Development and feasibility of virtual molecular tumor board.

Abstract

e18334 Background: Practicing precision oncology is challenging due to the complex molecular interpretation and its implications in deciding pertinent treatment options. This is addressed by institutional Molecular Tumor Board (MTB) which is presided by all oncology sub-specialists including molecular biologist and bioinformatician, doing a meticulous job in untwining the intricacies but fail to obtain experiences across institutes. Further, meeting of all MTB members is neither always feasible nor accessible for the community oncologists. We hereby offer a virtual formation of MTB that is easily accessible and remotely attended by various experts across institutes, giving their opinion objectively at their ease that can be documented and archived. Methods: Virtual MTB (vMTB), a mobile cloud-based application was developed for both android and iOS platforms. The vMTB process involves submission and review of cases, whereby assigned members can opine blindly and rate different treatment options. Followed by averaging of rating score and then a final recommendation generated by the vMTB case-convener within 7 days, based on clinical context. A pilot study (2 months duration) was carried out where clinical cases bearing molecular information were invited from various oncology centers across India. Results: 21 cases were submitted (19 relapsed refractory, 3 treatment naïve) that included Breast (6), Lung (5), Leukemia/Lymphoma (3), Gall bladder (2), Uterine (2), Urinary bladder (1), GBM (1) and Sarcoma (1) cancers. The molecular query was based on 18 somatic (8 FoundationOne & 10 Others) and 3 germline testing. Cases assigned to vMTB members (~7 members/case) had ~ 6 treatment options/case with a response turn-around time ~4 days. Therapeutic final recommendation(s) were given for all cases with 95% concordance among the members; 6 cases where multiple options were advised, discordance rate was 14%. Additional molecular diagnostic workup was advised in 3 cases. vMTB recommendations including 10 off label treatment options were accepted by majority of the submitting physicians (82%). Clinical benefit was observed in 5 (24%) cases within the stipulated analysis duration. Conclusions: vMTB is a user-friendly, feasible, acceptable mobile solution alternate to MTB for objectively generating clinically meaningful consensus document for complex molecular clinical case scenarios, where guidelines are limited. To best of our knowledge, this is a first smart mobile solution connecting various oncology experts and have an immediate utility for the practicing community oncologists globally.