A virtual molecular tumor board to improve efficiency and scalability of delivering precision oncology to physicians and their patients

Abstract

Objectives Scalable informatics solutions that provide molecularly tailored treatment recommendations to clinicians are needed to streamline precision oncology in care settings. Materials and Methods We developed a cloud-based virtual molecular tumor board (VMTB) platform that included a knowledgebase, scoring model, rules engine, an asynchronous virtual chat room and a reporting tool that generated a treatment plan for each of the 1725 patients based on their molecular profile, previous treatment history, structured trial eligibility criteria, clinically relevant cancer gene-variant assertions, biomarker-treatment associations, and current treatment guidelines. The VMTB systematically allows clinician users to combine expert-curated data and structured data from clinical charts along with molecular testing data to develop consensus on treatments, especially those that require off-label and clinical trial considerations. Results The VMTB was used as part of the cancer care process for a focused subset of 1725 patients referred by advocacy organizations wherein resultant personalized reports were successfully delivered to treating oncologists. Median turnaround time from data receipt to report delivery decreased from 14 days to 4 days over 4 years while the volume of cases increased nearly 2-fold each year. Using a novel scoring model for ranking therapy options, oncologists chose to implement the VMTB-derived therapies over others, except when pursuing immunotherapy options without molecular support. Discussion VMTBs will play an increasingly critical role in precision oncology as the compendium of biomarkers and associated therapy options available to a patient continues to expand. Conclusion Further development of such clinical augmentation tools that systematically combine patient-derived molecular data, real-world evidence from electronic health records and expert curated knowledgebases on biomarkers with computational tools for ranking best treatments can support care pathways at point of care.

Non-Small Cell Lung Cancer from Genomics to Therapeutics: A Framework for Community Practice Integration to Arrive at Personalized Therapy Strategies

“…This is especially concerning as the majority of patients or approximately 85% with cancer are treated in the community setting and 50% of collaborative group trial accruals occur in the community [160]. Several models have been proposed to integrate community oncologists into the academic paradigm of personalized medicine, with the most promising being the establishment of interpersonal relationships between community oncologists and academic site physicians through molecular tumor board (MTB) teams [161][162][163][164][165]. The establishment of an MTB team would allow for the proper evaluation of imaging, histopathology, and genomic information that is required to make the appropriate therapeutic decision [166].…”

“…of collaborative group trial accruals occur in the community [160]. Several models have been proposed to integrate community oncologists into the academic paradigm of personalized medicine, with the most promising being the establishment of interpersonal relationships between community oncologists and academic site physicians through molecular tumor board (MTB) teams [161][162][163][164][165].…”

“…The establishment of an MTB team would allow for the proper evaluation of imaging, histopathology, and genomic information that is required to make the appropriate therapeutic decision [ 166 ]. One reported study involving 1725 patients who were evaluated through a cloud-based virtual molecular tumor board (VMTB) showed that oncologists chose the VMTB-derived therapies over others, resulting in an increase of matched therapies [ 165 ]. Such a model also allows for the dissemination of information regarding available CLIA-certified vendors and platforms for both tissue and liquid biopsy testing that are imperative to improving testing rates and outcomes [ 167 ].…”

The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations

“…These clinical trial-related matters may be more acute at CHCs given their more limited resources and the absence of experienced clinical trialists [ 304 , 305 , 306 , 307 ]. The POTB provides appropriate, molecularly-informed clinical trial assignment for patients, maximizing both the utility of clinical trial participation and potential patient benefit [ 308 , 309 , 310 , 311 , 312 , 313 , 314 , 315 , 316 , 317 , 318 , 319 , 320 ].…”

Cardiovascular Phenotyping in Breast Cancer Patients Treated With Her2 Targeted Therapies Using Informatics Approaches

“…In 2019, Pishvaian et al [23]presented a new concept called Virtual Molecular Tumor Board (VTMB), which allowedclinicians to combine expert-curated data and data from clinical systems along with data from molecular diagnostics(MolDx) reports to develop consensus on treatments. It usesinterconnected cloud based virtual computing techniques and reduced the time needed for a clinician to assess a patient's tumor pro le and suitability for clinical trials from 14 to 4 days.…”