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Programmatic Precision Oncology Decision Support for Patients With Gastrointestinal Cancer
Rachel B Keller1, Tali Mazor2, Lynette Sholl3
1Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA.
Purpose:
With the growing number of available targeted therapeutics and molecular biomarkers, the optimal care of patients with cancer now depends on a comprehensive understanding of the rapidly evolving landscape of precision oncology, which can be challenging for oncologists to navigate alone.
Methods:
We developed and implemented a precision oncology decision support system, GI TARGET, (Gastrointestinal Treatment Assistance Regarding Genomic Evaluation of Tumors) within the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute. With a multidisciplinary team, we systematically reviewed tumor molecular profiling for GI tumors and provided molecularly informed clinical recommendations, which included identifying appropriate clinical trials aided by the computational matching platform MatchMiner, suggesting targeted therapy options on or off the US Food and Drug Administration-approved label, and consideration of additional or orthogonal molecular testing.
Results:
We reviewed genomic data and provided clinical recommendations for 506 patients with GI cancer who underwent tumor molecular profiling between January and June 2019 and determined follow-up using the electronic health record. Summary reports were provided to 19 medical oncologists for patients with colorectal (n = 198, 39%), pancreatic (n = 124, 24%), esophagogastric (n = 67, 13%), biliary (n = 40, 8%), and other GI cancers. We recommended ≥ 1 precision medicine clinical trial for 80% (406 of 506) of patients, leading to 24 enrollments. We recommended on-label and off-label targeted therapies for 6% (28 of 506) and 25% (125 of 506) of patients, respectively. Recommendations for additional or orthogonal testing were made for 42% (211 of 506) of patients.
Conclusion:
The integration of precision medicine in routine cancer care through a dedicated multidisciplinary molecular tumor board is scalable and sustainable, and implementation of precision oncology recommendations has clinical utility for patients with cancer.
Insights
A decision support system, GI TARGET, improved precision oncology care for gastrointestinal cancer patients. It provided molecularly informed recommendations, increasing clinical trial enrollment and targeted therapy use.
Area of Science:
- Oncology
- Genomics
- Clinical Decision Support Systems
Background:
- Precision oncology requires oncologists to navigate complex genomic data and targeted therapies.
- A comprehensive understanding of molecular biomarkers is crucial for optimal cancer care.
Approach:
- Developed and implemented GI TARGET, a precision oncology decision support system at Dana-Farber Cancer Institute.
- A multidisciplinary team reviewed tumor molecular profiling for GI tumors, providing molecularly informed clinical recommendations.
- Utilized MatchMiner for clinical trial matching and suggested targeted therapies (on- or off-label).
Key Points:
- Reviewed genomic data for 506 GI cancer patients, providing recommendations to 19 medical oncologists.
- Recommended precision medicine clinical trials for 80% of patients, resulting in 24 enrollments.
- Recommended targeted therapies for 6% (on-label) and 25% (off-label) of patients, and additional testing for 42%.
Conclusions:
- Integrating precision medicine via a multidisciplinary molecular tumor board is scalable and sustainable.
- Precision oncology recommendations have clinical utility for patients with cancer.
- Decision support systems enhance the application of precision medicine in routine cancer care.
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