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Implementation of a Molecular Tumor Registry to Support the Adoption of Precision Oncology Within an Academic Medical
Michelle F Green1, Jonathan L Bell1, Christopher B Hubbard1
1Department of Pathology, Duke University Medical Center, Durham, NC.
Abstract:
Comprehensive genomic profiling to inform targeted therapy selection is a central part of oncology care. However, the volume and complexity of alterations uncovered through genomic profiling make it difficult for oncologists to choose the most appropriate therapy for their patients. Here, we present a solution to this problem, The Molecular Registry of Tumors (MRT) and our Molecular Tumor Board (MTB).
Patients And Methods:
MRT is an internally developed system that aggregates and normalizes genomic profiling results from multiple sources. MRT serves as the foundation for our MTB, a team that reviews genomic results for all Duke University Health System cancer patients, provides notifications for targeted therapies, matches patients to biomarker-driven trials, and monitors the molecular landscape of tumors at our institution.
Results:
Among 215 patients reviewed by our MTB over a 6-month period, we identified 176 alterations associated with therapeutic sensitivity, 15 resistance alterations, and 51 alterations with potential germline implications. Of reviewed patients, 17% were subsequently treated with a targeted therapy. For 12 molecular therapies approved during the course of this work, we identified between two and 71 patients who could qualify for treatment based on retrospective MRT data. An analysis of 14 biomarker-driven clinical trials found that MRT successfully identified 42% of patients who ultimately enrolled. Finally, an analysis of 4,130 comprehensive genomic profiles from 3,771 patients revealed that the frequency of clinically significant therapeutic alterations varied from approximately 20% to 70% depending on the tumor type and sequencing test used.
Conclusion:
With robust informatics tools, such as MRT, and the right MTB structure, a precision cancer medicine program can be developed, which provides great benefit to providers and patients with cancer.
Insights
The Molecular Registry of Tumors (MRT) and Molecular Tumor Board (MTB) streamline cancer care by integrating genomic data. This system helps identify targeted therapies and clinical trials for patients, improving precision oncology outcomes.
Area of Science:
- Genomic Medicine
- Oncology Informatics
- Precision Cancer Therapy
Background:
- Comprehensive genomic profiling (CGP) is crucial for selecting targeted therapies in oncology.
- The complexity and volume of CGP data present challenges for oncologists in treatment selection.
- A need exists for integrated systems to manage and interpret genomic data for clinical decision-making.
Purpose of the Study:
- To present the Molecular Registry of Tumors (MRT) and Molecular Tumor Board (MTB) as a solution for managing complex genomic data.
- To demonstrate how MRT and MTB facilitate targeted therapy selection and clinical trial matching for cancer patients.
- To evaluate the impact of MRT and MTB on precision cancer medicine implementation.
Main Methods:
- Development of the Molecular Registry of Tumors (MRT), an internal system for aggregating and normalizing genomic profiling results.
- Establishment of a Molecular Tumor Board (MTB) to review genomic results for all cancer patients within the Duke University Health System.
- MRT and MTB functionalities include targeted therapy notification, clinical trial matching, and molecular landscape monitoring.
Main Results:
- Over a 6-month period, 215 patients were reviewed, identifying 176 sensitivity alterations and 51 potential germline alterations.
- 17% of reviewed patients received targeted therapy, and MRT data identified 2-71 patients eligible for 12 recently approved molecular therapies.
- MRT successfully identified 42% of patients enrolled in biomarker-driven trials, and clinically significant alterations varied from 20-70% by tumor type.
Conclusions:
- Robust informatics tools like MRT, coupled with an effective MTB structure, are essential for developing precision cancer medicine programs.
- The integrated approach of MRT and MTB significantly benefits both healthcare providers and cancer patients.
- This system enhances the utilization of genomic information for improved patient care and treatment strategies.
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