With accelerating development of personalised cancer treatments matched to a patient's DNA sequencing, proponents say frontline physicians increasingly need help to maneuver through the complex genomic landscape to find the most effective, individualised therapy.
In a paper published in the May 5 online issue of The Oncologist, researchers at the University of California, San Diego School of Medicine and Moores Cancer Center detail their experience evaluating 34 patients between December 2012 and June 2013 using a molecular tumour board – a new type of advisory group comprised of multidisciplinary experts, including those in the fields of tumour genetics, basic science and bioinformatics.
Next generation tools used to profile tumours
"Next generation sequencing tools were used to profile patients' tumors," said Dr Razelle Kurzrock, director of the Center for Personalized Cancer Therapy at UC San Diego Moores Cancer Center. In the 34 cases examined, no two patients shared the same genomic abnormalities. "We found 74 genes with 123 aberrations involved in cancer growth. Technology is permitting us to look at the molecular level of tumors, but most physicians are not trained in advanced genomics. We need access to experts in fundamental molecular biology to translate the data."
The Moores Cancer Center's Molecular Tumor Board brought together medical, surgical and radiation therapy oncologists, biostatisticians, radiologists, pathologists, clinical geneticists, basic and translational science researchers, and bioinformatics and pathway analysis specialists to discuss the intricacies of tumour genetics and tailor a personalised treatment plan for patients with advanced cancer or who have exhausted standard therapies.
The median time from physician order to receipt of molecular diagnostic test results was 27 days (range: 14–77 days).
Of the 123 abnormalities found in the patients' genetic cancer profiles, 107 of these irregularities appeared only once. "Cancer can be different in every patient," said Dr Barbara Parker, Moores Cancer Center deputy director for Clinical Affairs. "Standard therapy can be very efficient for many patients, but for those who do not respond to conventional treatment we need to find alternatives that will work for their disease."
For 12 patients studied who had failed to respond to conventional therapy, treatment plans were modified according to the results of their genomic testing and the molecular tumour board's input.
Among the 11 evaluable patients whose treatment had been informed by molecular diagnostics, 3 patients achieved a partial response.
A tailored plan to a patient's genetic makeup improve response to treatment
According to Dr Richard Schwab, Moores Cancer Center haematology oncologist and co-director of the Biorepository and Tissue Technology Shared Resource, "developing a plan tailored to a patient's genetic makeup is helping us treat patients who are not responding to standard care or whose disease may have become drug resistant."
Other patients in the study had their molecular profiling done while they were receiving treatment that was still working for them because their physicians anticipated that the therapy would become ineffective. The results of genomic matching in these patients are not yet available.
Some patients could not be treated on the basis of molecular tumour board discussions because there was no clinical trial for which they were eligible or could not travel to an appropriately targeted clinical trial or because insurance would not cover the discussed medications.
"We have found that molecular diagnostics play an important role in patient care when paired with the expertise of a molecular tumor board," said Maria Schwaederle, PharmD, lead author and a researcher in the Center for Personalized Cancer Therapy. "However, the immense complexity of tumors and their genomic aberrations will require sophisticated computer technologies for optimal interpretation, and patients need access to more clinical trials and to targeted drugs."
This research was funded, in part, by MyAnswerToCancer and the Joan and Irwin Jacobs Fund.
Schwaederle M, Parker BA, Schwab RB, et al. Molecular Tumor Board: The University of California San Diego Moores Cancer Center Experience. The Oncologist 2014; First Published Online May 5. doi: 10.1634/theoncologist.2013-0405