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Leadership Insights From a Pathology Peer-to-Peer Learning Collaborative in Immuno-oncology. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
As the use of immuno-oncology (IO) expands into more cancers, there is a growing need for pathologists and laboratory professionals to demonstrate leadership and guide biomarker testing processes and procedures at their own institutions. To educate and empower its members, the American Society for Clinical Pathology worked in collaboration with Q Synthesis to develop a peer-to-peer learning collaborative. This project was supported by an educational grant from Bristol Myers Squibb.
Methods/Case Report
18 pathologists and laboratory professionals participated in a 10-month program: IO ChangeMakers. Learners completed online modules covering scientific updates on IO biomarker testing. Through small-group, case-based discussions, learners reviewed operational challenges and opportunities to refine biomarker testing. They applied this knowledge to lead IO improvement projects at their own institutions.
Results (if a Case Study enter NA)
The learners identified the following leadership insights around IO biomarker testing: Reflex testing: Develop or refine reflex biomarker testing processes to ensure that tissue is sent for PD-L1 testing at the time of cancer diagnosis. Establish testing criteria with oncologists and implement steps to reduce delays in testing. Interobserver concordance: Evaluate interobserver concordance among pathologists scoring PD-L1, especially in upper GI cancers where the combined positive score (CPS) is used. Scoring upper GI cancers is challenging because of the spatial distribution of PD-L1 within a tumor. Tissue handling: Identify ways to improve tissue processing and handling to preserve small amounts of tissue for biomarker testing. If quantity is not sufficient, prioritize PD-L1 testing and contact the oncologist to order a liquid biopsy. Confusion around different PD-L1 antibody clones: Pathologists and clinicians are often confused about the use of different PD-L1 antibody clones (eg, 22C3, SP142, etc.) and scoring criteria (eg, TPS ≥ 1%, CPS ≥ 10, TC ≥ 25%, etc.). Develop education and reference guides to ensure the right PD-L1 test is ordered based on the type of tumor and intended treatment. Test ordering to reporting: In many cancer centers, biopsy samples are being sent out for PD-L1 testing. Refine electronic test ordering, tracking status, and reporting results.
Conclusion
Pathologists have numerous opportunities to lead improvement efforts in IO biomarker testing. As the use of IO expands into more cancers, there will be a growing need for pathologists to demonstrate leadership in this area.
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Education to Improve Ki67 Testing in Hormone Receptor-Positive/HER2-Negative Early-Stage Breast Cancer (HR+ EBC). Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Ki67 is a marker of active cellular proliferation with prognostic utility in EBC. However, clinical use has been limited due to variability in assay protocols and interpretation. Recently, a Ki67 companion diagnostic received FDA approval for assessing recurrence risk and guiding therapy decision-making for high-risk HR+ EBC. We report a comprehensive program to understand current clinical use of Ki67 and identify and address educational needs of healthcare professionals regarding Ki67 testing to improve patient care.
Methods/Case Report
The multimodal program included a baseline survey to explore gaps in knowledge, skills, and clinical confidence in Ki67 assessment; a live, virtual webinar featuring a pathologist and an oncologist discussing practice-changing developments; and an interactive on-demand webcast developed from the webinar.
Results (if a Case Study enter NA)
Of the 653 survey respondents (227 self-identified a role in medical oncology and 261 in pathology), 77% indicated that they currently test for Ki67 in patients with HR+ EBC, and 64% indicated they were very or moderately knowledgeable on how to use Ki67 as a diagnostic assay. However, only 46% indicated they were very or moderately knowledgeable about the strengths and limitations of Ki67 testing methods or identifying patients who would likely benefit from CDK4/6 inhibition. At the end of the webinar, 67% to 83% of the evaluation respondents (92 – 115) indicated that the education increased their knowledge and/or confidence around how to use and test for Ki67 and identify eligible patients. There were also statistically significant gains from the webcast, including knowledge of strengths/limitations of Ki67 testing methods and confidence in the ability to identify patients for targeted therapies or clinical trials.
Conclusion
These data suggest some challenges in integrating Ki67 as a biomarker for clinical practice, but education can enhance knowledge and confidence on this topic. A detailed analysis of the survey and outcomes from the linked education are presented.
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Engaging Pathologists in a Peer-to-Peer Learning Collaborative on HER2-Low Breast Cancer. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Recent advances in research have shown clinical effectiveness when targeting the lower range of HER2 expression (ie, HER2-low) in patients with metastatic breast cancer. American Society for Clinical Pathology worked in collaboration with Q Synthesis to develop a peer-to-peer learning collaborative to proactively prepare pathologists for HER2-low. This CME project was supported by an educational grant from AstraZeneca Pharmaceuticals LP and Daiichi Sankyo Inc.
Methods/Case Report
38 pathologists participated in the ASCP HER2 Breast Trailblazers. For foundational knowledge, learners completed online modules covering scientific updates on HER2-low. Through small-group, case- based discussions, learners reviewed operational challenges and opportunities to prepare for HER2-low. They applied this knowledge to lead projects at their own institutions focusing on the anticipated changes around HER2-low.
Results (if a Case Study enter NA)
The learners identified the following challenges and opportunities: Defining HER2-low: Several learners had heard misconceptions around the definition of HER2-low. Recent studies have defined HER2-low as IHC 1+ or IHC 2+ with ISH-negative. Interobserver concordance with IHC 0 vs 1+: Several learners discussed the challenges around interpreting IHC 0 vs 1+. They felt that some pathologists may need guided feedback to improve their diagnostic skills. Use of IHC vs. ISH: Several learners only performed ISH for HER2 testing on all breast cancer samples. If HER2-low emerges as a third category, they would need to return to IHC. Implications for non-metastatic breast cancer: Recent HER2-low studies have focused on patients with metastatic breast cancer. If HER2-low emerges as a third category, it is unclear whether this designation will also be used in patients who have early-stage breast cancer.
Leadership
As pathologists prepare for HER2-low, they have opportunities to lead projects to assess and improve IHC interobserver concordance, coach others on IHC interpretation, increase operational efficiency, strength communication skills, and build up the team by proactively anticipating challenges around HER2-low.
Conclusion
HER2-low breast cancer may be emerging as a new category. Through a peer-to-peer learning collaborative, pathologists identified ways to proactively prepare and demonstrate leadership so that cancer centers and laboratories may be ready to embrace a new paradigm of HER2 classification in breast cancer.
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