Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors

James L Rogers; Thomas Wall; Alvina A Acquaye-Mallory; Lisa Boris; Yeonju Kim; Kenneth Aldape; Martha M Quezado; John A Butman; James G Smirniotopoulos; Huma Chaudhry; Christina I Tsien; Prashant Chittiboina; Kareem Zaghloul; Orwa Aboud; Nicholas G Avgeropoulos; Eric C Burton; David M Cachia; Karan S Dixit; Jan Drappatz; Erin M Dunbar; Peter Forsyth; Edina Komlodi-Pasztor; Jacob Mandel; Byram H Ozer; Eudocia Q Lee; Surabhi Ranjan; Rimas V Lukas; Margarita Raygada; Michael E Salacz; Matthew A Smith-Cohn; James Snyder; Ariane Soldatos; Brett J Theeler; Brigitte C Widemann; Kevin A Camphausen; John D Heiss; Terri S Armstrong; Mark R Gilbert; Marta Penas-Prado

doi:10.1007/s11060-024-04613-6

Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors

J Neurooncol. 2024 Apr;167(2):349-359. doi: 10.1007/s11060-024-04613-6. Epub 2024 Mar 1.

Authors

James L Rogers¹, Thomas Wall¹, Alvina A Acquaye-Mallory¹, Lisa Boris¹, Yeonju Kim^{1

2}, Kenneth Aldape³, Martha M Quezado³, John A Butman⁴, James G Smirniotopoulos¹, Huma Chaudhry⁵, Christina I Tsien^{1

6}, Prashant Chittiboina⁷, Kareem Zaghloul⁷, Orwa Aboud⁸, Nicholas G Avgeropoulos^{9

10}, Eric C Burton¹, David M Cachia¹¹, Karan S Dixit¹², Jan Drappatz¹³, Erin M Dunbar¹⁴, Peter Forsyth¹⁵, Edina Komlodi-Pasztor^{1

16}, Jacob Mandel¹⁷, Byram H Ozer¹, Eudocia Q Lee¹⁸, Surabhi Ranjan¹⁹, Rimas V Lukas¹², Margarita Raygada²⁰, Michael E Salacz²¹, Matthew A Smith-Cohn^{1

22}, James Snyder²³, Ariane Soldatos²⁴, Brett J Theeler²⁵, Brigitte C Widemann²⁶, Kevin A Camphausen⁵, John D Heiss⁷, Terri S Armstrong¹, Mark R Gilbert¹, Marta Penas-Prado²⁷

Affiliations

¹ Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
² Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.
³ Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁴ Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁵ Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁶ Proton Therapy Center, Sibley Memorial Hospital, Johns Hopkins Medicine, 5255 Loughboro Rd NW, Washington, DC, 20016, USA.
⁷ Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
⁸ Department of Neurology and Neurological Surgery, UC Davis Comprehensive Cancer Center, 4860 Y Street, Sacramento, CA, 95817, USA.
⁹ Brain and Spine Tumor Program, Orlando Health Cancer Institute, 1400 S. Orange Ave, Orlando, FL, 32806, USA.
¹⁰ Global Medical Affairs, Novocure GmbH, D4 Pk. 6, 6039, Root, Switzerland.
¹¹ Department of Hematology/Oncology, University of Massachusetts, 55 Lake Ave, Worcester, MA, 01655, USA.
¹² Lou and Jean Malnati Brain Tumor Institute, Northwestern University Feinberg School of Medicine, 675 N St Clair St, Chicago, IL, 60611, USA.
¹³ Department of Neurology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA.
¹⁴ Piedmont Brain Tumor Center, Piedmont Atlanta Hospital, Atlanta, GA, 2001 Peachtree St30309, USA.
¹⁵ Department of Neuro-Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
¹⁶ Department of Neurology, MedStar Georgetown University Hospital, 3800 Reservoir Road Washington, Washington DC, 20007, USA.
¹⁷ Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Houston, TX, 77030, USA.
¹⁸ Center for Neuro-Oncology, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
¹⁹ Department of Neurology, Cleveland Clinic Florida, Weston Hospital, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, US.
²⁰ Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD, 20892, USA.
²¹ Department of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper, Cooper University Health Care, Two Cooper Plaza, Camden, NJ, 08103, USA.
²² Benefis Sletten Cancer Institute, 1117 29Th St. S, Great Falls, MT, 59405, USA.
²³ Hermelin Brain Tumor Center, Henry Ford Cancer Institute, 2800 W Grand Blvd, Detroit, MI, 48202, USA.
²⁴ National Institute of Neurological Disorders and Stroke,, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
²⁵ School of Medicine, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
²⁶ Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
²⁷ Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA. [email protected].

Abstract

Purpose: Multidisciplinary tumor boards (MTBs) integrate clinical, molecular, and radiological information and facilitate coordination of neuro-oncology care. During the COVID-19 pandemic, our MTB transitioned to a virtual and multi-institutional format. We hypothesized that this expansion would allow expert review of challenging neuro-oncology cases and contribute to the care of patients with limited access to specialized centers.

Methods: We retrospectively reviewed records from virtual MTBs held between 04/2020-03/2021. Data collected included measures of potential clinical impact, including referrals to observational or therapeutic studies, referrals for specialized neuropathology analysis, and whether molecular findings led to a change in diagnosis and/or guided management suggestions.

Results: During 25 meetings, 32 presenters discussed 44 cases. Approximately half (n = 20; 48%) involved a rare central nervous system (CNS) tumor. In 21% (n = 9) the diagnosis was changed or refined based on molecular profiling obtained at the NIH and in 36% (n = 15) molecular findings guided management. Clinical trial suggestions were offered to 31% (n = 13), enrollment in the observational NCI Natural History Study to 21% (n = 9), neuropathology review and molecular testing at the NIH to 17% (n = 7), and all received management suggestions.

Conclusion: Virtual multi-institutional MTBs enable remote expert review of CNS tumors. We propose them as a strategy to facilitate expert opinions from specialized centers, especially for rare CNS tumors, helping mitigate geographic barriers to patient care and serving as a pre-screening tool for studies. Advanced molecular testing is key to obtaining a precise diagnosis, discovering potentially actionable targets, and guiding management.

Keywords: Barriers to healthcare access; Collaborative practice; Multidisciplinary tumor boards; National Cancer Institute-Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT); Rare CNS tumors.

MeSH terms

Central Nervous System Neoplasms* / diagnosis
Central Nervous System Neoplasms* / therapy
Humans
Pandemics*
Patient Care Team
Referral and Consultation
Retrospective Studies