By Lori Solomon, Editor, Diagnostic Testing & Emerging Technologies
Multidisciplinary tumor boards can improve the clinical relevance of information derived from genomic testing, according to presenters at an extended education session “Expediting the Learning Curve for Applied Cancer Genomics” at the 2015 annual meeting of the American Society of Clinical Oncology (Chicago; May 29-June 2). Multidisciplinary tumor boards can help overcome clinicians’ self-reported discomfort with interpreting genomic data, presenters say.
Oncologists are still having difficulty turning the large volume of sequencing data into clinical action. In some scenarios clinicians need assistance determining if the data is actionable, while in other cases multiple treatment options may be possible given the genomic variants identified and clinicians could benefit from assistance in determining which would be most likely to be effective.
Robert McWilliams, M.D., from the Mayo Clinic in Rochester, described the results of an informal survey that confirmed what others are anecdotally reporting. He found that clinicians are incorporating complex genetic testing into clinical practice, but often feel uncomfortable with interpreting the results. The vast majority of respondents (80 percent) report utilizing large testing panels or exome sequencing in practice, but roughly 20 percent were “slightly uncomfortable,” and 25 percent were “not at all comfortable” interpreting the genomic information. Thirty percent say they are “moderately comfortable." More specifically, one-quarter of general oncologists said they were “slightly uncomfortable,” and 50 percent said they were “not at all comfortable.” When asked slightly differently, 70 percent of respondents “commonly” did not know what to do with genomic results, but encouragingly, more than 80 percent of respondents said they would find it helpful to be able to query a genomic tumor board with multidisciplinary expertise regarding a result.
McWilliams told the audience that the most benefit would be derived from a multidisciplinary tumor board with a broad range of expertise. Specifically, experts said, diverse tumor board members could include: a cytogeneticist to interpret copy numbers and patterns, an anatomic pathologist to help select the best tissue blocks for analysis, a molecular biologist to help understand potential interactions of molecular pathways, a malignant hematologist, solid tumor oncologist, clinical geneticist, bioinformatician, a clinical pharmacist, and even a business/billing representative to aid with insurance/payment issues.
Institutions are still developing best practices for this type of expanded tumor board and challenges remain. For one, tumor board work is uncompensated and representatives often "volunteer" for this duty. Additionally, not all facilities have the recommended comprehensive expertise to staff such a board. Lastly, boards must establish what kind of evidence is needed to determine actionability criteria.