TRACC
Treatment of Recurrent and Advanced Colorectal Cancer — supporting better understanding of colorectal cancer treatments
Principal investigators
Professor Peter Gibbs (Principal Investigator) and Dr Hui-li Wong
Sites
30 cancer centres across Australia and Hong Kong
Colorectal cancer is the second most common cancer in the community, and the second most common cause of cancer death, so it’s important to understand what treatments are being used, how well those treatments work, and long-term outcomes for patients.
The TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) registry is designed to deliver those results.
Established by the Gibbs Lab at the Walter and Eliza Hall Institute (WEHI), TRACC has been running since 2009, and in that time has enrolled over 4000 patients, resulting in many high impact abstracts and publications. It’s also making a significant contribution to this under-researched clinical area.
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. New sites are being brought on in Singapore and Taiwan. The dataset also records adverse events and disease progression.
Over the years it has been running, new treatments and new biomarkers have been added to the TRACC database as they've become part of standard care, but the core data set hasn't changed.
Developing an understanding of how treatments are evolving over time and how new approaches to treatment, such as biomarker-directed therapy, benefit real world colorectal cancer patients will better inform clinicians in the selection of therapy.
Sharing the insights enabled by TRACC is an integral part of creating awareness of the registry’s value and ensuring clinicians can utilise the information for their patients.
“When someone comes up with an interesting question to be asked, we get permission from the data custodians at the hospitals to use their data. Our analysts will run data and produce the results and then once we have the results, we typically present it at a conference. Usually that gets followed by a research manuscript that gets submitted to a journal,” says Professor Peter Gibbs.
“The journal publication is the most important output, but the presentations at conferences are also a valuable way to disseminate the information.”
To date, the TRACC group has authored more than 25 publications, with 4-6 new papers being written every year.
BioGrid Australia’s partnership approach delivers results
BioGrid Australia has worked closely with the TRACC team to develop and evolve the database which has been an essential element of the project’s success. Over time enhancements to the database have improved its functionality and allowed a greater depth of data on patient treatment to be collected.
However it’s BioGrid’s partnership approach that provides the greatest benefit to the researchers who use TRACC.
“BioGrid’s value lies in the data linkage facility and their coverage of ethics, privacy and security, so that really takes a lot of the stress out of it for someone who's beginning to collect data. To have an expert that can walk you through what's involved and give advice and support,” says Professor Gibbs.
“They've also got great capacity in terms of database development. It wouldn't be possible to get a similar database created by someone else for the same investment, so they've definitely got an expertise which comes from time and experience in working with clinicians to create databases that are attractive, intuitive and easy to use.”
ALT-TRACC
One of the additions to the TRACC research portfolio has been ALT-TRACC, believed to be one of 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 over time, and now almost 100 patients recruited.
Biomarker testing and biomarker-directed treatment utilisation for metastatic colorectal cancer in Australian practice
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.
Uptake of first-line triplet chemotherapy and epidermal growth factor receptor inhibitors in metastatic colorectal cancer
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
TRACC is being used for an increasingly diverse range of research projects, including generating data related to consensus quality indicators, with reports provided to participating sites on their performance vs other de-identified sites. TRACC data is also being used to develop clinical calculators and decision support tools.
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.”