Barcelona, Spain (UroToday.com) Dr. Scott Tomlins opened this education session emphasizing that the goal of genomic tumor boards is to eventually not have genomic tumor boards. This statement reflects the need for cancer care providers to ultimately be able to incorporate genomic information into the routine care of patients.
Genomic tumor boards evolve with time as resources and our understanding of tumor genomics changes. They can serve multiple purposes including guiding the management of individual patients, increasing provider and patient comfort with genomic testing and its results, identifying translational research opportunities, and identifying novel clinical trial hypotheses. Essential components of a tumor board are a deep understanding of the patients, the sample obtained, and the test(s) that were carried out. How these essential components are obtained, however, depends on the available resources and expertise at that location. For example, an institution or practice may have a larger tumor board that includes the oncologist, physician extenders, genetic counselors, clinical trialists, general disease specialists, anatomic and molecular pathologists, and bioinformaticians. Such a tumor board may discuss each patient in deep detail from their clinical history and personal preferences to nuances of testing and clinical trial implications. In contrast, a genomic tumor board could simply consist of oncologic providers and pathologists. In such a setting, it is important to make sure that the necessary deep understanding of the samples and tests are available, potentially through outsourcing.
As a pathologist, Dr. Tomlins emphasized the importance of providing the clinical history to the pathology team analyzing the sample, as well as the importance of understanding the characteristics of the test done. A clinical history suggesting that a lung biopsy was obtained from a patient with a history of prostate cancer will have a different testing pathway than a lung biopsy obtained from a patient with an extensive smoking history. Several questions to consider regarding the genomic test that was done are: (1) Was the analyzed tissue only tumor, or was there a normal comparison, (2) Is this a focused panel of tests, or is it a whole genome/transcriptome test, (3) What alterations can the test detect? For example, can it detect deep deletions, and how does the test detect features such as microsatellite instability?, and (4) What are the quality control metrics and are you satisfied with the QC results?
Ultimately, genomic testing cannot fully inform treatment decisions without real-time knowledge of the patient’s full clinical history, their wishes, and logistical issues such as available clinical trial slots and geographic/travel constraints. Tumor boards may choose to incorporate such discussions into their workflow, but this can also be handled by the patient’s primary providers.
Presented by: Scott Tomlins, MD, Ph.D., Adjunct Associate Professor, Genitourinary Pathology, MCTP Clinical Laboratory – Oncomine Cancer Panel Test, Department of Pathology, Michigan Medicine, University of Michigan, USA
Written by: Alok Tewari, MD, PhD, Medical Oncology Fellow at the Dana-Farber Cancer Institute, at the 2019 European Society for Medical Oncology annual meeting, ESMO 2019 #ESMO19, 27 Sept – 1 Oct 2019 in Barcelona, Spain