TY - JOUR
T1 - Personalized clinical decision making through implementation of a molecular tumor board
T2 - A German single-center experience
AU - Hoefflin, Rouven
AU - Geißler, Anna Lena
AU - Fritsch, Ralph
AU - Claus, Rainer
AU - Wehrle, Julius
AU - Metzger, Patrick
AU - Reiser, Meike
AU - Mehmed, Leman
AU - Fauth, Lisa
AU - Heiland, Dieter Henrik
AU - Erbes, Thalia
AU - Stock, Friedrich
AU - Csanadi, Agnes
AU - Miething, Cornelius
AU - Weddeling, Britta
AU - Meiss, Frank
AU - Bubnoff, Dagmar von
AU - Dierks, Christine
AU - Ge, Isabell
AU - Brass, Volker
AU - Heeg, Steffen
AU - Schäfer, Henning
AU - Boeker, Martin
AU - Rawluk, Justyna
AU - Botzenhart, Elke Maria
AU - Kayser, Gian
AU - Hettmer, Simone
AU - Busch, Hauke
AU - Peters, Christoph
AU - Werner, Martin
AU - Duyster, Justus
AU - Brummer, Tilman
AU - Boerries, Melanie
AU - Lassmann, Silke
AU - von Bubnoff, Nikolas
N1 - Publisher Copyright:
© 2018 by American Society of Clinical Oncology.
PY - 2018
Y1 - 2018
N2 - Purpose Dramatic advances in our understanding of the molecular pathophysiology of cancer, along with a rapidly expanding portfolio of molecular targeted drugs, have led to a paradigm shift toward personalized, biomarker-driven cancer treatment. Here, we report the 2-year experience of the Comprehensive Cancer Center Freiburg Molecular Tumor Board (MTB), one of the first interdisciplinary molecular tumor conferences established in Europe. The role of the MTB is to recommend personalized therapy for patients with cancer beyond standard-of-care treatment. Methods This retrospective case series includes 198 patients discussed from March 2015 through February 2017. The MTB guided individual molecular diagnostics, assessed evidence of actionability of molecular alterations, and provided therapy recommendations, including approved and off-label treatments as well as available matched clinical trials. Results The majority of patients had metastatic solid tumors (73.7%), mostly progressive (77.3%) after a mean of 2.0 lines of standard treatment. Diagnostic recommendations resulted in 867 molecular diagnostic tests for 172 patients (five per case), including exome analysis in 36 cases (18.2%). With a median turnaround time of 28 days, treatment recommendations were given to 104 patients (52.5%). These included single-agent targeted therapies (42.3%), checkpoint inhibitors (37.5%), and combination therapies (18.3%). Treatment recommendations were implemented in 33 of 104 patients (31.7%), of whom 19 (57.6%) showed stable disease or partial response, including 14 patients (7.1% of the entire population) receiving off-label treatments. Conclusion Personalized extended molecular-guided patient care is effective for a small but clinically meaningful proportion of patients in challenging clinical situations. Limited access to targeted drugs, lack of trials, and submission at late disease stage prevents broader applicability, whereas genome-wide analyses are not a strict requirement for predictive molecular testing.
AB - Purpose Dramatic advances in our understanding of the molecular pathophysiology of cancer, along with a rapidly expanding portfolio of molecular targeted drugs, have led to a paradigm shift toward personalized, biomarker-driven cancer treatment. Here, we report the 2-year experience of the Comprehensive Cancer Center Freiburg Molecular Tumor Board (MTB), one of the first interdisciplinary molecular tumor conferences established in Europe. The role of the MTB is to recommend personalized therapy for patients with cancer beyond standard-of-care treatment. Methods This retrospective case series includes 198 patients discussed from March 2015 through February 2017. The MTB guided individual molecular diagnostics, assessed evidence of actionability of molecular alterations, and provided therapy recommendations, including approved and off-label treatments as well as available matched clinical trials. Results The majority of patients had metastatic solid tumors (73.7%), mostly progressive (77.3%) after a mean of 2.0 lines of standard treatment. Diagnostic recommendations resulted in 867 molecular diagnostic tests for 172 patients (five per case), including exome analysis in 36 cases (18.2%). With a median turnaround time of 28 days, treatment recommendations were given to 104 patients (52.5%). These included single-agent targeted therapies (42.3%), checkpoint inhibitors (37.5%), and combination therapies (18.3%). Treatment recommendations were implemented in 33 of 104 patients (31.7%), of whom 19 (57.6%) showed stable disease or partial response, including 14 patients (7.1% of the entire population) receiving off-label treatments. Conclusion Personalized extended molecular-guided patient care is effective for a small but clinically meaningful proportion of patients in challenging clinical situations. Limited access to targeted drugs, lack of trials, and submission at late disease stage prevents broader applicability, whereas genome-wide analyses are not a strict requirement for predictive molecular testing.
UR - http://www.scopus.com/inward/record.url?scp=85066109811&partnerID=8YFLogxK
U2 - 10.1200/PO.18.00105
DO - 10.1200/PO.18.00105
M3 - Article
AN - SCOPUS:85066109811
SN - 2473-4284
SP - 1
EP - 16
JO - JCO Precision Oncology
JF - JCO Precision Oncology
IS - 2
ER -