The field of precision oncology has become so complex that even experienced oncologists can find it challenging to decipher the molecular test results of tumor tissue and navigate treatment options for patients. Investigators revealed that a new program may aid gastrointestinal cancer physicians in this process with the assistance of a multidisciplinary team to review test results and offer timely recommendations on treatment options, according to a new report published by Keller et al in JCO Precision Oncology.
Background
"Precision cancer medicine—which involves identifying key molecular changes within tumors and targeting them with the right drugs—has transformed the treatment of many malignancies," emphasized senior study author Marios Giannakis, MD, PhD, Assistant Professor in the Department of Medical Oncology at Harvard Medical School and a medical oncologist at the Dana-Farber Cancer Institute Gastrointestinal Cancer Center. "To make the best decisions for patients, oncologists would ideally need an understanding of the intricacies of genomic testing and a working knowledge of cancer genetics—which can be difficult to apply in a busy clinic. Our program relieves oncologists of some of that burden by having a team of experts assist,” he explained.
GI Target Program and Study Findings
The GI TARGET (Gastrointestinal Treatment Assistance Regarding Genomic Evaluation of Tumors) program involved the creation of a multidisciplinary team of gastrointestinal oncologists, pathologists, genomic scientists, and research coordinators. The team demonstrated that it was capable of functioning as a molecular tumor board, reviewing tests for genomic abnormalities in patients' gastrointestinal tumors and identifying clinical trials of drugs—as well as off- and on-label therapies—that targeted those abnormalities.
The new report focused its results on 506 patients with gastrointestinal cancer treated at the Dana-Farber Brigham Cancer Center between January 2019 and June 2019. Most of the patient tumor samples were analyzed by the genetic irregularity test OncoPanel. The results were reviewed by the tumor board, which also used the computational platform MatchMiner to match patients to targeted therapy trials based on the genetic alterations in the patients' tumors. The tumor board met weekly and issued recommendations for treatments and other clinical actions—which were entered directly into the patients' electronic medical records, where they could be reviewed by their oncologists and other providers. The median time between the testing of tumor samples and the issuing of treatment recommendations was 8 days.
The investigators highlighted that the program largely fulfilled expectations, providing expert treatment guidance for more than 500 patients over the 6-month evaluation period and identifying clinical trials appropriate for the majority of them. Overall, the team has reviewed the test results of more than 2,700 patients to date. The findings suggested that the program can be a model for other cancer centers.
Conclusions
"Our results show that precision medicine can be integrated into routine cancer care with a multidisciplinary tumor board, and that this program is both scalable and sustainable at a center like ours, which has a high volume of patients," Dr. Giannakis underscored.
The investigators noted that the new approach generated many actionable findings—the board was able to make clinical trial recommendations for 80% of the patients and recommended additional testing for 42% of them.
"The success of this program in gastrointestinal oncology at Dana-Farber suggests that similar programs could be implemented elsewhere, with investment of some resources and willingness to adjust workflows accordingly,” concluded study author Brian Wolpin, MD, MPH, Professor of Medicine in the Department of Medical Oncology at Harvard Medical School and Director of the Dana-Farber Cancer Institute Gastrointestinal Cancer Center.
Disclosure: The GI TARGET program was supported by philanthropic funding to the Gastrointestinal Cancer Center at Dana-Farber Cancer Institute and by a grant from the Fund for Innovation in Cancer Informatics. For full disclosures of the study authors, visit ascopubs.org.
