Implementation and utilization of the molecular tumor board to guide precision medicine

// Shuko Harada 1, 7 , Rebecca Arend 5, 7 , Qian Dai 1 , Jessica A. Levesque 1 , Thomas S. Winokur 1 , Rongjun Guo 1 , Martin J. Heslin 2, 7 , Lisle Nabell 3, 7 , L. Burt Nabors 4, 7 , Nita A. Limdi 4 , Kevin A. Roth 1 , Edward E. Partridge 7 , Gene P. Siegal 1 and Eddy S. Yang 6, 7 1 Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA 2 Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA 3 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA 4 Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA 5 Department of Obsterics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA 6 Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA 7 Department of The Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA Correspondence to: Eddy S. Yang, email: shyang@uabmc.edu Keywords: precision medicine, targeted therapy, next generation sequencing, molecular tumor board Received: March 09, 2017      Accepted: May 31, 2017      Published: June 14, 2017 ABSTRACT Background: With rapid advances in genomic medicine, the complexity of delivering precision medicine to oncology patients across a university health system demanded the creation of a Molecular Tumor Board (MTB) for patient selection and assessment of treatment options. The objective of this report is to analyze our progress to date and discuss the importance of the MTB in the implementation of personalized medicine. Materials and Methods: Patients were reviewed in the MTB for appropriateness for comprehensive next generation sequencing (NGS) cancer gene set testing based on set criteria that were in place. Because profiling of stage IV lung cancer, colon cancer, and melanoma cancers were standard of care, these cancer types were excluded from this process. We subsequently analyzed the types of cases referred for testing and approved with regards to their results. Results: 191 cases were discussed at the MTB and 132 cases were approved for testing. Forty-six cases (34.8%) had driver mutations that were associated with an active targeted therapeutic agent, including BRAF, PIK3CA, IDH1, KRAS, and BRCA1 . An additional 56 cases (42.4%) had driver mutations previously reported in some type of cancer. Twenty-two cases (16.7%) did not have any clinically significant mutations. Eight cases did not yield adequate DNA. 15 cases were considered for targeted therapy, 13 of which received targeted therapy. One patient experienced a near complete response. Seven of 13 had stable disease or a partial response. Conclusions: MTB at University of Alabama-Birmingham is unique because it reviews the appropriateness of NGS testing for patients with recurrent cancer and serves as a forum to educate our physicians about the pathways of precision medicine. Our results suggest that our detection of actionable mutations may be higher due to our careful selection. The application of precision medicine and molecular genetic testing for cancer patients remains a continuous educational process for physicians.