Trial Tests Genomic Tumor Board Impact, Reach

Observational studies have suggested that guidance from genomic tumor boards – panels of experts in interpreting these results – can help.

SWOG study S2108CD, activated earlier this week, will put this question to the test, as the first randomized controlled trial to measure the impact of an educationally enhanced genomic tumor board on both physician and patient outcomes.

The central question of the study is this: does using a tumor board in this way to evaluate patients’ genomic test results lead to more patients being treated with evidence-based, genome-informed therapy?

The trial will also measure the impact of this intervention on physician confidence in working with genomic testing results (a key metric) and will assess how sites’ use of genomic tumor testing changes over the course of the study.

Among its secondary objectives, the study will also compare clinical outcomes across arms – specifically survival and time to treatment discontinuation.

Who is eligible to enroll to S2108CD? Participants with a wide range of advanced or recurrent solid tumors. Moreover, patients may be co-enrolled on genome-informed therapeutic trials, such as Lung-MAP, NCI-MATCH, or TAPUR (two for one!).

An initial group of sixteen NCORPs are opening the trial, and there are plans to add two additional sites to the study. The initial sixteen have been cluster-randomized to either the intervention arm or to continuing their usual practice around genomic tumor testing.

This care delivery (hence the “CD” in the name) study is led by Drs. Jens Rueter, of the Jackson Laboratory, and Meghna Trivedi, of Columbia University Medical Center, with trial co-chairs Drs. Banu Symington, of Sweetwater Regional Cancer Center, and Douglas Reding, of CROWN NCORP/Ascension Columbia St. Mary’s Hospital, ensuring rural/NCORP representation.

The study’s genomic tumor board will include oncologists, pathologists, clinical trial and genomics experts, as well as external advisors. It will convene once a week, on average, and will provide, for clinicians, expert opinion, a guideline-enabled summary of the available evidence, and supporting educational materials, the latter developed by the study team and the Jackson Lab Clinical Education team.

Sites will submit cases for discussion ahead of each board meeting, and the board will discuss the clinical implications of the variants identified in test results, the available evidence on the utility of treatments, and the clinical experience with treatment options. The clinical teams will get a curated summary of the board’s discussion written by a subject matter expert.

Key support for operations of this tumor board comes from a SWOG Trial Support (STrS) grant from The Hope Foundation for Cancer Research.

The S2108CD genomic tumor board study builds on the model of the Maine Cancer Genomics Initiative, a program led by the Jackson Laboratory (and directed by Dr. Rueter) that reaches every oncology practice in the state of Maine, and that is a model for bringing precision oncology to community – often rural – settings.

Notably, all sites participating in S2108CD are members of the NCI’s Community Oncology Research Program, and many serve historically underserved populations and regions. Patients at these sites may not typically have easy access to the expertise represented by the genomic tumor board, nor to the curated educational materials the board provides with its personalized recommendations.

This means that, if it’s successful, the S2108CD study may outline a model for making such expertise – now often accessible only at leading academic sites or large urban cancer centers – more widely available to guide patient care regardless of where patients are treated. Just think – true precision oncology available everywhere patients seek cancer care. That’s a care delivery ideal worth striving for.
 

Want to introduce your patients to S2108CD? Try our patient-friendly, plain language summary of the trial.