Clinical utility of a molecular tumor board (MTB) in a community oncology practice.

Abstract

e15038 Background: We convened a molecular tumor board in an oncology specialty practice of 60 oncologists. Monthly meetings were held remotely, with participation of molecular oncology experts from Caris Life Sciences. Cases were selected for MTB by CLS or clinicians, largely from patients whose genomic testing results did not suggest level 1 guideline therapy options. Methods: We reviewed the clinical value of the genomic test results. To measure the impact of the MTB on patient care, we reviewed a sample of cases with a database instrument. Results: Over calendar year 2021, 491 genomic tests were reported by CLS. These tests involved whole exome and whole transcriptome analysis of microdissected tumor samples. 151 tests showed no association with approved therapy on initial report. In addition to the reported analysis of mutations and fusions, supplemental data concerning emerging biomarkers such as deletions, homologous repair deficiency, and gene expression was provided by CLS for MTB discussion. Between May 2020 and February 2021, 47 cases were presented, representing 19 different diagnoses. 17 cases were reviewed in detail. In 88% of cases (15/17) a recommendation was made by the group. These included suggestions for standard therapy, on sequencing of therapies, on genetic counseling and testing for inherited mutations, and on clinical trial opportunities for emerging biomarker guided therapeutics. In 35% of cases (6/17), the tumor board presentation had an impact on care. In 17% of cases (6/17), we suggested germline genetic testing for patient or family. In 23% of cases (4/17), patient treatment was changed based on discussion. In 9 cases, recommendations were not acted on, because patients deteriorated, remained stable, or chose other therapies. Many patients were presented after multiple lines of treatment or at a time of declining clinical status, which limited the clinical impact of MTB discussion. Evaluation of inherited mutations in patients and family members were difficult to complete when care was dispersed across multiple health systems. Conclusions: The MTB provided valuable updates on new molecular findings and targeted therapies. Incorporation of tumor genomic testing and MTB discussion at an earlier point in the clinical care continuum could improve overall patient outcomes. Challenges in the structure and utility of the conference will be discussed.