Objective:Rapid technological advances in DNA sequencing and molecular profiling have brought personalised cancer medicine from the lab bench into the consultation room. Physicians increasingly need to navigate complex genomic landscapes to find the most effective, individualised therapy for patients. However, most oncologists are not trained in interpreting complex cancer genomics. We initiated a molecular tumour board (MTB) involving all clinical institutions of the VCCC, the Walter and Eliza Hall Institute and the University of Melbourne.
Method:Clinicians were invited to submit cases with potential for molecular profiling to alter clinical management. A team of oncologists, clinician-scientists, bioinformaticians, basic scientists, pathologists and geneticists with expertise across a variety of tumour types attended monthly MTB meetings. Clinical case histories, molecular tests and pathology reports were reviewed. Outcome reports were fed back to the referring clinicians.
Results:From July 2013 16 cases involving 11 different tumour types were reviewed by an average of 15 clinicians and 8 non-clinical scientists. Patients had received a median of 2 prior therapies. Reports from 5 different DNA sequencing platforms were reviewed. A total of 39 mutations were discussed in detail, with 27 distinct abnormalities. Patients had a median of 2 molecular abnormalities of potential clinical impact (range: 1-5 abnormalities). The MTB offered additional clinical input in 81% of cases (13 of 16 cases), with a change in management occurring in 31% (5 cases) and referral for clinical trials in 19% (3 cases).
Conclusion:Engaging clinical and scientific experts in molecular and cell biology of cancer to translate genomic data is feasible to assist clinical interpretation of molecular profiling. Personalised medicine is coming of age and clinicians need support to optimally incorporate advancing technologies and targeted therapies in the management of their patients.