National Lung Matrix: The world’s largest precision medicine trial

At the University of Birmingham, Professor Gary Middleton is leading the world’s largest precision medicine clinical trial for non-small-cell lung cancer (NSCLC) patients. A pioneering £25m collaboration with Pfizer, AstraZeneca and other pharmaceutical companies, with support from the NHS, the National Lung Matrix Trial (NLMT) matches different treatments to different groups of patients based on genetic changes in their cancer.

NLMT uses an innovative trial design that incorporates multiple treatment arms, allowing for a more flexible and informed approach than traditional clinical trials. Each arm tests a different targeted treatment matched to a different genetic subtype of NSCLC. The trial’s adaptive approach makes it possible for new drugs and combinations to be added as soon as they become available or retired quickly and easily if evidence suggests they aren’t effective. 

Patients who sign up to take part in NLMT are genetically screened by the CRUK Stratified Medicine Programme 2 (SMP2) to understand more about their tumour type, and whether they possess the relevant genetic signatures to be matched to a targeted treatment. Importantly, if they don’t have the applicable genetic signatures to take part they will still be treated with the current standard of care for NSCLC. As of January 2020, SMP2 has genetically screened over 5500 patients and recruited over 330 to the trial.

Ultimately, NLMT is hoping to confirm that understanding the genetics of cancer can help patients get treatments that are most likely to work for them.