Abstract P2-03-12: An academic cancer center's experience in establishing a breast cancer-focused multidisciplinary genomic tumor board
Authors: McGowan Michelle , Vinayak Shaveta , Maximuk Steven , Ponsaran Roselle , Marshall Patricia , Harris Lyndsay , Silverman Paula 
Published: May 2015

Background. Clinically, it is becoming increasingly important to assess genomic alterations in breast cancers using Next Generation Sequencing to find potential targets for personalized treatment. However, care paths for using such results to guide treatment have not yet been established. Previously reported studies suggest that developing an interdisciplinary review board to evaluate genomic findings can help to guide patient care. We report on a prospective qualitative study of a multidisciplinary genomic tumor board (MGTB) developed to discuss breast cancer patients’ genomic test results in the context of the clinical history and current practice guidelines. Our goal was to observe and describe the establishment of the MGTB and its members’ perceptions of a tumor board approach to interpreting genomic test results.

Materials and Methods. After IRB approval, we used qualitative case study methodology to study the MGTB and its participants, which include medical, surgical, and radiation oncologists, pathologists, geneticists, epidemiologists, bioinformaticians, pharmacologists, nurses, and bioethicists. MGTB meets on a monthly basis. Cases are anonymously presented by the treating physician. Genomic tumor findings from commercial vendors and in-house studies are discussed. Treatment recommendations are made by consensus, with level of evidence assigned based on Simon-Paik-Hayes biomarker guidelines. After obtaining consent from MGTB members, MGTB proceedings and interviews were recorded and transcribed for thematic analysis. Social dynamics within the MGTB, which includes interaction among MGTB members regarding interpretation and communication of genomic findings, were analyzed.

Results. MGTB began meeting monthly in 10/2013. As of 6/2014, 24 cases have been presented. All were female with metastatic breast cancer; 16/24 (67%) hormone receptor positive (ER or PR &gt;1%), 7/24 (29%) triple negative, and 2/24 (9%) her2 positive. Analysis of meeting and interview transcripts revealed that though inherently multidisciplinary, the MGTB’s recommendations seem to be driven by medical oncologists with input from geneticists and pharmacologists when present. MGTB recommendations have become increasingly consistent over time. Based on genomic findings, the board often recommends referring patients to clinical trials (18/24, 75%) and to Medical Genetics (9/24, 38%) for evaluation of suspected germline abnormalities over other options such as drug therapies approved by the FDA for use in other tumor types.

Discussion and Conclusion. MGTB is a unique forum to discuss genomic test results and departs from typical tumor boards by involving non-clinicians. This case study suggests the feasibility of standardizing interdisciplinary evaluation and level of evidence recommendations for genomic results. The findings of this qualitative case study reveal MGTB members’ discomfort with recommending off-label use of FDA-approved therapies. Hence, on an institutional level, team dynamics will determine how testing and recommendations are established. Further study is required to assess institutional and professional variability in offering genomic testing and making treatment recommendations on the basis of genomic findings.

Citation Format: Michelle McGowan, Shaveta Vinayak, Steven Maximuk, Roselle Ponsaran, Patricia Marshall, Lyndsay Harris, Paula Silverman. An academic cancer center's experience in establishing a breast cancer-focused multidisciplinary genomic tumor board [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-03-12.