Molecular Tumor Boards Could Transform Precision Cancer Medicine

A new paper by researchers from the Dana-Farber Cancer Institute shows that the inclusion of precision medicine in regular cancer care with expert multidisciplinary molecular tumor boards is both sustainable and scalable.

The practice of precision oncology involves the detection of molecular alterations that cause malignancy in a tumor with the aim of targeting those changes. It can result in the adoption of different therapies for cancer patients with similar diagnoses.

However, the practice of precision oncology is becoming more and more complex. It has become hard to the extent that expert oncologists also find making sense of the results of molecular tumor tissue tests tricky. This makes treatment and matching of patients to potentially helpful trials challenging.

The work by a multidisciplinary team at Dana-Farber looks to help deal with these challenges. This team has been helping physicians that treat gastrointestinal (GI) cancer by reviewing molecular test results and providing timely and useful treatment option suggestions.

“To make the best decisions for patients, oncologists would ideally need an understanding of the intricacies of genomic testing and a working knowledge of cancer genetics – which can be difficult to apply in a busy clinic,” explained Marios Giannakis, MD, Ph.D., the senior author of the paper. “Our program relieves oncologists of some of that burden by having a team of experts assist.”

The paper was published online in JCO Precision Oncology, a journal of the American Society of Clinical Oncology.

Molecular tumor board

The multidisciplinary team that carried out this work comprised gastrointestinal oncologists, genomic scientists, pathologists, and research coordinators. It was formed as part of a program called GI TARGET – “TARGET” is an acronym for Treatment Assistance Regarding Genomic Evaluation of Tumors.

This program was created to provide support for precision oncology decisions by oncologists at Dana-Farber’s Gastrointestinal Cancer Center (GCC).

The team serves as a molecular tumor board. It reviews and interprets genomic testing results of people with GI tumors. The ultimate aim was to identify clinical drug trials that are focused on the identified genomic anomalies.

The team reviewed the genomic data of 506 patients with GI cancer. These were people who received treatment at Dana-Farber Brigham Cancer Center in the period from January to June 2019.

OncoPanel was used to analyze the bulk of tumor samples from the patients. This test is able to detect over 450 genetic tissue abnormalities.

The tumor board also used a computer program called MatchMiner to match patients to clinical trials offering target therapies. It carried out this matching in light of observed genetic alterations in the tumors of patients.

MatchMiner was developed at Dana-Farber as well.

Each week, the board met to review all complex cases – for example, tumors with multiple actionable alterations. It then provided recommendations for treatment options and other clinical measures.

The team entered these data into the electronic medical records of patients. This was to enable easy access and review by oncologists and other providers.

As per the paper, the median time from tumor sample testing to treatment recommendation issuance was eight days.

Clinical utility

The board successfully made clinical trial recommendations for most of the patients covered – about 80 percent. It also suggested extra testing for 42 percent of the patients.

“The success of this program in gastrointestinal oncology at Dana-Farber suggests that similar programs could be implemented elsewhere, with investment of some resources and willingness to adjust workflows accordingly,” said Brian Wolpin, MD, MPH, who is the director of the GCC.

This work shows that the use of precision oncology recommendations can be clinically beneficial to people with cancer.