Impact of Molecular Tumor Board on the Clinical Management of Patients With Cancer

Behel, Vichitra; Noronha, Vanita; Choughule, Anuradha; Shetty, Omshree; Chandrani, Pratik; Kapoor, Akhil; Bondili, Suresh Kumar; Bajpai, Jyoti; Kumar, Rajiv; Pai, Trupti; Bal, Munita; Gurav, Mamta; Bapat, Prachi; Mittal, Neha; Menon, Santosh; Patil, Vijay; Menon, Nandini; Dutt, Amit; Prabhash, Kumar

doi:10.1200/go.22.00030

Cited by 19 publications

(17 citation statements)

References 26 publications

(27 reference statements)

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“…A retrospective study showed that for a substantial proportion of patients there were no decided treatment plans before a thoracic MDTB and in close to 50% of those who had a previous plan of management, a change in plan resulted from the MDTB discussion [ 11 ]. Another recent assessment of the benefits of molecular MDTB showed similar advantages in terms of changes in management plans or a need for a new test [ 12 ]. The above two studies justify continuing with the MDTBs in helping make decisions for cancer patients.…”

Section: Reviewmentioning

confidence: 99%

The Emerging Boon of Information and Communication Technology in Multidisciplinary Cancer Care: A Force Multiplier With a Human Touch

Vijayakumar¹,

Lancaster²,

Nittala³

et al. 2023

Cureus

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Cancer care (CC) is incredibly complex and requires the coordination of multiple disciplines for optimal outcomes. Historically, this has been accomplished with multidisciplinary tumor boards (MDTBs), but the benefits, while perhaps intuitive, have not always been demonstrated with sufficient research robustness and validity. We hypothesize that this difficulty in demonstrating the benefit of MDTBs may be related to a delay in decision-making and operationalizing those decisions. The history and value of MDTBs are presented as well as their weaknesses and limited demonstration of improved outcomes. A major weakness highlighted by the challenges of MDTBs is the concept of total package time (TPT) (rather, the inability to keep it as short as possible); any significant delays in CC for any discipline may have a deleterious impact on any given patient's care outcome. Drawing on our own experience with utilizing information and communication technology (ICT) during an effort to apply accountability theory to improve specifically radiation therapy package time (RTPT), we argue that similar principles will be applicable in the improvement of not only the TPT which relies on multiple disciplines, but other factors of CC as well, such as coordination. Experience with improvement in RTPT is discussed and the underlying theory is demonstrated as a sound methodology to apply beyond RTPT to TPT involving coordination of multiple disciplines and stands to lead to the full realization of the benefits of the multidisciplinary approach. The complexity of cancer means that real solutions to optimal outcomes are also, by nature, complex, but here simple accountability theory is demonstrated that may unlock the next phase of multidisciplinary coordination. In this work, we argue that the benefits of the MDTB format can be fully realized with the addition of ICT, a technological breakthrough in the past two decades, while not forgetting about continued human factors.

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Section: Reviewmentioning

confidence: 99%

The Emerging Boon of Information and Communication Technology in Multidisciplinary Cancer Care: A Force Multiplier With a Human Touch

Vijayakumar¹,

Lancaster²,

Nittala³

et al. 2023

Cureus

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“…A recent study reported that doctors complied with MTB recommendations to make changes in treatment plan for 58% of the patients studied (N = 138). 9 To our knowledge, our study is the first from a non–high-income country to investigate the discordance between NGS treatment recommendations and MTB recommendations. We found the discordance to be 49% with low level of evidence listed as the most common discordance rationale (75%) in our study.…”

Section: Discussionmentioning

confidence: 93%

Discordance in Recommendation Between Next-Generation Sequencing Test Reports and Molecular Tumor Boards in India

Mathew,

Davis,

Boby

et al. 2024

JCO Glob Oncol

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PURPOSE Accurate understanding of the genomic and transcriptomic data provided by next-generation sequencing (NGS) is essential for the effective utilization of precision oncology. Molecular tumor boards (MTBs) aim to translate the complex data in NGS reports into effective clinical interventions. Often, MTB treatment recommendations differ from those in the NGS reports. In this study, we analyze the discordance between these recommendations and the rationales behind the discordances, in a non–high-income setting, with international input to evaluate the necessity of MTB in clinical practice. METHODS We collated data from MTB that were virtually hosted in Chennai, India. We included patients with malignancies who had NGS reports on solid tissue or liquid biopsies, and excluded those with incomplete data. MTB forms and NGS reports of each clinical case were analyzed and evaluated for recommendation concordance. Concordance was defined as an agreement between the first recommendation in the MTB forms and the therapeutic recommendations suggested in the NGS report. Discordance was the absence of the said agreement. The rationales for discordance were identified and documented. RESULTS Seventy MTB reports were analyzed with 49 cases meeting the inclusion criteria. The recommendation discordance was 49% (24 of 49). Discordant recommendations were mainly due to low level of evidence for the drug (75% of cases). CONCLUSION The discordance between MTB and NGS vendor recommendations highlights the clinical utility of MTB. The educational experiences provided by this initiative are an example of how virtual academic collaborations can enhance patient care and provider education across geographic borders.

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“…To the best of our knowledge, this is the first multicenter, nationwide precision medicine study that utilizes cMTB for all participants. While discussions on MTBs may positively affect treatment decisions [ 22 ], increase the likelihood of enrollment in clinical trials, and potentially improve clinical outcomes [ 23 ], the associated turnaround time and cost might prevent the adoption of MTB in clinical practice [ 24 ]. Additionally, MTBs have not been actively employed in many Korean institutions because of disparities in human resources, infrastructure for NGS interpretation, and clinical trial access [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Pragmatic nationwide master observational trial based on genomic alterations in advanced solid tumors: KOrean Precision Medicine Networking Group Study of MOlecular profiling guided therapy based on genomic alterations in advanced Solid tumors (KOSMOS)-II study protocol KCSG AL-22–09

Kim,

Kim

et al. 2024

BMC Cancer

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Background Next-generation sequencing (NGS) has been introduced to many Korean institutions to support molecular diagnostics in cancer since 2017, when it became eligible for reimbursement by the National Health Insurance Service. However, the uptake of molecularly guided treatment (MGT) based on NGS results has been limited because of stringent regulations regarding prescriptions outside of approved indications, a lack of clinical trial opportunities, and limited access to molecular tumor boards (MTB) at most institutions. The KOSMOS-II study was designed to demonstrate the feasibility and effectiveness of MGT, informed by MTBs, using a nationwide precision medicine platform. Methods The KOSMOS-II trial is a large-scale nationwide master observational study. It involves a framework for screening patients with metastatic solid tumors for actionable genetic alterations based on local NGS testing. It recommends MGT through a remote and centralized MTB meeting held biweekly. MGT can include one of the following options: Tier 1, the therapeutic use of investigational drugs targeting genetic alterations such as ALK, EGFR, ERBB2, BRAF, FH, ROS1, and RET, or those with high tumor mutational burden; Tier 2, comprising drugs with approved indications or those permitted for treatment outside of the indications approved by the Health Insurance Review and Assessment Service of Korea; Tier 3, involving clinical trials matching the genetic alterations recommended by the MTB. Given the anticipated proportion of patients receiving MGT in the range of 50% ± 3.25%, this study aims to enroll 1,000 patients. Patients must have progressed to one or more lines of therapy and undergone NGS before enrollment. Discussion This pragmatic master protocol provides a mass-screening platform for rare genetic alterations and high-quality real-world data. Collateral clinical trials, translational studies, and clinico-genomic databases will contribute to generating evidence for drug repositioning and the development of new biomarkers. Trial registration NCT05525858.

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Impact of Molecular Tumor Board on the Clinical Management of Patients With Cancer

Cited by 19 publications

References 26 publications

The Emerging Boon of Information and Communication Technology in Multidisciplinary Cancer Care: A Force Multiplier With a Human Touch

The Emerging Boon of Information and Communication Technology in Multidisciplinary Cancer Care: A Force Multiplier With a Human Touch

Discordance in Recommendation Between Next-Generation Sequencing Test Reports and Molecular Tumor Boards in India

Pragmatic nationwide master observational trial based on genomic alterations in advanced solid tumors: KOrean Precision Medicine Networking Group Study of MOlecular profiling guided therapy based on genomic alterations in advanced Solid tumors (KOSMOS)-II study protocol KCSG AL-22–09

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