Evaluating the impact of a molecular tumor board in a community oncology center: Results from the Avera Cancer Institute's experience.

Abstract

e13500 Background: The use of molecular tumor boards (MTB) has been widely documented at large academic medical centers, but there is limited experience and data available in smaller settings like community oncology centers. The Avera Cancer Institute has had a molecular tumor board in place since 2014, but the composition and methodology have changed over time. Our 10 years of hands-on experience and involvement in studies like I-PREDICT showed that in addition to molecular matching, considering factors like tumor type, previous treatment responses, comorbidities, medication coverage, and treatment availability provide crucial insights for determining optimal therapy for patients. Methods: We analyzed next-generation sequencing (NGS) testing results from August 2019 to December 2022. At the time of NGS testing result, providers were offered to have the case reviewed and presented at MTB. Our multidisciplinary team consists of members with backgrounds in bioinformatics, medical oncology, pathology, translational science, trial coordination, and pharmacy. Recommendations from the MTB discussions were provided in three categories: standard of care, clinical trials, and off-label options. Results: From August 2019 to December 2022, 1,514 qualified or resulted NGS reports were returned and considered for analysis. 733 (48%) were presented at the molecular tumor board and from this group, 629 patients were evaluable. Oncologists chose a recommended therapy 66% of the time. Of the remaining 34%, the most common reason for not utilizing recommendations was that patients were unable to receive further lines of systemic therapy. A subset analysis of 202 cases (June 2021 – August 2022) who either received a recommended therapy (n = 88, 43.6%, group 1) or not (n = 114, 56.4%, group 2) showed a survival benefit. Median overall survival was not reached in group 1, as compared with 14 months in group 2 (HR = 0.58; 95% CI, 0.37 – 0.92; p< 0.02). The median PFS was 8.2 months in group 1 versus 5 months in group 2 (HR, 0.67; 95% CI, 0.48 - 0.92; p< 0.017). Conclusions: The results of our study demonstrate the positive impact of a molecular tumor board review in helping oncologists determine the best treatment options for their patients. Our findings show that recommendations made by the board are well received and frequently adopted by providers. While providers generally prefer standard of care options or clinical trials, they are open to considering all available options to make informed therapy decisions.