Abstract P1-08-01: Virtual molecular and precision medicine (vMAP) clinic to improve access to clinical trials for patients with metastatic breast cancer: an academic-community collaboration
Authors: Mortensen Lindsey , Keenan Jennifer C. , Abraham Elizabeth , Padden Sarah , Ma Annie , Denault Elyssa , Ryan Lianne , Medford Arielle J. , Ellisen Leif , Schwartz Joel H. , Bardia Aditya , Spring Laura M. 
Published: March 2023

Abstract
Background: Despite improved outcomes for patients with metastatic breast cancer (MBC), attributed in part to advancements in precision therapeutics, clinical trial enrollment and genomic testing are relatively underutilized in the community oncology setting. To address this need, we launched a virtual molecular and precision medicine (vMAP) clinic to improve access for patients in our community network. Here we describe the initial results from the virtual clinic initiative. Methods: In 2020, the vMAP clinic was launched to provide real-time access to precision medicine expertise through virtual, email-based consultation directed to a multidisciplinary team. As part of the service, providers contacted vMAP regarding patients with MBC at the time of initial presentation or disease progression. Upon receipt, the vMAP team (including breast medical oncologists, a breast oncology research nurse, a research assistant, and ad hoc consultation from cancer genetics and molecular pathology representatives) engaged in discussion to identify potential clinical trials with slot availability or standard of care (SOC) options and provided recommendations to the referring provider within 72 hours. Relevant patient data and vMAP referral outcomes were recorded. Providers across the community network were surveyed at project onset and after seventeen months. Results: In its first 14-month period (June 2020-July 2021), 47 cases from 16 providers across seven community oncology sites and one academic site were referred to vMAP. A majority (88.6%) of patients had undergone somatic genomic testing (tissue-based, plasma-based, or both) to inform treatment guidance. All cases were screened for available clinical trials as well as SOC options at the time of referral. The average response time to the referring provider with a finalized recommendation was 1.77 days (range 0-5). Forty cases (85.1%) had clinical trial options identified on vMAP pre-screen. Subsequently, 22 patients (46.8%) screened for vMAP recommended clinical trials with 18 (38.3%) initiating enrollment. Of the remaining patients that did not pursue clinical trial screening, 17 (36.2%) started vMAP-recommended SOC treatment, five (10.6%) pursued a different treatment, one (2.1%) was not a candidate for further treatment, and two (4.3%) opted to receive care at a non-affiliated institution, and subsequent treatment information was not available. Reasons that patients did not enroll on trials included trial ineligibility, formal clinical trial screening failure, and patient/provider preference. At project onset, network provider survey results confirmed a previously suggested demand for improvements in processes surrounding genomic testing interpretation and clinical trial enrollment. Post-referral survey results indicated vMAP recommendations and pre-screenings improved the processes surrounding interpretation of genomic testing and clinical trial screening and enrollment, with high rates of referring provider satisfaction. Conclusion: A precision medicine virtual clinic demonstrated an efficient and flexible means to offer real-time interpretation of genomic and molecular test results and identification of appropriate treatment options, including clinical trials when applicable, for patients with MBC. The service highlights an example of an academic-community collaboration model to expand precision medicine and clinical trial access for patients with metastatic breast cancer.
Citation Format: Lindsey Mortensen, Jennifer C. Keenan, Elizabeth Abraham, Sarah Padden, Annie Ma, Elyssa Denault, Lianne Ryan, Arielle J. Medford, Leif Ellisen, Joel H. Schwartz, Aditya Bardia, Laura M. Spring. Virtual molecular and precision medicine (vMAP) clinic to improve access to clinical trials for patients with metastatic breast cancer: an academic-community collaboration [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-01.