Precision oncology is fast becoming the new paradigm for cancer treatment. This approach involves molecular profiling of patient tumors and tailoring of a treatment regimen based on the unique combination of targetable alterations identified therein. At Dana-Farber Cancer Institute (DFCI), over 24,000 patient tumors have been sequenced using the NGS platform OncoPanel since 2013. OncoPanel is a comprehensive genomic characterization of a tumor and it can be time-consuming to discern those alterations that are interesting from an academic or research perspective from those that can be leveraged to direct patient care. To address this issue, the GI TARGET (Treatment Assistance Regarding Genomic Evaluation of Tumors) project was initiated to provide decision support for oncologists within the DFCI Gastrointestinal Cancer Center (GCC). GI TARGET is a collaboration between the DFCI GCC, the Brigham & Women’s Hospital (BWH) Center for Advanced Molecular Diagnostics (CAMD), and the DFCI Knowledge Systems Group, developers of the precision medicine clinical trial matching platform MatchMiner. Report generation involves review of OncoPanel data in the context of patient clinical history via one of two workflows; complex genomic cases are reviewed in a weekly Molecular Tumor Board comprised of oncologists, molecular pathologists, a PhD-level Clinical Genomics Scientist, and representatives from the MatchMiner team, while ‘simple’ genomic cases are reviewed by both an oncologist and a PhD-level Clinical Genomics Scientist. Since the launch of the project in January 2018, we have signed out over 1000 GI TARGET reports. We are assessing the utility of these reports using a number of metrics including clinical trial enrollment tracking via MatchMiner, follow-up on recommendations via chart abstraction, and oncologist feedback. The aims of GI TARGET are 1) to reduce the burden of genomic analysis on the treating oncologist by providing expert-led deep review of OncoPanel and exploration of associated therapy/additional patient care considerations, 2) to support clinical trial enrollment by matching the results of somatic testing with ongoing clinical studies, and 3) to provide an example framework for how precision oncology can be incorporated into standard clinical cancer care, which may be helpful to guide efforts in other care settings, particularly in community hospitals where the vast majority (an estimated 80%-85%) of cancer patients in the United States receive their care.
Citation Format: Rachel B Keller, Tali Mazor, Marios Giannakis, Jonathan Nowak, Lynette Sholl, Andrew Aguirre, Adam Bass, Nilay Sethi, Ankur Nagaraja, Lauren Brais, Emma Reilly, Ethan Cerami, Brian Wolpin. Precision oncology decision support within the Gastrointestinal Cancer Center at Dana-Farber Cancer Institute (GI TARGET) [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr C130. doi:10.1158/1535-7163.TARG-19-C130