title: Preappointment testing for BRAF/KIT mutation in advanced melanoma: a model in molecular data delivery for individualized medicine.
abstract: The emergence of individualized medicine is driven by developments in precision diagnostics, epitomized by molecular testing. Because treatment decisions are being made based on such molecular data, data management is gaining major importance. Among data management challenges, creating workflow solutions for timely delivery of molecular data has become pivotal. This study aims to design and implement a scalable process that permits preappointment BRAF/KIT mutation analysis in melanoma patients, allowing molecular results necessary for treatment plans to be available before the patient's appointment. Process implementation aims to provide a model for efficient molecular data delivery for individualized medicine. We examined the existing process of BRAF/KIT testing in melanoma patients visiting our institution for oncology consultation. We created 5 working groups, each designing a specific segment of an alternative process that would allow preappointment BRAF/KIT testing and delivery of results. Data were captured and analyzed to evaluate the success of the alternative process. For 1 year, 35 (59%) of 55 patients had prior BRAF/KIT testing. The remaining 20 patients went through the new process of preappointment testing; results were available at the time of appointment for 12 patients (overall preappointment results availability, 85.5%). The overall process averaged 13.4 ± 4.7 days. In conclusion, we describe the successful implementation of a scalable workflow solution that permits preappointment BRAF/KIT mutation analysis and result delivery in melanoma patients. This sets the stage for further applications of this model to other conditions, answering an increasing demand for robust delivery of molecular data for individualized medicine.
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905. Electronic address: Mounajjed.Taofic@mayo.edu.
authors.forename: Taofic
authors.initials: T
authors.lastname: Mounajjed
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905.
authors.forename: Char L
authors.initials: CL
authors.lastname: Brown
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905.
authors.forename: Therese K
authors.initials: TK
authors.lastname: Stern
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905.
authors.forename: Annette M
authors.initials: AM
authors.lastname: Bjorheim
authors.affiliation: Mayo Integrated Clinical Systems Division, Mayo Clinic, Rochester, MN 55905.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bridgeman
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905.
authors.forename: Kandelaria M
authors.initials: KM
authors.lastname: Rumilla
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905.
authors.forename: Robert R
authors.initials: RR
authors.lastname: McWilliams
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Flotte
mesh_terms: D001071:Appointments and Schedules; D004252:DNA Mutational Analysis; D006801:Humans; D008545:Melanoma / Q000235:genetics* / Q000473:pathology; D009154:Mutation; D057285:Precision Medicine; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D019009:Proto-Oncogene Proteins c-kit / Q000235:genetics*; D012878:Skin Neoplasms / Q000235:genetics* / Q000473:pathology; D057188:Workflow
chemical_list: D019009:Proto-Oncogene Proteins c-kit; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
keywords: BRAF; KIT; Melanoma; Preappointment testing; Workflow solutions