When a patient is referred for Tumor Board discussion, the results of their Next Generation Sequencing test (from UK’s in-house testing or outside vendor testing) is sent to Molecular Tumor Board members. The report will be evaluated for gene mutations offering several possible options for care: potential clinical trials, FDA-approved therapies for that patient’s cancer type, FDA-approved therapies in another tumor type (colloquially known as “off-label use”), immunotherapy or further genetic testing.
As of September 2017, Markey’s Molecular Tumor Board had reviewed 130 patient cases. Seventysix of these cases have received an administrative review and recommendations, while the other 54 have been presented for broad discussion because of their complexity. Four to six patient cases are discussed at each meeting to allow the team adequate time to talk through each case in detail.
Although 28 different types of cancer have been presented, the vast majority of cases referred to the Tumor Board are lung cancer patients – a fitting trend for a state that has the worst rates of lung cancer incidence and death in the country.
Learning more about which gene mutations cause specific cancers here in Kentucky will help Markey researchers determine which clinical trials need to be created or recruited to aid the state’s cancer population.
“Not only are we able to recommend some truly innovative therapies for our patients, we’re also learning valuable information about the mutations causing these cancers,” said Rachel Miller, MD, co-director of the Molecular Tumor Board. “This knowledge will guide us as we grow our capacity for clinical trials.”
The Tumor Board’s gene panel focuses on somatic mutations, meaning mutations that have been acquired through a mistake in a patient’s DNA and that are present only in the cancer. However, the gene panel sometimes reveals an inherited mutation or other factors around the patient’s case may raise red flags about possible inherited mutations.
“Not only are we able to recommend some truly innovative therapies for our patients, we’re also learning valuable information about the mutations causing these cancers. This knowledge will guide us as we grow our capacity for clinical trials.”
– Rachel Miller, MD
Markey Genetic Counselor Justine Cooper attends the Tumor Board meeting and takes referrals for patients who may benefit from what’s known as germline genetic testing – that is, mutations that can be passed down family lineage.
For patients, this additional testing can provide important information for the future, both for themselves and for their loved ones.
“It can help guide them – for example, if a patient is being treated for breast cancer and her testing reveals a possible inherited cause for her breast cancer, then she may have a higher risk of developing another cancer in the future,” Cooper said. “Or it may not directly impact that specific patient, but it could impact their family members and help guide their cancer screening recommendations.”
Although the majority of presentations have been referred by internal UK physicians, other health systems across the state have participated, including TJ Samson Community Hospital in Columbia, Ky.; KentuckyOne Health; Commonwealth Health Corporation; Owensboro Health; and Hardin Memorial Health (HMH).
Chandler Park, MD, a medical oncologist at HMH, has been actively involved in Markey’s Molecular Tumor Board from the beginning. As a member of the Tumor Board, he provides valuable insight from the treating-physician perspective while also gathering knowledge on the latest cancer treatment options that he can take back to the entire team at HMH.
“We are able to clearly understand a patient’s cancer, its distinctive mutation, and hopefully identify treatment protocols that best address its unique qualities,” Park said. “The Molecular Tumor Board allows Kentucky’s cancer leaders to come together to consider all the potential treatments and agree on the very best option for patients from Paducah to Pikeville and beyond.”