title: Molecular tumor board: the University of California-San Diego Moores Cancer Center experience.
abstract: OBJECTIVE
  DNA sequencing tests are enabling physicians to interrogate the molecular profiles of patients' tumors, but most oncologists have not been trained in advanced genomics. We initiated a molecular tumor board to provide expert multidisciplinary input for these patients.
  
  
  METHODS
  A team that included clinicians, basic scientists, geneticists, and bioinformatics/pathway scientists with expertise in various cancer types attended. Molecular tests were performed in a Clinical Laboratory Improvement Amendments environment.
  
  
  RESULTS
  Patients (n = 34, since December 2012) had received a median of three prior therapies. The median time from physician order to receipt of molecular diagnostic test results was 27 days (range: 14-77 days). Patients had a median of 4 molecular abnormalities (range: 1-14 abnormalities) found by next-generation sequencing (182- or 236-gene panels). Seventy-four genes were involved, with 123 distinct abnormalities. Importantly, no two patients had the same aberrations, and 107 distinct abnormalities were seen only once. Among the 11 evaluable patients whose treatment had been informed by molecular diagnostics, 3 achieved partial responses (progression-free survival of 3.4 months, ≥6.5 months, and 7.6 months). The most common reasons for being unable to act on the molecular diagnostic results were that patients were ineligible for or could not travel to an appropriately targeted clinical trial and/or that insurance would not cover the cognate agents.
  
  
  CONCLUSIONS
  Genomic sequencing is revealing complex molecular profiles that differ by patient. Multidisciplinary molecular tumor boards may help optimize management. Barriers to personalized therapy include access to appropriately targeted drugs.
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Schwaederle
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA rkurzrock@ucsd.edu baparker@ucsd.edu.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Parker
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Schwab
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Fanta
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Boles
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Daniels
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Lyudmila A
authors.initials: LA
authors.lastname: Bazhenova
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Rupa
authors.initials: R
authors.lastname: Subramanian
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Alice C
authors.initials: AC
authors.lastname: Coutinho
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Haydee
authors.initials: H
authors.lastname: Ojeda-Fournier
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Datnow
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Webster
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Lippman
authors.affiliation: Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA rkurzrock@ucsd.edu baparker@ucsd.edu.
authors.forename: Razelle
authors.initials: R
authors.lastname: Kurzrock
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D015894:Genome, Human; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology; D057089:Pathology, Molecular; D057285:Precision Medicine; D016896:Treatment Outcome
keywords: Cancer; Molecular profile; Molecular tumor board; Mutation; Personalized