Clinical utility of an international multidisciplinary virtual tumor board for fibrolamellar carcinoma.

Abstract

e18624 Background: Fibrolamellar carcinoma (FLC) is a rare liver cancer with approximately 1500 new cases per year, worldwide. The lack of expertise locally often incurs significant travel for patients (pts). Virtual consults have improved access to expertise but identifying the best experts for an ultra-rare condition is difficult for pts and families and multidisciplinary tumor boards of experts offer better clinical guidance. Foundations and advocacy groups play a vital role in navigation and support for pts with rare cancers. Methods: Pts with FLC and their local treating oncologists were engaged by the FibroFighters Foundation and offered a multidisciplinary virtual tumor board (VTB) review. Each VTB included the local treating oncologist, a patient advocate, a molecular pharmacologist, and international experts in the clinical management of FLC including at least one medical oncologist, one radiation oncologist, one interventional radiologist, and one surgical oncologist. Each VTB reviewed the pts’ clinical history and relevant imaging and discussed surgical, radiological, and systemic approaches. Pts consented to the observational research protocol XCELSIOR ( NCT03793088 ) to enable longitudinal clinical summaries to be prepared and for outcomes to be annotated. Results: Between August 4th 2022 and February 9th, 2023, the VTB held a total of 71 discussions for 59 unique pts (12 discussed more than once): 12 new diagnoses, 28 relapses, 14 treatment failures, and 5 ongoing care. Median age at diagnosis of pts was 18 years (range 6-44 years). Pts were seen at 44 institutions/practices across 22 states and 4 countries (USA, Australia, Switzerland, and the Netherlands). A total of 36 unique treatment regimens were discussed, with 21 unique consensus top-ranked options delivered to treating oncologists. The most common consensus options included regimens of gemcitabine, lenvatinib, and nivolumab (13), interventional radiology (IR, 11), surgical resection (6), and a regimen of gemcitabine, oxaliplatin, and lenvatinib (6). The primary team implemented the VTB recommendations 60 times out of 71 (85%): change in systemic therapy (33), IR (11), continue current regimen (11), surgery (6), radiation oncology (2). Conclusions: This is the first demonstration of a patient-focused international multidisciplinary VTB for FLC. The high rate of recommendation adoption by local treating oncologists suggests this is a valuable service to improve patient care. Outcomes are being collected prospectively in a master observational research protocol to better define clinical utility.