The first phase of our project has been funded by a substantial grant from the Norwegian Research Council, under the Program for publicly initiated clinical cancer studies. The scond phase is funded by their BIOTEK 2021 programme. We are applying for more funds towards our more ambitious long-term goals.

After the presentation at Cancer Crosslinks in January, our national strategy for genomics-based cancer medicine gets international attention.

Interview Ragnhild Lothe and Ola Myklebost in NRK Morning News, Feb 8th 2012, and with CEO of Oslo Cancer Cluster Jónas Einarsson on personalised cancer medicine on Norwegian TV2

Introduction

While adjuvant chemotherapy has improved long-term survival for many types of cancer, the fact that many patients relapse despite optimal treatment underlines the limitations of con-temporary therapy. The mechanisms of chemoresistance in general are poorly under¬stood; thus, we are unable to predict who will benefit or not from treatments.

Over the last decades, a number of “targeted therapies” have been approved for certain histologically defined cancers. These therapies target defined goals such as the HER-2 proto-oncogene; thus, they are effective only in cancers harboring certain gene aberrations. Notably, even among patients with tumor harboring the targeted defects, many may not respond to treatment, and eventually relapse. These findings underline the need for a wider mutation analysis to define the gene defects responsible also for drug resistance with respect to all forms of anticancer therapies.

The accumulated data on tumour mutation spectra and outcome from traditional therapies will also yield important knowledge on which of the patients are likely to benefit from such therapy, and for whom other options need to be considered. Additionally, sequencing of the constitutional (normal) DNA will enable the identification of predisposition to acute and late adverse effects.

This project is a national research collaboration among regional cancer centres as visioned by the National Coordination Group for Research in the Health Service (NSG). The main long-term objective of this joint effort is to contribute to a national diagnostic service for all Norwegian cancer patients. In addition to the strong representation of clinical groups, we have involved some of strongest national networks in medical genomics, the Norwegian Microarray Consortium and the FUGE Bioinformatics Platform, with proven experience in the relevant deep sequencing of cancer mutations, as well as the CancerBioMedicine Centre of Excellence and the Norwegian Cancer Registry.

The aims of the project is to reach five specific end-points within the first three years: 1) to investigate the mutations of known actionable genes (where treatments exist) and all kinase genes (for which multiple inhibitory drugs are available or in development) across several important cancer types using existing biobanks (9 cancer types, 3000 patients); 2) establish sampling procedures and sample logistics, bioinformatics infrastructure, analysis and pipelines, as well as procedures for feedback to the treating centres and the Cancer Registry; 3) initiate clinical prospective studies based on biological hypotheses including two or more participating centres (1000 patients); and 4) implementation of phase 1 and 2 studies based on initial findings and current know-how; and 5) educational efforts towards the health service and patients. Throughout the study, the data generated will be evaluated by scientists, clinicians and pathologists, but also by experts in health economy.