14 institutions were engaged in the patient's evaluation; 20 researchers had no prior involvement in patient care and 18 were recruited specifically for this patient. Whole-exome sequencing of 3 bone marrow samples demonstrated a novel ROS1 variant that was estimated to be present in most or all tumor cells. After an initial response to cisplatin, a hypothesis of crizotinib sensitivity was disproven. Leukapheresis followed by partial CTC enrichment allowed for the development of a differential high-throughput drug screen and demonstrated sensitivity to investigational BH3-mimetic inhibitors of BCL-2 that could not be tested in the patient because requests to the pharmaceutical sponsors were denied. The number and size of CTC clusters correlated with clinical status and eventually death. Focusing the expertise of a distributed network of investigators on an intensively monitored patient with cancer can generate high-resolution views of the natural history of cancer and suggest new opportunities for therapy. Optimization requires access to investigational drugs.

PMID:
26733551
PMCID:
PMC4970582
[Indexed for MEDLINE]
Free PMC Article

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