A cloud-based virtual tumor board (VMTB) platform may play an increasing role in therapy selection for patients with cancer, according to a study published in JAMIA Open.
“Precision oncology holds great promise but its implementation is time consuming and requires the coalescence of patient-centric molecular and clinical data through user-friendly informatics tools,” the researchers wrote. “To address these challenges, molecular tumor boards that assess the clinical actionability of biomarkers are becoming critical. These tumor boards can help delineate individualized treatment strategies for patients, improve diagnosis, and significantly increase the identification of eligible clinical trial options for patients in the current complex health care environment.”
However, although most large cancer centers have molecular tumor boards, convening these busy experts is not always feasible. Additionally, many community cancer centers have limited access to molecular tumor boards.
In the study, the VMTB combined data from a knowledgebase, scoring model, rules engine, an asynchronous virtual chat room, and a reporting tool to generate a treatment plan for 1725 patients based on their molecular profile, previous treatment, structured trial eligibility criteria, clinically relevant cancer gene-variant assertions, biomarker-treatment association, and current treatment guidelines.
This information was delivered to clinicians as part of a cancer care process for these 1725 patients who were referred by advocacy organizations. Of the included patients, 1163 had pancreatic adenocarcinoma, 103 had pancreaticobiliary tumors, 104 had gastrointestinal cancer, and 355 had non-GI cancers.
During the 4-year study, turnaround time for these comprehensive reports decreased from 14 days to 4 days. During the same time period, use of the VMTB increased from 46 cases in 2014 to 622 in 2017.
Real-world outcomes indicated that treating oncologists frequently implemented the VMTB report-listed therapies. Looking at a group of 343 patients who initiated a new therapy after receiving the VMTB report, 81% received at least 1 therapy that was consistent with a report-listed option.
However, when a patient started an immunotherapy option after the VMTB report, there was no correlation between the rank of the VMTB-listed immunotherapy option and its relative rank compared to other options provided.
Additionally, unlike the historic rate of clinical trial enrollment in about 5% of patients with pancreatic cancer, about 22% of these study patients with pancreatic cancer enrolled in a clinical trial.
“These findings suggest that the options presented in the VMTB reports could influence therapeutic decisions; however, we acknowledge that this was a highly selected population of patients that were also highly motivated among other confounding factors,” the researchers wrote.
Pichvaian MJ, Blais EM, Bender RJ, et al. A virtual molecular tumor board to improve efficiency and scalability of delivering precision oncology to physicians and their patients [published online October 7, 2019]. JAMIA Open. doi: 10.1093/jamiaopen/ooz045