Impact of Molecular Tumor Board (MTB) on precision oncology in a community setting

Abstract

<h3>Objectives:</h3> Many cancer types, including gynecologic malignancies, have seen a surge of treatment and trial opportunities based on molecular profiling. We sought to evaluate the impact of a molecular tumor board (MTB) in a community setting on treatment decisions and outcomes. <h3>Methods:</h3> A systematic program of comphrensive genomic profiling (CGP) was initiated in December 2014. We performed a retrospective analysis of patients with MTB recommendations at a community-based oncology practice January 2015 to December 2018; exclusions were lack of follow-up or death within 60 days of the MTB and/or no metastatic disease. Potentially actionable genomic alterations from CGP (immunohistochemistry, in-situ hybridization, next-generation sequencing) were reviewed bi-weekly by MTB practice experts, pathologists, genetic counselors, and other support staff, and clinical care recommendations were provided. MTB recommendations by category (Figure 1) and number of recommendations followed by the treating physician were collated and analyzed for all cases presented at the MTB. <h3>Results:</h3> During the study period, 4,438 tests were ordered and 837 patients were presented at 87 MTBs Of these, 613/4,438 (14%) were evaluated. The median time between CGP result availability and MTB presentation was 12 days. The most common cancers were lung (23%), breast (19%), and colorectal (17%); others included ovarian, endometrial, bladder, and melanoma. Patients received 837 actionable recommendations: standard therapy (37%), clinical trial (31%), germline testing and genetic counseling (17%), off-label therapy (10%), subspecialty multidisciplinary tumor board review (2%), and advice for classifying tumor of unknown origin (2%). Of these recommendations, 36% to 78% were followed by the treating physician. Clinical trial recommendations were made for immediate enrollment, or for enrollment upon progression after standard of care therapy. Immediate trial recommendation was followed in 93 (56%) and 20 (12%) enrolled in a trial. For progression recommendations, 57 (60%) were followed and 15 (16%) enrolled on a clinical trial. MTB recommendations for standard therapy and off-label therapy were followed by the treating physician in 78% (n=244) and 37% (n=31) of cases, respectively. Germline testing and genetic counseling recommendations were followed in 36% (<i>n</i>=52) of cases. Of those who received testing, 39% (15/43) were positive for a germline mutation. <h3>Conclusions:</h3> The MTB was implemented to provide recommendations on clinical care, increase clinical trial participation, and improve awareness of standard or potential targeted therapies. We found MTB recommendations to be particularly useful in identifying clinical trial candidates. A community oncology-based comprehensive and high-throughput MTB provided useful clinical guidance in various treatment domains within an acceptable timeframe for patients with cancer in a large community setting.