Programmatic Precision Oncology Decision Support for Patients With Gastrointestinal Cancer
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Published:2023-01
Issue:7
Volume:
Page:
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ISSN:2473-4284
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Container-title:JCO Precision Oncology
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language:en
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Short-container-title:JCO Precision Oncology
Author:
Keller Rachel B.1ORCID, Mazor Tali2ORCID, Sholl Lynette3ORCID, Aguirre Andrew J.14ORCID, Singh Harshabad1ORCID, Sethi Nilay1ORCID, Bass Adam1, Nagaraja Ankur K.1, Brais Lauren K.1ORCID, Hill Emma1, Hennessey Connor1ORCID, Cusick Margaret1, Del Vecchio Fitz Catherine2ORCID, Zwiesler Zachary2, Siegel Ethan2ORCID, Ovalle Andrea2, Trukhanov Pavel2ORCID, Hansel Jason2, Shapiro Geoffrey I.1ORCID, Abrams Thomas A.1ORCID, Biller Leah H.1, Chan Jennifer A.1, Cleary James M.1ORCID, Corsello Steven M.1ORCID, Enzinger Andrea C.1ORCID, Enzinger Peter C.1, Mayer Robert J.1, McCleary Nadine J.1ORCID, Meyerhardt Jeffrey A.1ORCID, Ng Kimmie1ORCID, Patel Anuj K.1ORCID, Perez Kimberley J.1ORCID, Rahma Osama E.1ORCID, Rubinson Douglas A.1, Wisch Jeffrey S.1, Yurgelun Matthew B.1ORCID, Hassett Michael J.1ORCID, MacConaill Laura3ORCID, Schrag Deborah1, Cerami Ethan2, Wolpin Brian M.1ORCID, Nowak Jonathan A.3ORCID, Giannakis Marios14ORCID
Affiliation:
1. Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA 2. Department of Data Science, Dana-Farber Cancer Institute, Boston, MA 3. Center for Advanced Molecular Diagnostics, Brigham & Women's Hospital & Harvard Medical School, Boston, MA 4. Broad Institute of Harvard and MIT, Cambridge, MA
Abstract
PURPOSEWith the growing number of available targeted therapeutics and molecular biomarkers, the optimal care of patients with cancer now depends on a comprehensive understanding of the rapidly evolving landscape of precision oncology, which can be challenging for oncologists to navigate alone.METHODSWe developed and implemented a precision oncology decision support system, GI TARGET, (Gastrointestinal Treatment Assistance Regarding Genomic Evaluation of Tumors) within the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute. With a multidisciplinary team, we systematically reviewed tumor molecular profiling for GI tumors and provided molecularly informed clinical recommendations, which included identifying appropriate clinical trials aided by the computational matching platform MatchMiner, suggesting targeted therapy options on or off the US Food and Drug Administration–approved label, and consideration of additional or orthogonal molecular testing.RESULTSWe reviewed genomic data and provided clinical recommendations for 506 patients with GI cancer who underwent tumor molecular profiling between January and June 2019 and determined follow-up using the electronic health record. Summary reports were provided to 19 medical oncologists for patients with colorectal (n = 198, 39%), pancreatic (n = 124, 24%), esophagogastric (n = 67, 13%), biliary (n = 40, 8%), and other GI cancers. We recommended ≥ 1 precision medicine clinical trial for 80% (406 of 506) of patients, leading to 24 enrollments. We recommended on-label and off-label targeted therapies for 6% (28 of 506) and 25% (125 of 506) of patients, respectively. Recommendations for additional or orthogonal testing were made for 42% (211 of 506) of patients.CONCLUSIONThe integration of precision medicine in routine cancer care through a dedicated multidisciplinary molecular tumor board is scalable and sustainable, and implementation of precision oncology recommendations has clinical utility for patients with cancer.
Publisher
American Society of Clinical Oncology (ASCO)
Subject
Cancer Research,Oncology
Cited by
1 articles.
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