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01Oct 2019

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The DRUP study in Nature: taking stock of the first three years

In 2016, the Drug Rediscovery Protocol was launched in the Netherlands. This is a unique and innovative pan-cancer clinical trial that seeks to expand the use of EMA and/or FDA-approved targeted therapies beyond their approved indications. In a Nature paper, published online on 30 September, the research team now takes stock of the progress of DRUP over the first three years. 

In the DRUP, patients with metastasized cancer without any further treatment options, are given a medicine that was registered for another cancer type.

New reimbursement model

Amongst the first 215 patients to have been treated in this way, 34% remained stable for at least 4 months or the tumour grew smaller. In one of the two cohorts to have since closed (nivolumab for MSI tumours), this percentage was actually 67%. In order to give new patients access to this latest treatment, oncologists, the National Health Care Institute, and health insurers got together to devise a new reimbursement model, one made to measure for each patient: social innovation hand in hand with scientific innovation.

There were, however, also patient groups having DNA anomalies who experienced no benefit at all from their experimental drug. "One very important aspect of DRUP is that all this information is shared, so that we can all continuously learn from it," says medical oncologist Emile Voest from the Netherlands Cancer Institute, who is one of the research leaders. 

Whole genome sequencing

The DRUP is run by the Center for Personalized Cancer Treatment, in which the Netherlands Cancer Institute, the Erasmus MC Cancer Institute, and UMC Utrecht have combined their DNA-based research since 2010. In the DRUP trial, 36 Dutch hospitals are participating. 

With support of the collaboration between the Center for Personalized Cancer Treatment and Hartwig Medical Foundation, the world's largest database of metastasised tumours was established. This database links data obtained through comprehensive DNA analysis of tumour tissue and healthy DNA with treatment outcomes - thanks to the over 6000 patients with metastasised cancer who provided fresh tissue biopsies.

Emile Voest: "When we started analysing patients' whole DNA, in 13% of them we saw DNA anomalies for which registered medicines were already available. Because tumours had never been tested this broadly before, this had never been noticed before. Now it has been." The next question was: do patients derive real benefit from medicines that, according to the database study, would be appropriate to their tumour DNA? To answer this question, the DRUP was launched in 2016. 

The research leaders of DRUP are Emile Voest (the Netherlands Cancer Institute), Henk Verheul (Radboud University Medical Centre) and Hans Gelderblom (Leiden University Medical Centre). The study is supported by the Dutch Cancer Society, the Barcode For Life foundation, the Hartwig Medical Foundation, and pharmaceutical companies interested in performing supplementary research into medicines. 

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