Tumor Genomic Profiling Guides Patients with Metastatic Gastric Cancer to Targeted Treatment: The VIKTORY Umbrella Trial

• Published in: Cancer discovery Vol. 9; no. 10; pp. 1388 - 1405
• Main Authors: Lee, Jeeyun, Kim, Seung Tae, Kim, Kyung, Lee, Hyuk, Kozarewa, Iwanka, Mortimer, Peter G S, Odegaard, Justin I, Harrington, Elizabeth A, Lee, Juyoung, Lee, Taehyang, Oh, Sung Yong, Kang, Jung-Hun, Kim, Jung Hoon, Kim, Youjin, Ji, Jun Ho, Kim, Young Saing, Lee, Kyoung Eun, Kim, Jinchul, Sohn, Tae Sung, An, Ji Yeong, Choi, Min-Gew, Lee, Jun Ho, Bae, Jae Moon, Kim, Sung, Kim, Jae J, Min, Yang Won, Min, Byung-Hoon, Kim, Nayoung K D, Luke, Sally, Kim, Young Hwa, Hong, Jung Yong, Park, Se Hoon, Park, Joon Oh, Park, Young Suk, Lim, Ho Yeong, Talasaz, AmirAli, Hollingsworth, Simon J, Kim, Kyoung-Mee, Kang, Won Ki
• Format: Journal Article
• Language: English
• Published: United States 01.10.2019
• ISSN: 2159-8274; 2159-8290
• DOI: 10.1158/2159-8290.CD-19-0442

The VIKTORY (targeted agent eValuation In gastric cancer basket KORea) trial was designed to classify patients with metastatic gastric cancer based on clinical sequencing and focused on eight different biomarker groups ( aberration, mutation, mutation/amplification, amplification, MET overexpression, all negative, deficient, or amplification) to assign patients to one of the 10 associated clinical trials in second-line (2L) treatment. Capivasertib (AKT inhibitor), savolitinib (MET inhibitor), selumetinib (MEK inhibitor), adavosertib (WEE1 inhibitor), and vistusertib (TORC inhibitor) were tested with or without chemotherapy. Seven hundred seventy-two patients with gastric cancer were enrolled, and sequencing was successfully achieved in 715 patients (92.6%). When molecular screening was linked to seamless immediate access to parallel matched trials, 14.7% of patients received biomarker-assigned drug treatment. The biomarker-assigned treatment cohort had encouraging response rates and survival when compared with conventional 2L chemotherapy. Circulating tumor (ctDNA) analysis demonstrated good correlation between high copy number by ctDNA and response to savolitinib. SIGNIFICANCE: Prospective clinical sequencing revealed that baseline heterogeneity between tumor samples from different patients affected response to biomarker-selected therapies. VIKTORY is the first and largest platform study in gastric cancer and supports both the feasibility of tumor profiling and its clinical utility. .