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Shah PS, Hughes EG, Sukhadia SS, Green DC, Houde BE, Tsongalis GJ, Tafe LJ. Validation and Implementation of a Somatic-Only Tumor Exome for Routine Clinical Application. J Mol Diagn 2024:S1525-1578(24)00151-X. [PMID: 38972591 DOI: 10.1016/j.jmoldx.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/13/2024] [Accepted: 05/30/2024] [Indexed: 07/09/2024] Open
Abstract
Next-generation sequencing-based genomic testing is standard of care for tumor workflows. However, its application across different institutions continues to be challenging given the diversity of needs and resource availability among different institutions globally. Moreover, the use of a variety of different panels, including those from a few individual genes to those involving hundreds of genes, results in a relatively skewed distribution of care for patients. It is imperative to obtain a higher level of standardization without having to be restricted to specific kits or requiring repeated validations, which are generally expensive. We show the validation and clinical implementation of the DH-CancerSeq assay, a tumor-only whole-exome-based sequencing assay with integrated informatics, while providing similar input requirements, sensitivity, and specificity to a previously validated targeted gene panel and maintaining similar turnaround times for patient care.
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Affiliation(s)
- Parth S Shah
- Laboratory for Clinical Genomics and Advanced Technology, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Genome Informatics, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Edward G Hughes
- Laboratory for Clinical Genomics and Advanced Technology, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Shrey S Sukhadia
- Laboratory for Clinical Genomics and Advanced Technology, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Genome Informatics, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Donald C Green
- Laboratory for Clinical Genomics and Advanced Technology, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Brianna E Houde
- Laboratory for Clinical Genomics and Advanced Technology, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Gregory J Tsongalis
- Laboratory for Clinical Genomics and Advanced Technology, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Laura J Tafe
- Laboratory for Clinical Genomics and Advanced Technology, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
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El Helali A, Lam TC, Ko EYL, Shih DJ, Chan CK, Wong CH, Wong JW, Cheung LW, Lau JK, Liu AP, Chan AS, Loong HH, Lam STS, Chan GCF, Lee VH, Yuen KK, Ng WT, Lee AW, Ma ES. The impact of the multi-disciplinary molecular tumour board and integrative next generation sequencing on clinical outcomes in advanced solid tumours. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100775. [PMID: 37547050 PMCID: PMC10398587 DOI: 10.1016/j.lanwpc.2023.100775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 08/08/2023]
Abstract
Background The integration of next-generation sequencing (NGS) comprehensive gene profiling (CGP) into clinical practice is playing an increasingly important role in oncology. Therefore, the HKU-HKSH Multi-disciplinary Molecular Tumour Board (MTB) was established to advance precision oncology in Hong Kong. A multicenter retrospective study investigated the feasibility of the HKU-HKSH MTB in determining genome-guided therapy for treatment-refractory solid cancers in Hong Kong. Methods Patients who were presented at the HKU-HKSH MTB between August 2018 and June 2022 were included in this study. The primary study endpoints were the proportion of patients who receive MTB-guided therapy based on genomic analysis and overall survival (OS). Secondary endpoints included the proportion of patients with actionable genomic alterations, objective response rate (ORR), and disease control rate (DCR). The Kaplan-Meier method was used in the survival analyses, and hazard ratios were calculated using univariate Cox regression. Findings 122 patients were reviewed at the HKU-HKSH MTB, and 63% (n = 77) adopted treatment per the MTB recommendations. These patients achieved a significantly longer median OS than those who did not receive MTB-guided therapy (12.7 months vs. 5.2 months, P = 0.0073). Their ORR and DCR were 29% and 65%, respectively. Interpretation Our study demonstrated that among patients with heavily pre-treated advanced solid cancers, MTB-guided treatment could positively impact survival outcomes, thus illustrating the applicability of NGS CGPs in real-world clinical practice. Funding The study was supported by the Li Shu Pui Medical Foundation. Dr Aya El Helali was supported by the Li Shu Pui Medical Foundation Fellowship grant from the Li Shu Pui Medical Foundation. Funders had no role in study design, data collection, data analysis, interpretation, or writing of the report.
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Affiliation(s)
- Aya El Helali
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Oncology Medical Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Tai-Chung Lam
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Oncology Medical Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Elaine Yee-Ling Ko
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - David J.H. Shih
- School of Biomedical Science, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chun Kau Chan
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Charlene H.L. Wong
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Oncology Medical Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Jason W.H. Wong
- School of Biomedical Science, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lydia W.T. Cheung
- School of Biomedical Science, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Johnny K.S. Lau
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Oncology Medical Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Anthony P.Y. Liu
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ann S.Y. Chan
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - Herbert H. Loong
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Stephen Tak Sum Lam
- Clinical Genetics Service, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Godfrey Chi-Fung Chan
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Victor H.F. Lee
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Oncology Medical Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Kwok Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - Wai-Tong Ng
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Oncology Medical Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Anne W.M. Lee
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Oncology Medical Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Edmond S.K. Ma
- Division of Clinical Pathology & Molecular Pathology, Hong Kong Sanatorium Hospital, Hong Kong SAR, China
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3
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Martin-Sanchez F, Lázaro M, López-Otín C, Andreu AL, Cigudosa JC, Garcia-Barbero M. Personalized Precision Medicine for Health Care Professionals: Development of a Competency Framework. JMIR MEDICAL EDUCATION 2023; 9:e43656. [PMID: 36749626 PMCID: PMC9943053 DOI: 10.2196/43656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Personalized precision medicine represents a paradigm shift and a new reality for the health care system in Spain, with training being fundamental for its full implementation and application in clinical practice. In this sense, health care professionals face educational challenges related to the acquisition of competencies to perform their professional practice optimally and efficiently in this new environment. The definition of competencies for health care professionals provides a clear guide on the level of knowledge, skills, and attitudes required to adequately carry out their professional practice. In this context, this acquisition of competencies by health care professionals can be defined as a dynamic and longitudinal process by which they use knowledge, skills, attitudes, and good judgment associated with their profession to develop it effectively in all situations corresponding to their field of practice. OBJECTIVE This report aims to define a proposal of essential knowledge domains and common competencies for all health care professionals, which are necessary to optimally develop their professional practice within the field of personalized precision medicine as a fundamental part of the medicine of the future. METHODS Based on a benchmark analysis and the input and expertise provided by a multidisciplinary group of experts through interviews and workshops, a new competency framework that would guarantee the optimal performance of health care professionals was defined. As a basis for the development of this report, the most relevant national and international competency frameworks and training programs were analyzed to identify aspects that are having an impact on the application of personalized precision medicine and will be considered when developing professional competencies in the future. RESULTS This report defines a framework made up of 58 competencies structured into 5 essential domains: determinants of health, biomedical informatics, practical applications, participatory health, and bioethics, along with a cross-cutting domain that impacts the overall performance of the competencies linked to each of the above domains. Likewise, 6 professional profiles to which this proposal of a competency framework is addressed were identified according to the area where they carry out their professional activity: health care, laboratory, digital health, community health, research, and management and planning. In addition, a classification is proposed by progressive levels of training that would be advisable to acquire for each competency according to the professional profile. CONCLUSIONS This competency framework characterizes the knowledge, skills, and attitudes required by health care professionals for the practice of personalized precision medicine. Additionally, a classification by progressive levels of training is proposed for the 6 professional profiles identified according to their professional roles.
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Affiliation(s)
- Fernando Martin-Sanchez
- Department of Biomedical Informatics and Digital Health, National Institute of Health Carlos III, Madrid, Spain
| | - Martín Lázaro
- Department of Medical Oncology, University Hospital Complex of Vigo, Vigo, Spain
| | | | - Antoni L Andreu
- European Infrastructure for Translational Medicine, Amsterdam, Netherlands
| | - Juan Cruz Cigudosa
- Department of University, Innovation and Digital Transformation, the Government of Navarra, Navarra, Spain
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Kahraman A, Arnold FM, Hanimann J, Nowak M, Pauli C, Britschgi C, Moch H, Zoche M. MTPpilot: An Interactive Software for Visualization of Next-Generation Sequencing Results in Molecular Tumor Boards. JCO Clin Cancer Inform 2022; 6:e2200032. [PMID: 36007219 PMCID: PMC9470140 DOI: 10.1200/cci.22.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Comprehensive targeted next-generation sequencing (NGS) panels are routinely used in modern molecular cancer diagnostics. In molecular tumor boards, the detected genomic alterations are often discussed to decide the next treatment options for patients with cancer. With the increasing size and complexity of NGS panels, the discussion of these results becomes increasingly complex, especially if they are reported in a text-based form, as it is the standard in current molecular pathology.
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Affiliation(s)
- Abdullah Kahraman
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Fabian M Arnold
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Jacob Hanimann
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Marta Nowak
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Chantal Pauli
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian Britschgi
- Department of Medical Oncology and Hematology, Comprehensive Cancer Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Zoche
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
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Heinrich K, Miller-Phillips L, Ziemann F, Hasselmann K, Rühlmann K, Flach M, Biro D, von Bergwelt-Baildon M, Holch J, Herold T, von Baumgarten L, Greif PA, Jeremias I, Wuerstlein R, Casuscelli J, Spitzweg C, Seidensticker M, Renz B, Corradini S, Baumeister P, Goni E, Tufman A, Jung A, Kumbrink J, Kirchner T, Klauschen F, Metzeler KH, Heinemann V, Westphalen CB. Lessons learned: the first consecutive 1000 patients of the CCCMunich LMU Molecular Tumor Board. J Cancer Res Clin Oncol 2022; 149:1905-1915. [PMID: 35796778 PMCID: PMC9261163 DOI: 10.1007/s00432-022-04165-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/18/2022] [Indexed: 12/04/2022]
Abstract
Purpose In 2016, the University of Munich Molecular Tumor Board (MTB) was implemented to initiate a precision oncology program. This review of cases was conducted to assess clinical implications and functionality of the program, to identify current limitations and to inform future directions of these efforts. Methods Charts, molecular profiles, and tumor board decisions of the first 1000 consecutive cases (01/2016–03/2020) were reviewed. Descriptive statistics were applied to describe relevant findings. Results Of the first 1000 patients presented to the MTB; 914 patients received comprehensive genomic profiling. Median age of patients was 56 years and 58% were female. The most prevalent diagnoses were breast (16%) and colorectal cancer (10%). Different types of targeted or genome-wide sequencing assays were used; most of them offered by the local department of pathology. Testing was technically successful in 88%. In 41% of cases, a genomic alteration triggered a therapeutic recommendation. The fraction of patients receiving a tumor board recommendation differed significantly between malignancies ranging from over 50% in breast or biliary tract to less than 30% in pancreatic cancers. Based on a retrospective chart review, 17% of patients with an MTB recommendation received appropriate treatment. Conclusion Based on these retrospective analyses, patients with certain malignancies (breast and biliary tract cancer) tend to be more likely to have actionable variants. The low rate of therapeutic implementation (17% of patients receiving a tumor board recommendation) underscores the importance of meticulous follow-up for these patients and ensuring broad access to innovative therapies for patients receiving molecular tumor profiling. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-022-04165-0.
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Affiliation(s)
- Kathrin Heinrich
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Lisa Miller-Phillips
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Frank Ziemann
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Korbinian Hasselmann
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Katharina Rühlmann
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, Munich, Germany
| | - Madeleine Flach
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, Munich, Germany
| | - Dorottya Biro
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Julian Holch
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Tobias Herold
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurology and Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University, Munich, Germany
| | - Philipp A Greif
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Irmela Jeremias
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Apoptosis in Hematopoietic Stem Cells, Helmholtz Center Munich, German Center for Environmental Health (HMGU), Munich, Germany
- Department of Pediatrics, Dr Von Hauner Children's Hospital, LMU, Munich, Germany
| | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Jozefina Casuscelli
- Department of Urology and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Christine Spitzweg
- Department of Medicine IV and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Bernhard Renz
- Department of General, Visceral und Transplantation Surgery and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Philipp Baumeister
- Department of Otorhinolaryngology, Head and Neck Surgery and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Elisabetta Goni
- Department of Medicine II and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Amanda Tufman
- Department of Medicine V and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Andreas Jung
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, Munich, Germany
- Institute of Pathology, Ludwig Maximilians University (LMU), Munich, Germany
| | - Jörg Kumbrink
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, Munich, Germany
- Institute of Pathology, Ludwig Maximilians University (LMU), Munich, Germany
| | - Thomas Kirchner
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, Munich, Germany
- Institute of Pathology, Ludwig Maximilians University (LMU), Munich, Germany
| | - Frederick Klauschen
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, Munich, Germany
- Institute of Pathology, Ludwig Maximilians University (LMU), Munich, Germany
| | - Klaus H Metzeler
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Hematology, Cell Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Volker Heinemann
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, Munich, Germany
| | - C Benedikt Westphalen
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital Munich, Munich, Germany.
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Behel V, Noronha V, Choughule A, Shetty O, Chandrani P, Kapoor A, Bondili SK, Bajpai J, Kumar R, Pai T, Bal M, Gurav M, Bapat P, Mittal N, Menon S, Patil V, Menon N, Dutt A, Prabhash K. Impact of Molecular Tumor Board on the Clinical Management of Patients With Cancer. JCO Glob Oncol 2022; 8:e2200030. [PMID: 35802838 PMCID: PMC9296182 DOI: 10.1200/go.22.00030] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Multidisciplinary molecular tumor boards (MTBs) help in interpreting complex genomic data generated by molecular tumor profiling and improve patients' access to targeted therapies. The purpose of this study was to assess the impact of our institution's MTB on the clinical management of patients with cancer. METHODS This study was conducted at a tertiary cancer center in India. Cases to be discussed in the MTB were identified by molecular pathologists, scientists, or oncologists. On the basis of the clinical data and molecular test reports, a course of clinical management was recommended and made available to the treating oncologist. We determined the proportion of patients who were recommended a change in the clinical management. We also assessed compliance of the treating oncologists with MTB recommendations. RESULTS There were 339 discussions for 328 unique patients. The median age of the cohort was 54 years (range 17-87), and the majority of the patients were men (65.1%). Of 339 cases, 133 (39.2%) were recommended continuation of ongoing therapy while the remaining 206 (60.7%) were recommended a change in clinical management. Compliance with MTB recommendations for a change in clinical management was 58.5% (79 of 138 evaluable cases). Compliance and implementation for MTB's recommendation to start a new therapy in 104 evaluable cases were 60.5% and 44.2%, respectively. A total of 248 biopsies had at least one actionable mutation. A total of 646 mutations were identified in the cohort, with EGFR being the most frequently altered gene. CONCLUSION MTBs help in interpreting results of molecular tests, understanding the significance of molecular abnormalities, and assessing the benefits of available targeted therapies and clinical trials in the management of patients with targetable genetic alterations.
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Affiliation(s)
- Vichitra Behel
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Choughule
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Omshree Shetty
- Homi Bhabha National Institute, Mumbai, India
- Department of Molecular Pathology, Tata Memorial Hospital, Mumbai, India
| | - Pratik Chandrani
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
- Homi Bhabha Cancer Hospital, Varanasi, India
| | - Suresh Kumar Bondili
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Rajiv Kumar
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Trupti Pai
- Homi Bhabha National Institute, Mumbai, India
- Department of Molecular Pathology, Tata Memorial Hospital, Mumbai, India
| | - Munita Bal
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Mamta Gurav
- Homi Bhabha National Institute, Mumbai, India
- Department of Molecular Pathology, Tata Memorial Hospital, Mumbai, India
| | - Prachi Bapat
- Homi Bhabha National Institute, Mumbai, India
- Department of Molecular Pathology, Tata Memorial Hospital, Mumbai, India
| | - Neha Mittal
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Santosh Menon
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Amit Dutt
- Homi Bhabha National Institute, Mumbai, India
- Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
- Kumar Prabhash, Department of Medical Oncology, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai - 400 012, Maharashtra, India; e-mail:
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7
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Peh KH, Przybylski DJ, Fallon MJ, Bergsbaken JJ, Hutson PR, Yu M, Deming DA, Burkard ME. Clinical utility of a regional precision medicine molecular tumor board and challenges to implementation. J Oncol Pharm Pract 2022:10781552221091282. [DOI: 10.1177/10781552221091282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose Molecular tumor boards provide precision treatment recommendations based on cancer genomic profile. However, practical barriers limit their benefits. We studied the clinical utility of the precision medicine molecular tumor board (PMMTB) and described challenges with PMMTB implementation. Methods An observational cohort study included patients reviewed by the PMMTB between September 2015 to December 2017. Patients who had consented to the registry study were included. The primary endpoint of this study was time on treatment (ToT) ratio. Clinical utility was established if the primary endpoint had least 15% of patients achieving a ToT ratio of ≥1.3. Results Overall, 278 patients were presented to the PMMTB and 113 cases were included in the final analysis. The PMMTB identified at least one nonstandard of care (SOC) clinically actionable mutation for 69.0% (78/113) of cases. In patients who received non-SOC treatment, 43.8% (7/16) achieved a ToT ratio of 1.3 or more (p < 0.001). Fifty-nine patients did not receive non-SOC recommendations. Reasons for not pursuing treatment included 35.6% having response to current treatment, 20.3% died prior to starting or considering PMMTB recommendations, 13.6% pursued other treatment options based on clinician discretion, another 10.2% pursued other treatment options because clinical trials recommended were not geographically accessible, 8.5% had rapid decline of performance status, 6.8% lacked of financial support for treatment, and 5.1% were excluded from clinical trials due to abnormal laboratory values. Conclusion The regional PMMTB non-SOC recommendations benefitted a majority of patients and additional processes were implemented to assist with non-SOC treatment accessibility.
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Affiliation(s)
- Keng Hee Peh
- University of Kentucky College of Pharmacy, Lexington, KY, United States
| | | | | | | | - Paul R Hutson
- School of Pharmacy, University of Wisconsin - Madison, Madison, WI, United States
| | - Menggang Yu
- University of Wisconsin Carbone Cancer Center, Madison, WI, United States
| | - Dustin A Deming
- University of Wisconsin Carbone Cancer Center, Madison, WI, United States
- Department of Medicine, Hematology/Oncology and McArdle Laboratories, University of Wisconsin, Madison, WI, United States
| | - Mark E Burkard
- University of Wisconsin Carbone Cancer Center, Madison, WI, United States
- Department of Medicine, Hematology/Oncology and McArdle Laboratories, University of Wisconsin, Madison, WI, United States
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Cannon TL, Knopp L, Wang H, DeMarco T, Jessup JM, Randall J, Kim E, Trump DL. Patient attendance at molecular tumor board: A new means of shared decision making? Curr Probl Cancer 2022; 46:100860. [DOI: 10.1016/j.currproblcancer.2022.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
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Huehn M, Gaebel J, Oeser A, Dietz A, Neumuth T, Wichmann G, Stoehr M. Bayesian Networks to Support Decision-Making for Immune-Checkpoint Blockade in Recurrent/Metastatic (R/M) Head and Neck Squamous Cell Carcinoma (HNSCC). Cancers (Basel) 2021; 13:cancers13235890. [PMID: 34884998 PMCID: PMC8657168 DOI: 10.3390/cancers13235890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Tumor therapy in many human malignancies, including head and neck cancer, is increasingly demanding due to advances in diagnostics and individualized treatments. Multidisciplinary tumor boards, especially molecular tumor boards, consider a great amount of information to find the optimal treatment decision. Clinical decision support systems can help in optimizing this complex decision-making process. We designed a digital patient model based on conditional probability algorithms as Bayesian networks to support the decision-making process regarding treatment with approved immunotherapeutic agents (Nivolumab and Pembrolizumab). The model is able to process relevant clinical information to recommend a certain immunotherapeutic agent based on literature, approval, and guidelines. Abstract New diagnostic methods and novel therapeutic agents spawn additional and heterogeneous information, leading to an increasingly complex decision-making process for optimal treatment of cancer. A great amount of information is collected in organ-specific multidisciplinary tumor boards (MDTBs). By considering the patient’s tumor properties, molecular pathological test results, and comorbidities, the MDTB has to consent an evidence-based treatment decision. Immunotherapies are increasingly important in today’s cancer treatment, resulting in detailed information that influences the decision-making process. Clinical decision support systems can facilitate a better understanding via processing of multiple datasets of oncological cases and molecular genetic information, potentially fostering transparency and comprehensibility of available information, eventually leading to an optimum treatment decision for the individual patient. We constructed a digital patient model based on Bayesian networks to combine the relevant patient-specific and molecular data with depended probabilities derived from pertinent studies and clinical guidelines to calculate treatment decisions in head and neck squamous cell carcinoma (HNSCC). In a validation analysis, the model can provide guidance within the growing subject of immunotherapy in HNSCC and, based on its ability to calculate reliable probabilities, facilitates estimation of suitable therapy options. We compared actual treatment decisions of 25 patients with the calculated recommendations of our model and found significant concordance (Cohen’s κ = 0.505, p = 0.009) and 84% accuracy.
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Affiliation(s)
- Marius Huehn
- Head and Neck Surgery, Department of Otorhinolaryngology, University Hospital Leipzig, 04103 Leipzig, Germany; (M.H.); (A.D.); (G.W.)
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, University Leipzig, 04103 Leipzig, Germany; (J.G.); (A.O.); (T.N.)
| | - Jan Gaebel
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, University Leipzig, 04103 Leipzig, Germany; (J.G.); (A.O.); (T.N.)
| | - Alexander Oeser
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, University Leipzig, 04103 Leipzig, Germany; (J.G.); (A.O.); (T.N.)
| | - Andreas Dietz
- Head and Neck Surgery, Department of Otorhinolaryngology, University Hospital Leipzig, 04103 Leipzig, Germany; (M.H.); (A.D.); (G.W.)
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, University Leipzig, 04103 Leipzig, Germany; (J.G.); (A.O.); (T.N.)
| | - Gunnar Wichmann
- Head and Neck Surgery, Department of Otorhinolaryngology, University Hospital Leipzig, 04103 Leipzig, Germany; (M.H.); (A.D.); (G.W.)
| | - Matthaeus Stoehr
- Head and Neck Surgery, Department of Otorhinolaryngology, University Hospital Leipzig, 04103 Leipzig, Germany; (M.H.); (A.D.); (G.W.)
- Correspondence: ; Tel.: +49-341-97-21700
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Jain NM, Schmalz L, Cann C, Holland A, Osterman T, Lang K, Wiesner GL, Pal T, Lovly C, Stricker T, Micheel C, Balko JM, Johnson DB, Park BH, Iams W. Framework for Implementing and Tracking a Molecular Tumor Board at a National Cancer Institute-Designated Comprehensive Cancer Center. Oncologist 2021; 26:e1962-e1970. [PMID: 34390291 PMCID: PMC8571748 DOI: 10.1002/onco.13936] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Over the past few years, tumor next-generation sequencing (NGS) panels have evolved in complexity and have changed from selected gene panels with a handful of genes to larger panels with hundreds of genes, sometimes in combination with paired germline filtering and/or testing. With this move toward increasingly large NGS panels, we have rapidly outgrown the available literature supporting the utility of treatments targeting many reported gene alterations, making it challenging for oncology providers to interpret NGS results and make a therapy recommendation for their patients. METHODS To support the oncologists at Vanderbilt-Ingram Cancer Center (VICC) in interpreting NGS reports for patient care, we initiated two molecular tumor boards (MTBs)-a VICC-specific institutional board for our patients and a global community MTB open to the larger oncology patient population. Core attendees include oncologists, hematologist, molecular pathologists, cancer geneticists, and cancer genetic counselors. Recommendations generated from MTB were documented in a formal report that was uploaded to our electronic health record system. RESULTS As of December 2020, we have discussed over 170 patient cases from 77 unique oncology providers from VICC and its affiliate sites, and a total of 58 international patient cases by 25 unique providers from six different countries across the globe. Breast cancer and lung cancer were the most presented diagnoses. CONCLUSION In this article, we share our learning from the MTB experience and document best practices at our institution. We aim to lay a framework that allows other institutions to recreate MTBs. IMPLICATIONS FOR PRACTICE With the rapid pace of molecularly driven therapies entering the oncology care spectrum, there is a need to create resources that support timely and accurate interpretation of next-generation sequencing reports to guide treatment decision for patients. Molecular tumor boards (MTB) have been created as a response to this knowledge gap. This report shares implementation strategies and best practices from the Vanderbilt experience of creating an institutional MTB and a virtual global MTB for the larger oncology community. This report describe a reproducible framework that can be adopted to initiate MTBs at other institutions.
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Affiliation(s)
- Neha M. Jain
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Christopher Cann
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Adara Holland
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Travis Osterman
- Division of Hematology/Oncology, Vanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Biomedical Informatics, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Katie Lang
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Georgia L. Wiesner
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Tuya Pal
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
- Division of Hematology/Oncology, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Christine Lovly
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Thomas Stricker
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Christine Micheel
- Division of Hematology/Oncology, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Justin M. Balko
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Douglas B. Johnson
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ben Ho Park
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
- Division of Hematology/Oncology, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Wade Iams
- Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical CenterNashvilleTennesseeUSA
- Division of Hematology/Oncology, Vanderbilt University Medical CenterNashvilleTennesseeUSA
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11
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Angel MO, Pupareli C, Soule T, Tsou F, Leiva M, Losco F, Esteso F, O Connor JM, Luca R, Petracci F, Girotti R, Mahmoud YD, Martín C, Chacón M. Implementation of a molecular tumour board in LATAM: the impact on treatment decisions for patients evaluated at Instituto Alexander Fleming, Argentina. Ecancermedicalscience 2021; 15:1312. [PMID: 35047063 PMCID: PMC8723751 DOI: 10.3332/ecancer.2021.1312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The role of the molecular tumour board (MTB) is to recommend personalised therapy for patients with cancer beyond standard-of-care treatment. A comprehensive molecular analysis of the tumour in a molecular pathology laboratory is important for all targeted therapies approaches. Here we report the 1-year experience of the Instituto Alexander Fleming Molecular Tumour Board. PATIENTS AND METHODS The MTB of the Instituto Alexander Fleming was launched in December 2019 in a monthly meeting. In each interactive monthly session, five cases were presented and discussed by the members. These cases were referred by the treating oncologists. The MTB recommendations were sent to each physician individually, and to the rest of the meeting participants. This was discussed with the patients/families by the treating oncologist. The final decision to choose therapy was left to the treating physicians. Of the 32 patients presented at MTB, 28 (87.5%) had potentially actionable alterations and only 4 (12.5%) had no actionable mutation. Six (19%) patients received a local regulatory agency approved drug recommendation, nine (28%) patients received an off-label approval treatment recommendation and three (9%) patients did not receive the treatment due to access and reimbursement of the drug. CONCLUSION In most of the cases evaluated, the MTB was able to provide treatment recommendations based on targetable genetic alterations. Molecular-guided extended personalised patient care is effective for a small but clinically significant proportion of patients in challenging clinical situations. We believe that the implementation of a MTB is feasible in the Latin America (LATAM) region.
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Affiliation(s)
- Martín Osvaldo Angel
- Genitourinary Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0002-1463-8887
| | - Carmen Pupareli
- Thoracic Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
| | - Tomas Soule
- Sarcoma and Melanoma Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
| | - Florencia Tsou
- Thoracic Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0002-0322-0434
| | - Mariano Leiva
- Head and Neck Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
| | - Federico Losco
- Genitourinary Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0001-5084-3012
| | - Federico Esteso
- Gastrointestinal Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0003-1977-9846
| | - Juan Manuel O Connor
- Gastrointestinal Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0002-6975-5466
| | - Romina Luca
- Gastrointestinal Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
| | - Fernando Petracci
- Breast Cancer Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0002-7701-3331
| | - Romina Girotti
- Laboratorio de Inmuno-Oncología Traslacional, Instituto de Biología y Medicina Experimental (IBYME), Vuelta de Obligado 2490, Ciudad Autonoma de Buenos Aires, C1428ADN, Argentina
| | - Yamil Damián Mahmoud
- Laboratorio de Inmuno-Oncología Traslacional, Instituto de Biología y Medicina Experimental (IBYME), Vuelta de Obligado 2490, Ciudad Autonoma de Buenos Aires, C1428ADN, Argentina
- https://orcid.org/0000-0001-7254-5892
| | - Claudio Martín
- Thoracic Oncology Unit, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0003-4135-7332
| | - Matías Chacón
- Clinical Oncology, Instituto Alexander Fleming, Cramer 1180, Ciudad Autonoma de Buenos Aires, C1426ANZ, Argentina
- https://orcid.org/0000-0001-6872-4185
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Niogret J, Dalens L, Truntzer C, Chevrier S, Favier L, Lagrange A, Coudert B, Fraisse C, Foucher P, Zouak A, Westeel V, Goussot V, Dérangère V, Albuisson J, Arnould L, Boidot R, Kaderbhai CG, Ghiringhelli F. Does large NGS panel analysed using exome tumour sequencing improve the management of advanced non-small-cell lung cancers? Lung Cancer 2021; 161:98-107. [PMID: 34560426 DOI: 10.1016/j.lungcan.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/02/2021] [Accepted: 08/24/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Non-small-cell lung cancer (NSCLC) is one of the most common and deadly cancers. Several molecular drivers of oncogene addiction are now known to be strong predictive biomarkers for target therapies. Advances in large Next Generation Sequencing (LNGS) have improved the ability to detect potentially targetable mutations. However, the integration of LNGS into clinical management in an individualized manner remains challenging. METHODS In this single-center observational study we included all patients with advanced NSCLC who underwent LNGS. Somatic and germline exome analysis was performed with a restriction on 323 cancer related genes. Variants were classified and Molecular Tumour Board (MTB) made therapeutic propositions. RESULTS We performed LNGS analysis in 281 patients with advanced NSCLC between March 2015 and January 2018. Technical failure occurred in only 3% of cases. Three hundred and fifty-six targetable mutations were detected. At least one targetable mutation was found in 209 patients. For all these patients, the MTB was able to recommend treatment with a targeted agent based on the evaluation of the tumour's genetic profile and treatment history. Twenty-nine patients (13.9%) were subsequently treated with an MTB-recommended targeted therapy. We did not observe any improvement in terms of clinical benefit for these patients. CONCLUSIONS In this case series, we show that including LNGS into routine clinical management was feasible but does not appear to provide clinical benefit in the management of patients with advanced NSCLC.
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Affiliation(s)
- Julie Niogret
- Department of Medical Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; University of Burgundy-Franche Comté, Maison de l'université Esplanade Erasme, 21000 Dijon, France
| | - Lorraine Dalens
- Department of Medical Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; University of Burgundy-Franche Comté, Maison de l'université Esplanade Erasme, 21000 Dijon, France
| | - Caroline Truntzer
- Platform of Transfert in Biological Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; Genomic and Immunotherapy Medical Institute, Dijon University Hospital, 14 rue Paul Gaffarel 21000 Dijon, France
| | - Sandy Chevrier
- Platform of Transfert in Biological Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; Department of Tumour Biology and Pathology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France
| | - Laure Favier
- Department of Medical Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France
| | - Aurélie Lagrange
- Department of Medical Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France
| | - Bruno Coudert
- Department of Medical Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France
| | - Cléa Fraisse
- Department of Medical Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France
| | - Pascal Foucher
- Department of Thoracic Oncology, Dijon University Hospital, 14 rue Paul Gaffarel, 21000 Dijon, France
| | - Ayoub Zouak
- Department of Thoracic Oncology, Dijon University Hospital, 14 rue Paul Gaffarel, 21000 Dijon, France
| | - Virginie Westeel
- Department of Pneumology, Besançon University Hospital, 3 Boulevard Alexandre Fleming, 25000 Besançon, France
| | - Vincent Goussot
- Department of Tumour Biology and Pathology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France
| | - Valentin Dérangère
- University of Burgundy-Franche Comté, Maison de l'université Esplanade Erasme, 21000 Dijon, France; Platform of Transfert in Biological Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; Department of Tumour Biology and Pathology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; UMR INSERM 1231, 7 Boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Juliette Albuisson
- Platform of Transfert in Biological Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; Genomic and Immunotherapy Medical Institute, Dijon University Hospital, 14 rue Paul Gaffarel 21000 Dijon, France; Department of Tumour Biology and Pathology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France
| | - Laurent Arnould
- Department of Tumour Biology and Pathology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France
| | - Romain Boidot
- University of Burgundy-Franche Comté, Maison de l'université Esplanade Erasme, 21000 Dijon, France; Platform of Transfert in Biological Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; Genomic and Immunotherapy Medical Institute, Dijon University Hospital, 14 rue Paul Gaffarel 21000 Dijon, France; Department of Tumour Biology and Pathology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; UMR INSERM 1231, 7 Boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Courèche-Guillaume Kaderbhai
- Department of Medical Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France
| | - François Ghiringhelli
- Department of Medical Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; University of Burgundy-Franche Comté, Maison de l'université Esplanade Erasme, 21000 Dijon, France; Platform of Transfert in Biological Oncology, Georges François Leclerc Cancer Center - UNICANCER, 1 rue du Professeur Marion, Dijon 21000, France; Genomic and Immunotherapy Medical Institute, Dijon University Hospital, 14 rue Paul Gaffarel 21000 Dijon, France; UMR INSERM 1231, 7 Boulevard Jeanne d'Arc, 21000 Dijon, France.
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Marchetti A, Barbareschi M, Barberis M, Buglioni S, Buttitta F, Fassan M, Fontanini G, Marchiò C, Papotti M, Pruneri G, Scarpa A, Stanta G, Tallini G, Troncone G, Veronese SM, Truini M, Sapino A. Real-World Data on NGS Diagnostics: a survey from the Italian Society of Pathology (SIAPeC) NGS Network. Pathologica 2021; 113:262-271. [PMID: 34463674 PMCID: PMC8488986 DOI: 10.32074/1591-951x-324] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 12/31/2022] Open
Abstract
Next Generation Sequencing (NGS) is increasingly used in diagnostic centers for the assessment of genomic alterations to select patients for precision oncology. The Italian Society of Anatomic Pathology and Diagnostic Cytopathology (SIAPEC) through the Molecular Pathology and Predictive Medicine Study Group (PMMP) has been following the progressive development of centers that have adopted NGS technology in diagnostics over time. In July 2017, a study network on massive parallel sequencing was activated in Italy and recognized as the NGS SIAPeC National Network by the SIAPeC Scientific Society Board. Since then, activities have been implemented within the network that provide for alignment of laboratories through diagnostic concordance analysis and monitoring of centers adhering to the Network. Recently, considering the growing need for extended genomic analyses, the PMMP distributed a national survey to assess activities related to the use of genomic diagnostics in oncology within the NGS SIAPEC National Network. Thirty centers participated in the survey. Eighty percent of the centers are laboratories within Pathology Departments. The distribution of laboratories in the country, the diagnostic laboratory/population ratio, the staff dedicated, the type and number of sequencing and mechatronics platforms available, the genomic panels utilized, and the type and number of diagnostic tests carried out in the last year in each center, are reported. The centers were also asked whether they participated in a multidisciplinary Molecular Tumor Board (MTB) for management of patients. Thirty percent of the centers had a MTB that was ratified by regional decree. The professionals most frequently involved in the core team of the MTB are the pathologist, oncologist, molecular biologist, geneticist, pharmacologist, and bioinformatician. The data from this survey indicate that NGS diagnostics in Italy is still heterogeneous in terms of geographical distribution and the characteristics of laboratories and diagnostic test performed. The implementation of activities that favors harmonization, the logistics and the convergence of biological material in reference centers for molecular analyses is a priority for the development of a functional laboratory network.
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Affiliation(s)
- Antonio Marchetti
- Laboratory of Molecular Diagnostics, Center for Advanced Studies and Technology (CAST), University of Chieti-Pescara, Italy
| | | | - Massimo Barberis
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Lombardy, Italy
| | - Simonetta Buglioni
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fiamma Buttitta
- Laboratory of Molecular Diagnostics, Center for Advanced Studies and Technology (CAST), University of Chieti-Pescara, Italy
| | - Matteo Fassan
- Unit of Surgical Pathology, Department of Medicine (DIMED), University of Padua.,Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Caterina Marchiò
- Pathology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-Net Research Centre, University and Hospital Trust of Verona, Verona, Italy
| | - Giorgio Stanta
- DSM - Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Tallini
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, DIMES), University of Bologna, Italy.,Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giancarlo Troncone
- Division of Pathology, Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Mauro Truini
- Pathological Anatomy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Anna Sapino
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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14
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Koopman B, Groen HJ, Ligtenberg MJ, Grünberg K, Monkhorst K, de Langen AJ, Boelens MC, Paats MS, von der Thüsen JH, Dinjens WN, Solleveld N, van Wezel T, Gelderblom H, Hendriks LE, Speel EM, Theunissen TE, Kroeze LI, Mehra N, Piet B, van der Wekken AJ, ter Elst A, Timens W, Willems SM, Meijers RW, de Leng WW, van Lindert AS, Radonic T, Hashemi SM, Heideman DA, Schuuring E, van Kempen LC. Multicenter Comparison of Molecular Tumor Boards in The Netherlands: Definition, Composition, Methods, and Targeted Therapy Recommendations. Oncologist 2021; 26:e1347-e1358. [PMID: 33111480 PMCID: PMC8342588 DOI: 10.1002/onco.13580] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/25/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Molecular tumor boards (MTBs) provide rational, genomics-driven, patient-tailored treatment recommendations. Worldwide, MTBs differ in terms of scope, composition, methods, and recommendations. This study aimed to assess differences in methods and agreement in treatment recommendations among MTBs from tertiary cancer referral centers in The Netherlands. MATERIALS AND METHODS MTBs from all tertiary cancer referral centers in The Netherlands were invited to participate. A survey assessing scope, value, logistics, composition, decision-making method, reporting, and registration of the MTBs was completed through on-site interviews with members from each MTB. Targeted therapy recommendations were compared using 10 anonymized cases. Participating MTBs were asked to provide a treatment recommendation in accordance with their own methods. Agreement was based on which molecular alteration(s) was considered actionable with the next line of targeted therapy. RESULTS Interviews with 24 members of eight MTBs revealed that all participating MTBs focused on rare or complex mutational cancer profiles, operated independently of cancer type-specific multidisciplinary teams, and consisted of at least (thoracic and/or medical) oncologists, pathologists, and clinical scientists in molecular pathology. Differences were the types of cancer discussed and the methods used to achieve a recommendation. Nevertheless, agreement among MTB recommendations, based on identified actionable molecular alteration(s), was high for the 10 evaluated cases (86%). CONCLUSION MTBs associated with tertiary cancer referral centers in The Netherlands are similar in setup and reach a high agreement in recommendations for rare or complex mutational cancer profiles. We propose a "Dutch MTB model" for an optimal, collaborative, and nationally aligned MTB workflow. IMPLICATIONS FOR PRACTICE Interpretation of genomic analyses for optimal choice of target therapy for patients with cancer is becoming increasingly complex. A molecular tumor board (MTB) supports oncologists in rationalizing therapy options. However, there is no consensus on the most optimal setup for an MTB, which can affect the quality of recommendations. This study reveals that the eight MTBs associated with tertiary cancer referral centers in The Netherlands are similar in setup and reach a high agreement in recommendations for rare or complex mutational profiles. The Dutch MTB model is based on a collaborative and nationally aligned workflow with interinstitutional collaboration and data sharing.
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Affiliation(s)
- Bart Koopman
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Harry J.M. Groen
- Department of Pulmonary Diseases, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Marjolijn J.L. Ligtenberg
- Department of Pathology, Radboud University Medical CenterNijmegenThe Netherlands
- Department of Human Genetics, Radboud University Medical CenterNijmegenThe Netherlands
| | - Katrien Grünberg
- Department of Pathology, Radboud University Medical CenterNijmegenThe Netherlands
| | - Kim Monkhorst
- Department of Pathology, Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Adrianus J. de Langen
- Department of Thoracic Oncology, Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Mirjam C. Boelens
- Department of Pathology, Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Marthe S. Paats
- Department of Pulmonary Medicine, Erasmus Medical Center, University Medical Center RotterdamRotterdamThe Netherlands
| | - Jan H. von der Thüsen
- Department of Pathology, Erasmus Medical Center, University Medical Center RotterdamRotterdamThe Netherlands
| | - Winand N.M. Dinjens
- Department of Pathology, Erasmus Medical Center, University Medical Center RotterdamRotterdamThe Netherlands
| | - Nienke Solleveld
- Department of Pathology, Leiden University Medical CenterLeidenThe Netherlands
| | - Tom van Wezel
- Department of Pathology, Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Pathology, Leiden University Medical CenterLeidenThe Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical CenterLeidenThe Netherlands
| | - Lizza E. Hendriks
- Department of Pulmonary Diseases, GROW‐School for Oncology and Developmental Biology, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Ernst‐Jan M. Speel
- Department of Pathology, GROW‐School for Oncology and Developmental Biology, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Tom E. Theunissen
- Department of Pathology, GROW‐School for Oncology and Developmental Biology, Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Leonie I. Kroeze
- Department of Pathology, Radboud University Medical CenterNijmegenThe Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical CenterNijmegenThe Netherlands
| | - Berber Piet
- Department of Pulmonary Diseases, Radboud University Medical CenterNijmegenThe Netherlands
| | - Anthonie J. van der Wekken
- Department of Pulmonary Diseases, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Arja ter Elst
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Wim Timens
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Stefan M. Willems
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of Pathology, University Medical Center UtrechtUtrechtThe Netherlands
| | - Ruud W.J. Meijers
- Department of Pathology, University Medical Center UtrechtUtrechtThe Netherlands
| | - Wendy W.J. de Leng
- Department of Pathology, University Medical Center UtrechtUtrechtThe Netherlands
| | | | - Teodora Radonic
- Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Sayed M.S. Hashemi
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Daniëlle A.M. Heideman
- Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ed Schuuring
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Léon C. van Kempen
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
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15
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Larson KL, Huang B, Weiss HL, Hull P, Westgate PM, Miller RW, Arnold SM, Kolesar JM. Clinical Outcomes of Molecular Tumor Boards: A Systematic Review. JCO Precis Oncol 2021; 5:PO.20.00495. [PMID: 34632252 PMCID: PMC8277300 DOI: 10.1200/po.20.00495] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/18/2021] [Accepted: 06/09/2021] [Indexed: 01/12/2023] Open
Abstract
We conducted this systematic review to evaluate the clinical outcomes associated with molecular tumor board (MTB) review in patients with cancer. METHODS A systematic search of PubMed was performed to identify studies reporting clinical outcomes in patients with cancer who were reviewed by an MTB. To be included, studies had to report clinical outcomes, including clinical benefit, response, progression-free survival, or overall survival. Two reviewers independently selected studies and assessed quality with the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group or the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies depending on the type of study being reviewed. RESULTS Fourteen studies were included with a total of 3,328 patients with cancer. All studies included patients without standard-of-care treatment options and usually with multiple prior lines of therapy. In studies reporting response rates, patients receiving MTB-recommended therapy had overall response rates ranging from 0% to 67%. In the only trial powered on clinical outcome and including a control group, the group receiving MTB-recommended therapy had significantly improved rate of progression-free survival compared with those receiving conventional therapy. CONCLUSION Although data quality is limited by a lack of prospective randomized controlled trials, MTBs appear to improve clinical outcomes for patients with cancer. Future research should concentrate on prospective trials and standardization of approach and outcomes.
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Affiliation(s)
- Kara L. Larson
- Markey Cancer Center, University of
Kentucky, Lexington, Kentucky
| | - Bin Huang
- Markey Cancer Center, University of
Kentucky, Lexington, Kentucky
- Kentucky Cancer Registry, University of
Kentucky, Lexington, Kentucky
| | - Heidi L. Weiss
- Markey Cancer Center, University of
Kentucky, Lexington, Kentucky
| | - Pam Hull
- Markey Cancer Center, University of
Kentucky, Lexington, Kentucky
| | - Philip M. Westgate
- Department of Biostatistics, University of
Kentucky, Lexington, Kentucky
| | - Rachel W. Miller
- Markey Cancer Center, University of
Kentucky, Lexington, Kentucky
- Department of Obstetrics and Gynecology,
University of Kentucky, Lexington, Kentucky
| | - Susanne M. Arnold
- Markey Cancer Center, University of
Kentucky, Lexington, Kentucky
- Department of Internal Medicine,
University of Kentucky, Lexington, Kentucky
| | - Jill M. Kolesar
- Markey Cancer Center, University of
Kentucky, Lexington, Kentucky
- Department of Pharmacy Practice and
Science, University of Kentucky, Lexington, Kentucky
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16
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Fortin Ensign S, Hrachova M, Chang S, Mrugala MM. Assessing the utility and attitudes toward molecular testing in neuro-oncology: a survey of the Society for Neuro-Oncology members. Neurooncol Pract 2021; 8:310-316. [PMID: 34055378 PMCID: PMC8153811 DOI: 10.1093/nop/npab003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Molecular testing (MT) is utilized in neuro-oncology with increasing frequency. The aim of this study was to determine clinical practice patterns to acquire this information, interpret and utilize MT for patient care, and identify unmet needs in the practical clinical application of MT. METHODS We conducted a voluntary online survey of providers within the Society for Neuro-Oncology (SNO) membership database between March and April 2019. RESULTS We received 152 responses out of 2022 SNO members (7.5% of membership). 88.8% of respondents routinely order MT for newly diagnosed gliomas. Of those who do not, testing is preferentially performed in younger patients or those with midline tumors. 82.8% use MT in recurrent gliomas. Other common indications included: metastatic tumors, meningioma, and medulloblastoma. Many providers utilize more than one resource (36.0%), most frequently using in-house (41.8%) over commercially available panels. 78.1% used the results for clinical decision-making, with BRAF, EGFR, ALK, and H3K27 mutations most commonly directing treatment decisions. Approximately, half (48.5%) of respondents have molecular tumor boards at their institutions. Respondents would like to see SNO-endorsed guidelines on MT, organized lists of targeted agents available for specific mutations, a database of targetable mutations and clinical trials, and more educational programs on MT. CONCLUSION This survey was marked by several limitations including response rate and interpretation of MT. Among respondents, there is routine use of MT in Neuro-Oncology, however, there remains a need for increased guidance for providers to effectively incorporate the expanding genomic data resulting from MT into daily Neuro-Oncology practice.
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Affiliation(s)
| | - Maya Hrachova
- Department of Neurology, University of California, Irvine Medical Center, Orange, California
| | - Susan Chang
- Division of Neuro-Oncology, Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Maciej M Mrugala
- Department of Neurology, Mayo Clinic Cancer Center, Phoenix, Arizona
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17
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Establishment of a Molecular Tumor Board (MTB) and Uptake of Recommendations in a Community Setting. J Pers Med 2020; 10:jpm10040252. [PMID: 33260805 PMCID: PMC7711773 DOI: 10.3390/jpm10040252] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 01/02/2023] Open
Abstract
In the precision medicine era, molecular testing in advanced cancer is foundational to patient management. Molecular tumor boards (MTBs) can be effective in processing comprehensive genomic profiling (CGP) results and providing expert recommendations. We assessed an MTB and its role in a community setting. This retrospective analysis included patients with MTB recommendations at a community-based oncology practice January 2015 to December 2018; exclusions were death within 60 days of the MTB and/or no metastatic disease. Potentially actionable genomic alterations from CGP (immunohistochemistry, in-situ hybridization, next-generation sequencing) were reviewed bi-weekly by MTB practice experts, pathologists, genetic counselors, and other support staff, and clinical care recommendations were provided. Subsequent chart reviews determined implementation rates of recommendations. In 613 patients, the most common cancers were lung (23%), breast (19%), and colorectal (17%); others included ovarian, endometrial, bladder, and melanoma. Patients received 837 actionable recommendations: standard therapy (37%), clinical trial (31%), germline testing and genetic counseling (17%), off-label therapy (10%), subspecialty multidisciplinary tumor board review (2%), and advice for classifying tumor of unknown origin (2%). Of these recommendations, 36% to 78% were followed by the treating physician. For clinical trial recommendations (n = 262), 13% of patients enrolled in a clinical trial. The median time between CPG result availability and MTB presentation was 12 days. A community oncology-based comprehensive and high-throughput MTB provided useful clinical guidance in various treatment domains within an acceptable timeframe for patients with cancer in a large community setting.
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18
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Mateo J, McKay R, Abida W, Aggarwal R, Alumkal J, Alva A, Feng F, Gao X, Graff J, Hussain M, Karzai F, Montgomery B, Oh W, Patel V, Rathkopf D, Rettig M, Schultz N, Smith M, Solit D, Sternberg C, Van Allen E, VanderWeele D, Vinson J, Soule HR, Chinnaiyan A, Small E, Simons JW, Dahut W, Miyahira AK, Beltran H. Accelerating precision medicine in metastatic prostate cancer. ACTA ACUST UNITED AC 2020; 1:1041-1053. [PMID: 34258585 DOI: 10.1038/s43018-020-00141-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite advances in prostate cancer screening and treatment, available therapy options, particularly in later stages of the disease, remain limited and the treatment-resistant setting represents a serious unmet medical need. Moreover, disease heterogeneity and disparities in patient access to medical advances result in significant variability in outcomes across patients. Disease classification based on genomic sequencing is a promising approach to identify patients whose tumors exhibit actionable targets and make more informed treatment decisions. Here we discuss how we can accelerate precision oncology to inform broader genomically-driven clinical decisions for men with advanced prostate cancer, drug development and ultimately contribute to new treatment paradigms.
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Affiliation(s)
- Joaquin Mateo
- Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona Spain
| | - Rana McKay
- University of California at San Diego, San Diego, CA, USA
| | - Wassim Abida
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rahul Aggarwal
- University of California at San Francisco, San Francisco CA, USA
| | | | - Ajjai Alva
- University of Michigan, Ann Arbor, MI, USA
| | - Felix Feng
- University of California at San Francisco, San Francisco CA, USA
| | - Xin Gao
- Massachusetts General Hospital, Boston, MA, USA
| | - Julie Graff
- Oregon Health & Science University, VA Portland Health Care System, Portland, OR, USA
| | - Maha Hussain
- Lurie Comprehensive Cancer Center at Northwestern University, Chicago, IL USA
| | | | | | | | | | - Dana Rathkopf
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew Rettig
- University of California at Los Angeles, VA Greater Los Angeles, Los Angeles, CA, USA
| | | | | | - David Solit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - David VanderWeele
- Lurie Comprehensive Cancer Center at Northwestern University, Chicago, IL USA
| | - Jake Vinson
- Prostate Cancer Clinical Trials Consortium, New York, NY, USA
| | | | | | - Eric Small
- University of California at San Francisco, San Francisco CA, USA
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19
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Zhang Q, Fu Q, Bai X, Liang T. Molecular Profiling-Based Precision Medicine in Cancer: A Review of Current Evidence and Challenges. Front Oncol 2020; 10:532403. [PMID: 33194591 PMCID: PMC7652987 DOI: 10.3389/fonc.2020.532403] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022] Open
Abstract
Matched therapy based on next-generation sequencing is now a part of routine care to guide the treatment of patients with advanced solid tumors. However, whether and to what extent patients can benefit from this strategy on a large scale remains uncertain. In the past decade, several clinical studies were performed in this field, among which only one was a randomized trial. We reviewed the literature on this topic and summarize the existing data about the efficacy of this treatment strategy. Currently, the evidence is promising but not solid. Multiple ongoing trials are also summarized. We also discuss the limitations of this treatment strategy and certain unsolved important problems, including how to select the sample and target level, how to interpret the results, and the problem of drug accessibility. All these issues should receive more attention in future clinical trial design and the application of target therapy in cancer treatment.
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Affiliation(s)
- Qi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
- Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Qihan Fu
- The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
- Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueli Bai
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
- Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
- Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
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20
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Bot N, Waelli M. Implementing a clinical cutting-edge and decision-making activity: an ethnographic teamwork approach to a molecular tumorboard. BMC Health Serv Res 2020; 20:922. [PMID: 33028316 PMCID: PMC7542871 DOI: 10.1186/s12913-020-05786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background New technology implementation in healthcare must address important challenges such as interdisciplinary approaches. In oncology, molecular tumorboard (MTB) settings require biomedical researchers and clinical practitioners to collaborate and work together. While acknowledging that MTBs have been primarily investigated from a clinical rather than an organizational perspective, this article analyzes team processes and dynamics in a newly implemented MTB. Methods A systemic case study of a newly implemented MTB in a Swiss teaching hospital was conducted between July 2017 and February 2018, with in situ work observations, six exploratory interviews and six semi-structured interviews. Results An MTB workflow is progressively stabilized in four steps: 1) patient case submissions, 2) molecular analyses and results validation, 3) co-elaboration of therapeutic proposals, and 4) reporting during formal MTB sessions. The elaboration of a therapeutic proposal requires a framework for discussion that departs from the formality of institutional relationships, which was gradually incepted in this MTB. Conclusions Firstly, our research showed that an MTB organizational process requires the five teaming components that characterizes a learning organization. It showed that at the organizational level, procedures can be stabilized without limiting practice flexibility. Secondly, this research highlighted the importance of non-clinical outcomes from an MTB, e.g. an important support network for the oncologist community.
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Affiliation(s)
- Nathalie Bot
- Institute of Global Health, University of Geneva, Geneva, Switzerland.
| | - Mathias Waelli
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,EHESP, French School of Public Health, EA7348 MOS, Rennes, France
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21
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Ball J, Thompson J, Wulff-Burchfield E, Ellerbeck E, Kimminau K, Brooks JV, Petersen S, Rotich D, Kinney AY, Ellis SD. Precision community: a mixed methods study to identify determinants of adoption and implementation of targeted cancer therapy in community oncology. Implement Sci Commun 2020. [DOI: 10.1186/s43058-020-00064-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Precision medicine has enormous potential to improve cancer outcomes. Over one third of the 1.5 million Americans diagnosed with cancer each year have genetic mutations that could be targeted with an FDA-approved drug to treat their disease more effectively. However, the current uptake of targeted cancer therapy in clinical practice is suboptimal. Tumor testing is not widely used, and treatments based on molecular and genomic profiling are often not prescribed when indicated. Challenges with the uptake of precision medicine may disproportionately impact cancer patients in rural communities and other underserved populations. The objective of this study is to identify the determinants of adoption and implementation of precision cancer therapy to design an implementation strategy for community oncology practices, including those in rural areas.
Methods
This study is an explanatory sequential mixed methods study to identify factors associated with the use of targeted cancer therapy. Levels of targeted therapy use will be ascertained by secondary analysis of medical records to identify concordance with 18 national guideline recommendations for use of precision medicine in the treatment of breast, colorectal, lung, and melanoma skin cancer. Concurrently, facilitators and barriers associated with the use of precision cancer therapy will be elicited from interviews with up to a total of 40 oncologists, administrators, pathology, and pharmacy staff across the participating sites. Qualitative analysis will be a template analysis based on the Theoretical Domains Framework. Quantitative data aggregated at the practice level will be used to rank oncology practices’ adherence to targeted cancer therapy guidelines. Determinants will be compared among high and low users to isolate factors likely to facilitate targeted therapy use. The study will be conducted in eight community oncology practices, with an estimated 4121 targeted therapy treatment decision-making opportunities over a 3-year period.
Discussion
Despite unprecedented investment in precision medicine, translation into practice is suboptimal. Our study will identify factors associated with the uptake of precision medicine in community settings. These findings will inform future interventions to increase equitable uptake of evidence-based targeted cancer treatment.
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22
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Melas M, Subbiah S, Saadat S, Rajurkar S, McDonnell KJ. The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations. J Clin Med 2020; 9:E2125. [PMID: 32640668 PMCID: PMC7408957 DOI: 10.3390/jcm9072125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022] Open
Abstract
Recent public policy, governmental regulatory and economic trends have motivated the establishment and deepening of community health and academic medical center alliances. Accordingly, community oncology practices now deliver a significant portion of their oncology care in association with academic cancer centers. In the age of precision medicine, this alliance has acquired critical importance; novel advances in nucleic acid sequencing, the generation and analysis of immense data sets, the changing clinical landscape of hereditary cancer predisposition and ongoing discovery of novel, targeted therapies challenge community-based oncologists to deliver molecularly-informed health care. The active engagement of community oncology practices with academic partners helps with meeting these challenges; community/academic alliances result in improved cancer patient care and provider efficacy. Here, we review the community oncology and academic medical center alliance. We examine how practitioners may leverage academic center precision medicine-based cancer genetics and genomics programs to advance their patients' needs. We highlight a number of project initiatives at the City of Hope Comprehensive Cancer Center that seek to optimize community oncology and academic cancer center precision medicine interactions.
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Affiliation(s)
- Marilena Melas
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA;
| | - Shanmuga Subbiah
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Glendora, CA 91741, USA;
| | - Siamak Saadat
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Colton, CA 92324, USA;
| | - Swapnil Rajurkar
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Upland, CA 91786, USA;
| | - Kevin J. McDonnell
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA
- Center for Precision Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
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23
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Molecular matching and treatment strategies for advanced stage lung cancer at Dartmouth-Hitchcock Medical Center: A three-year review of a Molecular Tumor Board. Pract Lab Med 2020; 21:e00174. [PMID: 32613070 PMCID: PMC7322356 DOI: 10.1016/j.plabm.2020.e00174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022] Open
Abstract
Matching of actionable tumor mutations with targeted therapy increases response rates and prolongs survival in lung cancer patients. Drug development and trials targeting genetic alterations are expanding rapidly. We describe the role of a Molecular Tumor Board (MTB) in the design of molecularly informed treatment strategies in our lung cancer patient population. Tumor DNA was sequenced using a 50-gene targeted next-generation sequencing panel. Cases were evaluated by a multidisciplinary MTB who suggested a course of treatment based on each patient's molecular findings. During a three-year period, 21 lung cancer patients were presented at the MTB. All patients lacked common activating EGFR mutations and ALK rearrangements. One patient had Stage IIIb disease; all others were Stage IV; 18 patients had received ≥1 prior line of therapy (range 0-5). Suggestions for treatment with a targeted therapy were made for 19/21 (90.5%) patients, and four patients (21%) underwent treatment with a targeted agent, two as part of a clinical trial. Identified barriers to treatment with targeted therapy included: ineligibility for clinical trials (n = 2), lack of interest in study/distance to travel (n = 2), lack of disease progression (n = 2), poor performance status (n = 5), decision to treat next with immunotherapy (n = 3), and unknown (n = 1). For the majority of lung cancer patients, the MTB provided recommendations based on tumor genetic profiles. Identified barriers to treatment suggest that presentation to the MTB at earlier stages of disease may increase the number of patients eligible for treatment with a genetically informed targeted agent.
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24
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Singh AP, Shum E, Rajdev L, Cheng H, Goel S, Perez-Soler R, Halmos B. Impact and Diagnostic Gaps of Comprehensive Genomic Profiling in Real-World Clinical Practice. Cancers (Basel) 2020; 12:E1156. [PMID: 32375398 PMCID: PMC7281757 DOI: 10.3390/cancers12051156] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE next-generation sequencing based comprehensive genomic profiling (CGP) is becoming common practice. Although numerous studies have shown its feasibility to identify actionable genomic alterations in most patients, its clinical impact as part of routine management across all cancers in the community remains unknown. METHODS we conducted a retrospective study of all patients that underwent CGP as part of routine cancer management from January 2013 to June 2017 at an academic community-based NCI-designated cancer center. CGP was done in addition to established first tier reflex molecular testing as per national guidelines (e.g., EGFR/ALK for non-small cell lung cancer (NSCLC) and extended-RAS for colorectal cancer). RESULTS 349 tests were sent for CGP from 333 patients and 95% had at least one actionable genomic alteration reported. According to the reported results, 23.2% had a Food and Drug Administration (FDA) approved therapy available, 61.3% had an off-label therapy available and 77.9% were potentially eligible for a clinical trial. Treatment recommendations were also reviewed within the OncoKB database and 47% of them were not clinically validated therapies. The CGP results led to treatment change in only 35 patients (10%), most commonly in NSCLC. Nineteen of these patients (54% of those treated and 5% of total) had documented clinical benefit with targeted therapy. CONCLUSION we demonstrate that routine use of CGP in the community across all cancer types detects potentially actionable genomic alterations in a majority of patients, however has modest clinical impact enriched in the NSCLC subset.
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Affiliation(s)
- Aditi P. Singh
- Division of Hematology and Oncology, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA 19104, USA;
| | - Elaine Shum
- Division of Medical Oncology and Hematology, NYU Langone Perlmutter Cancer Center, New York, NY 10016, USA;
| | - Lakshmi Rajdev
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA; (L.R.); (H.C.); (S.G.); (R.P.-S.)
| | - Haiying Cheng
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA; (L.R.); (H.C.); (S.G.); (R.P.-S.)
| | - Sanjay Goel
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA; (L.R.); (H.C.); (S.G.); (R.P.-S.)
| | - Roman Perez-Soler
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA; (L.R.); (H.C.); (S.G.); (R.P.-S.)
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA; (L.R.); (H.C.); (S.G.); (R.P.-S.)
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25
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Jones SF, McKenzie AJ. Molecular Profiling in Drug Development: Paving a Way Forward. Am Soc Clin Oncol Educ Book 2020; 40:309-318. [PMID: 32463698 DOI: 10.1200/edbk_100024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As researchers learn more about tumor biology and the molecular mechanisms involved in tumorigenesis, metastasis, and tumor evolution, clinical trials are growing more complex and patient selection for clinical trials is becoming more specific. Rather than exploit certain phenotypic characteristics of tumor cells (e.g., rapid cell division and uncontrolled cell growth), pharmaceuticals targeting the genotypic causes of tumorigenesis are emerging. The sequencing of the human genome, advances in chemical techniques, and increased efficiency in drug target identification have changed the way drugs are developed. Now, more precise drugs targeting specific mutations within individual genes are being used to treat narrow patient populations harboring these specific driver mutations, often with greater efficacy and lower toxicity than traditional chemotherapeutic agents. This precision in drug development relies not only on the ability to design exquisitely specific pharmaceuticals but also to identify (with the same level of precision) the patients who are most likely to respond to those therapies. Robust screening techniques and adequate molecular oncology education are required to match the appropriate patient to precision therapies, and these same screening techniques provide the data necessary to advance to the next generation of drug development.
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Bourien H, Lespagnol A, Campillo-Gimenez B, Felten-Vinot I, Metges JP, Corre R, Lesimple T, le Marechal C, Boussemart L, Kammerer-Jacquet SF, le Gall E, Denoual F, de Tayrac M, Galibert MD, Mosser J, Edeline J. Implementation of a molecular tumor board at a regional level to improve access to targeted therapy. Int J Clin Oncol 2020; 25:1234-1241. [PMID: 32215806 DOI: 10.1007/s10147-020-01661-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the development of precision oncology, Molecular Tumor Boards (MTB) are developing in many institutions. However, the implementation of MTB in routine clinical practice has still not been thoroughly studied. MATERIAL AND METHODS Since the first drugs approved for targeted therapies, patient tumor samples were centralized to genomic testing platforms. In our institution, all tumor samples have been analyzed since 2014 by Next Generation Sequencing (NGS). In 2015, we established a regional MTB to discuss patient cases with 1 or more alterations identified by NGS, in genes different from those related to drug approval. We conducted a retrospective comparative analysis to study whether our MTB increased the prescriptions of Molecular Targeted Therapies (MTT) and the inclusions of patients in clinical trials with MTT, in comparison with patients with available NGS data but no MTB discussion. RESULTS In 2014, 86 patients had UGA, but the results were not available to clinicians and not discussed in MTB. During the years 2015 and 2016, 113 patients with an UGA (unreferenced genomic alteration) were discussed in MTB. No patients with an UGA were included in 2014 in a clinical trial, versus 2 (2%) in 2015-2016. 13 patients with an UGA (12%) were treated in 2015-2016 with a MTT whereas in 2014, no patient (p = 0.001). CONCLUSIONS In this retrospective analysis, we showed that the association of large-scale genomic testing and MTB was feasible, and could increase the prescription of MTT. However, in routine clinical practice, the majority of patients with UGA still do not have access to MTT.
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Affiliation(s)
| | | | | | | | - Jean-Philippe Metges
- Pôle Régionale de Cancérologie de Bretagne, Rennes, France.,CHU Brest, Brest, France.,ARPEGO (Accès à La Recherche Précoce Dans Le Grand-Ouest) Network, Rennes, France
| | - Romain Corre
- CHU Pontchaillou, Rennes, France.,ARPEGO (Accès à La Recherche Précoce Dans Le Grand-Ouest) Network, Rennes, France
| | - Thierry Lesimple
- Centre Eugene Marquis, Unicancer, Rennes, France.,ARPEGO (Accès à La Recherche Précoce Dans Le Grand-Ouest) Network, Rennes, France
| | | | - Lise Boussemart
- CHU Pontchaillou, Rennes, France.,Université Rennes, CNRS, IGDR, UMR 6290, Rennes, France
| | | | | | | | | | | | - Jean Mosser
- CHU Pontchaillou, Rennes, France.,Université Rennes, CNRS, IGDR, UMR 6290, Rennes, France
| | - Julien Edeline
- Centre Eugene Marquis, Unicancer, Rennes, France.,ARPEGO (Accès à La Recherche Précoce Dans Le Grand-Ouest) Network, Rennes, France
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Pishvaian MJ, Blais EM, Bender RJ, Rao S, Boca SM, Chung V, Hendifar AE, Mikhail S, Sohal DPS, Pohlmann PR, Moore KN, He K, Monk BJ, Coleman RL, Herzog TJ, Halverson DD, DeArbeloa P, Petricoin EF, Madhavan S. A virtual molecular tumor board to improve efficiency and scalability of delivering precision oncology to physicians and their patients. JAMIA Open 2019; 2:505-515. [PMID: 32025647 PMCID: PMC6994017 DOI: 10.1093/jamiaopen/ooz045] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/28/2019] [Accepted: 09/04/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Scalable informatics solutions that provide molecularly tailored treatment recommendations to clinicians are needed to streamline precision oncology in care settings. MATERIALS AND METHODS We developed a cloud-based virtual molecular tumor board (VMTB) platform that included a knowledgebase, scoring model, rules engine, an asynchronous virtual chat room and a reporting tool that generated a treatment plan for each of the 1725 patients based on their molecular profile, previous treatment history, structured trial eligibility criteria, clinically relevant cancer gene-variant assertions, biomarker-treatment associations, and current treatment guidelines. The VMTB systematically allows clinician users to combine expert-curated data and structured data from clinical charts along with molecular testing data to develop consensus on treatments, especially those that require off-label and clinical trial considerations. RESULTS The VMTB was used as part of the cancer care process for a focused subset of 1725 patients referred by advocacy organizations wherein resultant personalized reports were successfully delivered to treating oncologists. Median turnaround time from data receipt to report delivery decreased from 14 days to 4 days over 4 years while the volume of cases increased nearly 2-fold each year. Using a novel scoring model for ranking therapy options, oncologists chose to implement the VMTB-derived therapies over others, except when pursuing immunotherapy options without molecular support. DISCUSSION VMTBs will play an increasingly critical role in precision oncology as the compendium of biomarkers and associated therapy options available to a patient continues to expand. CONCLUSION Further development of such clinical augmentation tools that systematically combine patient-derived molecular data, real-world evidence from electronic health records and expert curated knowledgebases on biomarkers with computational tools for ranking best treatments can support care pathways at point of care.
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Affiliation(s)
- Michael J Pishvaian
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
- Perthera, Inc, McLean, Virginia, USA
| | | | | | - Shruti Rao
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington DC, USA
| | - Simina M Boca
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington DC, USA
| | | | | | - Sam Mikhail
- Mark H. Zangmeister Cancer Center, Columbus, Ohio, USA
| | - Davendra P S Sohal
- Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Kathleen N Moore
- Stephenson Oklahoma Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Kai He
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Bradley J Monk
- Arizona Oncology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Robert L Coleman
- University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Thomas J Herzog
- University of Cincinnati Cancer Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | | | | | - Emanuel F Petricoin
- Perthera, Inc, McLean, Virginia, USA
- George Mason University, Fairfax, Virginia, USA
| | - Subha Madhavan
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington DC, USA
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28
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Fishler KP, Breese EH, Walters-Sen L, McGowan ML. Experiences of a Multidisciplinary Genomic Tumor Board Interpreting Risk for Underlying Germline Variants in Tumor-Only Sequencing Results. JCO Precis Oncol 2019; 3:1-8. [DOI: 10.1200/po.18.00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although analyzing germline and tumor samples concurrently provides the best opportunity for differentiating between germline and somatic mutations, tumor-only sequencing is becoming increasingly common in clinical care. The purpose of this study is to assess how a multidisciplinary genomic tumor board (MGTB) evaluated patients’ tumor-only sequencing results and made genetics referrals. With limited professional society guidance on how to manage pathogenic mutations identified via tumor-only sequencing, this study contemplates the professional knowledge and skills necessary to have represented on an MGTB to interpret these results in context of potential germline findings. METHODS Qualitative interviews with MGTB members and an ethnographic case study of a breast cancer MGTB at a National Cancer Institute cancer center were examined. RESULTS This MGTB discussed 34 cases of women with advanced-stage breast cancer over 13 months. Interviews and observations of MGTB meetings indicated that members of the MGTB contemplated whether variants were germline or somatic and potential for identification of germline cancer predisposition. On the basis of existing professional society guidelines, 18 patients would be eligible for germline testing. However, the MGTB only referred 11 patients (61%) for additional germline testing, and the remaining seven patients (39%) were not referred, raising questions about the kind of genomic expertise needed on an MGTB to optimize results interpretation and referrals. CONCLUSION To ensure adequate interpretation, recommendation, and communication of tumor sequencing results, an MGTB should include professionals with knowledge and experience in clinical translation of tumor sequencing, testing methodology, molecular pathology, cancer biology, genomic pathways, germline variant interpretation, evaluation of family history, and application of professional recommendations for germline testing after tumor-only sequencing. These skills may not be held by a single professional on an MGTB.
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Affiliation(s)
- Kristen P. Fishler
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- University of Cincinnati, Cincinnati, OH
| | - Erin H. Breese
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- University of Cincinnati, Cincinnati, OH
| | - Lauren Walters-Sen
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- University of Cincinnati, Cincinnati, OH
| | - Michelle L. McGowan
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- University of Cincinnati, Cincinnati, OH
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Bourret P, Cambrosio A. Genomic expertise in action: molecular tumour boards and decision-making in precision oncology. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1568-1584. [PMID: 31197873 DOI: 10.1111/1467-9566.12970] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The recent development of cancer precision medicine is associated with the emergence of 'molecular tumour boards' (MTBs). Attended by a heterogenous set of practitioners, MTBs link genomic platforms to clinical practices by establishing 'actionable' connections between drugs and molecular alterations. Their activities rely on a number of evidential resources - for example databases, clinical trial results, basic knowledge about mutations and pathways - that need to be associated with the clinical trajectory of individual patients. Experts from various domains are required to master and align diverse kinds of information. However, rather than examining MTBs as an institution interfacing different kinds of expertise embedded in individual experts, we argue that expertise is the emergent outcome of MTBs, which can be conceptualised as networks or 'agencements' of humans and devices. Based on the ethnographic analysis of the activities of four clinical trial MTBs (three in France and an international one) and of two French routine-care MTBs, the paper analyses how MTBs produce therapeutic decisions, centring on the new kind of expertise they engender. The development and activities of MTBs signal a profound transformation of the evidentiary basis and processes upon which biomedical expertise and decision-making in oncology are predicated and, in particular, the emergence of a clinic of variants.
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Affiliation(s)
- Pascale Bourret
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Institut Paoli-Calmettes, Marseille, France
| | - Alberto Cambrosio
- Department of Social Studies of Medicine, McGill University, Montreal, QC, Canada
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30
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Nesline MK, DePietro P, Dy GK, Early A, Papanicolau-Sengos A, Conroy JM, Lenzo FL, Glenn ST, Chen H, Grand'Maison A, Boland P, Ernstoff MS, Puzanov I, Edge S, Akers S, Opyrchal M, Chatta G, Odunsi K, Frederick P, Lele S, Gardner M, Morrison C. Oncologist uptake of comprehensive genomic profile guided targeted therapy. Oncotarget 2019; 10:4616-4629. [PMID: 31384390 PMCID: PMC6659802 DOI: 10.18632/oncotarget.27047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/19/2019] [Indexed: 12/20/2022] Open
Abstract
We describe the extent to which comprehensive genomic profiling (CGP) results were used by oncologists to guide targeted therapy selection in a cohort of solid tumor patients tested as part of standard care at Roswell Park Comprehensive Cancer Center June 2016-June 2017, with adequate follow up through September 2018 (n = 620). Overall, 28.4% of CGP tests advised physicians about targeted therapy use supported by companion diagnostic or practice guideline evidence. Post-test targeted therapy uptake was highest for patients in active treatment at the time of order (86% versus 76% of treatment naïve patients), but also took longer to initiate (median 50 days versus 7 days for treatment naïve patients), with few patients (2.6%) receiving targeted agents prior to testing. 100% of patients with resistance variants did not receive targeted agents. Treatment naïve patients received immunotherapy as the most common alternative. When targeted therapy given off-label or in a trial was the best CGP option, (7%) of patients received it. Our data illustrate the appropriate and heterogeneous use of CGP by oncologists as a longitudinal treatment decision tool based on patient history and treatment needs, and that some patients may benefit from testing prior to initiation of other standard treatments.
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Affiliation(s)
| | | | - Grace K Dy
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Amy Early
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | | | - Jeffrey M Conroy
- OmniSeq Inc., Buffalo, NY 14203, USA.,Center for Personalized Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | | | | | - Hongbin Chen
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Anne Grand'Maison
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Patrick Boland
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Marc S Ernstoff
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Stephen Edge
- Department of Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Stacey Akers
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Mateusz Opyrchal
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Gurkamal Chatta
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Kunle Odunsi
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Peter Frederick
- Division of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Shashikant Lele
- Division of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | | | - Carl Morrison
- OmniSeq Inc., Buffalo, NY 14203, USA.,Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.,Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
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31
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Kolbe M, Boos M. Laborious but Elaborate: The Benefits of Really Studying Team Dynamics. Front Psychol 2019; 10:1478. [PMID: 31316435 PMCID: PMC6611000 DOI: 10.3389/fpsyg.2019.01478] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.
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Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Margarete Boos
- Institute for Psychology, University of Göttingen, Göttingen, Germany
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Molecular tumour boards and molecular diagnostics for patients with cancer in the Netherlands: experiences, challenges, and aspirations. Br J Cancer 2019; 121:34-36. [PMID: 31130724 PMCID: PMC6738039 DOI: 10.1038/s41416-019-0489-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 12/24/2022] Open
Abstract
Advances in molecular tumour diagnostics and the number of targeted therapies increase rapidly. Molecular tumour boards (MTBs) are designated to interpret these data and provide clinical recommendations. Not all patients with cancer have access to advice of an MTB. We aimed to determine the current status, opportunities, and challenges of the organisation of MTBs in the Netherlands. We interviewed several stakeholders about their experiences with an MTB, using template analysis. Most clinicians and patient representatives underscore the significance of an MTB, because it can stimulate rational treatment options, enrolment in clinical trials, and interdisciplinary knowledge transfer. Health insurance companies and financial managers are concerned about increasing costs. Registries to assess the clinical benefit of MTBs, guidelines on quality control, financial agreements, and logistical resources are lacking. The national organisation of MTBs and a registry of molecular and clinical data are important issues to address.
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Edelman EA, Tanner PC, Taber KAJ, McConnell SC, Nicholson LJ, Ingram TM, Steinmark L, Reed EK. Provider engagement in precision oncology education: an exploratory analysis of online continuing medical education data. Per Med 2019; 16:199-209. [DOI: 10.2217/pme-2018-0150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Given the rapid growth in genomic tests and targeted therapeutics, clinicians are likely to benefit from additional precision medicine education. Aim: This study evaluated the engagement and effectiveness of two interactive, case-based educational modules about somatic tumor testing, developed by the Jackson Laboratory, American Medical Association and Scripps Research Translational Institute, titled ‘Precision Medicine for Your Practice’. Results: 402 participants enrolled in one or both free online continuing education modules, including physicians, nurses, scientists and genetic counselors and 41% completed module evaluations. Over 90% of respondents reported alignment of program with practice needs and planned to change their practice, including patient communication, identifying candidates for testing and/or interpreting test results. Conclusion: These findings support Precision Medicine for Your Practice as an effective education offering for diverse clinical professionals.
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Affiliation(s)
- Emily A Edelman
- Clinical & Continuing Education Program, The Jackson Laboratory, Bar Harbor, ME 04609 and Farmington, CT 06032, USA
| | - Paige C Tanner
- Clinical & Continuing Education Program, The Jackson Laboratory, Bar Harbor, ME 04609 and Farmington, CT 06032, USA
| | | | | | | | - Therese M Ingram
- Clinical & Continuing Education Program, The Jackson Laboratory, Bar Harbor, ME 04609 and Farmington, CT 06032, USA
| | - Linda Steinmark
- Clinical & Continuing Education Program, The Jackson Laboratory, Bar Harbor, ME 04609 and Farmington, CT 06032, USA
| | - Eleanor K Reed
- Clinical & Continuing Education Program, The Jackson Laboratory, Bar Harbor, ME 04609 and Farmington, CT 06032, USA
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Ivanov M, Chernenko P, Breder V, Laktionov K, Rozhavskaya E, Musienko S, Baranova A, Mileyko V. Utility of cfDNA Fragmentation Patterns in Designing the Liquid Biopsy Profiling Panels to Improve Their Sensitivity. Front Genet 2019; 10:194. [PMID: 30915108 PMCID: PMC6422983 DOI: 10.3389/fgene.2019.00194] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/25/2019] [Indexed: 01/05/2023] Open
Abstract
Genotyping of cell-free DNA (cfDNA) in plasma samples has the potential to allow for a noninvasive assessment of tumor biology, avoiding the inherent shortcomings of tissue biopsy. Next generation sequencing (NGS), a leading technology for liquid biopsy analysis, continues to be hurdled with several major issues with cfDNA samples, including low cfDNA concentration and high fragmentation. In this study, by employing Ion Torrent PGM semiconductor technology, we performed a comparison between two multi-biomarker amplicon-based NGS panels characterized by a substantial difference in average amplicon length. In course of the analysis of the peripheral blood from 13 diagnostic non-small cell lung cancer patients, equivalence of two panels, in terms of overall diagnostic sensitivity and specificity was shown. A pairwise comparison of the allele frequencies for the same somatic variants obtained from the pairs of panel-specific amplicons, demonstrated an identical analytical sensitivity in range of 140 to 170 bp amplicons in size. Further regression analysis between amplicon length and its coverage, illustrated that NGS sequencing of plasma cfDNA equally tolerates amplicons with lengths in the range of 120 to 170 bp. To increase the sensitivity of mutation detection in cfDNA, we performed a computational analysis of the features associated with genome-wide nucleosome maps, evident from the data on the prevalence of cfDNA fragments of certain sizes and their fragmentation patterns. By leveraging the support vector machine-based machine learning approach, we showed that a combination of nucleosome map associated features with GC content, results in the increased accuracy of prediction of high inter-sample sequencing coverage variation (areas under the receiver operating curve: 0.75, 95% CI: 0.750–0.752 vs. 0.65, 95% CI: 0.63–0.67). Thus, nucleosome-guided fragmentation should be utilized as a guide to design amplicon-based NGS panels for the genotyping of cfDNA samples.
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Affiliation(s)
- Maxim Ivanov
- Department of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | | | - Valery Breder
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | | | - Ekaterina Rozhavskaya
- Atlas Oncology Diagnostics, Ltd., Moscow, Russia.,Vavilov Institute of General Genetics, Moscow, Russia
| | | | - Ancha Baranova
- Department of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia.,Atlas Oncology Diagnostics, Ltd., Moscow, Russia.,Research Centre for Medical Genetics, Moscow, Russia.,School of Systems Biology, George Mason University, Fairfax, VA, United States
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35
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Dickhoff C, Dahele M. The multidisciplinary lung cancer team meeting: increasing evidence that it should be considered a medical intervention in its own right. J Thorac Dis 2019; 11:S311-S314. [PMID: 30997206 DOI: 10.21037/jtd.2019.01.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Chris Dickhoff
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Cardiothoracic Surgery, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
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36
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Reed EK, Steinmark L, Seibert DC, Edelman E. Somatic Testing: Implications for Targeted Treatment. Semin Oncol Nurs 2019; 35:22-33. [PMID: 30660356 DOI: 10.1016/j.soncn.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To provide an overview of key considerations for somatic testing for the purpose of targeting cancer treatment. DATA SOURCES Literature; research reports. CONCLUSION Genomic testing of cancer cells to identify variants that drive the carcinogenic process is becoming common in clinical settings. Providers and patients need to weigh the potential benefits of testing with technologic and logistic issues. IMPLICATIONS FOR NURSING PRACTICE Testing is available for thousands of genomic variants to identify one or more to guide targeted treatment. Oncology nurses need to understand the benefits and limitations of participating in patient-centered implementation of this testing.
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37
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Buga AM, Docea AO, Albu C, Malin RD, Branisteanu DE, Ianosi G, Ianosi SL, Iordache A, Calina D. Molecular and cellular stratagem of brain metastases associated with melanoma. Oncol Lett 2019; 17:4170-4175. [PMID: 30944612 DOI: 10.3892/ol.2019.9933] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/17/2018] [Indexed: 12/24/2022] Open
Abstract
Tumors of the central nervous system are the most prevalent complications of melanoma, especially in the late stage of disease. Melanoma, lung and breast cancer are the leading cause of secondary tumors in the brain, the majority of them having a poor outcome. Brain dissemination is developed in half of stage IV melanomas and these cases can increase up to 75%, having a major impact on the quality of life. This review will focus on recent findings that provide new ways to potentially prevent brain metastases in malignant melanoma. The key of these findings is based on the heterogeneity of the melanoma and of the brain metastases at genetic levels. This new era of technologies provides new tools in understanding the dissemination mechanisms of malignant cells. The cellular and molecular changes, the immune status of the patient and the blood-brain barrier permeability are key regulators of cancer cell dissemination. Understanding these mechanisms can render new hope in preventing brain metastases by focusing on melanoma and new pharmacologic approaches.
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Affiliation(s)
- Ana-Maria Buga
- Department of Functional Science, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.,Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Carmen Albu
- Department of Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ramona Denise Malin
- Department of Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Gabriel Ianosi
- Department of Surgery, Dermatopharmacy and Cosmetology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Simona Laura Ianosi
- Department of Dermatology, Dermatopharmacy and Cosmetology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andrei Iordache
- Department of Clinical Pharmacy, Dermatopharmacy and Cosmetology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniela Calina
- Department of Clinical Pharmacy, Dermatopharmacy and Cosmetology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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McKenzie AJ, H Dilks H, Jones SF, Burris H. Should next-generation sequencing tests be performed on all cancer patients? Expert Rev Mol Diagn 2019; 19:89-93. [PMID: 30618301 DOI: 10.1080/14737159.2019.1564043] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Holli H Dilks
- a Sarah Cannon Research Institute , Nashville , Tennessee , USA
| | - Suzanne F Jones
- a Sarah Cannon Research Institute , Nashville , Tennessee , USA
| | - Howard Burris
- a Sarah Cannon Research Institute , Nashville , Tennessee , USA
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Py C, Christinat Y, Kreutzfeldt M, McKee TA, Dietrich PY, Tsantoulis P. Response of NF1-Mutated Melanoma to an MEK Inhibitor. JCO Precis Oncol 2018; 2:1-11. [DOI: 10.1200/po.18.00028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Céline Py
- All authors: University Hospital of Geneva, Geneva, Switzerland
| | - Yann Christinat
- All authors: University Hospital of Geneva, Geneva, Switzerland
| | | | - Thomas A. McKee
- All authors: University Hospital of Geneva, Geneva, Switzerland
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Powell SF, Dib EG, Bleeker JS, Keppen MD, Mazurczak M, Hack KM, Gitau MM, Steen PD, Terstriep SA, Reynolds J, Landsverk ML, Chan CH, Nelson ME, Thompson PA, Ellison C, Black LJ, Ford JM, Chung JH, Anhorn R, Gaba AG. Delivering Precision Oncology in a Community Cancer Program: Results From a Prospective Observational Study. JCO Precis Oncol 2018; 2:1-12. [DOI: 10.1200/po.17.00220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Precision oncology (PO) is a growing treatment approach in the era of next-generation sequencing (NGS) and matched therapies. Effective delivery of PO in the community has not been extensively studied. Our program developed a virtual molecular tumor board (MTB) strategy to help guide PO care. Materials and Methods Over 18 months, eligible adult patients with advanced, incurable solid tumor malignancies were enrolled in a molecular profiling (MP) study using the Foundation Medicine NGS panel. Results were reviewed through a weekly, videoconferenced MTB conducted across our largely rural integrated health system. Recommendations from the MTB were used to identify actionable alterations (AAs). Feasibility of PO care delivery was assessed as the primary outcome. Secondary outcomes included the frequency of AAs, genomic matched treatments, genomic matched clinical trial enrollment, and clinical outcomes. Results A total of 120 participants with a variety of advanced tumor types were enrolled. Of these, 109 (90.8%) had successful MP. Treatment on the basis of an AA was recommended by the MTB in 58% of patients (63 of 109) who had a successful MP result. For those completing MP, treatments included enrollment in a genomic matched clinical trial (n = 16; 14.6%) and genomic matched treatment with a Food and Drug Administration–approved agent (n = 23; 21.1%). Response and survival data were similar regardless of the matched treatment option chosen. Conclusion A video-conferenced MTB-facilitated NGS testing and treatment delivery system was implemented in our integrated community oncology program. Continued use of this model aims to increase understanding of the impact of PO in this setting.
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Affiliation(s)
- Steven F. Powell
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Elie G. Dib
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Jonathan S. Bleeker
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Michael D. Keppen
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Miroslaw Mazurczak
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Keely M. Hack
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Mark M. Gitau
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Preston D. Steen
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Shelby A. Terstriep
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - John Reynolds
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Megan L. Landsverk
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Chun-Hung Chan
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Morgan E. Nelson
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Paul A. Thompson
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Christie Ellison
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Lora J. Black
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - James M. Ford
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Jon H. Chung
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Rachel Anhorn
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
| | - Anu G. Gaba
- Steven F. Powell, Elie G. Dib, Jonathan S. Bleeker, Michael D. Keppen, Miroslaw Mazurczak, Keely M. Hack, Megan L. Landsverk, and Chun-Hung Chan, Sanford Cancer Center; Morgan E. Nelson, Paul A. Thompson, Christie Ellison, and Lora J. Black, Sanford Research, Sioux Falls, SD; Mark M. Gitau, Preston D. Steen, Shelby A. Terstriep, and Anu G. Gaba, Roger Maris Cancer Center, Fargo; John Reynolds, Sanford Cancer Center, Bismarck, ND; James M. Ford, Stanford University School of Medicine, Stanford, CA; Jon H
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Patel JN. Lessons in practicing cancer genomics and precision medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2018. [DOI: 10.1080/23808993.2018.1526081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jai N. Patel
- Department of Cancer Pharmacology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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Tsung K, Thompson CL, Knight JM, Maximuk S, Sadri N, Gilmore H, Keri R, Vinayak S, Harris L, Silverman P. A breast multi-disciplinary genomic tumor board is feasible and can provide timely and impactful recommendations. Breast J 2018. [DOI: 10.1111/tbj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Karen Tsung
- University Hospitals Seidman Cancer Center; Cleveland OH USA
| | - Cheryl L. Thompson
- Department of Nutrition; Case Western Reserve University; Cleveland OH USA
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
| | - Joy M. Knight
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
| | - Steve Maximuk
- University Hospitals Seidman Cancer Center; Cleveland OH USA
| | - Navid Sadri
- University Hospitals Seidman Cancer Center; Cleveland OH USA
| | - Hannah Gilmore
- University Hospitals Seidman Cancer Center; Cleveland OH USA
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
| | - Ruth A. Keri
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
- Department of Pharmacology; Case Western Reserve University; Cleveland OH USA
- Department of Genetics and Genome Sciences; Case Western Reserve University; Cleveland OH USA
| | - Shaveta Vinayak
- University Hospitals Seidman Cancer Center; Cleveland OH USA
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
| | | | - Paula Silverman
- University Hospitals Seidman Cancer Center; Cleveland OH USA
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
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43
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Kurnit KC, Dumbrava EEI, Litzenburger B, Khotskaya YB, Johnson AM, Yap TA, Rodon J, Zeng J, Shufean MA, Bailey AM, Sánchez NS, Holla V, Mendelsohn J, Shaw KM, Bernstam EV, Mills GB, Meric-Bernstam F. Precision Oncology Decision Support: Current Approaches and Strategies for the Future. Clin Cancer Res 2018; 24:2719-2731. [PMID: 29420224 PMCID: PMC6004235 DOI: 10.1158/1078-0432.ccr-17-2494] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/02/2017] [Accepted: 01/30/2018] [Indexed: 12/11/2022]
Abstract
With the increasing availability of genomics, routine analysis of advanced cancers is now feasible. Treatment selection is frequently guided by the molecular characteristics of a patient's tumor, and an increasing number of trials are genomically selected. Furthermore, multiple studies have demonstrated the benefit of therapies that are chosen based upon the molecular profile of a tumor. However, the rapid evolution of genomic testing platforms and emergence of new technologies make interpreting molecular testing reports more challenging. More sophisticated precision oncology decision support services are essential. This review outlines existing tools available for health care providers and precision oncology teams and highlights strategies for optimizing decision support. Specific attention is given to the assays currently available for molecular testing, as well as considerations for interpreting alteration information. This article also discusses strategies for identifying and matching patients to clinical trials, current challenges, and proposals for future development of precision oncology decision support. Clin Cancer Res; 24(12); 2719-31. ©2018 AACR.
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Affiliation(s)
- Katherine C Kurnit
- Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Beate Litzenburger
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Bioinformatics, Qiagen Inc., Redwood City, California
| | - Yekaterina B Khotskaya
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amber M Johnson
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Timothy A Yap
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jordi Rodon
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jia Zeng
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Md Abu Shufean
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ann M Bailey
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nora S Sánchez
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vijaykumar Holla
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Mendelsohn
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenna Mills Shaw
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elmer V Bernstam
- School of Biomedical Informatics and Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Gordon B Mills
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Funda Meric-Bernstam
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Meedendorp AD, Ter Elst A, 't Hart NA, Groen HJM, Schuuring E, van der Wekken AJ. Response to HER2 Inhibition in a Patient With Brain Metastasis With EGFR TKI Acquired Resistance and an HER2 Amplification. Front Oncol 2018; 8:176. [PMID: 29872644 PMCID: PMC5972286 DOI: 10.3389/fonc.2018.00176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/04/2018] [Indexed: 01/23/2023] Open
Abstract
A 62-year-old man was referred to our university hospital for treatment of advanced adenocarcinoma of the lung after disease progression on two lines of EGFR TKI and one line of chemotherapy. Fluorescent in situ hybridization analysis upon progression showed an HER2 amplification. At our weekly Molecular Tumor Board (MTB), a decision was made to treat this patient with afatinib, which resulted in a partial response. However, progression was observed with a facial nerve paresis due to a metastasis in the skull. A biopsy of a location in the thorax revealed the presence of an EGFR-T790M mutation associated with acquired resistance, after which treatment with osimertinib was started. After 6 months, disease progression was observed, and a new biopsy was taken from the pelvic bone, which revealed the original amplification of HER2 together with the EGFR-L858R mutation, the EGFR-T790M mutation was not detected. The MTB decided to treat the patient with trastuzumab/paclitaxel. A partial response was observed in different bone lesions, while the skull metastasis with ingrowth in the brain remained stable for 6 months. Because of progression of the bone metastases after 6 months, a biopsy of a lesion in the thorax wall was taken. In this lesion, the EGFR-T790M mutation could be detected again. The MTB advised to start treatment with a combination of osimertinib and afatinib. This resulted in an impressive clinical improvement and a partial response of the bone metastases on the most recent 18-fluorodeoxyglucose positron emission tomography and computer tomography-scan. In conclusion, adjusting treatment to the mutational make-up of the tumor is a great challenge. For optimal treatment response multiple biopsies and re-biopsy upon progression are imperative. As more genes are investigated, treatment decision becomes increasingly difficult, therefore, expert opinions from an MTB is essential.
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Affiliation(s)
- Arenda D Meedendorp
- University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Arja Ter Elst
- University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Nils A 't Hart
- University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Harry J M Groen
- University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Ed Schuuring
- University of Groningen and University Medical Center Groningen, Groningen, Netherlands
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Bryce AH, Egan JB, Borad MJ, Stewart AK, Nowakowski GS, Chanan-Khan A, Patnaik MM, Ansell SM, Banck MS, Robinson SI, Mansfield AS, Klee EW, Oliver GR, McCormick JB, Huneke NE, Tagtow CM, Jenkins RB, Rumilla KM, Kerr SE, Kocher JPA, Beck SA, Fernandez-Zapico ME, Farrugia G, Lazaridis KN, McWilliams RR. Experience with precision genomics and tumor board, indicates frequent target identification, but barriers to delivery. Oncotarget 2018; 8:27145-27154. [PMID: 28423702 PMCID: PMC5432324 DOI: 10.18632/oncotarget.16057] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/15/2017] [Indexed: 01/16/2023] Open
Abstract
Background The ability to analyze the genomics of malignancies has opened up new possibilities for off-label targeted therapy in cancers that are refractory to standard therapy. At Mayo Clinic these efforts are organized through the Center for Individualized Medicine (CIM). Results Prior to GTB, datasets were analyzed and integrated by a team of bioinformaticians and cancer biologists. Therapeutically actionable mutations were identified in 65% (92/141) of the patients tested with 32% (29/92) receiving genomically targeted therapy with FDA approved drugs or in an independent clinical trial with 45% (13/29) responding. Standard of care (SOC) options were continued by 15% (14/92) of patients tested before exhausting SOC options, with 71% (10/14) responding to treatment. Over 35% (34/92) of patients with actionable targets were not treated with 65% (22/34) choosing comfort measures or passing away. Materials and Methods Patients (N = 165) were referred to the CIM Clinic between October 2012 and December 2015. All patients received clinical genomic panel testing with selected subsets receiving array comparative genomic hybridization and clinical whole exome sequencing to complement and validate panel findings. A genomic tumor board (GTB) reviewed results and, when possible, developed treatment recommendations. Conclusions Treatment decisions driven by tumor genomic analysis can lead to significant clinical benefit in a minority of patients. The success of genomically driven therapy depends both on access to drugs and robustness of bioinformatics analysis. While novel clinical trial designs are increasing the utility of genomic testing, robust data sharing of outcomes is needed to optimize clinical benefit for all patients.
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Affiliation(s)
- Alan H Bryce
- Hematology/Oncology, Mayo Clinic, Phoenix, AZ, U.S.A.,Mayo Clinic Cancer Center, Phoenix, AZ, U.S.A.,Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - Jan B Egan
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - Mitesh J Borad
- Hematology/Oncology, Mayo Clinic, Phoenix, AZ, U.S.A.,Mayo Clinic Cancer Center, Phoenix, AZ, U.S.A.,Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - A Keith Stewart
- Hematology/Oncology, Mayo Clinic, Phoenix, AZ, U.S.A.,Mayo Clinic Cancer Center, Phoenix, AZ, U.S.A.,Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - Grzegorz S Nowakowski
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Hematology, Mayo Clinic, Rochester, MN, U.S.A
| | - Asher Chanan-Khan
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Hematology/Oncology, Mayo Clinic, Jacksonville, FL, U.S.A
| | - Mrinal M Patnaik
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Hematology, Mayo Clinic, Rochester, MN, U.S.A
| | - Stephen M Ansell
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Hematology, Mayo Clinic, Rochester, MN, U.S.A
| | - Michaela S Banck
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Medical Oncology, Mayo Clinic, Rochester, MN, U.S.A
| | - Steven I Robinson
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Medical Oncology, Mayo Clinic, Rochester, MN, U.S.A
| | - Aaron S Mansfield
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Medical Oncology, Mayo Clinic, Rochester, MN, U.S.A
| | - Eric W Klee
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Health Sciences Research, Mayo Clinic, Rochester, MN, U.S.A
| | - Gavin R Oliver
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Health Sciences Research, Mayo Clinic, Rochester, MN, U.S.A
| | | | - Norine E Huneke
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - Colleen M Tagtow
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - Robert B Jenkins
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, U.S.A
| | | | - Sarah E Kerr
- Anatomic Pathology, Mayo Clinic, Rochester, MN, U.S.A
| | - Jean-Pierre A Kocher
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Health Sciences Research, Mayo Clinic, Rochester, MN, U.S.A
| | - Scott A Beck
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - Martin E Fernandez-Zapico
- Schulze Center for Novel Therapeutics, Division of Oncology Research, Medical Oncology, Mayo Clinic, Rochester, MN, U.S.A
| | - Gianrico Farrugia
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Gastroenterology, Mayo Clinic, Rochester, MN, U.S.A
| | - Konstantinos N Lazaridis
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Gastroenterology, Mayo Clinic, Rochester, MN, U.S.A
| | - Robert R McWilliams
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, U.S.A.,Medical Oncology, Mayo Clinic, Rochester, MN, U.S.A.,Mayo Clinic Cancer Center, Rochester, MN, U.S.A
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Shee K, Miller TW. Trailblazing Precision Oncology for Rare Tumor Subtypes. Oncologist 2018; 23:143-144. [PMID: 29158369 PMCID: PMC5813755 DOI: 10.1634/theoncologist.2017-0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/17/2017] [Indexed: 11/30/2022] Open
Abstract
Molecular Tumor Boards seek to recommend therapeutics to patients based on varying levels of evidence linking specific genetic alterations to treatment response. This commentary highlights the study by Kato and colleagues, which reports the usage of precision medicine approaches in rare and ultra‐rare tumor subtypes, as well as the need to discover effective drugs for tumor subtypes without known targetable genetic alterations.
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Affiliation(s)
- Kevin Shee
- Department of Molecular & Systems Biology, Lebanon, New Hampshire, USA
| | - Todd W Miller
- Department of Molecular & Systems Biology, Lebanon, New Hampshire, USA
- Comprehensive Breast Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Kaderbhai CG, Boidot R, Beltjens F, Chevrier S, Arnould L, Favier L, Lagrange A, Coudert B, Ghiringhelli F. Use of dedicated gene panel sequencing using next generation sequencing to improve the personalized care of lung cancer. Oncotarget 2017; 7:24860-70. [PMID: 27027238 PMCID: PMC5029748 DOI: 10.18632/oncotarget.8391] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/16/2016] [Indexed: 12/24/2022] Open
Abstract
Advances in Next Generation Sequencing (NGS) technologies have improved the ability to detect potentially targetable mutations. However, the integration of NGS into clinical management in an individualized manner remains challenging. In this single-center observational study, we performed a dedicated NGS panel studying 41 cancer-related genes in 50 consecutive patients with metastatic non-small-cell lung cancer between May 2012 and October 2014. Molecular analysis could be performed in 48 patients with a good quality check. One hundred and thirty-three mutations, whose twenty-four unique mutations, were detected. At least one mutation was found in 46 patients. In 58% of cases, the Molecular Tumor Board (MTB) was able to recommend treatment with a targeted agent based on the evaluation of the tumor genetic profile and treatment history. Nine patients (18%) were subsequently treated with a MTB-recommended targeted therapy; four patients experienced a clinical benefit with a partial response or stabilization lasting more than 4 months. In this case series involving patients with metastatic non-small cell lung cancer, we show that including integrative clinical sequencing data into routine clinical management was feasible and could impact on patient therapeutic proposal.
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Affiliation(s)
| | - Romain Boidot
- INSERM, U866, Faculté de Médecine, Université de Bourgogne and Centre Georges François Leclerc, Dijon, France.,Department of Biology and Pathology of Tumors, Centre Georges-François Leclerc, Dijon, France.,Platform of Transfer in Cancer Biology, Centre Georges-François Leclerc, Dijon, France
| | - Françoise Beltjens
- Department of Biology and Pathology of Tumors, Centre Georges-François Leclerc, Dijon, France
| | - Sandy Chevrier
- Department of Biology and Pathology of Tumors, Centre Georges-François Leclerc, Dijon, France.,Platform of Transfer in Cancer Biology, Centre Georges-François Leclerc, Dijon, France
| | - Laurent Arnould
- Department of Biology and Pathology of Tumors, Centre Georges-François Leclerc, Dijon, France.,Platform of Transfer in Cancer Biology, Centre Georges-François Leclerc, Dijon, France
| | - Laure Favier
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Aurélie Lagrange
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Bruno Coudert
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - François Ghiringhelli
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France.,INSERM, U866, Faculté de Médecine, Université de Bourgogne and Centre Georges François Leclerc, Dijon, France.,Department of Biology and Pathology of Tumors, Centre Georges-François Leclerc, Dijon, France.,Platform of Transfer in Cancer Biology, Centre Georges-François Leclerc, Dijon, France
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48
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Previs RA, Sood AK, Mills GB, Westin SN. The rise of genomic profiling in ovarian cancer. Expert Rev Mol Diagn 2017; 16:1337-1351. [PMID: 27828713 DOI: 10.1080/14737159.2016.1259069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Next-generation sequencing and advances in 'omics technology have rapidly increased our understanding of the molecular landscape of epithelial ovarian cancers. Areas covered: Once characterized only by histologic appearance and clinical behavior, we now understand many of the molecular phenotypes that underlie the different ovarian cancer subtypes. While the current approach to treatment involves standard cytotoxic therapies after cytoreductive surgery for all ovarian cancers regardless of histologic or molecular characteristics, focus has shifted beyond a 'one size fits all' approach to ovarian cancer. Expert commentary: Genomic profiling offers potentially 'actionable' opportunities for development of targeted therapies and a more individualized approach to treatment with concomitant improved outcomes and decreased toxicity.
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Affiliation(s)
- Rebecca A Previs
- a Department of Gynecologic Oncology and Reproductive Medicine , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Anil K Sood
- a Department of Gynecologic Oncology and Reproductive Medicine , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Gordon B Mills
- b Department of Systems Biology , The University of Texas MD Anderson Cancer , Houston , TX , USA
| | - Shannon N Westin
- a Department of Gynecologic Oncology and Reproductive Medicine , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Burkard ME, Deming DA, Parsons BM, Kenny PA, Schuh MR, Leal T, Uboha N, Lang JM, Thompson MA, Warren R, Bauman J, Mably MS, Laffin J, Paschal CR, Lager AM, Lee K, Matkowskyj KA, Buehler DG, Rehrauer WM, Kolesar J. Implementation and Clinical Utility of an Integrated Academic-Community Regional Molecular Tumor Board. JCO Precis Oncol 2017; 1:1600022. [PMID: 32913980 DOI: 10.1200/po.16.00022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Precision oncology develops and implements evidence-based personalized therapies that are based on specific genetic targets within each tumor. However, a major challenge that remains is the provision of a standardized, up-to-date, and evidenced-based precision medicine initiative across a geographic region. Materials and Methods We developed a statewide molecular tumor board that integrates academic and community oncology practices. The Precision Medicine Molecular Tumor Board (PMMTB) has three components: a biweekly Web-based teleconference tumor board meeting provided as a free clinical service, an observational research registry, and a monthly journal club to establish and revise evidence-based guidelines for off-label therapies. The PMMTB allows for flexible and rapid implementation of treatment, uniformity in practice, and the ability to track outcomes. Results We describe the implementation of the PMMTB and its first year of activity. Seventy-seven patient cases were presented, 48 were enrolled in a registry, and 38 had recommendations and clinical follow-up. The 38 subjects had diverse solid tumors (lung, 45%; GI, 21%; breast, 13%; other, 21%). Of these subjects, targeted therapy was recommended for 32 (84%). Clinical trials were identified for 24 subjects (63%), and nontrial targeted medicines for 16 (42%). Nine subjects (28%) received recommended therapy with a response rate of 17% (one of six) and a clinical benefit rate (partial response + stable disease) of 38% (three of eight). Although clinical trials often were identified, patients rarely enrolled. Conclusion The PMMTB provides a model for a regional molecular tumor board with clinical utility. This work highlights the need for outcome registries and improved access to clinical trials to pragmatically implement precision oncology.
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Affiliation(s)
- Mark E Burkard
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Dustin A Deming
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Benjamin M Parsons
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Paraic A Kenny
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Marissa R Schuh
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Ticiana Leal
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Nataliya Uboha
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Joshua M Lang
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Michael A Thompson
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Ruth Warren
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Jordan Bauman
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Mary S Mably
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Jennifer Laffin
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Catherine R Paschal
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Angela M Lager
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Kristy Lee
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Kristina A Matkowskyj
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Darya G Buehler
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - William M Rehrauer
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
| | - Jill Kolesar
- , , , , , , , , , , , , , , and , University of Wisconsin-Madison; , University of Wisconsin School of Medicine and Public Health; , UW Health; , William S. Middleton VA Medical Center, Madison; and , Gundersen Health System, La Crosse; , Aurora Health Care, Milwaukee; and , Green Bay Oncology, Green Bay, WI
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Implementation and utilization of the molecular tumor board to guide precision medicine. Oncotarget 2017; 8:57845-57854. [PMID: 28915716 PMCID: PMC5593688 DOI: 10.18632/oncotarget.18471] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/31/2017] [Indexed: 12/25/2022] Open
Abstract
Background With rapid advances in genomic medicine, the complexity of delivering precision medicine to oncology patients across a university health system demanded the creation of a Molecular Tumor Board (MTB) for patient selection and assessment of treatment options. The objective of this report is to analyze our progress to date and discuss the importance of the MTB in the implementation of personalized medicine. Materials and Methods Patients were reviewed in the MTB for appropriateness for comprehensive next generation sequencing (NGS) cancer gene set testing based on set criteria that were in place. Because profiling of stage IV lung cancer, colon cancer, and melanoma cancers were standard of care, these cancer types were excluded from this process. We subsequently analyzed the types of cases referred for testing and approved with regards to their results. Results 191 cases were discussed at the MTB and 132 cases were approved for testing. Forty-six cases (34.8%) had driver mutations that were associated with an active targeted therapeutic agent, including BRAF, PIK3CA, IDH1, KRAS, and BRCA1. An additional 56 cases (42.4%) had driver mutations previously reported in some type of cancer. Twenty-two cases (16.7%) did not have any clinically significant mutations. Eight cases did not yield adequate DNA. 15 cases were considered for targeted therapy, 13 of which received targeted therapy. One patient experienced a near complete response. Seven of 13 had stable disease or a partial response. Conclusions MTB at University of Alabama-Birmingham is unique because it reviews the appropriateness of NGS testing for patients with recurrent cancer and serves as a forum to educate our physicians about the pathways of precision medicine. Our results suggest that our detection of actionable mutations may be higher due to our careful selection. The application of precision medicine and molecular genetic testing for cancer patients remains a continuous educational process for physicians.
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