title: Initiation of a formalized precision medicine program in gynecologic oncology.
abstract: OBJECTIVE
  In an effort to better incorporate precision medicine into clinical practice, we initiated a pilot project to screen, discuss, and genetically characterize patients with metastatic or recurrent gynecologic malignancies for whom no curative standard of care exists.
  
  
  METHODS
  In 7/2014, we initiated a multi-disciplinary Precision Medicine Board (PMB) whose purpose was to apply molecular profiling to select and prioritize early phase clinical trial enrollment for high-risk gynecologic malignancies. Additional objectives were to record outcomes and enable scientific discussions of mutations which may foster local translational research. FoundationOne was the preferred genomic platform; results were reviewed by a team comprised of disease site specialists, phase I trialists, and basic and translational scientists affiliated with the Gynecologic Cancer Program. A detailed database for each patient was created and is followed prospectively for treatment use and resultant outcomes.
  
  
  RESULTS
  To date, we have presented 62 cases with interpretable FoundationOne testing on 60 tumor samples (31 ovarian, 18 uterine, 9 cervical, and 4 other female genital tract). Significant genomic alterations were commonly found in all tumor types (median: 3); TP53 (45%) and PIK3CA (27%) were the most frequently noted mutations; however, molecular profiling resulted in identification of few actionable mutations (6%). To date, we have matched 4 patients on therapies based on actionable mutations.
  
  
  CONCLUSIONS
  The predominant function of our PMB is establishment of a forum to enhance research while providing clinical care for refractory malignancies. We have matched patients with specific mutations to ongoing trials and are developing investigator-initiated studies based on trends within genomic profiling results. Longer-term follow up will be required to determine the success of this strategy.
authors.affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th Street, Oklahoma City, OK 73104, USA. Electronic address: camille-gunderson@ouhsc.edu.
authors.forename: Camille C
authors.initials: CC
authors.lastname: Gunderson
authors.affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th Street, Oklahoma City, OK 73104, USA. Electronic address: michelle-rowland@ouhsc.edu.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Rowland
authors.affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th Street, Oklahoma City, OK 73104, USA. Electronic address: deborah-wright@ouhsc.edu.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Wright
authors.affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th Street, Oklahoma City, OK 73104, USA. Electronic address: kelsi-andrade@ouhsc.edu.
authors.forename: Kelsi L
authors.initials: KL
authors.lastname: Andrade
authors.affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th Street, Oklahoma City, OK 73104, USA. Electronic address: robert-mannel@ouhsc.edu.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Mannel
authors.affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th Street, Oklahoma City, OK 73104, USA. Electronic address: scott-mcmeekin@ouhsc.edu.
authors.forename: D Scott
authors.initials: DS
authors.lastname: McMeekin
authors.affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th Street, Oklahoma City, OK 73104, USA. Electronic address: kathleen-moore@ouhsc.edu.
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy / Q000235:genetics*; D023281:Genomics; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D010865:Pilot Projects; D057285:Precision Medicine
keywords: Actionable mutations; Genomic alterations; Precision medicine; Variants of known significance