Research taking place in Matrix is divided into five work packages, which together will develop new personalized diagnostic and treatment options. Furthermore, patient-centred care pathways will be developed, ensuring that the “patient’s voice” is fully integrated into the entire course of treatment. Each work package is described in more detailed below.
Almost 35 000 patients are diagnosed with cancer in Norway every year, and this number will according the Cancer Registry of Norway, increase in the coming years. Most patients recover, but cancer is still the number one death cause in Norway and more than 10,000 people die annually from cancer. Thus, there is a significant need to increase the cure rate and to prolong survival. In addition, efforts to relieve distressing symptoms are called for.
A key element in modern cancer treatment is the possibility to guide patient treatment based on a detailed molecular characterization of each patient’s disease – precision cancer medicine (PCM). These molecular properties may explain why patients with the same type and stage of cancer may respond differently to the same treatment. Based on our increased understanding of cancer, the goal is to offer patients more precise and targeted diagnostics and anticancer treatment, while avoiding ineffective treatment with potentially adverse effects on Quality-of-Life (QoL).
As a national research center for clinical cancer treatment, Matrix has an overarching goal of contributing to prolonging the lives of cancer patients as well as involving the patients actively in treatment decisions and thus improving their quality of life. Fifteen hospitals from all over the country and a number of research environments are involved in the Centre.
There is great potential to improve the benefit of therapy for individual cancer patients by better patient selection through increased biological characterization of their disease, as well as by design of unique synergistic combination therapies that could give cure or overcome treatment resistance. The overall aim of WP1 is to predict treatment responses to advice optimal individualized single or poly-agent therapies for patients with hard-to-treat cancers. Deliverables include new methods, biomarkers and tools for patient stratification and follow-up. The work is split into two sub-projects:
WP1a: will utilize and develop the recently available technologies in InPreD (national network for precision diagnostics), leading to implementation of next-generation diagnostics. We will include other -omics (incl. but not limited to proteomics, flow cytometry and multiplex immunohistochemistry-based biomarkers), liquid biopsy assays as well as functional approaches like cancer drug sensitivity screening and pharmacogenomic profiling.
WP1b: will leverage new imaging (MRI and PET) technologies and methodologies such as multi-parametric scanning to gain decisive insight into resistance factors such as tumour vasculature and metabolism. Including clinic-pathological and / or molecular factors and analysis by learning algorithms (machine and deep learning), this is expected to aid the development of predictive/prognostic markers for treatment selection.
WP1 will in particular collaborate with:
InPreD – National Network for Precision Diagnostics
ACT-Centre – Centre for Advanced Cell & Gene Therapy
The CRAI-project – Computational Radiology & Artificial Intelligence
Next-generation diagnostics, including drug sensitivity screening, patient characteristics and symptomatology, imaging and omics-data, will guide the use of new and old drugs, alone and in combinations, in specified cohorts (defined by tumour type and molecular profile) of patients. Matrix will facilitate the use of material and data across trials and connect clinical investigators with appropriate research groups and core facilities, allowing for use of cutting-edge-technology and expertise within immunology, genomics, proteomics, imaging and other areas. Furthermore, interventions targeting mechanisms for tumour resistance and escape during therapy will be assessed.
This work package aim is to increase the number of available clinical trials for patients with hard-to-treat cancers. We want to both increase the number of patients included in studies, increase the number of national studies (i.e. where several hospitals are involved at the same time) and include studies within cell therapy. An overarching goal is to increase survival by using precision cancer medicine, and we therefore want to move the precision medicine approach forward in earlier lines of treatment and not just in the final phase. The work in work package 2 is divided into two sub-projects:
WP2a: is focusing on targeted treatment and precision medicine. Next-generation diagnostics will provide indications for response to specific drugs and drug combinations, and the team will therefore collaborate closely with work package 1.
WP2b: focuses on cell therapy, including products developed in-house. A pipeline for new cell therapy approaches available to larger patient populations is an integral part of the Centre.
WP2 will in particular collaborate with:
InPreD – National Network for Precision Diagnostics
ACT-senteret – Centre for Advanced Cell & Gene Therapy
The Pharma Industry
Patient-centred care focuses on the patient living with a disease, or life after treatment has ended and is achieved by asking the patient, in a systematic manner, about symptoms and functions. These are called Patient Reported Outcome Measures (PROMs). The aim is for the patients to live as well as possible, and patient-centred care is therefore adapted to the patients' individual needs, wishes and prerequisites. Patient-centred care needs to complement tumour-directed treatment in order to improve current cancer treatment. However, systematic patient-centred care is not part of the routine in clinical practice today.
The WP3 team will develop and implement patient-centred care pathways in collaboration with DNV Imatis, a Norwegian supplier of digital interaction solutions. These processes will provide both patients and health care workers with a plan for individual measures based on the patient’s self-reported, digital assessment of symptoms, problems and needs. Thus, the input is used to conclude on treatment decisions in consultation with the patient and next of kin. Patient-centred care pathways, such as pain management or nutritional problems, will be generated automatically and be available to both healthcare workers and patients. Direct communication between the parties, is part of these pathways. While work package 3 operates on a national level, corresponding international solutions are being developed in the EU-projects MyPath.
WP3 will in particular collaborate with:
MyPath – EU-project funded by the Horizon Europe programme. This project is coordinated by Prof Stein Kaasa, OUH.
DIPS og Helseplattformen – electronic journal systems in Norway.
There are several hurdles in initiating and conducting clinical trials. This is a particular challenge for academic investigators. As a result, academic trials often suffer from delayed start-up and slow patient enrollment. Matrix is in work package 4 addressing this issue by establishing a Clinical Trial Engine (CTE), a joint asset with hands-on support to investigators across the country. Speed and quality in all parts of the study, including planning, regulatory approvals, eCRF-solutions, data privacy / sharing, trial-specific logistics and multi-center trial organization, statistical analyses, data interpretation and final publication will be attended to.
The Clinical Trial Engine will offer tailored services according to the needs, which may vary. In addition to make the start-up of clinical trials more efficient, we also aim to stimulate the establishment of more decentralized studies and thus in the long term, build up expertise nationally and establish a network for clinical studies in Norway. The CTE will build on the existing Clinical Trial Office at the Dept. of Experimental Cancer Therapy at OUH, which has a track-record in setting up investigator-initiated trials. The Matrix Clinical Trial Engine will in addition interact closely with the OUH Dept. of Research Support, InPreD as well as with research support teams at other hospitals involved in Matrix.
A well-recognized obstacle for implementation of precision cancer medicine as described in the Norwegian Strategy for Personalized Medicine in Health Care, is access to employees with state-of-the-art knowledge and expertise with precision cancer medicine. There is a need to raise the competence of all types of study personnel (e.g. doctors, study nurses, project coordinators, radiation therapists). Work package 4 will therefore, in collaboration with OsloMet, develop new master courses in clinical intervention studies. Furthermore, a program in collaboration with the Health Innovation School is also planned.
WP4 will in particular collaborate with:
Research Support Teams for other hospitals in Matrix
Tumour-directed treatment focuses on the disease, i.e. the tumour. Solid research results document positive effects of systematic patient-centred care in terms of quality of life, symptom management, mental health, functional level and tolerance for tumour-directed treatment. Despite these findings, systematic patient-centred care has not yet been introduced in practice. However, WHO, ASCO and ESMO recommend that the patient's own assessment of symptoms, problems, wishes and values should be included in treatment decisions. This requires a systematic and comprehensive survey of the patient's physical, social and family situation, including the patient's understanding of his or her own illness.
Work package 5 focuses on how patient-centred care with digital, individually adapted patient processes can be implemented in the Norwegian healthcare system. This requires the introduction of digital solutions at hospital level that allow the transfer of clinical and patient-centred data faster and better than today. Work package 5 will ensure that the patient-centred care pathways are available for and used in clinical practise. A prerequisite is that they are available in the official systems used by health personnel. In addition, a direct communication flow between patient and health personnel as well as across specialties and health service levels must be possible. Furthermore, today’s routines and ways of working must be changed, and this is part of the implementation strategy in work package 5, in close collaboration with work package 3.
WP5 will in particular collaborate with:
MyPath – EU-project funded by the Horizon Europe programme. This project is coordinated by Prof Stein Kaasa, OUH.
DIPS og Helseplattformen – electronic journal systems in Norway
