Yale Cancer Center Precision Medicine Tumor Board: new technology, new drugs, and the value of repeat testing

2020 ◽  
Vol 21 (3) ◽  
pp. 343-344
Author(s):  
Navid Hafez ◽  
Zenta Walther ◽  
Joseph P Eder ◽  
Jeffrey L Sklar ◽  
Scott N Gettinger ◽  
...  
2018 ◽  
Vol 19 (12) ◽  
pp. 1567-1568 ◽  
Author(s):  
Tyler Stewart ◽  
Karin Finberg ◽  
Zenta Walther ◽  
Jeffrey L Sklar ◽  
Navid Hafez ◽  
...  

2018 ◽  
Vol 19 (1) ◽  
pp. 23-24 ◽  
Author(s):  
Michael Cecchini ◽  
Zenta Walther ◽  
Jeffrey L Sklar ◽  
Ranjit S Bindra ◽  
Daniel P Petrylak ◽  
...  

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14006-e14006
Author(s):  
Kevin McDonnell ◽  
Amit Kulkarni ◽  
Melissa Woodhouse ◽  
Sidney A Smith ◽  
Christine Hong ◽  
...  

e14006 Background: Next generation sequencing (NGS) allows for reliable, comprehensive and cost-effective identification of clinically actionable genetic and genomic alterations. The increasing adoption of NGS in clinical oncology has increased our ability to identify germline alterations predisposing to cancer development as well as somatic changes enabling prescription of individualized cancer treatment and enhanced clinical trial participation. Here we summarize implementation of an NGS-based precision medicine initiative involving oncology patients from a single institution cancer center. Methods: IRB-approved NGS matched whole exome (WES) germline and solid tumor somatic tumor sequencing together with somatic tumor RNA sequencing (RNA-seq) were performed using germline DNA extracted from peripheral blood lymphocytes and nucleic acids for tumor DNA and RNA sequencing obtained from formalin-fixed, paraffin-embedded tumor specimens. Results of sequencing and analyses were presented to a multi-disciplinary tumor board to establish recommendations for management of germline pathogenic variation, therapeutic drug matching, clinical trials eligibility and molecularly informed patient prognosis. Results: A total of 1,005 patients completed sequencing. Germline and somatic WES exceeded 100X and 250X mean target coverage, respectively; somatic RNA-seq exceeded 200 million mean reads. Patients ranged in age from 17 to 90 years. The study cohort comprised comparable numbers of female (51%) and male (49%) patients. Ethnicities and races were broadly represented with 22% of participants identifying as Hispanic, 14% as Asian, 4% as Black, 55% as Non-Hispanic White and 5% as other. The most common solid tumor histological classification was colorectal (18%), followed by breast (16%), prostate (7%), head and neck (7%), sarcoma (7%), ovarian (5%), melanoma (4%) and lung (3%). Bioinformatic analyses and precision medicine tumor board review established that 12% of patients harbored a germline pathogenic variant and 43% carried clinically actionable genetic/genomic alterations; a majority of patients met molecular requirements for participation in a clinical trial. Conclusions: This study confirms the feasibility and utility of clinical NGS and precision medicine tumor board review in clinical oncology to identify germline genetic pathology, deliver personalized cancer therapeutics, increase clinical trial enrollment and clarify diagnosis and prognosis.


2021 ◽  
Vol 22 (3) ◽  
pp. 306-307
Author(s):  
Joanna A Gibson ◽  
Karin E Finberg ◽  
ILKe Nalbantoglu ◽  
Michael Cecchini ◽  
Amanda Ganzak ◽  
...  

2020 ◽  
Vol 51 (3) ◽  
pp. 120-124
Author(s):  
Dominik Dytfeld

AbstractIn spite of the introduction of several new drugs in the last 10 years, multiple myeloma (MM) remains incurable. Thus, an adoptive cellular therapy using chimeric antigen receptor T (CART), a strategy to increase the frequency of tumor-directed and functionally active T cells targeting antigens present on the cancer cell, might change the treatment in MM as it did in lymphoma and ALL. There are several targets for CART therapy in MM on different levels of development, which are discussed in the manuscript. B-cell maturation antigen (BCMA) being tested in the studies of phase 1–2 is the most promising, but so far CART has not been approved in the cure of MM and remains an experimental approach. The hematological society is facing a new technology which with its potential ability to cure MM, in spite of its complexity, cost, and toxicity, will definitely and soon change the landscape of myeloma in Europe and world-wide.


Author(s):  
Yakov Ben-Haim

Innovations create both opportunities and dilemmas. Innovations provide new and purportedly better opportunities, but—because of their newness—they are often more uncertain and potentially worse than existing options. There are new drugs, new energy sources, new foods, new manufacturing technologies, new toys and new pedagogical methods, new weapon systems, new home appliances, and many other discoveries and inventions. To use or not to use a new and promising but unfamiliar and hence uncertain innovation? That dilemma faces just about everybody. Furthermore, the paradigm of the innovation dilemma characterizes many situations even when a new technology is not actually involved. The dilemma arises from new attitudes, like individual responsibility for the global environment, or new social conceptions, like global allegiance and self-identity transcending all nation-states. These dilemmas have far-reaching implications for individuals, organizations, and society at large as they make decisions in the age of innovation. The uncritical belief in outcome optimization—“more is better, so most is best”—pervades decision-making in all domains, but this is often irresponsible when facing the uncertainties of innovation. There is a great need for practical conceptual tools for understanding and managing the dilemmas of innovation. This book offers a new direction for a wide audience. It discusses examples from many fields, including e-reading, online learning, bipolar disorder and pregnancy, disruptive technology in industry, stock markets, agricultural productivity and world hunger, military hardware, military intelligence, biological conservation, and more.


Cells ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 596
Author(s):  
Christian Jorgensen ◽  
Matthieu Simon

Joint-on-a-chip is a new technology able to replicate the joint functions into microscale systems close to pathophysiological conditions. Recent advances in 3D printing techniques allow the precise control of the architecture of the cellular compartments (including chondrocytes, stromal cells, osteocytes and synoviocytes). These tools integrate fluid circulation, the delivery of growth factors, physical stimulation including oxygen level, external pressure, and mobility. All of these structures must be able to mimic the specific functions of the diarthrodial joint: mobility, biomechanical aspects and cellular interactions. All the elements must be grouped together in space and reorganized in a manner close to the joint organ. This will allow the study of rheumatic disease physiopathology, the development of biomarkers and the screening of new drugs.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16149-e16149
Author(s):  
Veena Shankaran ◽  
Shasank Chennupati ◽  
Hayley Sanchez ◽  
Qin Sun ◽  
Abdalla Aly ◽  
...  

e16149 Background: Though the treatment landscape for HCC has changed significantly in the last several years with the refinement of liver-directed therapy techniques and the introduction of multiple new drugs, few studies have investigated the impact of the changing treatment landscape on lifetime treatment costs, particularly in Barcelona Clinic Liver Cancer (BCLC) stage C disease. We therefore sought to investigate real-world clinical characteristics, treatment patterns, healthcare use, and costs in patients with HCC treated at a single high-volume institution in WA. Methods: We conducted a retrospective cohort study of patients diagnosed with HCC between 2007 and 2018 at a single clinical cancer center using a database containing abstracted data from the electronic medical record (EMR) linked to cancer registry data and health claims from commercial insurance plans, Medicare, and Medicaid. We described clinical characteristics, including BCLC stage and Child Pugh score, and treatment patterns. We investigated the mean per patient lifetime treatment costs by BCLC stage using Kaplan-Meier cost estimator methods. Results: The final cohort included 215 patients, majority white (71%), male (68%), and with underlying hepatitis C (61%). Most patients had either Child Pugh A (76%) or B (20%) liver disease and BCLC A (45%), B (20%), or C (19%) stage HCC. Only 40% of BCLC C patients received systemic chemotherapy. Mean per patient lifetime costs were highest in BCLC A ($289,318) and BCLC C ($255,430) patients and lowest in BCLC D ($123,701) patients (Table). Surgical costs, hospital costs, imaging, and outpatient visits were the major contributors to total lifetime costs in BCLC A patients. Chemotherapy costs were highest in BCLC C patients, but still were not the predominant area of spending. Conclusions: In a WA state cohort of HCC patients, mean lifetime costs were highest in patients with BCLC A disease, largely driven by surgery and hospital costs. As utilization of newer and less toxic therapies in BCLC C patients increases, mean lifetime costs in this group may surpass other stages.[Table: see text]


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