Experience with precision genomics and tumor board, indicates frequent target identification, but barriers to delivery

Alan H Bryce, Jan B. Egan, Mitesh J Borad, Alexander Keith Stewart, Grzegorz S Nowakowski, Asher A Chanan Khan, Mrinal M Patnaik, Stephen Maxted Ansell, Michaela S. Banck, Steven Robinson, Aaron Mansfield, Eric W Klee, Gavin R. Oliver, Jennifer B. McCormick, Norine E. Huneke, Colleen M. Tagtow, Robert Brian Jenkins, Kandelaria M. Rumilla, Sarah E. Kerr, Jean-Pierre KocherScott A. Beck, Martin E Fernandez-Zapico, Gianrico Farrugia, Konstantinos N Lazaridis, Robert R Mc Williams

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: The ability to analyze the genomics of malignancies has opened up new possibilities for off-label targeted therapy in cancers that are refractory to standard therapy. At Mayo Clinic these efforts are organized through the Center for Individualized Medicine (CIM). Results: Prior to GTB, datasets were analyzed and integrated by a team of bioinformaticians and cancer biologists. Therapeutically actionable mutations were identified in 65% (92/141) of the patients tested with 32% (29/92) receiving genomically targeted therapy with FDA approved drugs or in an independent clinical trial with 45% (13/29) responding. Standard of care (SOC) options were continued by 15% (14/92) of patients tested before exhausting SOC options, with 71% (10/14) responding to treatment. Over 35% (34/92) of patients with actionable targets were not treated with 65% (22/34) choosing comfort measures or passing away. Materials and Methods: Patients (N = 165) were referred to the CIM Clinic between October 2012 and December 2015. All patients received clinical genomic panel testing with selected subsets receiving array comparative genomic hybridization and clinical whole exome sequencing to complement and validate panel findings. A genomic tumor board (GTB) reviewed results and, when possible, developed treatment recommendations.Conclusions: Treatment decisions driven by tumor genomic analysis can lead to significant clinical benefit in a minority of patients. The success of genomically driven therapy depends both on access to drugs and robustness of bioinformatics analysis. While novel clinical trial designs are increasing the utility of genomic testing, robust data sharing of outcomes is needed to optimize clinical benefit for all patients.

Original languageEnglish (US)
Pages (from-to)27145-27154
Number of pages10
JournalOncotarget
Volume8
Issue number16
DOIs
StatePublished - 2017

Fingerprint

Genomics
Neoplasms
Precision Medicine
Standard of Care
Therapeutics
Clinical Trials
Exome
Comparative Genomic Hybridization
Information Dissemination
Computational Biology
Pharmaceutical Preparations
Mutation

Keywords

  • Cancer genomics
  • Genomic tumor board
  • Precision medicine
  • Targeted therapeutics

ASJC Scopus subject areas

  • Oncology

Cite this

@article{327be641a8ce4a79b5c2ec3d35213284,
title = "Experience with precision genomics and tumor board, indicates frequent target identification, but barriers to delivery",
abstract = "Background: The ability to analyze the genomics of malignancies has opened up new possibilities for off-label targeted therapy in cancers that are refractory to standard therapy. At Mayo Clinic these efforts are organized through the Center for Individualized Medicine (CIM). Results: Prior to GTB, datasets were analyzed and integrated by a team of bioinformaticians and cancer biologists. Therapeutically actionable mutations were identified in 65{\%} (92/141) of the patients tested with 32{\%} (29/92) receiving genomically targeted therapy with FDA approved drugs or in an independent clinical trial with 45{\%} (13/29) responding. Standard of care (SOC) options were continued by 15{\%} (14/92) of patients tested before exhausting SOC options, with 71{\%} (10/14) responding to treatment. Over 35{\%} (34/92) of patients with actionable targets were not treated with 65{\%} (22/34) choosing comfort measures or passing away. Materials and Methods: Patients (N = 165) were referred to the CIM Clinic between October 2012 and December 2015. All patients received clinical genomic panel testing with selected subsets receiving array comparative genomic hybridization and clinical whole exome sequencing to complement and validate panel findings. A genomic tumor board (GTB) reviewed results and, when possible, developed treatment recommendations.Conclusions: Treatment decisions driven by tumor genomic analysis can lead to significant clinical benefit in a minority of patients. The success of genomically driven therapy depends both on access to drugs and robustness of bioinformatics analysis. While novel clinical trial designs are increasing the utility of genomic testing, robust data sharing of outcomes is needed to optimize clinical benefit for all patients.",
keywords = "Cancer genomics, Genomic tumor board, Precision medicine, Targeted therapeutics",
author = "Bryce, {Alan H} and Egan, {Jan B.} and Borad, {Mitesh J} and Stewart, {Alexander Keith} and Nowakowski, {Grzegorz S} and {Chanan Khan}, {Asher A} and Patnaik, {Mrinal M} and Ansell, {Stephen Maxted} and Banck, {Michaela S.} and Steven Robinson and Aaron Mansfield and Klee, {Eric W} and Oliver, {Gavin R.} and McCormick, {Jennifer B.} and Huneke, {Norine E.} and Tagtow, {Colleen M.} and Jenkins, {Robert Brian} and Rumilla, {Kandelaria M.} and Kerr, {Sarah E.} and Jean-Pierre Kocher and Beck, {Scott A.} and Fernandez-Zapico, {Martin E} and Gianrico Farrugia and Lazaridis, {Konstantinos N} and {Mc Williams}, {Robert R}",
year = "2017",
doi = "10.18632/oncotarget.16057",
language = "English (US)",
volume = "8",
pages = "27145--27154",
journal = "Oncotarget",
issn = "1949-2553",
publisher = "Impact Journals",
number = "16",

}

TY - JOUR

T1 - Experience with precision genomics and tumor board, indicates frequent target identification, but barriers to delivery

AU - Bryce, Alan H

AU - Egan, Jan B.

AU - Borad, Mitesh J

AU - Stewart, Alexander Keith

AU - Nowakowski, Grzegorz S

AU - Chanan Khan, Asher A

AU - Patnaik, Mrinal M

AU - Ansell, Stephen Maxted

AU - Banck, Michaela S.

AU - Robinson, Steven

AU - Mansfield, Aaron

AU - Klee, Eric W

AU - Oliver, Gavin R.

AU - McCormick, Jennifer B.

AU - Huneke, Norine E.

AU - Tagtow, Colleen M.

AU - Jenkins, Robert Brian

AU - Rumilla, Kandelaria M.

AU - Kerr, Sarah E.

AU - Kocher, Jean-Pierre

AU - Beck, Scott A.

AU - Fernandez-Zapico, Martin E

AU - Farrugia, Gianrico

AU - Lazaridis, Konstantinos N

AU - Mc Williams, Robert R

PY - 2017

Y1 - 2017

N2 - Background: The ability to analyze the genomics of malignancies has opened up new possibilities for off-label targeted therapy in cancers that are refractory to standard therapy. At Mayo Clinic these efforts are organized through the Center for Individualized Medicine (CIM). Results: Prior to GTB, datasets were analyzed and integrated by a team of bioinformaticians and cancer biologists. Therapeutically actionable mutations were identified in 65% (92/141) of the patients tested with 32% (29/92) receiving genomically targeted therapy with FDA approved drugs or in an independent clinical trial with 45% (13/29) responding. Standard of care (SOC) options were continued by 15% (14/92) of patients tested before exhausting SOC options, with 71% (10/14) responding to treatment. Over 35% (34/92) of patients with actionable targets were not treated with 65% (22/34) choosing comfort measures or passing away. Materials and Methods: Patients (N = 165) were referred to the CIM Clinic between October 2012 and December 2015. All patients received clinical genomic panel testing with selected subsets receiving array comparative genomic hybridization and clinical whole exome sequencing to complement and validate panel findings. A genomic tumor board (GTB) reviewed results and, when possible, developed treatment recommendations.Conclusions: Treatment decisions driven by tumor genomic analysis can lead to significant clinical benefit in a minority of patients. The success of genomically driven therapy depends both on access to drugs and robustness of bioinformatics analysis. While novel clinical trial designs are increasing the utility of genomic testing, robust data sharing of outcomes is needed to optimize clinical benefit for all patients.

AB - Background: The ability to analyze the genomics of malignancies has opened up new possibilities for off-label targeted therapy in cancers that are refractory to standard therapy. At Mayo Clinic these efforts are organized through the Center for Individualized Medicine (CIM). Results: Prior to GTB, datasets were analyzed and integrated by a team of bioinformaticians and cancer biologists. Therapeutically actionable mutations were identified in 65% (92/141) of the patients tested with 32% (29/92) receiving genomically targeted therapy with FDA approved drugs or in an independent clinical trial with 45% (13/29) responding. Standard of care (SOC) options were continued by 15% (14/92) of patients tested before exhausting SOC options, with 71% (10/14) responding to treatment. Over 35% (34/92) of patients with actionable targets were not treated with 65% (22/34) choosing comfort measures or passing away. Materials and Methods: Patients (N = 165) were referred to the CIM Clinic between October 2012 and December 2015. All patients received clinical genomic panel testing with selected subsets receiving array comparative genomic hybridization and clinical whole exome sequencing to complement and validate panel findings. A genomic tumor board (GTB) reviewed results and, when possible, developed treatment recommendations.Conclusions: Treatment decisions driven by tumor genomic analysis can lead to significant clinical benefit in a minority of patients. The success of genomically driven therapy depends both on access to drugs and robustness of bioinformatics analysis. While novel clinical trial designs are increasing the utility of genomic testing, robust data sharing of outcomes is needed to optimize clinical benefit for all patients.

KW - Cancer genomics

KW - Genomic tumor board

KW - Precision medicine

KW - Targeted therapeutics

UR - http://www.scopus.com/inward/record.url?scp=85017522803&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017522803&partnerID=8YFLogxK

U2 - 10.18632/oncotarget.16057

DO - 10.18632/oncotarget.16057

M3 - Article

AN - SCOPUS:85017522803

VL - 8

SP - 27145

EP - 27154

JO - Oncotarget

JF - Oncotarget

SN - 1949-2553

IS - 16

ER -