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COMPASS showed that a fresh biopsy of advanced pancreatic cancer can be whole-genome and RNA sequenced fast enough to report before the first scan, and that classical-subtype tumours responded to first-line chemotherapy far better than basal-like ones.
Patients with advanced pancreatic ductal adenocarcinoma were prospectively recruited before first-line combination chemotherapy; fresh image-guided core biopsies underwent laser capture microdissection, whole-genome and RNA sequencing. Sixty-three patients were biopsied between December 2015 and June 2017; sequencing succeeded in 62 (98%) and 60 (95%), with results reported at a median of 35 days, meeting the feasibility endpoint. Objective responses to first-line chemotherapy were significantly better in the classical RNA subtype than the basal-like (P = 0.004), with the best progression-free survival in classical tumours on modified FOLFIRINOX. GATA6 expression by RNA in situ hybridisation was a robust surrogate for the subtypes. Potentially actionable alterations were found in 30%.
COMPASS is the prospective evidence that transcriptional subtype predicts chemotherapy response, and it produced the practical GATA6 test that trials now use to stratify.
Shares COMPASS: real-time sequencing of advanced pancreatic cancer for treatment selection, GATA6 as the marker of classical versus basal-like pancreatic cancer, Ontario Institute for Cancer Research, Princess Margaret Cancer Centre.
Shares COMPASS: real-time sequencing of advanced pancreatic cancer for treatment selection, GATA6 as the marker of classical versus basal-like pancreatic cancer, Ontario Institute for Cancer Research, Princess Margaret Cancer Centre.
Shares Clinical Cancer Research, FOLFIRINOX / mFOLFIRINOX, RNA sequencing & expression profiling, Pancreatic ductal adenocarcinoma.
Shares COMPASS: real-time sequencing of advanced pancreatic cancer for treatment selection, GATA6 as the marker of classical versus basal-like pancreatic cancer, Whole-exome & whole-genome sequencing, Pancreatic ductal adenocarcinoma.
Shares COMPASS: real-time sequencing of advanced pancreatic cancer for treatment selection, GATA6 as the marker of classical versus basal-like pancreatic cancer, FOLFIRINOX / mFOLFIRINOX, Metastatic pancreatic ductal adenocarcinoma.
Shares Ontario Institute for Cancer Research, Princess Margaret Cancer Centre.
Shares Ontario Institute for Cancer Research, Princess Margaret Cancer Centre.
Shares Ontario Institute for Cancer Research, Princess Margaret Cancer Centre, Whole-exome & whole-genome sequencing, Pancreatic ductal adenocarcinoma.