The Italian Alliance Against Cancer (ACC) collaborative effort and a perspective on novel methodological approaches to Precision Oncology

Gennaro Ciliberto – Scientific Director – IRCCS Regina Elena National Cancer Institute – Rome, Italy
on behalf of the ACC network and ACC genomics.

The implementation of a precision oncology strategy at a national level is a complex multidisciplinary effort which requires the alignment of a broad screening strategy with a clinical research enterprise that will use molecular profiling data to accelerate development of new treatments. The Alliance Against Cancer (Alleanza Contro il Cancro-ACC), is a large network of more than 20 high standard
comprehensive cancer patient care and research institutes that was established in Italy in 2002. The primary aim of ACC is to promote clinical and translational research in order to bring state - of-the-art diagnostics and advanced therapeutics to patient care. Recently, ACC started to develop a nationwide genomic screening program based on implementing Next Generation Sequencing (NGS) using proprietary gene panels of increasing complexity and low costs. ACC’s most advanced application of this approach is in NSCLC. Currently, NSCLC is considered a heterogeneous disease, including rare molecularly classified lung tumors, that are susceptible to targeted inhibition. A Lung Oncochip, including the sequences of 182 genes, 139 translocations and 141 germline variants, was recently developed by ACC genomics. The initial goal of this effort is to prospectively validate the Lung Oncochip in 1000 newly diagnosed advanced NSCLC patients. This is the first nationwide Italian prospective study, evaluating the use of NGS to classify NSCLC patients. ACC is currently developing a prescription database where genomic data generated by our screening program are clinically annotated and made available to scientific and clinical investigators belonging to our network. The prescription database can be queried by clinicians for the purpose of identifying open clinical trials that best match a patient’s molecular and clinical profile. Our next goal will be utilizing the genomic information together with conduct genotype matched umbrella trials to experimental new therapies. The development of genomically selected treatments will require the availability of clinical studies to treat the large number of patients with potentially targetable alterations which will be identified through our screening efforts.