Personalized medicine in the oncology clinic: Implementation and outcomes of the Johns Hopkins molecular tumor board

W. Brian Dalton, Patrick M. Forde, Hyunseok Kang, Roisin M. Connolly, Vered Stearns, Christopher D. Gocke, James R. Eshleman, Jennifer Axilbund, Dana Petry, Cindy Geoghegan, Antonio C. Wolff, David M. Loeb, Christine A. Pratilas, Christian F. Meyer, Eric S. Christenson, Shannon A. Slater, Jennifer Ensminger, Heather A. Parsons, Ben H. Park, Josh Lauring

Research output: Contribution to journalArticle

Abstract

Purpose Tumor genomic profiling for personalized oncology therapy is being widely applied in clinical practice even as it is being evaluated more formally in clinical trials. Given the complexities of genomic data and its application to clinical use, molecular tumor boards with diverse expertise can provide guidance to oncologists and patients seeking to implement personalized genetically targeted therapy in practice. Methods A multidisciplinary molecular tumor board reviewed tumor molecular profiling reports from consecutive referrals at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins over a 3-year period. The tumor board weighed evidence for actionability of genomic alterations identified by molecular profiling and provided recommendations including US Food andDrugAdministration-approved drug therapy, clinical trials ofmatchedtargeted therapy, offlabel use of such therapy, and additional tumor or germline genetic testing. Results One hundred fifty-five patients were reviewed. Actionable genomic alterations were identified in 132 patients (85%). Off-label therapies were recommended in 37 patients (24%). Eleven patients were treated off-label, and 13 patients were enrolled onto clinical trials of matched targeted therapies. Median progression-free survival of patients treated with matched therapies was 5 months ( 95% CI, 2.9 months to not reached), and the progression-free survival probability at6monthswas43%(95%CI,26%to 71%).Lackof locally available clinical trials was the major limitation on clinical actionability of tumor profiling reports. Conclusion The molecular tumor board recommended off-label targeted therapies for a quarter of all patients reviewed. Outcomes were heterogeneous, although 43% of patients receiving genomically matched therapy derived clinical benefit lasting at least 6 months. Until more data become available from precision oncology trials, molecular tumor boards can help guide appropriate use of tumor molecular testing to direct therapy.

Original languageEnglish (US)
Pages (from-to)1-19
Number of pages19
JournalJCO Precision Oncology
Volume2017
Issue number1
DOIs
StatePublished - Jan 1 2017

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Precision Medicine
Neoplasms
Clinical Trials
Therapeutics
Disease-Free Survival
Genetic Testing
Referral and Consultation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Brian Dalton, W., Forde, P. M., Kang, H., Connolly, R. M., Stearns, V., Gocke, C. D., ... Lauring, J. (2017). Personalized medicine in the oncology clinic: Implementation and outcomes of the Johns Hopkins molecular tumor board. JCO Precision Oncology, 2017(1), 1-19. https://doi.org/10.1200/PO.16.00046

Personalized medicine in the oncology clinic : Implementation and outcomes of the Johns Hopkins molecular tumor board. / Brian Dalton, W.; Forde, Patrick M.; Kang, Hyunseok; Connolly, Roisin M.; Stearns, Vered; Gocke, Christopher D.; Eshleman, James R.; Axilbund, Jennifer; Petry, Dana; Geoghegan, Cindy; Wolff, Antonio C.; Loeb, David M.; Pratilas, Christine A.; Meyer, Christian F.; Christenson, Eric S.; Slater, Shannon A.; Ensminger, Jennifer; Parsons, Heather A.; Park, Ben H.; Lauring, Josh.

In: JCO Precision Oncology, Vol. 2017, No. 1, 01.01.2017, p. 1-19.

Research output: Contribution to journalArticle

Brian Dalton, W, Forde, PM, Kang, H, Connolly, RM, Stearns, V, Gocke, CD, Eshleman, JR, Axilbund, J, Petry, D, Geoghegan, C, Wolff, AC, Loeb, DM, Pratilas, CA, Meyer, CF, Christenson, ES, Slater, SA, Ensminger, J, Parsons, HA, Park, BH & Lauring, J 2017, 'Personalized medicine in the oncology clinic: Implementation and outcomes of the Johns Hopkins molecular tumor board', JCO Precision Oncology, vol. 2017, no. 1, pp. 1-19. https://doi.org/10.1200/PO.16.00046
Brian Dalton, W. ; Forde, Patrick M. ; Kang, Hyunseok ; Connolly, Roisin M. ; Stearns, Vered ; Gocke, Christopher D. ; Eshleman, James R. ; Axilbund, Jennifer ; Petry, Dana ; Geoghegan, Cindy ; Wolff, Antonio C. ; Loeb, David M. ; Pratilas, Christine A. ; Meyer, Christian F. ; Christenson, Eric S. ; Slater, Shannon A. ; Ensminger, Jennifer ; Parsons, Heather A. ; Park, Ben H. ; Lauring, Josh. / Personalized medicine in the oncology clinic : Implementation and outcomes of the Johns Hopkins molecular tumor board. In: JCO Precision Oncology. 2017 ; Vol. 2017, No. 1. pp. 1-19.
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abstract = "Purpose Tumor genomic profiling for personalized oncology therapy is being widely applied in clinical practice even as it is being evaluated more formally in clinical trials. Given the complexities of genomic data and its application to clinical use, molecular tumor boards with diverse expertise can provide guidance to oncologists and patients seeking to implement personalized genetically targeted therapy in practice. Methods A multidisciplinary molecular tumor board reviewed tumor molecular profiling reports from consecutive referrals at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins over a 3-year period. The tumor board weighed evidence for actionability of genomic alterations identified by molecular profiling and provided recommendations including US Food andDrugAdministration-approved drug therapy, clinical trials ofmatchedtargeted therapy, offlabel use of such therapy, and additional tumor or germline genetic testing. Results One hundred fifty-five patients were reviewed. Actionable genomic alterations were identified in 132 patients (85{\%}). Off-label therapies were recommended in 37 patients (24{\%}). Eleven patients were treated off-label, and 13 patients were enrolled onto clinical trials of matched targeted therapies. Median progression-free survival of patients treated with matched therapies was 5 months ( 95{\%} CI, 2.9 months to not reached), and the progression-free survival probability at6monthswas43{\%}(95{\%}CI,26{\%}to 71{\%}).Lackof locally available clinical trials was the major limitation on clinical actionability of tumor profiling reports. Conclusion The molecular tumor board recommended off-label targeted therapies for a quarter of all patients reviewed. Outcomes were heterogeneous, although 43{\%} of patients receiving genomically matched therapy derived clinical benefit lasting at least 6 months. Until more data become available from precision oncology trials, molecular tumor boards can help guide appropriate use of tumor molecular testing to direct therapy.",
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AU - Stearns, Vered

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AU - Eshleman, James R.

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AU - Christenson, Eric S.

AU - Slater, Shannon A.

AU - Ensminger, Jennifer

AU - Parsons, Heather A.

AU - Park, Ben H.

AU - Lauring, Josh

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N2 - Purpose Tumor genomic profiling for personalized oncology therapy is being widely applied in clinical practice even as it is being evaluated more formally in clinical trials. Given the complexities of genomic data and its application to clinical use, molecular tumor boards with diverse expertise can provide guidance to oncologists and patients seeking to implement personalized genetically targeted therapy in practice. Methods A multidisciplinary molecular tumor board reviewed tumor molecular profiling reports from consecutive referrals at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins over a 3-year period. The tumor board weighed evidence for actionability of genomic alterations identified by molecular profiling and provided recommendations including US Food andDrugAdministration-approved drug therapy, clinical trials ofmatchedtargeted therapy, offlabel use of such therapy, and additional tumor or germline genetic testing. Results One hundred fifty-five patients were reviewed. Actionable genomic alterations were identified in 132 patients (85%). Off-label therapies were recommended in 37 patients (24%). Eleven patients were treated off-label, and 13 patients were enrolled onto clinical trials of matched targeted therapies. Median progression-free survival of patients treated with matched therapies was 5 months ( 95% CI, 2.9 months to not reached), and the progression-free survival probability at6monthswas43%(95%CI,26%to 71%).Lackof locally available clinical trials was the major limitation on clinical actionability of tumor profiling reports. Conclusion The molecular tumor board recommended off-label targeted therapies for a quarter of all patients reviewed. Outcomes were heterogeneous, although 43% of patients receiving genomically matched therapy derived clinical benefit lasting at least 6 months. Until more data become available from precision oncology trials, molecular tumor boards can help guide appropriate use of tumor molecular testing to direct therapy.

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