All aboard: Will molecular tumor boards help cancer patients?

Erdmann, Jeanne

doi:10.1038/nm0715-655

Cited by 26 publications

(23 citation statements)

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“…They also advised on the nature of the communication to the oncologist. In this regard the work of CPM-TB was unique because many genomic tumor boards consider treatment choices in light of the results of the DNA sequencing after they have been reported to the treating clinician [3]. …”

Section: Methodsmentioning

confidence: 99%

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The Fuzzy World of Precision Medicine: Deliberations of a Precision Medicine Tumor Board

et al. 2016

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Aim:To understand how a cancer precision medicine tumor board (CPM-TB) made choices about return of results.Materials & methods:Observed CPM-TB deliberations and completed in-depth interviews with committee members.Results:Responding to complex evidence of ambiguous significance, deliberations of the CPM-TB were predicated on analytic validity and clinical utility. Members had concerns both about potential harms due to returning results based on weak evidence and about withholding potentially meaningful results. Group dynamics and the clinical experiences of individual committee members shaped their work.Conclusion:Both scientific evidence and the social context surrounding deliberations of a CPM-TB influenced decisions about return of results. Subjective elements, while present in any scientific endeavor, may carry more weight in the face of ambiguous findings.

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Section: Methodsmentioning

confidence: 99%

“…Review and deliberation by a multidisciplinary group may represent one mechanism to ensure rigorous consideration of genomic data [2]. Toward this end, some institutions convene so-called precision medicine or molecular tumor boards [3–5]. …”

Section: Introductionmentioning

confidence: 99%

The Fuzzy World of Precision Medicine: Deliberations of a Precision Medicine Tumor Board

et al. 2016

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“…Oncology practitioners themselves have called attention to the development of MTBs as a noteworthy characteristic of the emerging field of precision oncology (Erdmann , Hoefflin et al . , Horak et al .…”

Section: Mtbs a Novel Institution For Precision Oncologymentioning

confidence: 99%

“…Oncology practitioners themselves have called attention to the development of MTBs as a noteworthy characteristic of the emerging field of precision oncology (Erdmann 2015, Hoefflin et al 2018, Horak et al 2017, Knepper et al 2017, McGraw et al 2017, Schwaederle et al 2014, Stoekl e et al 2017, Tafe et al 2015. The purpose of these practitioners' contributions is to document and promote the role and practices of these novel institutions, whose multidisciplinary line-up is justified by relation to the introduction of innovative diagnostic and therapeutic approaches such as targeted therapies, immunotherapies, molecular biomarkers and next-generation sequencing techniques (NGS).…”

mentioning

confidence: 99%

Genomic expertise in action: molecular tumour boards and decision‐making in precision oncology

Bourret

Cambrosio

2019

Sociology Health & Illness

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The recent development of cancer precision medicine is associated with the emergence of ‘molecular tumour boards’ (MTBs). Attended by a heterogenous set of practitioners, MTBs link genomic platforms to clinical practices by establishing ‘actionable’ connections between drugs and molecular alterations. Their activities rely on a number of evidential resources – for example databases, clinical trial results, basic knowledge about mutations and pathways – that need to be associated with the clinical trajectory of individual patients. Experts from various domains are required to master and align diverse kinds of information. However, rather than examining MTBs as an institution interfacing different kinds of expertise embedded in individual experts, we argue that expertise is the emergent outcome of MTBs, which can be conceptualised as networks or ‘agencements’ of humans and devices. Based on the ethnographic analysis of the activities of four clinical trial MTBs (three in France and an international one) and of two French routine‐care MTBs, the paper analyses how MTBs produce therapeutic decisions, centring on the new kind of expertise they engender. The development and activities of MTBs signal a profound transformation of the evidentiary basis and processes upon which biomedical expertise and decision‐making in oncology are predicated and, in particular, the emergence of a clinic of variants.

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“…Preliminary experiences have described the opportunity of using tumor genomic information to guide a specific treatment in certain patients through so-called molecular tumor boards [19] . In a prospective study including 250 adult patients mostly with colorectal, breast, lung and pancreas cancers, only 10% of the patients tested could be treated mainly through a clinical trial [20] .…”

Section: Prevalence and Clinical Evidencementioning

confidence: 99%

Off-label use of targeted therapies in oncology

Levêque

2016

WJCO

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Off-label use is defined by the prescription of a marketed drug outside the conditions described in the summary of product characteristics. In oncology, off-label prescribing of targeted therapies may occur in patients with other tumor types expressing the same target. Agents associated to phenotypic approaches such as therapies against the tumoral vasculature (anti-angiogenic drugs) and new immunotherapies (checkpoint inhibitors) also carry the potential of alternative indications or combinations. Off-label use of targeted therapies is little documented and appears to be in the same range than that regarding older drugs with wide variations among agents. When compared with older agents, off-label use of targeted therapies is probably more rational through tumoral genotyping but is faced with a limited clinical support, reimbursement challenges related to the very high pricing and the cost of genotyping or molecular profiling, when applicable. Core tip: Off-label use is defined by the prescription of a marketed drug outside the conditions described in the summary of product characteristics. This review is the first one focussing on the off-label use of targeted therapies in oncology. When compared with older agents, off-label use of targeted therapies is probably more rational through tumoral genotyping but is faced with a limited clinical support, reimbursement challenges related to the very high pricing and the cost of genotyping or molecular profiling, when applicable.Levêque D. Off-label use of targeted therapies in oncology.

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All aboard: Will molecular tumor boards help cancer patients?

Cited by 26 publications

References 1 publication

The Fuzzy World of Precision Medicine: Deliberations of a Precision Medicine Tumor Board

The Fuzzy World of Precision Medicine: Deliberations of a Precision Medicine Tumor Board

Genomic expertise in action: molecular tumour boards and decision‐making in precision oncology

Off-label use of targeted therapies in oncology

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