A virtual molecular tumor board to improve efficiency and scalability of delivering precision oncology to physicians and their patients
A virtual molecular tumor board to improve efficiency and scalability of delivering precision oncology to physicians and their patients
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DOI：
10.1093/jamiaopen/ooz045
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发表时间：
2019-12-01
期刊：
影响因子：
2.1
通讯作者：
Madhavan, Subha
中科院分区：
文献类型：
--
作者：
Pishvaian, Michael J.;Blais, Edik M.;Madhavan, Subha
目的：需要可扩展的信息学解决方案，为临床医生提供分子定制的治疗建议，以简化护理环境中的精确肿瘤学。材料和方法：我们开发了一个基于云的虚拟分子肿瘤委员会（VMTB）平台，该平台包括知识库，评分模型，规则引擎，一个异步虚拟聊天室和一个报告工具，根据1725名患者的分子特征，以前的治疗史，结构化试验合格性标准、临床相关癌症基因变异断言、生物标志物治疗关联和当前治疗指南。VMTB系统地允许临床医生用户将来自临床图表的专家策划数据和结构化数据沿着分子测试数据相结合，以形成治疗共识，特别是那些需要标签外和临床试验考虑的治疗。VMTB被用作癌症护理过程的一部分，用于由倡导组织转介的1725名患者的重点子集，其中成功地生成了个性化报告。提供给治疗肿瘤的医生。从收到数据到提交报告的中位周转时间在4年中从14天减少到4天，而案件数量每年增加近2倍。使用一种新的评分模型对治疗方案进行排名，肿瘤学家选择实施VMTB衍生的治疗，除了在没有分子支持的情况下寻求免疫治疗方案时。讨论：随着生物标志物和患者可用的相关治疗方案的不断扩展，VMTB将在精确肿瘤学中发挥越来越重要的作用。进一步开发系统地将联合收割机患者来源的分子数据，真实的-来自电子健康记录和专家策划的生物标志物知识库的世界证据，以及用于排名最佳治疗的计算工具，可以支持护理途径在护理点。
Objectives: Scalable informatics solutions that provide molecularly tailored treatment recommendations to clinicians are needed to streamline precision oncology in care settings.Materials and Methods: We developed a cloud-based virtual molecular tumor board (VMTB) platform that included a knowledgebase, scoring model, rules engine, an asynchronous virtual chat room and a reporting tool that generated a treatment plan for each of the 1725 patients based on their molecular profile, previous treatment history, structured trial eligibility criteria, clinically relevant cancer gene-variant assertions, biomarkertreatment associations, and current treatment guidelines. The VMTB systematically allows clinician users to combine expert-curated data and structured data from clinical charts along with molecular testing data to develop consensus on treatments, especially those that require off-label and clinical trial considerations.Results: The VMTB was used as part of the cancer care process for a focused subset of 1725 patients referred by advocacy organizations wherein resultant personalized reports were successfully delivered to treating oncologists. Median turnaround time from data receipt to report delivery decreased from 14 days to 4 days over 4 years while the volume of cases increased nearly 2-fold each year. Using a novel scoring model for ranking therapy options, oncologists chose to implement the VMTB-derived therapies over others, except when pursuing immunotherapy options without molecular support.Discussion: VMTBs will play an increasingly critical role in precision oncology as the compendium of biomarkers and associated therapy options available to a patient continues to expand.Conclusion: Further development of such clinical augmentation tools that systematically combine patient-derived molecular data, real-world evidence from electronic health records and expert curated knowledgebases on biomarkers with computational tools for ranking best treatments can support care pathways at point of care.