519MO - Concordance analysis of treatment recommendations between central consensus and multidisciplinary tumor boards

Background

In the era of cancer genome medicine, the role of multidisciplinary tumor boards (MTBs) has been growing and, accordingly, the assurance of the quality of MTBs is rapidly needed. Here we present the results of a prospective analysis evaluating the concordance between treatment recommendations by the MTBs and central consensus treatment recommendations.

Methods

The central committee of the study developed 50 simulated cases which included frequently observed genomic alterations selected from The Cancer Genome Atlas database. The central committee then developed a consensus recommendation for all 50 cases, according to the Japanese practice guideline (Naito Y et al., Int J Clin Oncol 26: 233-283; 2021). The MTBs from twelve leading cancer institutes in Japan independently recommended a treatment for all 50 cases in a blinded manner to the consensus recommendations. The primary objective was to estimate the concordance rate which was defined as the proportion of treatment recommendations by MTBs that were concordant to the consensus recommendations. Mixed effects logistic regression model adjusted for institutes as random intercept was applied.

Results

In 600 (=50 cases×12 institutes) treatment recommendations by the MTBs, the adjusted rate of concordance was 62% (95% confidence interval [CI], 54-69%); the concordance rate across the MTBs varied from 50% to 86%. A high concordance was observed in the subgroups of cases with colorectal cancer (83%), ROS1 fusion (100%), and high evidence level A/R (88/100%), whereas a low concordance was seen in cases with cervical cancer (10%), TP53 mutation (16%), and low evidence level C/D/E (30/25/18%). A multivariate analysis revealed that the level of evidence (high [A/B/R] vs low [C/D/E]; odds ratios, 4.4 [95%CI; 1.8-10.8]), and TP53 alteration (yes vs no; 0.06 [0.03-0.10]) were significant factors associated with concordance.

Conclusions

Our results indicate that sharing the information of matched therapy, particularly for that with low evidence level, may be needed to improve the quality of treatment recommendations by MTBs.

Clinical trial identification

Editorial acknowledgement

Brian Quinn, Japan Medical Communication.

Legal entity responsible for the study

Takayuki Yoshino.

Funding

Ministry of Health, Labour and Welfare, Japan.

Disclosure

H. Kage: Financial Interests, Institutional, Funding: Konica Minolta, Inc..K. Sunami: Financial Interests, Personal, Speaker’s Bureau: Chugai; Financial Interests, Personal, Speaker’s Bureau: Pfizer; Financial Interests, Personal, Speaker’s Bureau: Novartis; Financial Interests, Personal, Speaker’s Bureau: Sysmex; Financial Interests, Personal, Speaker’s Bureau: Amgen. Y. Naito: Financial Interests, Personal, Speaker’s Bureau: AstraZeneca; Financial Interests, Personal, Speaker’s Bureau: Bayer; Financial Interests, Personal, Speaker’s Bureau: Chugai; Financial Interests, Personal, Speaker’s Bureau: Eisai; Financial Interests, Personal, Speaker’s Bureau: Eli Lilly; Financial Interests, Personal, Speaker’s Bureau: Fuji Film Toyama Chemistry; Financial Interests, Personal, Speaker’s Bureau: Guardant; Financial Interests, Personal, Speaker’s Bureau: Nihon Kayaku; Financial Interests, Personal, Speaker’s Bureau: Novartis; Financial Interests, Personal, Speaker’s Bureau: Ono; Financial Interests, Personal, Speaker’s Bureau: Pfizer; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: Taiho; Financial Interests, Personal, Invited Speaker: Takeda; Financial Interests, Personal, Research Grant: ABBVIE; Financial Interests, Personal, Research Grant: Boehringer Ingelheim; Financial Interests, Personal, Research Grant: Chugai; Financial Interests, Personal, Research Grant: Daiichi Sankyo; Financial Interests, Personal, Research Grant: Ono; Financial Interests, Personal, Research Grant: Pfizer; Financial Interests, Personal, Research Grant: Roche; Financial Interests, Personal, Research Grant: Taiho. D. Ennishi: Financial Interests, Institutional, Writing Engagements: Eisai Pharmaceutical; Financial Interests, Institutional, Writing Engagements: Kyowa Kirin Pharmaceutical; Financial Interests, Institutional, Research Grant: Chugai Pharmaceutical; Financial Interests, Institutional, Research Grant: Nipponshinyaku Pharmaceutical. M. Kanai: Financial Interests, Personal, Writing Engagements: Chugai. H. Kenmotsu: Financial Interests, Personal, Writing Engagements: Chugai Pharmaceutical; Financial Interests, Personal, Writing Engagements: Ono Pharmaceutical; Financial Interests, Personal, Writing Engagements: Boehringer Ingelheim; Financial Interests, Personal, Writing Engagements: Eli Lilly; Financial Interests, Personal, Writing Engagements: Kyowa Hakko Kirin; Financial Interests, Personal, Writing Engagements: Bristol Myers Squibb; Financial Interests, Personal, Writing Engagements: Novartis Pharma; Financial Interests, Personal, Writing Engagements: Daiichi Sankyo; Financial Interests, Personal, Writing Engagements: AstraZeneca; Financial Interests, Personal, Writing Engagements: Pfizer; Financial Interests, Personal, Writing Engagements: Taiho; Financial Interests, Institutional, Research Grant: Chugai Pharmaceutical; Financial Interests, Institutional, Research Grant: Novartis Pharma; Financial Interests, Institutional, Research Grant: Daiichi Sankyo; Financial Interests, Institutional, Research Grant: AstraZeneca. T. Koyama: Financial Interests, Personal, Writing Engagements: Chugai; Financial Interests, Personal, Writing Engagements: Sysmex; Financial Interests, Personal, Research Grant: PACT. D. Sakai: Financial Interests, Personal, Speaker’s Bureau: Chugai Pharmaceutical; Financial Interests, Institutional, Research Grant: Daiichi Sankyo; Financial Interests, Institutional, Research Grant: Eli Lilly; Financial Interests, Institutional, Research Grant: Chugai Pharmaceutical; Financial Interests, Institutional, Research Grant: Yakult Honsha; Financial Interests, Institutional, Research Grant: Ono Pharmaceutical; Financial Interests, Institutional, Research Grant: Astellas Pharmaceutical; Financial Interests, Institutional, Research Grant: Incyte; Financial Interests, Institutional, Research Grant: Taiho Pharmaceutical; Financial Interests, Institutional, Research Grant: Eisai. T. Yamanaka: Financial Interests, Personal, Writing Engagements: AstraZeneca; Financial Interests, Personal, Writing Engagements: Otsuka; Financial Interests, Personal, Writing Engagements: Ono; Financial Interests, Personal, Writing Engagements: Kyowa Kirin; Financial Interests, Personal, Writing Engagements: Taiho; Financial Interests, Personal, Writing Engagements: Takeda; Financial Interests, Personal, Writing Engagements: Chugai; Financial Interests, Personal, Writing Engagements: Boehringer Ingelheim; Financial Interests, Personal, Writing Engagements: Bayer; Financial Interests, Personal, Writing Engagements: Gilead Sciences; Financial Interests, Personal, Writing Engagements: Sanofi; Financial Interests, Personal, Writing Engagements: Merck Serono; Financial Interests, Institutional, Research Grant: Taiho; Financial Interests, Institutional, Research Grant: Boehringer Ingelheim; Financial Interests, Institutional, Research Grant: Ono; Financial Interests, Institutional, Research Grant: Chugai; Financial Interests, Institutional, Research Grant: Takeda; Financial Interests, Institutional, Research Grant: Astellas; Financial Interests, Institutional, Research Grant: Bayer; Financial Interests, Institutional, Research Grant: Daiichi Sankyo; Financial Interests, Institutional, Research Grant: EPS. S. Kohsaka: Financial Interests, Institutional, Research Grant: AstraZeneca; Financial Interests, Institutional, Research Grant: Boehringer Ingelheim; Financial Interests, Institutional, Research Grant: Eisai; Financial Interests, Institutional, Research Grant: Daiichi Sankyo; Financial Interests, Institutional, Research Grant: Chordia Therapeutics. T. Yoshino: Financial Interests, Personal, Writing Engagements: Taiho; Financial Interests, Personal, Writing Engagements: Chugai; Financial Interests, Personal, Writing Engagements: Eli Lilly; Financial Interests, Personal, Writing Engagements: Merck Biopharma; Financial Interests, Personal, Writing Engagements: Bayer; Financial Interests, Personal, Writing Engagements: Ono; Financial Interests, Institutional, Research Grant: Taiho; Financial Interests, Institutional, Research Grant: Sumitomo Dainippon; Financial Interests, Institutional, Research Grant: Ono; Financial Interests, Institutional, Research Grant: Chugai; Financial Interests, Institutional, Research Grant: Amgen; Financial Interests, Institutional, Research Grant: Parexel International; Financial Interests, Institutional, Research Grant: MSD; Financial Interests, Institutional, Research Grant: Daiichi Sankyo; Financial Interests, Institutional, Research Grant: Sanofi. All other authors have declared no conflicts of interest.