Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors

James L Rogers¹, Thomas Wall¹, Alvina A Acquaye-Mallory¹, Lisa Boris¹, Yeonju Kim^{1

2}, Kenneth Aldape³, Martha M Quezado³, John A Butman⁴, James G Smirniotopoulos¹, Huma Chaudhry⁵, Christina I Tsien^{1

6}, Prashant Chittiboina⁷, Kareem Zaghloul⁷, Orwa Aboud⁸, Nicholas G Avgeropoulos^{9

10}, Eric C Burton¹, David M Cachia¹¹, Karan S Dixit¹², Jan Drappatz¹³, Erin M Dunbar¹⁴, Peter Forsyth¹⁵, Edina Komlodi-Pasztor^{1

16}, Jacob Mandel¹⁷, Byram H Ozer¹, Eudocia Q Lee¹⁸, Surabhi Ranjan¹⁹, Rimas V Lukas¹², Margarita Raygada²⁰, Michael E Salacz²¹, Matthew A Smith-Cohn^{1

22}, James Snyder²³, Ariane Soldatos²⁴, Brett J Theeler²⁵, Brigitte C Widemann²⁶, Kevin A Camphausen⁵, John D Heiss⁷, Terri S Armstrong¹, Mark R Gilbert¹, Marta Penas-Prado²⁷

Affiliations

¹ Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
² Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.
³ Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁴ Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁵ Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁶ Proton Therapy Center, Sibley Memorial Hospital, Johns Hopkins Medicine, 5255 Loughboro Rd NW, Washington, DC, 20016, USA.
⁷ Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁸ Department of Neurology and Neurological Surgery, UC Davis Comprehensive Cancer Center, 4860 Y Street, Sacramento, CA, 95817, USA.
⁹ Brain and Spine Tumor Program, Orlando Health Cancer Institute, 1400 S. Orange Ave, Orlando, FL, 32806, USA.
¹⁰ Global Medical Affairs, Novocure GmbH, D4 Pk. 6, 6039, Root, Switzerland.
¹¹ Department of Hematology/Oncology, University of Massachusetts, 55 Lake Ave, Worcester, MA, 01655, USA.
¹² Lou and Jean Malnati Brain Tumor Institute, Northwestern University Feinberg School of Medicine, 675 N St Clair St, Chicago, IL, 60611, USA.
¹³ Department of Neurology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA.
¹⁴ Piedmont Brain Tumor Center, Piedmont Atlanta Hospital, Atlanta, GA, 2001 Peachtree St30309, USA.
¹⁵ Department of Neuro-Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
¹⁶ Department of Neurology, MedStar Georgetown University Hospital, 3800 Reservoir Road Washington, Washington DC, 20007, USA.
¹⁷ Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Houston, TX, 77030, USA.
¹⁸ Center for Neuro-Oncology, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
¹⁹ Department of Neurology, Cleveland Clinic Florida, Weston Hospital, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, US.
²⁰ Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD, 20892, USA.
²¹ Department of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper, Cooper University Health Care, Two Cooper Plaza, Camden, NJ, 08103, USA.
²² Benefis Sletten Cancer Institute, 1117 29Th St. S, Great Falls, MT, 59405, USA.
²³ Hermelin Brain Tumor Center, Henry Ford Cancer Institute, 2800 W Grand Blvd, Detroit, MI, 48202, USA.
²⁴ National Institute of Neurological Disorders and Stroke,, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
²⁵ School of Medicine, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
²⁶ Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
²⁷ Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA. marta.penas-prado@nih.gov.

PMID: 38427131
PMCID: PMC11023967
DOI: 10.1007/s11060-024-04613-6

Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors

James L Rogers et al. J Neurooncol. 2024 Apr.

. 2024 Apr;167(2):349-359.

doi: 10.1007/s11060-024-04613-6. Epub 2024 Mar 1.

Authors

Affiliations

¹ Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
² Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.
³ Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁴ Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁵ Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁶ Proton Therapy Center, Sibley Memorial Hospital, Johns Hopkins Medicine, 5255 Loughboro Rd NW, Washington, DC, 20016, USA.
⁷ Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁸ Department of Neurology and Neurological Surgery, UC Davis Comprehensive Cancer Center, 4860 Y Street, Sacramento, CA, 95817, USA.
⁹ Brain and Spine Tumor Program, Orlando Health Cancer Institute, 1400 S. Orange Ave, Orlando, FL, 32806, USA.
¹⁰ Global Medical Affairs, Novocure GmbH, D4 Pk. 6, 6039, Root, Switzerland.
¹¹ Department of Hematology/Oncology, University of Massachusetts, 55 Lake Ave, Worcester, MA, 01655, USA.
¹² Lou and Jean Malnati Brain Tumor Institute, Northwestern University Feinberg School of Medicine, 675 N St Clair St, Chicago, IL, 60611, USA.
¹³ Department of Neurology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA.
¹⁴ Piedmont Brain Tumor Center, Piedmont Atlanta Hospital, Atlanta, GA, 2001 Peachtree St30309, USA.
¹⁵ Department of Neuro-Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
¹⁶ Department of Neurology, MedStar Georgetown University Hospital, 3800 Reservoir Road Washington, Washington DC, 20007, USA.
¹⁷ Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Houston, TX, 77030, USA.
¹⁸ Center for Neuro-Oncology, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
¹⁹ Department of Neurology, Cleveland Clinic Florida, Weston Hospital, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, US.
²⁰ Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD, 20892, USA.
²¹ Department of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper, Cooper University Health Care, Two Cooper Plaza, Camden, NJ, 08103, USA.
²² Benefis Sletten Cancer Institute, 1117 29Th St. S, Great Falls, MT, 59405, USA.
²³ Hermelin Brain Tumor Center, Henry Ford Cancer Institute, 2800 W Grand Blvd, Detroit, MI, 48202, USA.
²⁴ National Institute of Neurological Disorders and Stroke,, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
²⁵ School of Medicine, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
²⁶ Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
²⁷ Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA. marta.penas-prado@nih.gov.

PMID: 38427131
PMCID: PMC11023967
DOI: 10.1007/s11060-024-04613-6

Abstract

Purpose: Multidisciplinary tumor boards (MTBs) integrate clinical, molecular, and radiological information and facilitate coordination of neuro-oncology care. During the COVID-19 pandemic, our MTB transitioned to a virtual and multi-institutional format. We hypothesized that this expansion would allow expert review of challenging neuro-oncology cases and contribute to the care of patients with limited access to specialized centers.

Methods: We retrospectively reviewed records from virtual MTBs held between 04/2020-03/2021. Data collected included measures of potential clinical impact, including referrals to observational or therapeutic studies, referrals for specialized neuropathology analysis, and whether molecular findings led to a change in diagnosis and/or guided management suggestions.

Results: During 25 meetings, 32 presenters discussed 44 cases. Approximately half (n = 20; 48%) involved a rare central nervous system (CNS) tumor. In 21% (n = 9) the diagnosis was changed or refined based on molecular profiling obtained at the NIH and in 36% (n = 15) molecular findings guided management. Clinical trial suggestions were offered to 31% (n = 13), enrollment in the observational NCI Natural History Study to 21% (n = 9), neuropathology review and molecular testing at the NIH to 17% (n = 7), and all received management suggestions.

Conclusion: Virtual multi-institutional MTBs enable remote expert review of CNS tumors. We propose them as a strategy to facilitate expert opinions from specialized centers, especially for rare CNS tumors, helping mitigate geographic barriers to patient care and serving as a pre-screening tool for studies. Advanced molecular testing is key to obtaining a precise diagnosis, discovering potentially actionable targets, and guiding management.

Keywords: Barriers to healthcare access; Collaborative practice; Multidisciplinary tumor boards; National Cancer Institute-Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT); Rare CNS tumors.

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Conflict of interest statement

Dr. Aboud has served on the advisory board for Servier. Dr. Cachia is a consultant for RedHill BioPharma Ltd, Guidepoint Global LLC, and Dedham Group and a paid speaker for the Massachusetts Neurological Society. Dr. Drappatz is a stock owner for Gilead, Pfizer, and GSK, receives royalties from Elsevier and Wolters Kluwer and receives research support from Servier and Novocure. Dr. Forsyth’s COI includes NIH/NCI (consultant), Pfizer (grant/research support), DOD (grant/research support), BMS (consultant), and Genentech (research support). Dr Lukas has served on advisory boards for Merck, AstraZeneca, Bayer, Cardinal Health, and Servier and serves on the speakers’ bureau for Merck and Novocure, receives research support (drug only) from BMS, and has received honoraria for medical editing from Medlink Neurology, Elsevier, EBSCO publishing, and Oxford University Press. Dr. Mandel is on the Medical advisory board for Servier and Bayer. Dr. Snyder received consulting fee from Monteris Medical Corporation and speaker fee from Blue Earth Diagnostics Limited. All other authors report no conflicts of interest.

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Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors

Affiliations

Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

LinkOut - more resources

Full Text Sources