Aurora Cancer Care, Oncology Precision Medicine, Advocate Aurora Health, Milwaukee, WI.
Hereditary Cancer Prevention and Management Center, Advocate Aurora Health, Milwaukee, WI.
JCO Precis Oncol. 2022 Oct;6:e2200132. doi: 10.1200/PO.22.00132.
Molecular tumor boards (MTBs) provide interventions that assist the patient's primary oncologist's interpretation and application of precision oncology and avoid clinical and financial toxicities of prescribing inappropriate targeted therapy. In this article, we describe a novel method for illustrating MTBs value and recommendation discordance rate and report associated drug cost avoidance data.
From January 1, 2021, to December 31, 2021, patients assessed by our program's MTB were retrospectively evaluated. Recommendation discordance was defined as any disagreement between MTB therapeutic recommendations and those provided in the next-generation sequencing vendor's report.
In 2021, our program processed 1,119 next-generation sequencing orders via external vendors for 1,029 unique patients with a variety of solid tumor and hematologic malignancies. During this period, 962 patients were reviewed through our MTB process. MTB recommendation discordance rate was high (229 of 502; 45.6%) and varied across test vendors. Rationales for discordance included the following: low level of evidence (88% of patients), alternative standard of care available (60%), and tolerability concerns (42%), among others. Discordance was highest for Vendor C (30%), followed by Vendor A (24%) and Vendor B (8%). The most common drug classes not supported were mTOR, PARP, MEK, and PIK3CA inhibitors when recommended by vendors in off-label settings. MTB interventions accounted for $3,209,070 in US dollars in potential drug cost avoidance.
Therapeutic recommendation discordance rates can provide quantitative insight into the benefit of MTB. Discordance-associated drug cost avoidance further demonstrates MTB's financial value. These measures may be used as part of the justification for this service line within a cancer care program.
分子肿瘤委员会（MTB）提供干预措施，帮助患者的主要肿瘤医生解读和应用精准肿瘤学，并避免开具不适当的靶向治疗的临床和财务毒性。在本文中，我们描述了一种新的方法来展示 MTB 的价值和推荐不一致率，并报告相关的药物成本节约数据。
从 2021 年 1 月 1 日至 2021 年 12 月 31 日，对我们计划的 MTB 进行评估的患者进行了回顾性评估。推荐不一致定义为 MTB 治疗建议与下一代测序供应商报告中提供的建议之间的任何分歧。
2021 年，我们的计划通过外部供应商处理了 1119 个下一代测序订单，涉及 1029 个具有各种实体瘤和血液恶性肿瘤的独特患者。在此期间，我们的 MTB 流程审查了 962 名患者。MTB 推荐不一致率很高（502 次中有 229 次；45.6%），并且因测试供应商而异。不一致的原因包括：证据水平低（88%的患者）、有替代的标准治疗方法（60%）、耐受性问题（42%）等。不一致率最高的是供应商 C（30%），其次是供应商 A（24%）和供应商 B（8%）。当供应商在标签外环境下推荐时，最常见的未被支持的药物类别是 mTOR、PARP、MEK 和 PIK3CA 抑制剂。MTB 干预措施可避免 320.907 万美元的潜在药物成本。
治疗推荐不一致率可以为 MTB 的益处提供定量见解。不一致相关的药物成本节约进一步证明了 MTB 的财务价值。这些措施可以作为癌症护理计划中该服务线的正当理由的一部分。
