While traditional tumor boards are common at most academic medical centers, Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) has taken its 10-year-old tumor board to the next level by integrating molecular pathology into their discussions.
The DF/BWCC Molecular Pathology Tumor Board (MPTB) is a partnership between the Brigham’s Division of Urology and Dana-Farber Cancer Institute’s Center for Genitourinary Oncology. According to Himisha Beltran, MD, who leads the effort, a tumor’s molecular underpinnings provide important information that can inform decisions around targeted therapies and other treatments.
“The MPTB allows us to apply information about molecular abnormalities in a clinical setting, providing a more complete patient picture and helping to improve decision-making and ultimately patient outcomes,” she said. “It gives us additional data to help us predict how aggressive the cancer is, determine how closely we need to follow the patient and decide on appropriate systemic therapy strategies.”
Guiding Treatment Along the Disease Spectrum
During the monthly MPTB conferences, medical oncologists, urologists, radiation oncologists, other specialists and basic scientists discuss patient cases along the disease spectrum, from those with localized tumors to those with advanced, metastatic and recurrent cases.
“We have good experience using molecular data in advanced disease settings to determine patient eligibility for targeted therapies of immunotherapy and clinical trials of drugs in development,” Dr. Beltran said. “Now, we can apply those observations earlier in the disease progression to determine if a patient at high risk of metastatic disease should consider trials using novel neoadjuvant therapies, for example.”
One of the regular participants in the MPTB is Adam Stuart Kibel, MD, chief of the Brigham’s Division of Urology. He and his urology colleagues are excited to improve care and cure through understanding the molecular cause of the cancer. For example, the tumor boards will ensure that men with metastatic prostate cancer and BRCA2 will be put on a PARP inhibitor. Bladder cancer patients with fibroblast growth factor receptor (FGFR) mutations can be started on standard of care erdafitinib.
“I’m truly excited about the next step,” he said. “Soon, when we see a mutation in the BRCA2 gene in a patient with high-risk, localized prostate cancer, we will be able to put them on an innovative, standard-of-care PARP inhibitor that will directly target the molecular underpinnings of the cancer’s aggressiveness.”
While mutations in individual genes such as BRCA2 and FGFR drive treatment decisions, the MPTB does not look at those genes in isolation. Rather than sequencing individual genes, Dr. Beltran explained, “We sequence panels of genes to get important information about significant co-occurring alterations.”
Profile Program Provides Comprehensive Tumor Database
The MPTB pulls its data from Profile, a large-scale research project launched in 2011 that collects tumor tissue from cancer patients and scans the tissue for hundreds of gene mutations linked to cancer. The tissue scan data is linked to data from patients’ medical records, which also include details about the course of their disease, its response to treatment and any relapse and side effects.
“DF/BWCC has been on the cutting edge of tumor-based and germline genomic research for years, and Profile contains a vast amount of molecular data from cancer patients,” Dr. Kibel said. “Profile allows us to compare an individual patient’s mutation with other patients’ mutations across the Brigham network to see how often it occurs within the same type of cancer as well as other cancers.”
Profile also integrates with MatchMiner, a DF/BWCC program that matches patients with available clinical trials.
“DF/BWCC has a large portfolio of basket trials for rare mutations that don’t have an associated standard of care,” Dr. Beltran said. “Our work on the MPTB helps us link a patient’s specific mutation to trials for which they are eligible.”
Exploring How Mutations Can Drive Novel Therapies
Dr. Kibel called the DF/BWCC MPTB the start of something great in precision medicine.
“The MPTB is a powerful platform to explore how mutations can drive novel therapies and whether we can move targeted therapies to earlier in the disease process, where they can make a bigger impact,” he said. “Precision medicine is the future, and DF/BWCC has been at the forefront of applying multidisciplinary expertise to translate molecular alterations into value — both from the perspective of individual patient care and to drive future research that goes beyond the individual patient.”