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Published on: April 11, 2016
Implementation and Clinical Utility of an Integrated Academic-Community Regional Molecular Tumor Board
Mark E Burkard1, Dustin A Deming1, Benjamin M Parsons1
1, , , , , , , , , , , , , , 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.
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.
Insights
A statewide molecular tumor board improved precision oncology by standardizing care and tracking outcomes. This initiative highlights the need for better clinical trial access to enhance targeted therapy delivery.
Area of Science:
- Oncology
- Genomics
- Clinical Informatics
Background:
- Precision oncology offers personalized cancer therapies based on tumor genetic targets.
- A key challenge is standardizing and updating precision medicine initiatives regionally.
Purpose of the Study:
- To develop and implement a statewide molecular tumor board to address regional precision oncology challenges.
- To integrate academic and community oncology practices for standardized care.
Main Methods:
- Established the Precision Medicine Molecular Tumor Board (PMMTB) with teleconference meetings, a research registry, and a journal club.
- Focused on evidence-based guidelines for off-label therapies and flexible treatment implementation.
Main Results:
- PMMTB presented 77 cases, enrolling 48 in a registry; 38 received recommendations.
- Targeted therapy was recommended for 84% of subjects; clinical trials were identified for 63%.
- Nine subjects received recommended therapy, showing a 17% response rate and 38% clinical benefit rate.
Conclusions:
- The PMMTB serves as a viable model for regional molecular tumor boards.
- The study emphasizes the importance of outcome registries and improved clinical trial access for precision oncology.
