How to Maximize the Genomic Tumor Board Experience
A Genomic Tumor Board (GTB), also called a molecular tumor board, is similar to typical multidisciplinary tumor boards but has a narrower focus. A GTB convenes experts to carefully evaluate your patient’s genomic tumor testing (GTT, also called tumor profiling, somatic tumor testing, comprehensive genomic profiling, and biomarker testing) results. The goal is to support you to identify appropriate oncology treatments and/or clinical trials that map to your patient’s GTT results, tumor findings, and overall care preferences or plan. Wherever possible, discussions may also include diagnostics and prognostic biomarker assessments.
GTBs run virtually and include specialists in:
- Medical oncology
- Medical genetics and genetic counseling
- Molecular pathology
- Genetic testing technology (diagnostic laboratory)
Ways to Maximize the GTB Experience
Before the GTB
Select the right patient to present. Listed below are common prompts for clinicians to present a patient at a GTB:
- Gain a deeper understanding of GTT results
- Understand how to prioritize multiple actionable GTT findings
- Clear up mismatches between GTT results and your patient’s tumor type, other genetic test results, clinical presentation
- Clarify unexpected or ambiguous GTT results (e.g. variant of unknown significance or VUS in a well-characterized gene) based on scientific evidence
- Learn about the limitations of GTT from testing technology experts
- Due diligence to confirm all available treatment or clinical trial options, even if there are currently none
- Identify a need for additional GTT and best practices for ordering the testing
- Explore a risk for a hereditary cancer syndrome and possible need for germline genetic testing
Gather clinical details. The GTB team will ask for your patient’s clinical details for their review. Details that are particularly useful for a GTB include:
- Diagnosis, demographics
- Pathology results, including additional immunohistochemistry (IHC) and/or fluorescence in situ hybridization (FISH) testing
- GTT results and any prior genetic test results (somatic and germline)
- Types of treatments the patient previously had and their responses to those treatments, as well as if they are currently on an effective treatment
- Patient’s willingness and ability to pursue a clinical trial
- Family history of cancer and personal history of any prior cancers
Think of your questions. It’s easy to lose track of questions during a busy GTB discussion, so take a moment to consider what you want to ask.
- Review your patient’s GTT results and flag areas where you have questions. Don’t worry about your expertise on the GTT – the GTB team will bring that.
- Jot down the #1 question or clinical challenge you have for your patient.
During the GTB
The GTB offers a moderated, guided discussion. After you present key details of your patient’s medical history, GTB experts will review the GTT results, scientific evidence, and map it to any available treatments and/or clinical trial options.
During the discussion, make the most of this time by:
- Taking brief notes, if needed. Don’t worry about details – the GTB team will send you minutes after the GTB.
- Asking questions – especially practical ones that the GTB team won’t know to ask, or that may help you explain the GTT results to your patient and answer questions they may have
- Asking for clarity about a topic or concept before moving to the next one
- Being sure to ask about your #1 question or clinical challenge
- Remembering that the GTB is not a “one and done” opportunity – you can reach out to the GTB team after the meeting
After the GTB
- Review the GTB minutes that you receive.These will contain an overall summary, evidence summary, clinical trial listing, and discussion highlights.
- Consider if your #1 question got answered. Did it? If not, reach out to the GTB team to follow up as they remain available to you.
- Take the GTB learnings back to your institution’s tumor board and to your patient.
Exploring Cancer Biomarker Testing (CME | CNE). Learn about benefits, limitations, and challenges of using cancer biomarker testing.
Interpreting Results from Somatic Cancer Panels (CME | CNE). 15 to 30-minute case-based modules that let you learn how to find and use important information on somatic cancer testing panel reports.
Assessing Genomic Variants for Targeted Therapies. Provides a framework for assessing the evidence supporting targeted treatment options.
This resource was developed as part of the Maine Cancer Genomics Initiative (MCGI) and is supported by The Harold Alfond Foundation and The Jackson Laboratory.
Updated May 2023