title: Implementation of a Molecular Tumor Board: The Impact on Treatment Decisions for 35 Patients Evaluated at Dartmouth-Hitchcock Medical Center.
abstract: BACKGROUND
  Although genetic profiling of tumors is a potentially powerful tool to predict drug sensitivity and resistance, its routine use has been limited because clinicians are often unfamiliar with interpretation and incorporation of the information into practice. We established a Molecular Tumor Board (MTB) to interpret individual patients' tumor genetic profiles and provide treatment recommendations.
  
  
  METHODS
  DNA from tumor specimens was sequenced in a Clinical Laboratory Improvement Amendments-certified laboratory to identify coding mutations in a 50-gene panel (n = 34) or a 255-gene panel (n = 1). Cases were evaluated by a multidisciplinary MTB that included pathologists, oncologists, hematologists, basic scientists, and genetic counselors.
  
  
  RESULTS
  During the first year, 35 cases were evaluated by the MTB, with 32 presented for recommendations on targeted therapies, and 3 referred for potential germline mutations. In 56.3% of cases, MTB recommended treatment with a targeted agent based on evaluation of tumor genetic profile and treatment history. Four patients (12.5%) were subsequently treated with a MTB-recommended targeted therapy; 3 of the 4 patients remain on therapy, 2 of whom experienced clinical benefit lasting >10 months.
  
  
  CONCLUSIONS
  For the majority of cases evaluated, the MTB was able to provide treatment recommendations based on targetable genetic alterations. The most common reasons that MTB-recommended therapy was not administered stemmed from patient preferences and genetic profiling at either very early or very late stages of disease; lack of drug access was rarely encountered. Increasing awareness of molecular profiling and targeted therapies by both clinicians and patients will improve acceptance and adherence to treatments that could significantly improve outcomes.
  
  
  CONCLUSIONS
  Case evaluation by a multidisciplinary Molecular Tumor Board (MTB) is critical to benefit from individualized genetic data and maximize clinical impact. MTB recommendations shaped treatment options for the majority of cases evaluated. In the few patients treated with MTB-recommended therapy, disease outcomes were positive and support genetically informed treatment.
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Tafe
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Ivan P
authors.initials: IP
authors.lastname: Gorlov
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Francine B
authors.initials: FB
authors.lastname: de Abreu
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Lefferts
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Liu
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Pettus
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Marotti
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Kasia J
authors.initials: KJ
authors.lastname: Bloch
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Memoli
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Arief A
authors.initials: AA
authors.lastname: Suriawinata
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Konstantin H
authors.initials: KH
authors.lastname: Dragnev
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Camilo E
authors.initials: CE
authors.lastname: Fadul
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Gary N
authors.initials: GN
authors.lastname: Schwartz
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Clinton R
authors.initials: CR
authors.lastname: Morgan
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Britt M
authors.initials: BM
authors.lastname: Holderness
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Peterson
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Tsongalis
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA Todd.W.Miller@Dartmouth.edu Mary.D.Chamberlin@Hitchcock.org.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Miller
authors.affiliation: Departments of Pathology, Community and Family Medicine, Medicine, and Pharmacology & Toxicology, Comprehensive Breast Program, and Familial Cancer Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA Todd.W.Miller@Dartmouth.edu Mary.D.Chamberlin@Hitchcock.org.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Chamberlin
mesh_terms: D004273:DNA, Neoplasm / Q000032:analysis / Q000235:genetics; D003661:Decision Support Techniques; D005260:Female; D059014:High-Throughput Nucleotide Sequencing / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D057089:Pathology, Molecular / Q000379:methods; D057285:Precision Medicine / Q000379:methods*
chemical_list: D004273:DNA, Neoplasm
keywords: Genetic profiling; Molecular tumor board; Next-generation sequencing; Precision medicine; Targeted therapy