Pishvaian Michael J, Blais Edik M, Bender R Joseph, Rao Shruti, Boca Simina M, Chung Vincent, Hendifar Andrew E, Mikhail Sam, Sohal Davendra P S, Pohlmann Paula R, Moore Kathleen N, He Kai, Monk Bradley J, Coleman Robert L, Herzog Thomas J, Halverson David D, DeArbeloa Patricia, Petricoin Emanuel F, Madhavan Subha
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA.
Perthera, Inc, McLean, Virginia, USA.
JAMIA Open. 2019 Oct 7;2(4):505-515. doi: 10.1093/jamiaopen/ooz045. eCollection 2019 Dec.
Scalable informatics solutions that provide molecularly tailored treatment recommendations to clinicians are needed to streamline precision oncology in care settings.
We developed a cloud-based virtual molecular tumor board (VMTB) platform that included a knowledgebase, scoring model, rules engine, an asynchronous virtual chat room and a reporting tool that generated a treatment plan for each of the 1725 patients based on their molecular profile, previous treatment history, structured trial eligibility criteria, clinically relevant cancer gene-variant assertions, biomarker-treatment associations, and current treatment guidelines. The VMTB systematically allows clinician users to combine expert-curated data and structured data from clinical charts along with molecular testing data to develop consensus on treatments, especially those that require off-label and clinical trial considerations.
The VMTB was used as part of the cancer care process for a focused subset of 1725 patients referred by advocacy organizations wherein resultant personalized reports were successfully delivered to treating oncologists. Median turnaround time from data receipt to report delivery decreased from 14 days to 4 days over 4 years while the volume of cases increased nearly 2-fold each year. Using a novel scoring model for ranking therapy options, oncologists chose to implement the VMTB-derived therapies over others, except when pursuing immunotherapy options without molecular support.
VMTBs will play an increasingly critical role in precision oncology as the compendium of biomarkers and associated therapy options available to a patient continues to expand.
Further development of such clinical augmentation tools that systematically combine patient-derived molecular data, real-world evidence from electronic health records and expert curated knowledgebases on biomarkers with computational tools for ranking best treatments can support care pathways at point of care.
需要可扩展的信息学解决方案，为临床医生提供分子定制的治疗建议，以简化医疗环境中的精准肿瘤学。
我们开发了一个基于云的虚拟分子肿瘤委员会（VMTB）平台，该平台包括一个知识库、评分模型、规则引擎、一个异步虚拟聊天室和一个报告工具，该工具根据1725名患者的分子特征、既往治疗史、结构化试验纳入标准、临床相关癌症基因变异断言、生物标志物-治疗关联以及当前治疗指南，为每位患者生成治疗方案。VMTB系统地允许临床医生用户将专家策划的数据、临床图表中的结构化数据以及分子检测数据结合起来，就治疗方案达成共识，尤其是那些需要考虑超说明书用药和临床试验的方案。
VMTB被用作癌症护理流程的一部分，为倡导组织转诊的1725名患者中的一个重点子集提供服务，最终成功地将个性化报告交付给主治肿瘤学家。在4年时间里，从数据接收到报告交付的中位周转时间从14天减少到了4天，而病例数量每年几乎增加1倍。使用一种新颖的评分模型对治疗方案进行排名，肿瘤学家选择采用VMTB衍生的治疗方案而非其他方案，但在没有分子支持的情况下选择免疫治疗方案时除外。
随着患者可用的生物标志物和相关治疗方案的不断扩展，VMTB在精准肿瘤学中将发挥越来越关键的作用。
进一步开发此类临床增强工具，系统地将患者来源的分子数据、电子健康记录中的真实世界证据以及关于生物标志物的专家策划知识库与用于排名最佳治疗方案的计算工具相结合，可以在护理点支持护理路径。
