A virtual molecular tumor board to improve efficiency and scalability of delivering precision oncology to physicians and their patients

• Published in: JAMIA open Vol. 2; no. 4; pp. 505 - 515
• Main Authors: Pishvaian, Michael J, Blais, Edik M, Bender, R Joseph, Rao, Shruti, Boca, Simina M, Chung, Vincent, Hendifar, Andrew E, Mikhail, Sam, Sohal, Davendra P S, Pohlmann, Paula R, Moore, Kathleen N, He, Kai, Monk, Bradley J, Coleman, Robert L, Herzog, Thomas J, Halverson, David D, DeArbeloa, Patricia, Petricoin, 3rd, Emanuel F, Madhavan, Subha
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-12-2019
• Subjects: Analysis; Cancer; Care and treatment; Genetic aspects; Immunotherapy; Medical records; Research and Applications; precision informatics; precision oncology; virtual tumor boards; molecular tumor boards; implementation science
• ISSN: 2574-2531; 2574-2531
• DOI: 10.1093/jamiaopen/ooz045

Scalable informatics solutions that provide molecularly tailored treatment recommendations to clinicians are needed to streamline precision oncology in care settings.
We developed a cloud-based virtual molecular tumor board (VMTB) platform that included a knowledgebase, scoring model, rules engine, an asynchronous virtual chat room and a reporting tool that generated a treatment plan for each of the 1725 patients based on their molecular profile, previous treatment history, structured trial eligibility criteria, clinically relevant cancer gene-variant assertions, biomarker-treatment associations, and current treatment guidelines. The VMTB systematically allows clinician users to combine expert-curated data and structured data from clinical charts along with molecular testing data to develop consensus on treatments, especially those that require off-label and clinical trial considerations.
The VMTB was used as part of the cancer care process for a focused subset of 1725 patients referred by advocacy organizations wherein resultant personalized reports were successfully delivered to treating oncologists. Median turnaround time from data receipt to report delivery decreased from 14 days to 4 days over 4 years while the volume of cases increased nearly 2-fold each year. Using a novel scoring model for ranking therapy options, oncologists chose to implement the VMTB-derived therapies over others, except when pursuing immunotherapy options without molecular support.
VMTBs will play an increasingly critical role in precision oncology as the compendium of biomarkers and associated therapy options available to a patient continues to expand.
Further development of such clinical augmentation tools that systematically combine patient-derived molecular data, real-world evidence from electronic health records and expert curated knowledgebases on biomarkers with computational tools for ranking best treatments can support care pathways at point of care.