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Treatment of Recurrent and Advanced Colorectal Cancer
Professor Peter Gibbs (Principal Investigator) and Dr Hui-li Wong
30 cancer centres across Australia and Hong Kong
The TRACC registry for patients with recurrent and advanced colorectal cancer is about to celebrate its 10 year anniversary. In that time, more than 3000 patients have been enrolled in the registry, resulting in close to 100 abstracts and publications and making a significant contribution to an under-researched clinical area.
BioGrid Australia has worked closely with the TRACC team over that time to develop, evolve and redesign the database which has been an essential element of the project’s success. Later versions of the database have enhanced functionality and allow a greater depth of data on patient treatment to be collected.
Data is collected prospectively at sites in many major Australian medical centres, as well as Hong Kong, with a focus on the outcomes of varying types of surgical and systemic treatments. The dataset also records adverse events and disease progression. Developing an understanding of how treatments are evolving over time and how patients benefit from new approaches to treatment, such as biomarker-directed therapy, in real world colorectal cancer patients will better inform clinicians in the selection of therapy.
To date, the TRACC group has authored 15 publications with 3 manuscripts currently in preparation.
An exciting recent addition to the TRACC research portfolio is ALT-TRACC, believed to be the first registry-based randomised controlled trial in oncology. Patients with previously untreated metastatic colorectal cancer are randomised to standard chemotherapy or alternating cycles of the two most active chemotherapy combinations. A number of TRACC sites are already recruiting to the trial, with more sites opening in 2019.
The majority of Australian chemotherapy-treated mCRC patients undergo RAS mutation testing, with at least 50% of RAS wild-type patients receiving an EGFRI during their treatment course.
Despite data supporting the first-line use of FOLFOXIRI, and of EGFRI in left-sided RAS wild-type mCRC, uptake of these therapies is low at most Australian centres and appears to be mostly reserved for younger patients with potentially resectable metastases.
Dr Matthew Burge is a medical oncologist working at the Royal Brisbane and Women’s Hospital and lecturing at the University of Queensland. He relies on the size and statistical strength of the TRACC database to consider treatment outcomes in advanced CRC.
“BioGrid has enabled us to create a large cross-hospital, international mCRC database,” he said.
"This year I have used TRACC to ask specific questions regarding the optimal sequencing of biological therapies and whether molecular subtypes of cancers influence recurrence rates after resection. Without BioGrid, these data could not be collated and analysed. The size of TRACC allows us to consider questions that could not be explored with patient data from one or two (institutions). BioGrid gives access to sufficient patient data to give reliable answers.”
The number of patients in the database gives us statistical power to examine standard patterns of care and patient outcome.
Dr Matthew Burge
TRACC was initiated due to the many potential benefits of collecting real world data. TRACC has received support from several sources, including Roche Australia, but functions independently of any sponsor.
For more information about TRACC go to the Australian and New Zealand Clinical Trials Registry ID: ACTRN12618000404224.
Professor Peter Gibbs is Laboratory Head, Walter and Eliza Hall Institute of Medical Research, Professor, University of Melbourne and Medical Oncologist Western Hospital.
Dr Hui-li Wong is a Clinical Research Fellow and Medical Oncologist at the Walter and Eliza Hall Institute of Medical Research, The University of Melbourne and the Peter MacCallum Cancer Centre.
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