The ALCHEMIST Trial for Lung Cancer Patients

By Jamie E. Chaft, MD and David R. Jones, MD,

Friday, September 23, 2016

Memorial Sloan Kettering Cancer Center is proud to be participating in the Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trial (ALCHEMIST).

ALCHEMIST is a large, multicenter trial sponsored by the National Cancer Institute to assess newly available and investigational drugs for patients with early-stage non-small cell lung cancer with ALK and EGFR gene mutations.

This placebo-controlled trial is enrolling patients with completely resectable lung cancer. As at other study sites, at MSK we are collecting tumor tissue and performing tests to further our understanding of the spectrum of the disease. As part of the screening component, we are testing all tumors for mutations in EGFR and ALK, two genes that are known to drive lung cancer growth.

After receiving standard adjuvant chemotherapy, patients who have tumors with EGFR or ALK mutations will be offered the chance to participate in a study comparing a pill targeted against their cancer. Patients with the EGFR mutation will receive erlotinib (Tarceva®) or a placebo; patients with the ALK mutation will receive crizotinib (Xalkori®) or a placebo.

The objective is to see if the use of these targeted drugs after surgery can improve survival outcomes. In both arms of this trial, patients receive a targeted drug treatment or the placebo for up to two years, or until they experience unacceptable toxicity or their cancer recurs. After the treatment period, participants will be monitored for recurrence and survival.

ALCHEMIST researchers are also preparing a further therapeutic study of patients who are not eligible for one of the targeted pills. They will receive nivolumab, a postoperative immunotherapy; researchers will compare results to standard postoperative observation.

For ALCHEMIST, the overall goal is to identify actionable alterations in patients with early-stage non-small cell lung cancer and to accrue sufficient patient enrollment to power definitive analyses. In total, ALCHEMIST plans to screen up to 8,000 participants at numerous sites across the United States during a five- to six-year period. Each arm of the trial will enroll approximately 400 patients, for a total of 800 patients.

We believe that these studies have the potential to change the standard-of-care treatment for resected lung cancer.

For more information about this study and to inquire about eligibility, please contact Dr. David R. Jones at 212-639-6428.