The Benefits of a Molecular Tumor Board
- A tumor board is a meeting of several cancer specialists that often occurs weekly or biweekly. Specific patients and their cancers are discussed in depth during these meetings, and treatment recommendations are made.
- A tumor board discussion regarding your cancer can happen at any point and multiple times in your cancer care. It is commonly done on initial diagnosis or workup of the cancer or if there is a recurrence or progression of the disease.
- Molecular tumor boards are a specialized type of tumor board that discusses molecular testing, namely next-generation sequencing and prior cancer history, to provide recommendations that can include targeted therapies and potential clinical trials.
- Molecular tumor boards typically discuss patients with complex cancer history and multiple prior treatment courses with progressive cancer with ineffective treatments.
- Your current treating medical oncologist can initiate molecular tumor board evaluation. If this is not available with your current healthcare team, you can also undergo a second opinion at an academic center.
- If you feel you are a candidate for evaluation by the molecular tumor board or next-generation sequencing, please discuss further with your healthcare team.
What Is a Tumor Board?When you are diagnosed with cancer, it is common practice for your physician to discuss your cancer and the available information gathered at this point with a team of experts to come up with additional recommendations. This meeting of cancer experts is called a tumor board. The experts in a standard tumor board often comprise a wide range of specialists, including surgeons, chemotherapy doctors (medical oncologists), radiation doctors (radiation oncologists), pathologists, radiologists, and social workers, to name a few. These meetings typically happen once weekly or every other week. The structure, topics of discussion, and frequency at which these meetings are held can vary based on several factors, including your cancer type and where you are receiving your care.
The time in your treatment course, when you and your cancer may be discussed in tumor boards, can vary. People’s cases are commonly discussed at the tumor board when they are first diagnosed to develop a treatment plan, which often involves coordination from multiple cancer specialties. Discussing the cancer during the tumor board is common if the disease is returned or new treatments are needed because current therapies are ineffective. Often, patients can be discussed at multiple points throughout their disease and treatment course. The recommendations can vary and are specific to the patient and the cancer. Recommendations can include a specific treatment regimen, additional imaging or lab tests, repeat biopsy, or observing the disease, to name a few.
Why Do We Have Tumor Boards?Read More
What Makes a Molecular Tumor Board Different?
Standard Tumor BoardA standard tumor board will discuss a variety of information regarding your cancer based on the current state of the disease and the familiarity of the tumor board team with your disease. Standard tumor boards are widespread practice and available at most care facilities. The information discussed can include your personal cancer history, social and family history, imaging, biopsy results, and surgery findings, to name a few. This can be done at any point in the course of your disease to make a variety of recommendations.
Molecular Tumor Board
Molecular Tumor Boards are a more focused type of tumor board comprising a team of experts who analyze and interpret molecular testing results. The team consists of multiple specialties (like standard tumor boards) and includes molecular pathology, genetics experts, and oncologists specializing in that disease, among others. This is often reserved for more complicated cases that have undergone prior treatment, and a new, targeted therapy is needed.
“We do a deep dive into that person’s next-generation sequencing results, their clinical history, their prior treatments, and integrate all of that information ultimately to come up with treatment recommendations,” according to Dr. Jessica Tao, a breast medical oncologist at Johns Hopkins Kimmel Cancer Center and co-leader of the Johns Hopkins Molecular Tumor Board.
The Importance of the Molecular Tumor Board
A standard tumor board is often sufficient to provide personalized and effective treatment recommendations for treating your cancer. Molecular tumor boards can be used when more targeted therapy is needed, often in patients with a complex cancer history. It is also important to note that molecular testing is routinely discussed in tumor boards regardless of whether this is a molecular tumor board or not.
When you present with advanced cancer that has progressed and more standardized treatments have become ineffective, next-generation sequencing (NGS) is often performed. NGS tests multiple genes, or parts of DNA, to identify mutations (DNA changes) commonly seen in certain cancers. Although NGS is widely used and can identify well-known DNA mutations that can cause cancer, the results of NGS can be complex and difficult to interpret. There is still much unknown about many DNA mutations and their risk of causing cancer.
Additionally, the type of NGS testing that is performed can vary widely based on where you are receiving treatment and cancer type.
“The interpretation of molecular testing can be complex, and that’s where molecular tumor boards come in,” Dr. Valsamo Anagnostou, a thoracic oncologist and leader of the Johns Hopkins Molecular Tumor Board, explains. “These are expert opinion-based precision oncology initiatives. They have actually been shown to improve outcomes by matching the genomic profile of your cancer with available therapies, a standard of care, and most importantly, as part of a clinical trial.”
Molecular tumor boards allow specialists to interpret these complex NGS results and then apply this new information along with a prior history of your cancer and prior treatments to come up with new treatment recommendations, identify treatments that might be ineffective, and also identify ongoing clinical trials for which you might be eligible.
“We provide personalized recommendations tailored to the genomic footprint of your cancer,” Dr. Anagnostou says.
When to Consider Evaluation by a Molecular Tumor Board
The indication for additional testing, NGS specifically, can vary based on your cancer type, the disease course, and personal factors, among other things. In general, NGS testing can be considered when your cancer has progressed, current standard therapies have become ineffective, and a new targeted treatment is needed. If you fit these criteria, your treating medical oncologist will often refer you for molecular tumor board evaluation. “So anybody can be referred to the molecular tumor board. It’s usually a treating oncologist, a patient’s primary treating oncologist, who submits a case.” Says Dr. Tao.
If you feel like you are eligible for molecular tumor board evaluation and have not been offered, please discuss further with your healthcare team.
Where and How Do I Get Evaluated by a Molecular Tumor Board?
Standard tumor boards are widespread and common practice. Typically, your treating medical oncologist will refer you for molecular tumor board if you meet the criteria for NGS testing and further expert input is needed on treatment recommendations. However, a molecular tumor board may not be available where you are currently undergoing cancer treatment. Also, many tumor boards throughout the country are able to make decisions using the same information during tumor boards; they may not call it a molecular tumor board at that particular institution. What is most important is that you discuss options with your healthcare team.
“If you don’t have access to a molecular tumor board, one option is to seek a second opinion at an academic medical center and ask about molecular testing there,” says Dr. Tao. But, ask your primary treatment team about molecular testing as a first step.
If you feel there are other treatment options that are not being offered or you have additional questions regarding your cancer care that are not addressed, it is important to consider obtaining a second opinion.
“Our goal is to make it open and accessible to everyone. And so we often receive cases from physicians elsewhere, meaning across the US and even internationally as well,” says Dr. Tao.
Several academic centers have molecular tumor boards. If you feel like you might be a candidate for further evaluation, it is important to either discuss with your medical oncologist so he can refer you to the molecular tumor board or seek a second opinion at an academic center. You do not need to be local or previously known to the cancer center where the molecular tumor board is performed to be considered for evaluation. If you go to a cancer center that is not aware of your prior history and cancer information, it is important that you have detailed information regarding your cancer history and prior treatments, which can be obtained by asking your current healthcare team.