Expansion of an Academic Molecular Tumor Board to Enhance Access to Biomarker-Driven Trials and Therapies in the Rural Southeastern United States

Abstract

Targeting tumor-specific molecular alterations has shown significant clinical benefit. Molecular tumor boards (MTBs) connect cancer patients with personalized treatments and clinical trials. However, rural cancer centers often have limited access to MTB expertise. We established an academic-community partnership expanding our academic MTB to affiliated rural community cancer centers. We developed a centralized molecular registry of tumors (MRT) to aggregate the comprehensive genomic profiling (CGP) results and facilitate multidisciplinary MTB review. Of the 151 patients included, 87 (58%) had actionable genomic biomarkers, 42 (28%) were eligible for a targeted off-label therapy, and 27 (18%) were matched to a clinical trial. Of those with a clinical trial match, only 1 of 27 (3%) was enrolled in the identified trial. One year into implementation, community oncology providers were anonymously surveyed on persistent barriers to precision treatment utilization. The primary barriers to clinical trial enrollment were the distance to the trial center (70%), lack of transportation (55%), and lack of local trials (50%). This study offers a framework to improve access to molecular expertise, but significant barriers to the equitable use of CGP and trial enrollment persist.

Keywords: cancer disparities; comprehensive genomic profiling; molecular profiling; targeted therapy.

Figure 1

Flow diagram describing the workflow of Duke MTB review for community centers.

Figure 2

Cancer types and molecular targets reviewed. (A) Bar chart detailing the cancer types reviewed for this study. Colors represent the number of cases profiled by circulating tumor DNA (ctDNA) or tissue sequencing. (B) Bar chart showing the genes identified with a clinical trial or targeted therapy. Colors represent the number of cases for which either a clinical trial or FDA-approved targeted therapy was available. If both a targeted therapy and a clinical trial was matched (N = 9), the patients were colored based on their clinical trial match.

Figure 3

Barriers to CGP. (A) Bar chart with provider-reported barriers to ordering CGP. (B) Bar chart with provider-reported barriers to completing CGP after ordering. The “Other” bar includes the following responses: difficulty choosing a molecular testing vendor.

Figure 4

Bar chart describing provider-reported barriers to use of biomarker-associated targeted therapy. The “Other” bar includes the following responses: inadequate specimen size (N = 1), limited experience with administering targeted therapy (N = 1).

Figure 5

Bar chart showing provider-reported barriers to patient clinical trial enrollment.