Importance of clinical decision making in precision oncology: Discordance in recommendation between next generation sequencing test vendor and molecular tumour board in India.

Bhawna Sirohi BALCO Medical Center, Raipur, India info_outline Bhawna Sirohi, Sissmol Davis, Anu R I, Moushumi Suryavanshi, Shaheenah S. Dawood, Pankaj Kumar Panda, Shona Milon Nag, Arunangshu Das, Nitesh Rohatgi, Sanjay Popat, Riyaz N.H. Shah, Cherian Thampy, Aparna Raj Parikh, Siddhartha Yadav, Prashant Mehta, Randeep Singh, Deborah Mukherji, Ramila Shilpakar, Sujith Kumar Mullapally, Aju Mathew

Authors Bhawna Sirohi BALCO Medical Center, Raipur, India info_outline Bhawna Sirohi, Sissmol Davis, Anu R I, Moushumi Suryavanshi, Shaheenah S. Dawood, Pankaj Kumar Panda, Shona Milon Nag, Arunangshu Das, Nitesh Rohatgi, Sanjay Popat, Riyaz N.H. Shah, Cherian Thampy, Aparna Raj Parikh, Siddhartha Yadav, Prashant Mehta, Randeep Singh, Deborah Mukherji, Ramila Shilpakar, Sujith Kumar Mullapally, Aju Mathew Organizations BALCO Medical Center, Raipur, India, Ernakulam Medical Centre and MOSC Medical College, Ernakulam, India, MVR Cancer Center and Research Institute, Calicut, India, Amrita Institute of Medical Sciences, Faridabad, India, Mediclinic City Hospital, Dubai, United Arab Emirates, Apollo Proton Cancer Centre, Chennai, India, Sahyadri Hospital, Pune, India, Square Hospitals Ltd, New Market, Bangladesh, Fortis Cancer Institute, New Delhi, India, Department of Medicine, The Royal Marsden Hospital - NHS Foundation, London, United Kingdom, Kent Oncology Centre, Kent, United Kingdom, NMC, Abu Dhabi, United Arab Emirates, Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, Mayo Clinic, Rochester, MN, Amrita institute of Medical Sciences, Faridabad, India, Narayana Health, Gurugram, India, American University of Beirut Medical Center, Beirut, Lebanon, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal, Kerala Cancer Care, Ernakulam, India Abstract Disclosures Research Funding No funding received None. Background: Molecular tumour boards (MTB) facilitate discussions among medical professionals, scientists, bioinformaticians and geneticists for clinical application of precision oncology, via interpretation of various genomic sequencing studies, most commonly Next Generation Sequencing (NGS). NGS test vendor recommendation may differ from the MTB recommendations. We aim to study the discordance rate between these recommendations. Methods: MTB discussions between April 1, 2021 and December 31, 2021, were retrospectively evaluated. MTBs which assessed NGS reports with or without significant genetic mutations but with drug recommendations were included. NGS testing was done with multiple vendors. Patients from all over India, Nepal, Bangladesh, Dubai and Abu Dhabi were discussed. We excluded MTBs which assessed NGS data without any drug recommendations. We compared therapeutic recommendations provided in the NGS report with the first-choice recommendation in the MTB discussion. Recommendation discordance was defined as disagreement between the NGS recommendation and the first MTB recommendation that either instructed its implementation either immediately or on disease progression. Results: 70 MTB data was studied. 49 MTBs assessing NGS reports of 49 unique patients (median age 54 years; range, 32-82) were included in the study. 13 patients had lung cancer, 10 colorectal, 6 breast, 7 hepatopancreatobiliary, 4 carcinoma of unknown primary and 9 others. 17 did not provide any treatment recommendations and hence were excluded. 4 were discussions based on NGS reports previously discussed in an MTB that was already included in the study, hence were excluded. Recommendation discordance rate was 49% (24 of 49). Conclusions: To our knowledge, this is the first study that assessed discordance rate in recommendations between NGS report and MTB from a low- and middle-income country setting. Accurate clinical translation of complex genomic data is at the forefront of personalized cancer care.