Klinischer Nutzen der Flüssigkeitsbiopsie beim uvealen Melanom

2021 ◽  
pp. 1-3
Author(s):  
Ira Seibel
Keyword(s):  
Decision Making ◽  
Liquid Biopsy ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
High Rate ◽  
Precision Oncology ◽  
Noninvasive Biomarker ◽  
Biopsy Methods ◽  
Disease Understanding ◽  
Made In

In the era of precision oncology, major strides are being made to use individual tumor information for clinical decision-making. Differing from traditional biopsy methods, the emerging practice of liquid biopsy provides a minimally invasive way of obtaining tumor cells and derived molecules. Liquid biopsy provides a means to detect and monitor disease progression, recurrence, and treatment response in a noninvasive way, and to potentially complement classical biopsy. Uveal melanoma (UM) is a unique malignancy, with diagnosis heavily reliant on imaging, few repeat biopsies, and a high rate of metastasis, which occurs hematogenously and often many years after diagnosis. In this disease setting, a noninvasive biomarker to detect, monitor, and study the disease in real time could lead to better disease understanding and patient care. While advances have been made in the detection of tumor-disseminated components, sensitivity and specificity remain important challenges. Ambiguity remains in how to interpret current findings and in how liquid biopsy can have a place in clinical practice. Related publications in UM are few compared to other cancers, but with further studies we may be able to uncover more about the biology of disseminated molecules and the mechanisms involved in the progression to metastasis.

The Johns Hopkins Molecular Tumor Board Precision Oncology elective for Medical Oncology fellows.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11035-11035
Author(s):  
Kristen Marrone ◽  
Jessica Tao ◽  
Jenna VanLiere Canzoniero ◽  
Paola Ghanem ◽  
Emily Nizialek ◽  
...  
Keyword(s):  
Decision Making ◽  
Precision Medicine ◽  
Clinical Decision Making ◽  
Cancer Genomics ◽  
Medical Oncology ◽  
Clinical Decision ◽  
Tumor Board ◽  
Precision Oncology ◽  
Adaptive Expertise ◽  
Molecular Tumor Board

11035 Background: The accelerated impact of next generation sequencing (NGS) in clinical decision making requires the integration of cancer genomics and precision oncology focused training into medical oncology education. The Johns Hopkins Molecular Tumor Board (JH MTB) is a multi-disciplinary effort focused on integration of NGS findings with critical evidence interpretation to generate personalized recommendations tailored to the genetic footprint of individual patients. Methods: The JH MTB and the Medical Oncology Fellowship Program have developed a 3-month precision oncology elective for fellows in their research years. Commencing fall of 2020, the goals of this elective are to enhance the understanding of NGS platforms and findings, advance the interpretation and characterization of molecular assay outputs by use of mutation annotators and knowledgebases and ultimately master the art of matching NGS findings with available therapies. Fellow integration into the MTB focuses on mentored case-based learning in mutation characterization and ranking by levels of evidence for actionability, with culmination in form of verbal presentations and written summary reports of final MTB recommendations. A mixed methods questionnaire was administered to evaluate progress since elective initiation. Results: Three learners who have participated as of February 2021 were included. Of the two who had completed the MTB elective, each have presented at least 10 cases, with at least 1 scholarly publication planned. All indicated strong agreement that MTB elective had increased their comfort with interpreting clinical NGS reports as well as the use of knowledgebases and variant annotators. Exposure to experts in the field of molecular precision oncology, identification of resources necessary to interpret clinical NGS reports, development of ability to critically assess various NGS platforms, and gained familiarity with computational analyses relevant to clinical decision making were noted as strengths of the MTB elective. Areas of improvement included ongoing initiatives that involve streamlining variant annotation and transcription of information for written reports. Conclusions: A longitudinal elective in the JHU MTB has been found to be preliminarily effective in promoting knowledge mastery and creating academic opportunities related to the clinical application of precision medicine. Future directions will include leveraging of the MTB infrastructure for research projects, learner integration into computational laboratory meetings, and expansion of the MTB curriculum to include different levels of learners from multiple medical education programs. Continued elective participation will be key to understanding how best to facilitate adaptive expertise in assigning clinical relevance to genomic findings, ultimately improving precision medicine delivery in patient care and trial development.

Diagnostic conversations: Clinical Decision Making in surgery – Part 2

Diagnosis ◽  
2014 ◽  
Vol 1 (2) ◽  
pp. 189-193 ◽  
Author(s):  
David Allan Watters ◽  
Spencer Wynyard Beasley ◽  
Wendy Crebbin
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Learning Opportunities ◽  
Clinical Decisions ◽  
Decision Making Processes ◽  
Royal Australasian College ◽  
Insight Into ◽  
Made In

AbstractProceduralists who fail to review their decision making are unlikely to learn from their experiences, irrespective of whether the operative outcome is successful or not. Teaching junior surgeons to develop ‘insight’ into their own decision making has long been a challenge. Surgeons and staff of the Royal Australasian College of Surgeons worked together to develop a model to help explain the processes around clinical decision making and incorporated this model into a Clinical Decision Making (CDM) training course. In this course, faculty apply the model to specific surgical cases, within the model’s framework of how clinical decisions are made; thus providing an opportunity to identify specific decision making processes as they occur and to highlight some of the learning opportunities they provide. The conversation in this paper illustrates the kinds of case-based interactions which typically occur in the development and teaching of the CDM course.The focus in this, the second of two papers, is on reviewing post-operative clinical decisions made in relation to one case, to improve the quality of subsequent decision making.

A comparison of patients' and physicians' expectations regarding precision oncology tests.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1568-1568
Author(s):  
Navdeep Dehar ◽  
Tasnima Abedin ◽  
Patricia A. Tang ◽  
D. Gwyn Bebb ◽  
Winson Y. Cheung
Keyword(s):  
Decision Making ◽  
Genetic Testing ◽  
Cancer Biology ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Survey Study ◽  
Precision Oncology ◽  
Diagnosis And Prognosis ◽  
Genetic Test Results ◽  
Survey Responses

1568 Background: With the increasing number and frequency of biomarker and genetic tests that are offered to patients with cancer, it is important to ensure that they fully understand the implications of these tests. In this survey study, we aimed to compare the attitudes and expectations of patients and cancer physicians about the role of biomarker and genetic testing in clinical decision-making. Methods: Two separate, complimentary, self-administered questionnaires for cancer patients and their physicians, respectively, were collected in Calgary, Alberta, Canada. Survey responses from patients were subsequently matched with those of their corresponding oncologists to form patient–oncologist dyads. We determined the concordance rates between responses of patients and those of their oncologists. Results: A total of 113 patients and 15 physicians participated in the study from July to September 2019. Patients demonstrated good understanding of general cancer biology (79%) and diagnostic processes (91%) associated with precision oncology. About 70% patients were willing to undergo minor procedures, and participate in research involving biomarker or genetic testing; however, this was over-estimated by their physicians in 82% of cases. Many patients felt that their tumor should be tested to guide treatment (70%) and were not bothered by potential delays in treatment due to testing (23%). These views from patients were largely shared by their oncologists (concordance 64%). While only 28% patients thought that they had enough knowledge to make informed decisions, majority (68%) said that they needed more information. Importantly, knowledge and expectations regarding the applications of biomarker or genetic test results on actual diagnosis and prognosis were grossly discrepant between patients and their oncologists (concordance 26% and 36%, respectively). Conclusions: Patients and cancer physicians tend to be aware of the advances in precision oncology and are willing to participate in biomarker and genetic testing and research. However, they do not consistently agree about the roles and applications of these tests, which may result in misplaced expectations. Strategies to improve education and communication are needed to align these expectations and improve the quality of clinical decision-making.

scholarly journals Support systems to guide clinical decision-making in precision oncology: The Cancer Core Europe Molecular Tumor Board Portal

2020 ◽  
Vol 26 (7) ◽  
pp. 992-994 ◽  
Author(s):  
David Tamborero ◽  
◽  
Rodrigo Dienstmann ◽  
Maan Haj Rachid ◽  
Jorrit Boekel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Support Systems ◽  
Clinical Decision ◽  
Tumor Board ◽  
Precision Oncology ◽  
Molecular Tumor Board

scholarly journals Measuring and Quantifying Collateral Information in Psychiatry: Feasibility study of the McLean Collateral Information and Clinical Actionability scale (M-CICAS) (Preprint)

2020 ◽  
Author(s):  
Praise Owoyemi ◽  
Sarah Salcone ◽  
Christopher King ◽  
Heejung Julie Kim ◽  
Kerry James Ressler ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Records ◽  
Interrater Reliability ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Collateral Information ◽  
Psychiatric Setting ◽  
Study Staff ◽  
Minimal Research ◽  
Made In

BACKGROUND The review of collateral information is an essential component of patient care. Though this is standard practice, minimal research has been devoted to quantifying collateral information collection and to understanding how collateral information translates to clinical decision-making. To address this, we developed and piloted a novel measure (the McLean collateral information and clinical actionability scale (M-CICAS)) to evaluate the types and number of collateral sources viewed and resulting actions made in a psychiatric setting. OBJECTIVE Study aims included: 1) feasibility testing of the M-CICAS measure, 2) validating this measure against clinician notes via medical records, and 3) evaluating whether reviewing a higher volume of collateral sources is associated with more clinical actions taken. METHODS For the M-CICAS measure, we developed a three-part instrument, focusing on measuring collateral sources reviewed, clinical actions taken, and shared decision-making between clinician and patient. We recruited clinicians providing psychotherapy services at McLean hospital (N = 7) to complete the M-CICAS measure after individual clinical sessions. We also independently completed the M-CICAS using only the clinician’s corresponding note from that session, in order to validate the reported measure against the electronic health record which served as the objective point of comparison. Based on this, we estimated inter-rater reliability, reporting validity and whether significant variance in clinical actions taken could be attributed to inter-clinician differences. RESULTS Study staff had high interrater reliability on the M-CICAS for the sources reviewed (r=0.98, P<.001) and actions taken (r=0.97, P <.001). Clinician and study staff ratings were moderately correlated and statistically significant on the M-CICAS summary scores for the sources viewed (r’s=0.24 and 0.25, P=.02202 and P=.0188, respectively). Univariate regression modelling demonstrated a significant association between collateral sources and clinical actions taken when clinicians completed the M-CICAS (B=.27, t=2.47, P =.015). Multilevel fixed slopes random intercepts model confirmed a significant association even when accounting for clinician differences (B=.23, t=2.13, P =.037). CONCLUSIONS This pilot study establishes feasibility and preliminary validity for the M-CICAS measure in assessing collateral sources and clinical decision-making in psychiatry. This study also indicated that reviewing more collateral sources may lead to an increased number of clinical actions following a session.

scholarly journals The Influence of Personalised Sarcoma Care (PERSARC) Prediction Modelling on Clinical Decision Making in a Multidisciplinary Setting

Sarcoma ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
H. S. Femke Hagenmaier ◽  
Annelies G. K. van Beeck ◽  
Rick L. Haas ◽  
Veroniek M. van Praag ◽  
Leti van Bodegom-Vos ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Patient Centered ◽  
Treatment Protocols ◽  
Treatment Decision Making ◽  
Heterogenous Group ◽  
Centered Care ◽  
Made In

Background. With soft-tissue sarcoma of the extremity (ESTS) representing a heterogenous group of tumors, management decisions are often made in multidisciplinary team (MDT) meetings. To optimize outcome, nomograms are more commonly used to guide individualized treatment decision making. Purpose. To evaluate the influence of Personalised Sarcoma Care (PERSARC) on treatment decisions for patients with high-grade ESTS and the ability of the MDT to accurately predict overall survival (OS) and local recurrence (LR) rates. Methods. Two consecutive meetings were organised. During the first meeting, 36 cases were presented to the MDT. OS and LR rates without the use of PERSARC were estimated by consensus and preferred treatment was recorded for each case. During the second meeting, OS/LR rates calculated with PERSARC were presented to the MDT. Differences between estimated OS/LR rates and PERSARC OS/LR rates were calculated. Variations in preferred treatment protocols were noted. Results. The MDT underestimated OS when compared to PERSARC in 48.4% of cases. LR rates were overestimated in 41.9% of cases. With the use of PERSARC, the proposed treatment changed for 24 cases. Conclusion. PERSARC aids the MDT to optimize individualized predicted OS and LR rates, hereby guiding patient-centered care and shared decision making.

scholarly journals Systematic discovery of gene fusions in pediatric cancer by integrating RNA-seq and WGS

2021 ◽  
Author(s):  
Ianthe A.E.M. van Belzen ◽  
Casey Cai ◽  
Marc van Tuil ◽  
Shashi Badloe ◽  
Eric Strengman ◽  
...  
Keyword(s):  
Decision Making ◽  
Pediatric Cancer ◽  
Copy Number ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Specific Gene ◽  
Precision Oncology ◽  
Gene Fusions ◽  
Rna Seq ◽  
High Confidence

Background Gene fusions are important cancer drivers in pediatric cancer and their accurate detection is essential for diagnosis and treatment. Clinical decision-making requires high confidence and precision of detection. Recent developments show RNA sequencing (RNA-seq) is promising for genome-wide detection of fusion products, but hindered by many false positives that require extensive manual curation and impede discovery of pathogenic fusions. Results We developed Fusion-sq to detect tumor-specific gene fusions by integrating and 'fusing' evidence from RNA-seq and whole genome sequencing (WGS) using intron-exon gene structure. In a pediatric pan-cancer cohort of 130 patients, we identified 165 high confidence tumor-specific gene fusions and their underlying structural variants (SVs). This includes all clinically relevant fusions known to be present in this cohort (30 patients). Fusion-sq distinguishes healthy-occurring from tumor-specific fusions, and resolves fusions in amplified regions and copy number unstable genomes. A high gene fusion burden is associated with copy number instability. We identified 27 potentially pathogenic fusions involving oncogenes or tumor-suppressor genes characterised by underlying SVs or expression changes indicative of activating or disruptive effects. Conclusions Our results indicate how clinically relevant and potentially pathogenic gene fusions can be identified and their functional effects investigated by combining WGS and RNA-seq. Integrating RNA fusion predictions with underlying SVs advances fusion detection beyond extensive manual filtering. Taken together, we developed a method for identifying candidate fusions that is suitable for precision oncology applications. Our method provides multi-omics evidence for assessing the pathogenicity of tumor-specific fusions for future clinical decision making.

Role of Liquid Biopsy in Clinical Decision-Making for Breast Cancer

2019 ◽  
Vol 11 (2) ◽  
pp. 52-66
Author(s):  
Carolyn Hall ◽  
Vanessa Sarli ◽  
Salyna Meas ◽  
Anthony Lucci
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Liquid Biopsy ◽  
Clinical Decision Making ◽  
Clinical Decision

The impact of clinical decision making in a molecular tumor board at a tertiary care center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3128-3128
Author(s):  
Meena Sadaps ◽  
Kathryn Demski ◽  
Ying Ni ◽  
Vicky Konig ◽  
Brandie Leach ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Genetic Counselors ◽  
Tumor Board ◽  
Treatment Recommendation ◽  
Precision Oncology ◽  
Off Label ◽  
Tumor Boards ◽  
Molecular Tumor Board

3128 Background: Multidisciplinary molecular tumor boards were first established with the onset of precision oncology (PO), as many clinicians were unfamiliar with the interpretation and incorporation of the information into clinical practice. PO has since rapidly evolved and integrated itself into standard of care practices for most cancer patients, yet molecular tumor boards have not grown accordingly and in fact some have been discontinued. There remains a paucity of data in regards to the value and impact of molecular tumor board discussions themselves. We previously reported on our longitudinal experiences in PO ( Sadaps et al, 2018), focusing on the therapeutic impact of matched therapy. Here, we report on the utility of our molecular tumor board in clinical decision making. Methods: We conducted a retrospective review of patients seen at Cleveland Clinic with a solid tumor malignancy who had large panel, next-generation-sequencing (NGS) performed via any commercial platform from November 2019-January 2021. Cases were filtered through a local therapeutic algorithm and then reviewed individually. Initial review was performed by a core genomics committee comprised of 2 oncologists and 2 genetic counselors. Interesting and/or complex cases were flagged for discussion at our bimonthly molecular tumor board, which is regularly attended by medical oncologists, pathologists, genetic counselors, bioinformaticians, and patient care coordinators. Data analyzed included categorization of treatment recommendations and the percentage of cases for which initial recommendations were changed based on tumor board discussion. Results: Of 782 total cases, 575 (73.5%) had a clinically relevant genomics tumor board (GTB) recommendation as compared to 51.7% from our previously reported study. 16.7% of patients had on label recommendation(s) and 86.4% had off label/ clinical trial recommendation(s). 179 (22.9%) patients were recommended for genetic counseling (GC). During our bimonthly GTB, we discussed 173 (22.1%) of these cases. Of the discussed cases, the most common tumor types were hepatobiliary (18.5%), lower gastrointestinal (17.3%), and breast (16.2%). Topics of discussion at GTB included such things as pathologic/histologic/molecular testing, prioritization of available trials, appropriateness of an off label therapy, and need for a genetics consult. Discussion at GTB resulted in a change in treatment recommendation in 63 (36.4%) cases. Conclusions: Discussions from multidisciplinary molecular tumor board impacted treatment decisions for our patients. Referral to GC was also common and should be considered an integral part of somatic sequencing review. Molecular tumor boards remain a crucial platform for treatment guidance and clinical management, especially given the increase in “actionability” over the years due to newly discovered targets and targeted therapies in this rapidly evolving field.

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