Intestinal tumor, artwork
Credit: JUAN GARTNER/Getty Images

A molecular tumor board at Dana-Farber Cancer Institute (DFCI) provided treatment guidance for more than 500 patients with gastrointestinal tumors over a six-month period. With 80% of the patients matched to appropriate trials and additional testing recommended for 42%. Overall, the board has reviewed test results for more than 2,700 patients to date.

The team’s findings, reported this month in JCO Precision Oncology, suggest that the DFCI program can be a model for other cancer centers.

“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,” said the study’s senior author, Dana-Farber’s Marios Giannakis, MD, PhD.

Tumor boards have become more widespread as precision oncology has advanced. This DFCI program comprises a multi-disciplinary team that has been assisting gastrointestinal (GI) cancer physicians by reviewing test results and offering timely recommendations on treatment options. GI cancers evaluated included biliary, esophagogastric, colorectal, and pancreatic tumors.

Called GI TARGET (for Treatment Assistance Regarding Genomic Evaluation of Tumors), the program involves a team of gastrointestinal oncologists, pathologists, genomic scientists, and research coordinators. The board reviews tests for genomic abnormalities in patients’ GI tumors and finds clinical trials of drugs (or available off- and on-label therapies) that target those abnormalities.

Comprehensive tumor profiling, Giannakis told Inside Precision Medicine is done for all Dana-Farber patients and other molecular tumor boards have also been launched. “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,” he said. “Our program relieves oncologists of some of that burden by having a team of experts assist.”

Giannakis told Inside Precision Medicine that key factors affect the value of such a board: “One, is the presence and prevalence of molecular ‘driver’ alterations in a particular malignancy that are captured by current technologies for tumor profiling. The second is whether such alterations are actionable based on the available targeted- and immune-based therapeutic approaches and clinical trials”.

The research reports results for 506 patients with gastrointestinal cancer treated at Dana-Farber Brigham Cancer Center between January and June 2019. Most of the patient tumor samples were analyzed by OncoPanel, a test that can detect more than 450 genetic irregularities in tissue. OncoPanel was created based on Profile, a database of cancer-driving genetic abnormalities which the Center says is one of the largest in the world.

The results were reviewed by the tumor board, which also used MatchMiner, a computational platform developed at Dana-Farber, to match patients to targeted therapy trials based on the genetic alterations in the patients’ tumors. The board met weekly and the median time between the testing of tumor samples and the issuing of treatment recommendations was eight days.

The knowledgebase the board used was updated in real-time. For reports generated in the past, which might need updated annotation and new trial matching, there could be another multidisciplinary discussion. In certain cases, GI TARGET recommended repeat sampling and testing of the cancer to account for evolution and/or tumor heterogeneity.

Giannakis said, “We hope that the GI TARGET program and our experience can be instructive for the development of similar programs across the country and in multiple, including non-academic, settings. As next steps at Dana-Farber Cancer Institute, we are thinking about incorporating additional assays, such as immune-based profiling and pre-clinical models.”

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