Keng Hee Peh1, Daniel J Przybylski2, Michael J Fallon3, Jason J Bergsbaken3, Paul R Hutson4, Menggang Yu5, Dustin A Deming5,6, Mark E Burkard5,6. 1. 12253University of Kentucky College of Pharmacy, Lexington, KY, United States. 2. 24560Northwestern Medicine, Chicago, IL, United States. 3. 529799UW Health, Madison, WI, United States. 4. School of Pharmacy, 5228University of Wisconsin - Madison, Madison, WI, United States. 5. 206022University of Wisconsin Carbone Cancer Center, Madison, WI, United States. 6. Department of Medicine, Hematology/Oncology and McArdle Laboratories, University of Wisconsin, Madison, WI, United States.
Abstract
PURPOSE: Molecular tumor boards provide precision treatment recommendations based on cancer genomic profile. However, practical barriers limit their benefits. We studied the clinical utility of the precision medicine molecular tumor board (PMMTB) and described challenges with PMMTB implementation. METHODS: An observational cohort study included patients reviewed by the PMMTB between September 2015 to December 2017. Patients who had consented to the registry study were included. The primary endpoint of this study was time on treatment (ToT) ratio. Clinical utility was established if the primary endpoint had least 15% of patients achieving a ToT ratio of ≥1.3. RESULTS: Overall, 278 patients were presented to the PMMTB and 113 cases were included in the final analysis. The PMMTB identified at least one nonstandard of care (SOC) clinically actionable mutation for 69.0% (78/113) of cases. In patients who received non-SOC treatment, 43.8% (7/16) achieved a ToT ratio of 1.3 or more (p < 0.001). Fifty-nine patients did not receive non-SOC recommendations. Reasons for not pursuing treatment included 35.6% having response to current treatment, 20.3% died prior to starting or considering PMMTB recommendations, 13.6% pursued other treatment options based on clinician discretion, another 10.2% pursued other treatment options because clinical trials recommended were not geographically accessible, 8.5% had rapid decline of performance status, 6.8% lacked of financial support for treatment, and 5.1% were excluded from clinical trials due to abnormal laboratory values. CONCLUSION: The regional PMMTB non-SOC recommendations benefitted a majority of patients and additional processes were implemented to assist with non-SOC treatment accessibility.
PURPOSE: Molecular tumor boards provide precision treatment recommendations based on cancer genomic profile. However, practical barriers limit their benefits. We studied the clinical utility of the precision medicine molecular tumor board (PMMTB) and described challenges with PMMTB implementation. METHODS: An observational cohort study included patients reviewed by the PMMTB between September 2015 to December 2017. Patients who had consented to the registry study were included. The primary endpoint of this study was time on treatment (ToT) ratio. Clinical utility was established if the primary endpoint had least 15% of patients achieving a ToT ratio of ≥1.3. RESULTS: Overall, 278 patients were presented to the PMMTB and 113 cases were included in the final analysis. The PMMTB identified at least one nonstandard of care (SOC) clinically actionable mutation for 69.0% (78/113) of cases. In patients who received non-SOC treatment, 43.8% (7/16) achieved a ToT ratio of 1.3 or more (p < 0.001). Fifty-nine patients did not receive non-SOC recommendations. Reasons for not pursuing treatment included 35.6% having response to current treatment, 20.3% died prior to starting or considering PMMTB recommendations, 13.6% pursued other treatment options based on clinician discretion, another 10.2% pursued other treatment options because clinical trials recommended were not geographically accessible, 8.5% had rapid decline of performance status, 6.8% lacked of financial support for treatment, and 5.1% were excluded from clinical trials due to abnormal laboratory values. CONCLUSION: The regional PMMTB non-SOC recommendations benefitted a majority of patients and additional processes were implemented to assist with non-SOC treatment accessibility.
Authors: Gennaro Ciliberto; Marco Canfora; Irene Terrenato; Chiara Agnoletto; Francesco Agustoni; Loredana Amoroso; Gustavo Baldassarre; Giuseppe Curigliano; Angelo Delmonte; Antonella De Luca; Michelangelo Fiorentino; Vanesa Gregorc; Toni Ibrahim; Chiara Lazzari; Angela Mastronuzzi; Paolo Pronzato; Armando Santoro; Giovanni Scambia; Stefania Tommasi; Andrea Vingiani; Patrizio Giacomini; Ruggero De Maria Journal: J Exp Clin Cancer Res Date: 2022-10-17