Dec 19, 2017
By Caroline Hopkins, ASCO Publishing
Precision oncology is gaining ground. Treatment decisions and clinical trial matches increasingly cater to specific genomic profiles, risk factors, and alterations in cancer biology. The targeted approach has already proven beneficial, and has disrupted traditional notions that all cancers of a specific type should be treated the same. In personalizing treatment based on unique patient cases, however, it can be difficult to establish guidelines and standardized approaches. In fact, in precision oncology, “standard” is hardly applicable.
In learning to address patient cases based on specific tumors and germline genome sequencing, it is therefore necessary to focus on the process of arriving at a conclusion, rather than the conclusion itself. This requires looking closely at experts in precision oncology and studying their past processes. How have oncologists made treatment recommendations based on genomic profiles? What information did they take into consideration? Who else did they consult?
This is where Molecular Tumor Boards (MTBs) come into play. By convening a wide range of experts to address unique patient cases, MTBs have provided academic institutions with a method for oncologists to learn how a patient’s medical history and cancer genomic profile, among other unique variables, determine their treatment options.
Experts who weigh in on patient cases in an MTB can range from medical oncologists to cancer geneticists, biologists, molecular pathologists, genetic counselors, bioinformaticians, and others. Together, these experts assess variants of unknown clinical significance that occur in a patient’s cancer, and select which of these variants within the cancer could go on to illuminate a treatment option for that specific patient. The multidisciplinary discussions that take place in MTBs have a largely untapped potential for use as a learning tool among oncologists beyond the particular academic institution in which that MTB takes place.
In an effort to spread the valuable knowledge inherent in MTB discussions, JCO Precision Oncology (JCO PO) will launch a new series publishing real and representative cases that have come before MTBs. JCO PO plans to publish these MTB cases bimonthly, and will begin by soliciting submissions from institutions with established MTBs. In the future, the journal may publish unsolicited MTB case discussions as well.
Each MTB article will include a brief but comprehensive specific case discussion, which will cover a patient’s treatment history as well as any molecular diagnostic test results. The article will present the highlights of the MTB discussion, focusing on treatment options and any outcomes available. When imaging and laboratory reports are included in case reports, they will be void of information that could potentially identify the patient, such as names, birth dates, service dates, or patient identification codes.
JCO PO’s MTB case discussion series will be educational in nature, and will allow readers to channel the knowledge of past experts. By familiarizing themselves with the collaborative processes in MTBs, the hope is that oncologists will develop the needed skills to approach precision oncology with confidence.
“As the idea and application of precision oncology gains momentum, the need for evidence-based guidelines and expert opinions is essential,” James M. Ford, MD, FASCO, editor in chief of JCO PO, said. “We hope this MTB case discussion series will be an important learning platform for the oncology community on how to effectively use genomic information for optimal targeted drugs and clinical trial matches.”
Separately, ASCO University currently offers a series of monthly user-driven Molecular Oncology Tumor Board discussions moderated by an expert pathologist and medical oncologist. The discussions are designed to help cancer care providers interpret and understand unique tumor molecular profiling tests and studies.