HOPA 2018 | Molecular tumor boards for personalized medicine

Jill Kolesar

Speaking from the 2018 Hematology/Oncology Pharmacy Association (HOPA) Annual Meeting, held in Denver, CO, Jill Kolesar, PharmD, MS, BCPS, FCCP, of the University of Kentucky, Lexington, KY, explains the role of a molecular tumor board, a group of experts in all areas of medicine, including pharmacists, oncologists, geneticists and bioinformaticians.

Transcript (edited for clarity):

One of the things that I did at my former institution is start a molecular tumor board, and so the problem when we get those genetic somatic mutation reports, there’s hundreds of different mutations on there and lots and lots of different drugs and different opportunities. And so what a molecular tumor board does is that it brings together a group of experts; pharmacists, medical oncologists, hematologists, pathology, radiation science and basic scientists and interprets the reports and tries to come up with a plan that is the best treatment option for that patient.

So I also developed a molecular tumor board at the University of Kentucky, and in addition to developing these molecular tumor boards, we have studied their effects to see if they’re worthwhile to do if patients benefit from them. So what I’m going to talk about in the presentation today is basically three pharmacist-led molecular tumor boards; one at Moffitt Cancer Center, one at Indiana University and one at the University of Wisconsin which is my former institution. And all of those molecular tumor boards have shown to be beneficial for patients.

Some of the things that we found at the University of Wisconsin was that almost 2/3 of our patients were candidates for a targeted therapy or a clinical trial of targeted therapy. The main results that we found at the University of Wisconsin is that a good percentage of patients who were seen at the molecular tumor board actually had actionable mutations, meaning that we had a drug that we could suggest for them. Unfortunately what we learned though is that in most circumstances if the clinical trial was not open at the University of Wisconsin, patients were unable to travel to that. So one thing we took away from that is that we need to have more clinical trials available locally for them, and the third thing that we found is that the majority of patients who received a targeted therapy actually did benefit from that.

I have a since gone to University of Kentucky, we’ve started a molecular tumor board there as well and we’ve really taken the next step at the University of Kentucky. So what we know is that although, so academic medical centers are usually the first centers of innovation, but more than 90% of patients are actually treated in the community. And so what we’ve done at the University of Kentucky is we’ve developed a collaboration with our community partners. So we’ve gone out into the community in many different parts of Kentucky and engaged those community medical oncologists. They’re participating in our molecular tumor board and they’re contributing to helping us understand the mutation profile for their patients as well. So the next big step for us was actually to engage our community partners so all patients in Kentucky actually have access to molecular tumor board recommended therapies. Take-home message number one as pharmacists are very important to the running of a molecular tumor board, the other take-home message is that the majority of patients who are seen by a molecular tumor board both have an actual mutation and you can recommend a targeted therapy and for the most part the literature is showing that targeted therapies are both more effective and have less adverse effects than the standard chemotherapy.

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