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Providence System-Wide Virtual Molecular Tumor Board Boosts Use of Precision Oncology Treatments


NEW YORK – Multi-state health system Providence has implemented an organization-wide virtual molecular tumor board (MTB) to help match patients to precision oncology therapies.

At the Association for Molecular Pathology's annual meeting earlier this month, researchers at the organization — which operates more than 50 hospitals and 1,000 clinics in Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington — presented a poster describing the formation, implementation, and initial impact of an MTB for guiding precision oncology decisions for cancer patients treated at its hospitals. Over the first six months since the MTB was launched in late 2021, experts were able to recommend a targeted treatment or immunotherapy based on molecular profiling results for 62 percent of 30 patient cases taken up by the tumor board, either as a standard of care treatment or through a clinical trial, according to the poster.

Historically, for patients who had genomic testing but whose cases were not discussed within an MTB, utilization of targeted therapies and immunotherapy tend to be lower, with 18 percent of patients receiving targeted therapy, 30 percent receiving immunotherapy treatment, and 4 percent enrolling in clinical trials.

The fact that the MTB was able to boost the number of patients in the healthcare system receiving personalized treatment options, speaks to "tremendous" clinician buy-in to the program, according to Brian Piening, assistant member of the Cancer Immuno-Genomics Laboratory within the Earle A. Chiles Research Institute at Providence Cancer Institute, and lead author on the poster.

"I'm inspired on a weekly basis to attend these virtual tumor boards and hear the high level of discourse that goes on, people sharing information and folks learning more about genomics and precision oncology," he said. "We've done a lot of good for our patients."

Over the first six months of the virtual MTB program, experts discussed about 30 cases, commonly patients with brain cancers, followed by colon, lung, and bile duct tumors.

Other institutions that have implemented MTBs have found that not only do they improve treatment matching for patients, but that the MTB-recommended treatments also improve patients' outcomes. A 2021 UK study that found that patients on treatments without MTB review had more than eight times higher risk of dying than those with similar clinical features who received MTB treatment recommendations.

According to a paper published last month, 60 out of 80 patients at the University of California, San Diego whose cases were reviewed by an MTB matched to therapies that more closely addressed the molecular features of their cancer. In this cohort, patients with a high matching score had improved median progression-free survival compared to those with a low score, 6.4 months versus 3 months, respectively, as well as longer median overall survival, 15.3 months versus 4.7 months, respectively.

To facilitate the virtual MTB at Providence, Piening and colleagues developed a cloud-based platform with health tech firm Omics Data Automation to collect and organize patient data for cases being discussed by experts. Providence's platform was built on Omics Data Automation's MyPatient360, software that helps visualize healthcare data to facilitate decision-making.

However, the group ran into difficulty in adapting a single platform for use by the MTB across a healthcare organization that includes hospitals and affiliates in seven states that operate disparate electronic health records (EHR) systems.

"There are multiple health record systems operating independently within Providence that we had to integrate," Piening said. "A lot of information is in narrative fashion and in physician notes, and imaging can be difficult to access. Largely, genomics results are typically embedded as a PDF report somewhere in the chart." Ultimately, Piening said the group decided to implement the software so it would integrate data feeds coming from the EHR, as well as genomics and imaging databases, and all the information that the MTB would need was available in a "dynamic and structured" format.  

The platform extracts the relevant information from EHRs and genomic testing reports using natural language processing and organizes it to better facilitate discussion among MTB experts. The platform also integrates radiology images for faster viewing. With this information, the platform can also offer real-time clinical trial matching and timeline visualizations of a patient's treatment trajectory.

The development of this platform began three years before the MTB launched as an effort to aggregate genomic and imaging data from the EHR to help individual case interpretations, Piening said. "We quickly realized that this would be immediately useful in the context of a tumor board," he said.

Once the virtual MTB launched last year, the experts gathered twice a month to discuss cases. The MTB meetings typically include a lead oncologist, up to three molecular pathologists who have performed molecular case workups for the cases being discussed, a clinical trials coordinator with expertise in basket trials, a medical geneticist or genetic counselor, and disease area experts that vary based on the cases being discussed.

However, Piening said the MTBs can have as many as 30 attendees. "Most are oncologists eager to participate in the discussion or who view the MTB as an opportunity to learn more about precision therapies that they can apply in their own practice," he said.

Cases could be discussed at the MTB within "a couple weeks" of patients presenting to one of its hospitals with advanced cancer because Providence largely conducts genomic profiling and pathology assessments in-house, Piening noted.

The MTB has also discussed cases for patients whose tumors were sequenced years ago but have progressed and their oncologists need new treatment recommendations, he said.

The success of the MTB so far can also be attributed to the wider adoption of video conferencing due to the COVID-19 pandemic, Piening said. "It would have been much more challenging [to implement] pre-pandemic, when a lot of our meetings were local and in-person," he said. "We were able to use the universal access to video conferencing platforms to enable clinicians to come together virtually and implement this system-wide."

Piening and colleagues hope the virtual MTB will not only help patients whose cases are discussed, but also improve education among oncologists who listen in on these expert reviews and increase their confidence and willingness to prescribe precision cancer treatments and enroll patients into clinical trials.

The virtual MTB also has room to continue growing and discussing more cases. Providence's internal labs perform genomic profiling for about 5,000 cancer patients per year, Piening said, with additional patients receiving testing from commercial labs.

Going forward, the researchers will continue tracking the impact of the MTB program on precision oncology therapy usage and clinical trial enrollment both for the MTB cases and system wide. They also hope to make the MyPatient360 platform more widely available across Providence to facilitate local organ-specific tumor boards.

"We built a lot to enhance the experience of the tumor board, but that shouldn't be a hindrance to any hospital or health system wanting to launch its own virtual tumor board," Piening said. "The core piece of the tumor board is really the experts and enabling that discussion. We used big data and software to help empower them, but the core of it is these disease or treatment experts coming together to guide treatment for a patient."