Multicenter Comparison of Molecular Tumor Boards in The Netherlands: Definition, Composition, Methods, and Targeted Therapy Recommendations

Koopman, Bart; Groen, Harry J.M.; Ligtenberg, Marjolijn J. L.; Grünberg, Katrien; Monkhorst, Kim; Langen, Adrianus J de; Boelens, Mirjam C.; Paats, Marthe S.; Thüsen, Jan H. von der; Dinjens, Winand N.M.; Solleveld, Nienke; Wezel, Tom van; Gelderblom, Hans; Hendriks, Lizza; Speel, Ernst J. M.; Theunissen, Tom E. J.; Kroeze, Leonie I.; Mehra, Niven; Piet, Berber; Wekken, Anthonie J. van der; Elst, Arja ter; Timens, Wim; Willems, Stefan M.; Meijers, Ruud W. J.; Leng, Wendy W.J. de; Lindert, Anne S R van; Radonic, Teodora; Hashemi, S.; Heideman, Daniëlle A.M.; Schuuring, Ed; Kempen, Léon C van

doi:10.1002/onco.13580

Cited by 35 publications

(27 citation statements)

References 34 publications

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“…However, these perspectives might change with new evidence: for example, there are promising novel agents and combination therapies currently under investigation that may be effective against EGFR exon 20 insertions, including amivantamab [ 79 ], poziotinib [ 80 ], and mobocertinib [ 81 ], or combining osimertinib or afatinib with cetuximab [ 82 ]. In the Netherlands, all Tier II and III EGFR variants are nowadays commonly discussed in Molecular Tumor Boards [ 83 ], resulting in favorable treatment outcomes [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

A Nationwide Study on the Impact of Routine Testing for EGFR Mutations in Advanced NSCLC Reveals Distinct Survival Patterns Based on EGFR Mutation Subclasses

Koopman

Garcia

Kuijpers³

et al. 2021

Cancers

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EGFR mutation analysis in non-small-cell lung cancer (NSCLC) patients is currently standard-of-care. We determined the uptake of EGFR testing, test results and survival of EGFR-mutant NSCLC patients in the Netherlands, with the overall objective to characterize the landscape of clinically actionable EGFR mutations and determine the role and clinical relevance of uncommon and composite EGFR mutations. Non-squamous NSCLC patients diagnosed in 2013, 2015 and 2017 were identified in the Netherlands Cancer Registry (NCR) and matched to the Dutch Pathology Registry (PALGA). Overall, 10,254 patients were included. Between 2013–2017, the uptake of EGFR testing gradually increased from 72.7% to 80.9% (p < 0.001). Multi-gene testing via next-generation sequencing (increased from 7.8% to 78.7% (p < 0.001), but did not affect the number of detected EGFR mutations (n = 925; 11.7%; 95% confidence interval (CI), 11.0–12.4) nor the distribution of variants. For patients treated with first-line EGFR inhibitors (n = 651), exon 19 deletions were associated with longer OS than L858R (HR 1.58; 95% CI, 1.30–1.92; p < 0.001) or uncommon, actionable variants (HR 2.13; 95% CI, 1.60–2.84; p < 0.001). Interestingly, OS for patients with L858R was similar to those with uncommon, actionable variants (HR 1.31; 95% CI, 0.98–1.75; p = 0.069). Our analysis indicates that grouping exon 19 deletions and L858R into one class of ‘common’ EGFR mutations in a clinical trial may mask the true activity of an EGFR inhibitor towards specific mutations.

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Section: Discussionmentioning

confidence: 99%

A Nationwide Study on the Impact of Routine Testing for EGFR Mutations in Advanced NSCLC Reveals Distinct Survival Patterns Based on EGFR Mutation Subclasses

Koopman

Garcia

Kuijpers³

et al. 2021

Cancers

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“…In this regard, interdisciplinary solutions must be established to facilitate ongoing exchange between the various experts of precision medicine. Molecular tumor boards represent critical instruments for bringing together these decoupled knowledge domains to inform clinical decisions that ultimately benefit the patient and relieve healthcare systems [ 33 , 67 , 171 – 173 ]. Interestingly, although its importance is frequently emphasized at conferences and in other media [ 52 , 174 , 175 ], further education platforms for clinicians without access to MTBs are not prevalent, although young oncologists in particular would benefit immensely from learning about the fundamentals of genomics and liquid biopsy profiling early on in their training.…”

Section: Discussionmentioning

confidence: 99%

A clinician’s handbook for using ctDNA throughout the patient journey

Hasenleithner

Speicher

2022

Mol Cancer

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Background The promise of precision cancer medicine presently centers around the genomic sequence of a patient’s tumor being translated into timely, actionable information to inform clinical care. The analysis of cell-free DNA from liquid biopsy, which contains circulating tumor DNA (ctDNA) in patients with cancer, has proven to be amenable to various settings in oncology. However, open questions surrounding the clinical validity and utility of plasma-based analyses have hindered widespread clinical adoption. Main body Owing to the rapid evolution of the field, studies supporting the use of ctDNA as a biomarker throughout a patient’s journey with cancer have accumulated in the last few years, warranting a review of the latest status for clinicians who may employ ctDNA in their precision oncology programs. In this work, we take a step back from the intricate coverage of detection approaches described extensively elsewhere and cover basic concepts around the practical implementation of next generation sequencing (NGS)-guided liquid biopsy. We compare relevant targeted and untargeted approaches to plasma DNA analysis, describe the latest evidence for clinical validity and utility, and highlight the value of genome-wide ctDNA analysis, particularly as it relates to early detection strategies and discovery applications harnessing the non-coding genome. Conclusions The maturation of liquid biopsy for clinical application will require interdisciplinary efforts to address current challenges. However, patients and clinicians alike may greatly benefit in the future from its incorporation into routine oncology care.

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“…Relying on Rotter’s 2010 Cochrane Review, the key dimensions identified for Patient Centered Care were communication [ 10 ], audit/feedback [ 11 ], informative systems [ 12 ], evidence-based application [ 13 ], multidisciplinary approach [ 14 ] and education sessions [ 11 ]. With regards to Personalized Medicine, on the other hand, the European Council’s document of 2015 identifies the molecular board [ 15 ], evidence-based genetic testing [ 16 ] and shared-clinical decision-making [ 17 ]. As such, eligible studies were those fulfilling t the definitions of patient-centered care and/or personalized medicine in terms of inclusion of the aforementioned dimensions.…”

Section: Methodsmentioning

confidence: 99%

Success Factors and Barriers in Combining Personalized Medicine and Patient Centered Care in Breast Cancer. Results from a Systematic Review and Proposal of Conceptual Framework

Belvis

Pellegrino

Castagna

et al. 2021

JPM

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Breast Cancer (BC) is the leading cause of death due to cancer in women. Ensuring equitable, quality-assured and effective care has increased the complexity of BC management. This systematic review reports on the state-of-the art of available literature investigating the enactment of personalized treatment and patient-centered care models in BC clinical practice, building a framework for the delivery of personalized BC care within a Patient-Centered model. Databases were searched for articles (from the inception to December 2020) reporting on Patient-Centered or Personalized Medicine BC management models, assessing success factors or limits. Out of 1885 records, 25 studies were included in our analysis. The main success factors include clearly defined roles and responsibilities within a multi-professional collaboration, appropriate training programs and adequate communication strategies and adopting a universal genomic language to improve patients’ involvement in the decision-making process. Among detected barriers, delays in the use of genetic testing were linked to the lack of public reimbursement schemes and of clear indications in timing and appropriateness. Overall, both care approaches are complementary and necessary to effectively improve BC patient management. Our framework attempts to bridge the gap in assigning a central role played by shared decision-making, still scarcely investigated in literature.

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Multicenter Comparison of Molecular Tumor Boards in The Netherlands: Definition, Composition, Methods, and Targeted Therapy Recommendations

Abstract: Disclosures of potential conflicts of interest may be found at the end of this article.

Cited by 35 publications

References 34 publications

A Nationwide Study on the Impact of Routine Testing for EGFR Mutations in Advanced NSCLC Reveals Distinct Survival Patterns Based on EGFR Mutation Subclasses

A Nationwide Study on the Impact of Routine Testing for EGFR Mutations in Advanced NSCLC Reveals Distinct Survival Patterns Based on EGFR Mutation Subclasses

A clinician’s handbook for using ctDNA throughout the patient journey

Success Factors and Barriers in Combining Personalized Medicine and Patient Centered Care in Breast Cancer. Results from a Systematic Review and Proposal of Conceptual Framework

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