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Published on: April 11, 2016
Real-World Data From a Molecular Tumor Board: Improved Outcomes in Breast and Gynecologic Cancers Patients With
Lindsey M Charo1,2, Ramez N Eskander1,2, Jason Sicklick1,3
1Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA.
Purpose:
Next-generation sequencing is increasingly used in gynecologic and breast cancers. Multidisciplinary Molecular Tumor Board (MTB) may guide matched therapy; however, outcome data are limited. We evaluate the effect of the degree of matching of tumors to treatment as well as compliance to MTB recommendations on outcomes.
Methods:
Overall, 164 patients with consecutive gynecologic and breast cancers presented at MTB were assessed for clinicopathologic data, next-generation sequencing results, MTB recommendations, therapy received, and outcomes. Matching score (MS), defined as percentage of alterations targeted by treatment over total pathogenic alterations, and compliance to MTB recommendations were analyzed in context of oncologic outcomes.
Results:
Altogether, 113 women were evaluable for treatment after MTB; 54% received matched therapy. Patients with MS ≥ 40% had higher overall response rate (30.8% v 7.1%; P = .001), progression-free survival (PFS; hazard ratio [HR] 0.51; 95% CI, 0.31 to 0.85; P = .002), and a trend toward improved overall survival (HR 0.64; 95% CI, 0.34 to 1.25; P = .082) in univariate analysis. The PFS advantage remained significant in multivariate analysis (HR 0.5; 95% CI, 0.3 to 0.8; P = .006). Higher MTB recommendation compliance was significantly associated with improved median PFS (9.0 months for complete; 6.0 months for partial; 4.0 months for no compliance; P = .004) and overall survival (17.1 months complete; 17.8 months partial; 10.8 months none; P = .046). Completely MTB-compliant patients had higher MS (P < .001). In multivariate analysis comparing all versus none MTB compliance, overall response (HR 9.5; 95% CI, 2.6 to 35.0; P = .001) and clinical benefit (HR 8.8; 95% CI, 2.4 to 33.2; P = .001) rates were significantly improved with higher compliance.
Conclusion:
Compliance to MTB recommendations resulted in higher degrees of matched therapy and correlates with improved outcomes in patients with gynecologic and breast cancers.
Insights
Molecular Tumor Boards (MTB) improve cancer treatment matching. Compliance with MTB recommendations leads to better outcomes for gynecologic and breast cancer patients.
Area of Science:
- Oncology
- Genomics
- Clinical Trials
Background:
- Next-generation sequencing (NGS) is vital in gynecologic and breast cancers.
- Molecular Tumor Boards (MTBs) aim to guide targeted therapy selection.
- Limited outcome data exist for MTB recommendations and treatment matching.
Purpose of the Study:
- To evaluate the impact of treatment-tumor matching on patient outcomes.
- To assess the influence of adherence to MTB recommendations on oncologic outcomes.
- To analyze the correlation between matching score and compliance with survival data.
Main Methods:
- Retrospective analysis of 164 gynecologic and breast cancer patients.
- Assessment of clinicopathologic data, NGS results, and MTB recommendations.
- Calculation of Matching Score (MS) and analysis of MTB compliance in relation to outcomes.
Main Results:
- Patients with MS ≥ 40% showed improved overall response rate and progression-free survival (PFS).
- Higher MTB recommendation compliance significantly correlated with improved PFS and overall survival.
- Complete MTB compliance was associated with higher MS and significantly improved response and clinical benefit rates.
Conclusions:
- Adherence to MTB recommendations enhances treatment matching.
- MTB compliance is a significant predictor of improved outcomes in gynecologic and breast cancer patients.
- Integrating molecular profiling with expert review improves targeted therapy efficacy.
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