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The Front Line


The Front Line: Charles D. Blanke, MD, SWOG Chair

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DART Launch a Potential Big Win for Patients with Rare Cancers

January 20, 2017 - My first job was selling radio time advising motorists to observe the Cís: caution, courtesy, and just a little bit of...common sense. Our new DART immunotherapy trial for rare cancers has launched, and itís notable for three equally alliterative reasons: impact, ingenuity, and immunotherapy.

DART, or Dual Anti-CTLA-4 & Anti-PD-1 blockade in Rare Tumors, is a product of our early therapeutics and rare cancers committee chaired by Dr. Razelle Kurzrock. DART is testing two leading-edge agents Ė the Bristol-Myers Squibb drugs ipilimumab and nivolumab Ė on dozens of rare tumor types. Itís the first federally funded immunotherapy trial devoted to uncommon malignancies.

This trial could have a big impact. Rare tumors cumulatively make up more than 20 percent of cancers diagnosed worldwide. If these therapies prove successful in one or more tumor types, DART could point to an effective treatment option for thousands of people. Biomarker assessment, an important translational medicine component of the trial, may guide us in knowing who responds better to combination immunotherapy. Patients most likely to benefit are those under 40 Ė the demographic more likely to get a rare cancer diagnosis.

The DART design is also ingenious. For obvious reasons of scale, itís tough to identify a critical mass of a single rare cancer type in order to conduct a dedicated, focused clinical study. DART leverages NCI-MATCH to make it possible. NCI-MATCH is run by ECOG-ACRIN, our colleagues in the National Clinical Trials Network, and it uses a customized tumor gene testing method to match patients with any solid tumor with specified genetic drivers, along with lymphoma and myeloma, with 24 targeted treatments. NCI-MATCH patients who donít have a treatment option, or ones with cancers that donít respond to treatment on that trial, may be eligible to enroll in DART.

In a way, NCI-MATCH creates the haystack for DART Ė while also identifying the needles in that haystack. Itís a way to speed treatments to a population in critical need.

Finally, DART is notable for its drugs. I donít have to tell readers how hot immunotherapy is. Ipilimumab and nivolumab have FDA approval in treatment of melanoma, and the combination is currently being tested in thoracic malignancies Ė and even in a few rare cancers. Hopes are high that these agents can be used across many cancer types, even rare ones.

Congratulations Ė and thanks Ė for this innovative trial go to the entire DART study team. Dr. Sandip Patel is the principal investigator, and Dr. Young Kwang Chae is principal investigator for the translational medicine portion of the trial. This team has worked for months, guided by SWOG executive officer Dr. Chris Ryan, to create and activate DART.

To learn more, read the press release.

Note: Itís that time of year folks. The ASCO Annual Meeting will be held June 2-6, 2017 in Chicago. If youíre submitting a SWOG study abstract, please submit it to publications manager Pat Arlauskas at arlauskp@ohsu.edu no later than Jan. 25 for internal processing. Abstracts are due to ASCO by Feb. 7.

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