The Precision Medicine Molecular Tumor Board

geneticsMost cancers arise from alterations in the genes of the tumor. These alterations can have various effects on the tumor, including over-activation of cellular function or loss of tumor suppressor function. Therefore, identifying the DNA alterations that “drive” cancer growth and development is critically important in selecting effective targeted therapies. The ability to distinguish these changes requires a high level of expertise across multiple medical and scientific areas. These disciplines, including population genetics, cancer biology, and clinically applied bioinformatics, have not typically been part of the training for most oncologists and other cancer care specialists.

As part of a multi-disciplinary molecular tumor board at Rutgers Cancer Institute of New Jersey, various specialists meet once a week to discuss patient cases and findings from DNA analyses. These disciplines are diverse and include medical and surgical oncologists, basic scientists, as well as those specialists in the areas of bioinformatics, genetic counseling, systems biology, pathology, tumor and population genetics, and clinical trials. These specialists use their expertise and patient findings to support clinical decision making and help provide access to targeted treatment for patients with rare tumors or advanced tumors that are resistant to standard therapy.

precision medicineThe presentation of cases in both traditional and molecular tumor boards typically begins with a summary of patient characteristics, treatment history, as well as a pathologic review of the tumor. However, unlike traditional tumor boards that analyze tumors by the organs in which they originated, molecular tumor boards are focused on an analysis of mutations or alterations in the DNA of the tumor. Cases from both adult and pediatric patients from within Rutgers Cancer Institute, as well as from community oncology practices are considered.  

Following informed discussions between the diverse members of the molecular tumor board, which includes consideration of the most recently published research, the team reaches a decision regarding the interpretation of DNA data from tumor specimens. The team then uses this information to recommend treatment decisions for patients. This could include recommended therapy on a drug that is already approved by the U.S. Food and Drug Administration for the indicated purpose or for another purpose (“off-label”) or enrollment in a clinical trial that is exploring investigational treatment.  

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