NCI-COG Pediatric MATCH (APEC1621)
Pediatric MATCH was the first nationwide precision-medicine trial for children: every child with a relapsed solid tumour could have their tumour sequenced and, if a matching drug existed, join a trial arm for it. It proved the plumbing works, even though most single drugs given alone did little.
Overview
Histology-agnostic screening protocol run by NCI and COG at Children's Oncology Group sites from 2017. Tumours underwent targeted cancer-gene panel sequencing and limited immunohistochemistry; patients with a predefined actionable alteration were assigned to phase 2 arms (selumetinib, larotrectinib, ensartinib, vemurafenib, erdafitinib, tazemetostat, samotolisib, ulixertinib, palbociclib, olaparib, tipifarnib, ivosidenib, selpercatinib, among others). In the first 1,000 tumours screened, testing was completed for 94.7%, actionable alterations were found in 31.5%, and 28.4% of patients were assigned and 13.1% enrolled on a treatment arm (Parsons et al., JCO 2022). MAPK-pathway alterations were most frequent (11.2%). Most single-agent arms produced few objective responses; the selumetinib arm in MAPK-altered tumours had no responses in 20 treated patients (Eckstein et al., JCO 2022), while larotrectinib in NTRK-fusion tumours and selpercatinib in RET-altered tumours were active. Screening is closed and arms are completing follow-up. Lessons: molecular screening at relapse is feasible nationally; single-agent targeted therapy is rarely enough outside fusion drivers; combination arms and earlier-line testing are the next step.
- 31.5 out of 100 people reached this endpoint with Screened tumours.
- 13.1 out of 100 people reached this endpoint with Screened patients.
- There was no comparison group, so this number cannot tell you how much of the effect is due to the treatment.
- This endpoint is not one of the standard survival or response measures; read it alongside the trial's primary result.
- These results apply to the people the trial enrolled: Relapsed or refractory solid tumours, non-Hodgkin lymphomas and histiocytic disorders, age 1-21: tumour sequencing then assignment to one of a dozen single-agent targeted-therapy phase 2 arms. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,377 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Actionable alteration detected (first 1,000 tumours)primary | Screened tumours | 1,000 | 31.5% | — | — | link |
| Enrolled on a treatment arm | Screened patients | 1,000 | 13.1% | — | — | link |
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