Obtaining, storing and analyzing accurate genetic data, resulting in more precise therapy at the molecular level, is the way to a future where cancer is not a fatal diagnosis, and if it cannot be cured altogether, then a chronic disease that can be lived with.
Since precision medicine is based on information about the tumor genome obtained through biomolecular testing, it has the potential to optimize cancer therapy, taking into account the tumor response and the possible development of drug resistance for each individual patient, thus providing the most appropriate treatment and improving the patient's prognosis, quality of life overall. Clinical benefit, i.e. progression-free survival, has almost doubled with personalized treatment, according to research data (Haslem et al, 2016).
At the International Precision Medicine Networking (PMNET) forum held in October in Riga, we invited two prominent guests to a conversation about a new approach to the effective treatment of oncological diseases. Martin Zoche is the director at the Molecular Tumor Profiling Dept. of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland.
Brian Healey Bird is a consultant and medical oncologist at Bon Secours Hospital in Cork, Ireland's largest private hospital.
It is a conversation about a new method that has already appeared episodically in cancer treatment. Molecular Cancer Diagnostic Councils, otherwise known as molecular tumor boards, are a group of experts who meet to review detailed molecular (usually genomic) data that provide precise information about which genes are mutated in a patient's tumor and what more precisely targeted therapy can be prescribed for that patient. It is also part of the future of precision medicine and oncology. Precision medicine is a new approach to disease treatment and prevention of each person's genetic diversity, environment, and lifestyle. In addition to the patient's genetic data the genetic data of cancer cells are discussed in oncology.
First a question for Martin Zoche - what modern tools could we use to prioritize the fight against cancer?
– One of the keys is the diagnosis of molecular pathology. These are molecular cancer diagnostic councils ( MTB - Molecular Tumor Board). The recommendations prepared within MTB provide the patient with the best treatment options. On the other hand, healththe health insurance is confident that healthcare money is invested and targeted optimally. Comprehensive tumor genome profiling is considered a more effective form of molecular diagnosis than reflex testing. However, the successful and effective use of MTB opportunities for patients is based on three essential things - good communication between different medical disciplines, good infrastructure for the immediate presentation of patient data, as well as access to the medications needed by the specific patient. Policymakers should support a seamless diagnostic pathway from molecular pathology, and comprehensive panel tests to MTB so that oncology patients can receive the best medical advice.
What are your insights on the importance of health data sharing for molecular tumor board decisions on personalized treatment?
– Data is essential in MVDK's decision-making. Today, the knowledge of an individual oncologist is no longer broad enough and does not cover all aspects of the disease and the knowledge gained in clinical trials. Therefore, sharing data and supporting MTB with additional information is important and necessary.
What are future trends in molecular tumor board development?
- Access to data on the clinical results of the use of specific drugs and comparison of these data is the next step in the future of MTB. Access to internal patient data from different hospital departments is also essential. Despite the development of technology, nowadays these data are not available electronically, for example, clinical information about the side effects of the disease of patients treated for cardiovascular disease.
What problem did you face while implementing MTB?
- That was the first reaction of the treating doctors, who believed that there was no need for another council on tumors.
What is the importance of data analytics and evidence-based medicine?
- My first experience with data analytics and evidence-based medicine seems promising. For example, within a few days, we receive additional tumor profile-specific information to discuss with the board from Flatiron Health. It is a health technology company that has robust and reliable electronic real-world health data available for specific cancers, including rare diseases, also for multiple tumors.
What is needed to create MTB and what are the opportunities for specialists from Latvia?
– It first requires the commitment of experts to take the time to meet once a week (or once every two weeks). MTB core consists of a molecular biologist, a molecular pathologist, and an oncologist. The Council is held as an online meeting. All attending physicians can join but do not have to meet in person. It is also possible to consider the possibilities of our cooperation so that oncologists from Latvia can participate in our MTB as guests.
How has it improved patient outcomes?
– MTB provides patients with the best treatment options – not only the right medication, but also inclusion in the appropriate clinical trials.
What are the main problems in data collection and what do we need to improve?
– The biggest problem is digital access to clinical information about patients. The department of tumor molecular profiling is well adapted, all genomic data is available.
Next, we would like to ask Brian Haley Baird - what specific needs or problems does the implementation of MTB MVDK solve in your experience?
– Molecular Cancer Diagnostics Councils help busy clinicians understand Next Generation Gene Sequencing (NGS) results and determine whether a case requires action, whether the change is inherited or can be ignored. (NGS is a molecular biology method that allows the simultaneous study of changes in dozens or even hundreds of genes.)
How are molecular data incorporated into treatment recommendations?
– First, MTB experts decide whether the NGS result was caused by tumor cells or a hereditary mutation. It is then decided whether there is data to support a therapy that targets the mutation in the patient's tumor and whether this treatment is needed immediately or when the tumor progresses after chemotherapy.
Name a successful example where MTB recommendations led to a personalized treatment plan?
– For a healthy elderly lady whose cholangiocarcinoma had progressed within a year of standard chemotherapy, local NGS testing revealed a genetic mutation in the tumor tissue. MTB recommended a specific appropriate medication, and this recommendation helped to obtain the exact medication. After three months of treatment, the patient feels well and is looking forward to re-staging the tumor. A patient with colorectal cancer had tumor progression after therapy. MTB recommended immunohistochemical examination of metastases to confirm HER2 protein overexpression in tumor cells. The test was positive and was followed by successful treatment with two anti-HER2 drugs.
What would be the key criteria for MTB to be successful in providing effective treatment solutions to patients?
– First, a clear and concise clinical history should be taken, including the type and stage of cancer, the results of standard-of-care immunohistochemistry, and tumor genetic testing. Experts usually want the full NGS report (suitably anonymized). The MTB manager issues a report to be attached to the patient's health care records. Treatment decisions are the responsibility of the treating physician, but records help document why the decision was made.
How often is online MTB and what is the experience of using these councils?
– MTBs are held once a month and discuss two to four cases each from across the country. From November 2020 to September 2023, 27 panels or councils have been held. In my experience, it takes 30-45 minutes to prepare case information, including documenting a brief overview of previous treatment. MTB has a double meaning - it teaches me and my colleagues something new and helps us make quality decisions about the treatment of our patients.
A question for both Martin Zoche and Brian Haley Baird - are there any projects and cooperation with Latvia?
- Martin Zoche: We are currently cooperating with the Children's Hospital in Riga where the local representative is Valts Ābols with support from the Swiss government. Brian Haley Bird expresses the hope that there will be more cooperation in EU projects, which facilitates data sharing and cooperation. There could be opportunities to combine the experience of the Irish and Latvian Molecular Tumor Boards for the preparation of publications or to provide exchange programs for students or researchers. I would be more than happy to participate in joint workshops and online MTBs so that we can learn from each other.
The publication is implemented in cooperation with the Investment and Development Agency of Latvia and the European Regional Development Fund project 184.108.40.206. "Support for the improvement of the technology transfer system" (project identification number 220.127.116.11/16/I/001), implementing ERDF 1.2.1. of the specific support objective "Increase private sector investments in R&D".
More information about the PMNET forum program and speakers: www.pmnetforum.com, as well as on social media Facebook: PMNET - Precision Medicine Networking Forum and LinkedIn: Precision Medicine Networking Forum using hashtags #MissionLatvia #PMNETforum #PMNETforum2023 #PrecisionMedicineNetwork