Virtual Tumor Boards Expand Access to Clinical Trials and Immunotherapy in the Community Center Setting

Meg Barbor, MPH

November 2016, Vol 6, No 11 - ACCC Conference Highlights

Interest in immuno-oncology continues to grow, but many patients with cancer do not benefit from cutting-edge immunotherapies, because a lack of access to clinical trials, according to Steven Powell, MD, Medical Oncologist and Associate Scientist, Sanford Cancer Center at Sanford Health, Sioux Falls, SD. He provided some insights on expanding access to clinical trials in the community cancer center at his presentation at the Association of Community Cancer Centers 2016 National Oncology Conference.

Community Cancer Care in Rural America

To expand immunotherapy treatments access across their network of rural cancer centers—comprising 43 hospitals and nearly 250 clinics in 9 states—Sanford Health established a systemwide virtual tumor board. Providers at all sites participate in weekly tumor-specific video conferences in which they evaluate patients for clinical trials eligibility and immunotherapy treatment options to facilitate patient access to clinical trials and to novel therapies.

“Every patient with cancer should have access to a clinical trial, but only 5% will ever participate in one. That needs to change,” Dr Powell said. “Our patients are very spread out and have to travel long distances just to get standard cancer care, and to get into a trial they have to travel even further. But 85% of patients get treatment in the community setting, so that’s where the trials have to be,” he added.

Expanding Access to Trials in Community Centers

Dr Powell and his team developed an infrastructure to improve personalized testing (ie, next-generation sequencing, PD-L1 testing), and educate clinicians about novel biomarkers and treatment options. Before they could expand access to promising cancer therapies through clinical trials, they had to determine the clinical trials needs among their patients.

“We developed a multidisciplinary tumor board as the best avenue to streamline all of these needs,” Dr Powell said.

The team also developed the Sanford GEMMA study to identify genomically matched treatments for patients with advanced cancer who have limited options. They identified a potential genetic mutation or a treatable target in approximately 90% of patients. Overall, 39% of the patients were initiated therapy based on their genomic testing, and the researchers matched 16% of patients to clinical trials.

“As we went through this process, we didn’t at that time understand how important immunotherapy was going to be,” Dr Powell emphasized.

Virtual Tumor Board in Rural Communities

Once they observed the success of their genomic tumor board, they developed a head and neck cancer program, solidifying their move from single-institution genomic tumor boards to multi-institutional virtual boards. According to Dr Powell, expanding their head and neck tumor board involved communication and coordination between sites, identification of clinical trial gaps, and expansion of the role of immunotherapy in their patient population.

The head and neck cancer board conducts a weekly videoconference immediately after the genomic tumor board.

Sanford Health now has a thriving immunotherapy clinical trials program, spanning numerous malignancies.

“After we opened up a large number of head and neck trials, other tumor boards started to catch on, and we were able to really expand our immuno-oncology program. This is huge, because patients would typically have to travel to the Mayo Clinic for these trials,” Dr Powell said.

To further examine the impact of their tumor boards, the team developed the Community Oncology Use of Molecular Profiling to Personalize the Approach to Specialized Cancer Treatment at Sanford (COMPASS) study, which gathers data on all patients who come through the genomic tumor board and measures its impact on various areas, such as treatment decisions, patient satisfaction, cost reduction, and improved patient outcomes.

Sanford Health has also increased its focus on translational research in all tumor types, expanding their immunotherapy biomarker research and drug development.

Rural communities face unique challenges in accessing novel therapies, but according to Dr Powell, virtual tumor boards facilitate provider education and clinical trial matching, thereby improving patient access to clinical trials and novel therapies. “As immunotherapy changes, we have to change with it,” he said.

By expanding access to clinical trials and improving the precision of novel cancer therapies, Sanford Health has become a leader in providing innovative cancer care in their community. They received the 2016 Institute for Clinical Immuno-Oncology Innovator Award for their contributions to improving access to immunotherapy in the community setting.