928 - Molecular Tumor Board (MTB): development of clinical pathways for precision medicine. Experiences of Center for Breast cancer at National cancer center, Korea

Background

Many of the newly approved drugs in breast cancer are not based on just conventional subtypes but are targeting to a variety of cancer characteristics, such as DNA repair, metabolism, apoptosis, or immune. NGS-based biomarker research is particularly needed in triple-negative breast cancer (TNBC) with no effective treatment. Collaborative research among researchers based on genetic information from patients can further improve patient care. Purpose of this project was the development of Clinical pathways for Realization of Customized Therapy and Building the Platform for Practical Application.

Methods

Patients with metastatic TNBC were enrolled and reviewed in the MTB with clinical records and comprehensive next gene sequencing (NGS) data including wholes exome sequencing and RNA sequencing. MTB was consisted with medical oncologists, pathologists, bioinformaticians, and geneticists. The variants of the genes in NGS testing were classified into 3 categories in the order of 1 to 3 based on data quality and clinical meanings.

Results

A total of 48 cases were submitted to the MTB. The median age was 50 (range 36-69). 64.6% of patients have not been treated for their metastatic TNBC. TP53, PI3KCA and KDM6A were most frequent variants in these patient population. In each patient, median 2 genetic variants (level 1 and 2) were detected like PI3KCA, ERBB2, AKT, BRCA1 and BRAF etc. We also found a case having FGFR2-RASSF3 fusion which was potential targetable variant. For CNV analysis, CCND1 (11q13.3), MYC (8q24.21), and NOTCH3 (1q21.3) were found to be amplified and those cases were considered as candidates for targeted therapy.

Conclusions

Identification of a driver, targetable genetic mutation can lead to a specific targeted therapy and result in personalized therapy. NGS is a powerful tool to detect candidate targets, however better understanding and timely incorporation in clinical care are needed. MTB has a role to serve a forum to educate attendee from various clinical and research fields and to play a center point to proceed precision medicine.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

National Cancer Center, Goyang, Korea.

Funding

National Cancer Center, Goyang, Korea.

Disclosure

All authors have declared no conflicts of interest.