In the rapidly evolving field of precision cancer medicine, new trials and targeted therapies approved for use in patients with advanced-stage cancer harboring specific genetic alterations are continually becoming available. But the volume and complexity of molecular profiling data make it difficult for oncology care teams to keep up with those clinical advances in real time and choose the most appropriate therapies for their patients.

To address this ongoing challenge, the Duke Cancer Institute (DCI) has developed a centralized informatics tool and an active multidisciplinary panel of experts to help deliver high-impact genomic information to clinicians across Duke Health. A report on the development and implementation of Duke’s Molecular Registry of Tumors (MRT) and Molecular Tumor Board (MTB) to support the adoption of precision oncology within an academic medical center was featured in the October 2021 issue of JCO Precision Oncology.

Highlights of Duke’s precision oncology program include:

• Duke MRT: The MRT is a secure clinical database that maintains an ever-growing list of comprehensive genomic profiling test results. With this tool, Duke clinicians can easily search for patients with specific molecular alterations—even extremely rare targets—who could benefit from a newly approved drug or a molecular-or biomarker-driven trial. It also provides notifications to clinicians about new classes of drugs and new therapies.
• Duke MTB: The MTB—co-led by John H. Strickler, MD, a medical oncologist, and Matthew S. McKinney, MD, a hematologic oncologist—brings together more than 30 molecular pathologists, oncologists, scientists, medical geneticists, and clinical trial teams, who review the weekly output of cases from the MRT. The board then analyzes results of next-generation sequencing tests, discusses clinical recommendations based on specific mutational profiles, and shares its insights with the patient’s care team.

“We’re using this tool to provide real-time clinical decision-making support for our oncologists, so that every eligible patient at DCI is getting access in real time to these new therapies, which can potentially inhibit the growth, progression, and spread of the cancer,” says Strickler, who specializes in gastrointestinal oncology. “Our precision medicine tools are critical to our ability to get our patients the most effective therapies possible, at that moment at which it’s needed.”

Since its inception in 2015, the MTB has provided decision-making support for more than 7,000 advanced-stage oncology patients. McKinney notes that the MRT can now link a patient’s treatments to their molecular profiling data, which helps Duke oncologists to better analyze and understand why some patients may be responding better than others to a therapy.

Strickler says that the goal is to continue to expand the MRT registry to include clinical outcomes for patients with solid tumor and hematologic malignancies. “We want to ensure our patients are actually getting the particular therapy or trial that has become available for them, and then we want to drive insights from that to push the next generation of breakthroughs,” he adds.

Patients interested in presenting to Duke for a second opinion will benefit from the consultative support of the MTB, McKinney says. “Precision medicine has the capability and promise of transforming our treatment for almost any cancer across the board. It gives us the chance to potentially treat the untreatable,” he says.