Network Integrated Platform for Clinical Trials Navigation from the New South Wales Early Phase Clinical Trials Alliance

PURPOSE: Access to early-phase clinical trials (EPCTs) is increasingly constrained by delays in genomic testing and lack of coordinated system-level navigation. The New South Wales Early Phase Clinical Trials Alliance (NECTA) was established to improve EPCT access. PANNA-COTA (Practical Assessment of NECTA Network Assistance in Cancer Outpatient Trials Access) prospectively evaluated whether integrating circulating tumour DNA (ctDNA) profiling with a real-time, cross-site molecular tumor board (MTB) facilitates EPCT enrolment. METHODS: In this multicentre prospective study across nine NECTA sites, patients referred for EPCT consideration underwent ctDNA testing using the Guardant360® 74-gene assay. Results were reviewed at a fortnightly MTB incorporating cross-site trial mapping and dynamic eligibility review. The primary endpoint was proportion enrolled into EPCTs. Secondary endpoints included ctDNA findings and trial outcomes. RESULTS: Of 104 consented participants, 101 were eligible. Participants had advanced, heavily pre-treated solid tumours; 48% lacked prior tumour NGS. ctDNA alterations were detected in 85%, with actionable alterations in 44%. Therapeutic options were identified in 88%, and EPCTs were recommended in 76%. Despite this, only 7% of participants received genomically matched therapy. In contrast, 37% enrolled in EPCTs within 3 months and 47% overall (95% CI 0.37-0.56). Among enrolled participants, disease control rate was 81% and objective response rate 33%. CONCLUSIONS: PANNA-COTA demonstrates that integrating liquid biopsy with real-time, network-level trial navigation enables high rates of EPCT enrolment despite low rates of genomically matched therapy. These findings indicate that clinical trial access is influenced by navigation, eligibility, and system-level coordination rather than genomic actionability alone.