: A number of genomic applications for cancer have become available for assessing disease risk, prognosis, and drug response prediction, offering the promise of effective and efficient cancer care tailored to the genetic profile of the patient or disease - Genomics and Personalized Medicine (GPM). The current regulatory structure - which focuses on analytical accuracy rather than clinical validity or utility - creates a potential that genomic tests will be introduced into clinical practice without sufficient evidence supporting their value compared to standard care, or conversely that tests that provide high clinical utility and value will not be utilized or reimbursed in practice. In many cases, evidence from randomized controlled trials (RCTs) will be needed to establish clinical value. To provide useful information for decision makers, such trials will need to extend beyond traditional designs to include patient outcomes and economic evaluation. In addition, greater use of trial designs that more closely represent clinical practice, such as pragmatic trials, are needed. The National Cancer Institute (NCI)-supported cancer clinical trials Cooperative Group Program offers a compelling infrastructure for the conduct of high-quality prospective comparative effectiveness research (CER) studies of GPM applications for cancer. To maximize the impact of this infrastructure on cancer practice, it is also critical to develop methods for identifying CER topics in cancer genomics that are priorities from multiple stakeholder perspectives. In addition, to address the challenge of making innovative GPM technologies available to patients while at the same time generating high quality evidence needed by decision makers, novel shared funding mechanisms such as Coverage with Evidence Development (CED) are needed. We propose to develop a Center for Comparative Effectiveness Research in Cancer Genomics (CANCERGEN), a sustainable, multidisciplinary, collaborative consortium including the Fred Hutchinson Cancer Research Center, the Center for Medical Technology Policy, University of Washington, and the Southwest Oncology Group, one of the largest of the National Cancer Institute-supported cancer clinical trials cooperative groups in the United States. CANCERGEN will integrate expertise in decision modeling, database linkage, ethics, policy, and clinical trial design in order to leverage and build upon the existing strengths of the SWOG clinical trials network to facilitate the rapid design and implementation of prospective CER studies of GPM technologies. Moreover, CANCERGEN will create a unique and valuable partnership with the Center for Medical Technology Policy, whereby multidisciplinary stakeholders will collaborate with CANCERGEN to identify research priorities. Our vision is that CANCERGEN will overcome structural barriers that have limited the quality and timeliness of evaluations in GPM, with the result that promising technologies in the cancer genomics pipeline can move rapidly from """"""""proof of principle"""""""" to improving the effectiveness and costeffectiveness of cancer clinical care.
A variety of genomic and personalized medicine applications for cancer offer the promise of improved cancer care, but the process by which genomic tests move from development to market availability rarely generates high quality evidence supporting their clinical utility or economic value. To address this problem, we will create a Center that includes researchers from the Fred Hutchinson Cancer Research Center, the Center for Medical Technology Policy, the University of Washington, and the Southwest Oncology Group, one of the largest of the National Cancer Institute-supported cancer clinical trials cooperative groups in the United States. This collaborative network will overcome barriers that have limited the quality and timeliness of evaluations in genomics and personalized medicine, with the result that promising technologies currently in the cancer genomics pipeline can move rapidly from """"""""proof of principle"""""""" to improving the effectiveness and cost effectiveness of cancer clinical care to benefit public health.
