Rieke Damian T, Lamping Mario, Schuh Marissa, Le Tourneau Christophe, Basté Neus, Burkard Mark E, Metzeler Klaus H, Leyvraz Serge, Keilholz Ulrich
Damian T. Rieke, Mario Lamping, Serge Leyvraz, and Ulrich Keilholz, Charité Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin; Damian T. Rieke, Berlin Institute of Health, Berlin; Klaus H. Metzeler, University Hospital, LMU Munich, Munich, Germany; Marissa Schuh, Markey Cancer Center, University of Kentucky, Lexington, KY; Christophe Le Tourneau, Institut Curie and INSERM U900 Research Unit, Saint-Cloud; Christophe Le Tourneau, Institut Curie, Paris; Christophe Le Tourneau, Versailles-Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France; Neus Basté, Vall d'Hebron Institute of Oncology, Barcelona, Spain; and Mark E. Burkard, UW Carbone Cancer Center, University of Wisconsin, Madison, WI.
JCO Precis Oncol. 2018 Nov;2:1-14. doi: 10.1200/PO.18.00098.
Precision oncology holds the promise of improving patient outcome. It is based on the idea that the testing of genomic biomarkers can lead to the recommendation of a treatment option tailored to the specific patient. To derive treatment recommendations from molecular profiles, interdisciplinary molecular tumor boards (MTBs) have been established recently in many academic institutions. The recommendation process in MTBs, however, has not been well defined, which limits applicability to larger clinical trials and patient populations.
We created four fictional patients on the basis of recent real cases with genomic information on mutations, fusions, copy numbers, and gene expression. We identified 29 tumor boards from nine countries worldwide and asked them to provide treatment recommendations for the sample patients. In addition, a questionnaire regarding the setup and methods used by MTBs was circulated.
Five MTBs from four countries provided treatment recommendations and answered the questionnaire. For one patient, three tumor board treatment recommendations were identical, and two tumor boards had identical treatment strategies for the other three patients. There was heterogeneity in the interpretation of tumor and germline aberrations as well as in standards of prioritization.
Differences in the interpretation and recommendation process contribute to heterogeneity in MTB recommendations. Additional comparative analyses of recommendations could help improve rational decision making and lead to standardization.
精准肿瘤学有望改善患者预后。它基于这样一种理念，即对基因组生物标志物进行检测能够为特定患者推荐量身定制的治疗方案。为了从分子图谱中得出治疗建议，许多学术机构最近都成立了跨学科分子肿瘤委员会（MTB）。然而，MTB中的推荐流程尚未得到明确界定，这限制了其在更大规模临床试验和患者群体中的适用性。
我们根据近期具有突变、融合、拷贝数和基因表达等基因组信息的真实病例创建了四名虚拟患者。我们从全球九个国家确定了29个肿瘤委员会，并要求它们为这些样本患者提供治疗建议。此外，还分发了一份关于MTB的设置和使用方法的问卷。
来自四个国家的五个MTB提供了治疗建议并回答了问卷。对于一名患者，三个肿瘤委员会的治疗建议相同，对于其他三名患者，两个肿瘤委员会有相同的治疗策略。在肿瘤和种系畸变的解读以及优先级标准方面存在异质性。
解读和推荐过程中的差异导致了MTB推荐的异质性。对推荐进行额外的比较分析有助于改善合理决策并实现标准化。
