Patients receiving care for advanced cancer based on the recommendations of a molecular tumor board were more likely to survive or experience a longer period without disease progression, according to results from a study published by Kato et al in Nature Communications.
Razelle Kurzrock, MD, Director of the Center for Personalized Cancer Therapy at Moores Cancer Center at UC San Diego Health and senior author of the study, led the research team. A multidisciplinary molecular tumor board was established to advise treating physicians on course of care using an individual patient’s molecular tumor makeup to design precision medicine strategies.
"Patients who underwent a molecular tumor board–recommended therapy were better matched to genomic alterations in their cancer and had improved outcomes."— Razelle Kurzrock, MD
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“Patients who underwent a molecular tumor board–recommended therapy were better matched to genomic alterations in their cancer and had improved outcomes,” said Dr. Kurzrock. “The 3-year survival for patients with the highest degree of matching and who received a personalized cancer therapy was approximately 55%, compared to 25% in patients who received therapy that was unmatched or had low degrees of matching.”
Molecular Tumor Board Details
The molecular tumor board was made up of basic/translational/clinical investigators, bioinformaticians, geneticists, and physicians from multiple specialties. It also included a project manager to facilitate obtaining clinical-grade biomarkers (blood/tissue next-generation sequencing, specific immunohistochemistry/RNA expression including for immune biomarkers, per physician discretion) and medication-acquisition specialists/clinical trial coordinators/navigators to assist with medication access.
Of 429 patients evaluated by the molecular tumor board, 62% were matched to at least one drug. Twenty percent of patients matched to all recommended drugs, including combination therapies.
The tumor board acted in an advisory role. Treating physicians chose not to use the board’s recommended strategy in 38% of cases, opting instead for a standard therapy approach that might have been unmatched to the patient’s genetic alterations or had a low degree of matching; these patients experienced lower progression-free and overall survival rates.
The use of next-generation sequencing allows for the identification of novel potential targets for patients with cancer to improve outcomes, but there are challenges to using this approach widely, explained first study author Shumei Kato, MD, Associate Professor of Medicine at UC San Diego School of Medicine.
“One of the hurdles is that every … patient appears to be carrying different molecular and genomic patterns, despite having the same cancer type,” said Dr. Kato. “This can be challenging since we are customizing therapy based on the unique genomic pattern patients have, and thus it is difficult to predict the response. In addition, this approach requires multidisciplinary expertise as well as access to drugs or clinical trials not always available in smaller practices.”
Further clinical investigations with a larger sample size are necessary to identify the matching score thresholds that determine the usefulness of a precision medicine approach, said the researchers. They concluded, “Patients who receive molecular tumor board–based therapy are better matched to their genomic alterations, and the degree of matching is an independent predictor of improved oncologic outcomes including survival.”
Disclosure: For full disclosures of the study authors, visit nature.com.
