Using next-generation sequencing to help inform treatment options is growing in frequency, but the results can be difficult to interpret and implement in clinical practice.
Expanding the use of multidisciplinary tumor boards (MTBs) to help guide treatment decisions and match therapies has demonstrated positive outcomes in patients with gynecologic and breast cancers, according to findings from investigators at the Moores Cancer Center at UC San Diego Health.1 When investigators matched therapies with patients whose genomic alterations were identified through next-generation sequencing (NGS), it revealed higher overall response rates and progression-free survival (PFS), and a trend toward improved overall survival (OS).
Using NGS to help inform treatment options is growing in frequency, but the results can be difficult to interpret and implement in clinical practice. Multiple institutions have implemented MTBs to help clinicians improve outcomes in patients.
A total of 164 female patients with breast (n = 128; 78.0%) and ovarian (n = 36; 22.0%) cancers were presented to the UC San Diego MTB.1 Overall, 113 patients were evaluable for treatment after review by the MTB. Sixty-one patients (54%) received matched therapy. Investigators calculated the matching score, which was the percentage of alterations targeted by treatment over total pathogenic alterations, and adherence to MTB recommendations in the context of oncologic outcomes. For evaluable patients, the median PFS was 5.1 months (range, 0.4-73.5) and OS was 12.9 months (range, 0.7-73.5). Patients with an MS of less than 40% (n = 87) had a median PFS of 3.9 months (range, 0.4-73.5), whereas patients with an MS of 40% or greater (n = 26) had a median PFS of 9.3 months (range, 1.4-19.0; HR, 0.51; 95% CI, 0.31-0.85; P = .002; TABLE).
In univariate analysis, patients with an MS greater than 40% had a higher overall response rate vs those whose MS was less than 40% (30.8% vs 7.1%; P = .001). They also had a higher PFS (HR, 0.51; 95% CI, 0.31-0.85; P = .002) and a trend toward improved OS (HR, 0.64; 95% CI, 0.34-1.25; P = .082).
The advantage in PFS continued in multi-variate analysis according to the investigators (HR, 0.5; 95% CI, 0.3-0.8; P = .006). Higher MTB recommendation adherence was significantly associated with improved median PFS (9.0 months for complete adherence, 6.0 months for partial, 4.0 months for none; P=.004) and OS (17.1 months for complete, 17.8 months for partial, 10.8 months for none; P = .046).
The majority (90.2%) of patients had undergone tissue-based NGS and 37.2% of patients had a liquid biopsy alone; 27.4% had both tissue and liquid biopsies. The median age was 50 years (range, 20-80), and 71.7% of patients were White, 13.3% were Hispanic, 8.0% were Asian, 3.5% were Black, 2 (1.8%) were of mixed race/ethnicity, and 2 (1.8%) declined to answer. The investigators noted no differences in outcomes by race.
The investigators reported that patients with higher matching scores had higher complete response (CR) rates (4.5% vs 2.2%) and partial response (PR) rates (22.7% vs 6.7%), and higher rates of stable disease (SD) at 6 months or more (45.5% vs 27.0%), compared with patients with lower MSs. Patients with higher matching scores had significantly improved ORRs (30.8% vs 7.1%; P = .001) and clinical benefit rates (SD≥6 months, PR or CR; 73.1% vs 34.1%; P = .001; FIGURE1).
Adherence to MTB recommendations was significantly associated with improved objective response rates; women who received treatment that followed all MTB recommendations had 10.9 (95% CI, 1.9-63.8) times higher odds of objective response than women who did not receive any MTB-recommended treatments (P =.008). Women who received part (odds ratio [OR], 2.6; 95% CI, 1.5-8.7; P =.004) or all (OR, 9.5; 95% CI, 1.6- 8.7; P =.004) of the recommended treatments had significantly higher odds of clinical benefit compared with women who received physician’s choice of regimen.
The investigators recommended expanding the role of MTBs to assist with treatment decisions for patients with breast and gynecologic cancers as it could lead to improved response rates and outcomes.
Charo LM, Eskander RN, Sicklick J, et al. Real-world data from a molecular tumor board: improved outcomes in breast and gyneco- logic cancers patients with precision medicine. JCO Precis Oncol. 2022;6:e2000508. doi:10.1200/PO.20.00508