Delivering Precision Oncology in a Community Cancer Program: Results From a Prospective Observational Study

Abstract

Introduction Precision oncology (PO) is a growing treatment approach in the era of next-generation sequencing (NGS) and matched therapies. Effective delivery of PO in the community has not been extensively studied. Our program developed a virtual molecular tumor board (MTB) strategy to help guide PO care. Materials and Methods Over 18 months, eligible adult patients with advanced, incurable solid tumor malignancies were enrolled in a molecular profiling (MP) study using the Foundation Medicine NGS panel. Results were reviewed through a weekly, videoconferenced MTB conducted across our largely rural integrated health system. Recommendations from the MTB were used to identify actionable alterations (AAs). Feasibility of PO care delivery was assessed as the primary outcome. Secondary outcomes included the frequency of AAs, genomic matched treatments, genomic matched clinical trial enrollment, and clinical outcomes. Results A total of 120 participants with a variety of advanced tumor types were enrolled. Of these, 109 (90.8%) had successful MP. Treatment on the basis of an AA was recommended by the MTB in 58% of patients (63 of 109) who had a successful MP result. For those completing MP, treatments included enrollment in a genomic matched clinical trial (n = 16; 14.6%) and genomic matched treatment with a Food and Drug Administration–approved agent (n = 23; 21.1%). Response and survival data were similar regardless of the matched treatment option chosen. Conclusion A video-conferenced MTB-facilitated NGS testing and treatment delivery system was implemented in our integrated community oncology program. Continued use of this model aims to increase understanding of the impact of PO in this setting.

Benefits and drawbacks of videoconferencing for collaborating multidisciplinary teams in regional oncology networks: a scoping review

“…57 58 60 ► Tailor the VC to local needs and disease-specific aspects including diagnosis and the treatment phase depending on the biology of the tumour. 29 VC meeting logistics ► Run VC meetings within an established framework such as used with local MDTMs. 61 ► Ensure appropriate case selection ('admission rules').…”

Impact of a Clinical Genomics Program on Trial Accrual for Targeted Treatments: Practical Approach Overcoming Barriers to Accrual for Underserved Patients

“…MTB review has led to up to 58% of patients treated with a molecularly matched therapy and trial enrollment from 2% to 22%, with trial availability being a key factor. 15,16,27,28 Because of the potential impact that MP can have on treatment decisions, we examined the role of a clinical genomics program (CGP) providing a standardized process for ordering, reporting, and decision support in a large multistate system with urban and isolated rural practices to empower physicians to obtain and use MP. We leveraged the system's icon-driven clinical care electronically accessible pathways (EAPathways), 29 a small, centralized team for specimen review and submission, and integrated tools 30 for automated reporting of results and potential molecularly matched clinical trials to the physician.…”

Barriers and enablers to cancer clinical trial participation and initiatives to improve opportunities for rural cancer patients: A scoping review

“…Forty-eight studies met the inclusion criteria 35–82 (Figure 1). Study characteristics are summarised in Table 1.…”