|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 154-155
Multidisciplinary tumor board has another member – Molecular
Kirti Chadha, Sushant Vinarkar, Pratiksha Chheda
Department of Integrated Oncopathology, Metropolis Healthcare Ltd., Mumbai, Maharashtra, India
|Date of Submission||31-Dec-2019|
|Date of Acceptance||08-Jan-2020|
|Date of Web Publication||24-Feb-2020|
Department of Integrated Oncopathology, Metropolis Healthcare Ltd., Unit No. 409–416, 4th Floor, Commercial Building A, Kohinoor City, Near Kohinoor Mall, Kirol Road, Kurla-W, Mumbai - 400 070, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chadha K, Vinarkar S, Chheda P. Multidisciplinary tumor board has another member – Molecular. Cancer Res Stat Treat 2020;3:154-5
Cancer patients harbor genomic alterations that are either recognized as biomarkers for optimal treatment selection or carry genomic aberrations with enough clinical evidence supporting their use as predictive biomarkers for drug response outside the registered indication. With the generation of vast amount of genomic data by the use of next-generation sequencing (NGS) technology, correct interpretation of molecular tumor profiles is extremely important for optimal patient care. To address this, leading cancer-care providers have institutionalized 'Molecular Tumor Boards' (MTBs) to bring together cancer experts from across the network to discuss treatment plans based on a patient's molecular profile.
Kapoor et al. described a series of molecular aberrations detected in a 62-year-old female diagnosed with non-small cell lung cancer. Besides a classical epidermal growth factor receptor (EGFR)-activating mutation detected on real-time polymerase chain reaction (PCR) and increased PD-L1 expression by IHC, amplifications of MYCN, FGFR3, EGFR, and MYC, along with variants of unknown significance in ALK, FGFR4, MET, and BRCA1, were detected by NGS, indicating high intratumor heterogeneity. Despite the presence of multiple mutations, the patient was initiated on and continues to be on afatinib (EGFR-directed therapy) based on real-time PCR results of EGFR as per the decision made in the MTB. However, authors have clearly outlined several treatment options such as anti-PD-L1, MET inhibitor, and combination of EGFR-TKIs and checkpoint inhibitors based on Phase I and Phase II studies in the article.
In sync with the complexity and heterogeneity of the lung cancer molecular signature highlighted by the authors, our institution is also validating a similar approach. This approach addresses major concerns related to the depletion of tumor tissue on sequential testing and also improves turnaround time for tumor profiling while reducing cost. Hence, if we replace multiple technology-dependent sequential testing with NGS-based concurrent detection of actionable variants and fusions, it will have multiple advantages.
Although the initial choice of treatment is based on biomarkers that predict response or resistance to the US FDA-approved therapies, off-label drugs can be considered based on prognostic significance of certain other NGS variants. It is vital to educate physicians and clinicians on molecular profiling assays and their interpretation and also the strengths and pitfalls of technologies which would further help in treatment decisions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Kapoor A, Noronha V, Chougule A, Patil VM, Menon N, Joshi A, et al
. Molecular tumor board: Case 1-Interplay of EGFR, MET and PD-L1 in non-small cell lung carcinoma. Cancer Res Stat Treat 2019;2:228-31. [Full text]
Perera-Bel J, Hutter B, Heining C, Bleckmann A, Fröhlich M, Fröhling S, et al
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