Personalized Clinical Decision Making Through Implementation of a Molecular Tumor Board: A German Single-Center Experience.

Autor:	Hoefflin R; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Geißler AL; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Fritsch R; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Claus R; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Wehrle J; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Metzger P; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Reiser M; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Mehmed L; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Fauth L; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Heiland DH; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Erbes T; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Stock F; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Csanadi A; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Miething C; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Weddeling B; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Meiss F; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., von Bubnoff D; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Dierks C; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Ge I; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Brass V; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Heeg S; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Schäfer H; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Boeker M; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Rawluk J; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Botzenhart EM; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Kayser G; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Hettmer S; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Busch H; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Peters C; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Werner M; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Duyster J; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Brummer T; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Boerries M; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., Lassmann S; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany., von Bubnoff N; University of Freiburg, Freiburg; , , , , , , , , , and , German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; , Augsburg Medical Center, Augsburg; and , University of Lübeck, Lübeck, Germany.
Jazyk:	angličtina
Zdroj:	JCO precision oncology [JCO Precis Oncol] 2018 Aug 16; Vol. 2. Date of Electronic Publication: 2018 Aug 16 (Print Publication: 2018).
DOI:	10.1200/PO.18.00105
Abstrakt:	Purpose: Dramatic advances in our understanding of the molecular pathophysiology of cancer, along with a rapidly expanding portfolio of molecular targeted drugs, have led to a paradigm shift toward personalized, biomarker-driven cancer treatment. Here, we report the 2-year experience of the Comprehensive Cancer Center Freiburg Molecular Tumor Board (MTB), one of the first interdisciplinary molecular tumor conferences established in Europe. The role of the MTB is to recommend personalized therapy for patients with cancer beyond standard-of-care treatment. Methods: This retrospective case series includes 198 patients discussed from March 2015 through February 2017. The MTB guided individual molecular diagnostics, assessed evidence of actionability of molecular alterations, and provided therapy recommendations, including approved and off-label treatments as well as available matched clinical trials. Results: The majority of patients had metastatic solid tumors (73.7%), mostly progressive (77.3%) after a mean of 2.0 lines of standard treatment. Diagnostic recommendations resulted in 867 molecular diagnostic tests for 172 patients (five per case), including exome analysis in 36 cases (18.2%). With a median turnaround time of 28 days, treatment recommendations were given to 104 patients (52.5%). These included single-agent targeted therapies (42.3%), checkpoint inhibitors (37.5%), and combination therapies (18.3%). Treatment recommendations were implemented in 33 of 104 patients (31.7%), of whom 19 (57.6%) showed stable disease or partial response, including 14 patients (7.1% of the entire population) receiving off-label treatments. Conclusion: Personalized extended molecular-guided patient care is effective for a small but clinically meaningful proportion of patients in challenging clinical situations. Limited access to targeted drugs, lack of trials, and submission at late disease stage prevents broader applicability, whereas genome-wide analyses are not a strict requirement for predictive molecular testing. Competing Interests: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/po/author-center. Rouven HoefflinEmployment: Roche Pharma AG (I)Anna-Lena GeißlerNo relationship to discloseRalph FritschHonoraria: Genentech, Servier, Merck, Amgen Consulting or Advisory Role: Genentech Travel, Accommodations, Expenses: Amgen, Celgene, Servier, MerckRainer ClausStock and Other Ownership Interests: Medigene, Evotec Honoraria: Roche, Abbvie, Novartis, Janssen Oncology, Gilead Sciences Consulting or Advisory Role: Abbvie, Roche, Janssen Oncology Speakers' Bureau: Janssen Oncology, Roche Travel, Accommodations, Expenses: Janssen Oncology, AbbvieJulius WehrleTravel, Accommodations, Expenses: PharmaMar, NovartisPatrick MetzgerNo relationship to discloseMeike ReiserTravel, Accommodations, Expenses: AstraZenecaLeman MehmedNo relationship to discloseLisa FauthNo relationship to discloseDieter Henrik HeilandNo relationship to discloseThalia ErbesHonoraria: Roche, Novartis, Teva, Pfizer, AstraZeneca, EisaiFriedrich StockNo relationship to discloseAgnes CsanadiNo relationship to discloseCornelius MiethingConsulting or Advisory Role: Roche Pharma AG, Novartis Travel, Accommodations, Expenses: CelgeneBritta WeddelingNo relationship to discloseFrank MeissHonoraria: Bristol-Myers Squibb, Novartis, MSD Oncology Consulting or Advisory Role: Bristol-Myers Squibb, Novartis Travel, Accommodations, Expenses: Novartis, Bristol-Myers SquibbDagmar von BubnoffHonoraria: Roche, iOMEDICO AG Travel, Accommodations, Expenses: Bristol-Myers SquibbChristine DierksNo relationship to discloseIsabell GeNo relationship to discloseVolker BrassNo relationship to discloseSteffen HeegNo relationship to discloseHenning SchäferHonoraria: Genentech Consulting or Advisory Role: Bristol-Myers Squibb Travel, Accommodations, Expenses: Bristol-Myers SquibbMartin BoekerNo relationship to discloseJustyna RawlukConsulting or Advisory Role: Roche Pharma AG, Takeda, Boehringer Ingelheim, MSD, Bristol-Myers Squibb, Chugai Pharma, AstraZenecaElke Maria BotzenhartNo relationship to discloseGian KayserNo relationship to discloseSimone HettmerNo relationship to discloseHauke BuschNo relationship to discloseChristoph PetersLeadership: University Medical Center Freiburg Honoraria: University Medical Center Freiburg Travel, Accommodations, Expenses: NovartisMartin WernerHonoraria: Diakovere Consulting or Advisory Role: Roche, Novartis, Johnson & Johnson Research Funding: Agilent (Inst), Novartis (Inst), Roche (Inst)Justus DuysterHonoraria: Novartis, Genentech, Pfizer Consulting or Advisory Role: Novartis, Roche Travel, Accommodations, Expenses: NovartisTilman BrummerNo relationship to discloseMelanie BoerriesNo relationship to discloseSilke LassmannHonoraria: Novartis, AstraZeneca Travel, Accommodations, Expenses: Novartis, AstraZenecaNikolas von BubnoffHonoraria: AstraZeneca, Amgen, Bristol-Myers Squibb Consulting or Advisory Role: Novartis Research Funding: Novartis Travel, Accommodations, Expenses: Novartis (© 2018 by American Society of Clinical Oncology.)
Databáze:	MEDLINE
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