Virtual Tumorboards del diagnóstico al tratamiento. Christian Fegeler CENS TechTalks, Santiago de Chile,
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1 Virtual Tumorboards del diagnóstico al tratamiento Christian Fegeler CENS TechTalks, Santiago de Chile,
2 ... our molecular tumor board (MTB) started in May 2017 weekly conference Multidisciplinary (Research + Clinic) supplements organ-specific tumor conferences as needed
3 Abstract Number CT074 Non-comparative, Open-label, Multiple Cohort, Phase 1/2 Study to Evaluate Nivolumab in Patients With Virusassociated Tumors (CheckMate 358): Efficacy and Safety in Merkel Cell Carcinoma Suzanne L. Topalian, 1 Shailender Bhatia, 2 Antoine Hollebecque, 3 Ahmad Awada, 4 Jan Paul De Boer, 5 Ragini R. Kudchadkar, 6 Anthony Goncalves, 7 Jean-Pierre Delord, 8 Uwe M. Martens, 9 Jose Maria Lopez Picazo, 10 Ana Oaknin, 11 William C. Spanos, 12 Raid Aljumaily, 13 William H. Sharfman, 1 Shangbang Rao, 14 Ibrahima Soumaoro, 14 Z. Alexander Cao, 14 Paul Nghiem, 15 Dirk Schadendorf 16 1 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA; 2 Univeristy of Washington, Seattle, WA, USA; 3 Gustave Roussy Cancer Institute, Villejuif, France; 4 Jules Bordet Institute, Brussels, Belgium; 5 Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; 6 Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA; 7 Institut Paoli-Calmettes, Marseille, France; 8 University Department of Oncology, Toulouse University Cancer Institute IUCT-Oncopole, Toulouse, France; 9 SLK-Clinics, Cancer Center Heilbronn-Franken, Heilbronn, Germany; 10 Clinica Universidad de Navarra, Navarra, Spain; 11 Vall d Hebron University Hospital, Vall d Hebron Institute of Oncology (VHIO), Barcelona, Spain; 12 Sanford Health, USD Sanford School of Medicine, Sioux Falls, SD, USA; 13 Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA; 14 Bristol-Myers Squibb, Princeton, NJ, USA; 15 Seattle Cancer Care Alliance, Seattle, WA, USA; 16 University of Essen, Essen, Germany
4 4
5 personalized immunotherapy leads to tumor regression 05/ / /2016
6 The key question: Which therapy option suits best? Responder (15%) Probably nonresponder BRAFm (5-10%) Nonresponder KRASm/PI3CAm/PTENdel Nonreponder with no known molecular aberration (20-35%) Nonresponder RASm (40%) Probably nonresponder PI3KCAm and/or PTENdel (15-20%) Nonresponder BRAFm/PI3CAm/del/PTENdel Adapted from J Clin Oncol 2ß10:28(7):1254
7 From digital data to digital workflows
8 Three simple questions... Where can we arrange appointments for further diagnostics for the patient? What is the best available therapy option for this one patient? For which patients are all requested diagnostic results available so that the case can be discussed in the tumor board? for which we need interoperable IT systems
9 The best flight? - another issue of interoperability
10 Interoperability - connecting different systems to one service
11 Digital workflow as a combination of multiple systems on different platforms Ticketing pay Check in
12 Workflow from tumor tissue to MTB report treatment case Obtaining the tumor material of the patient (CT or sonographically controlled or surgical specimen) sample shipment Patient Tissue team molecular diagnostics DNA sequencing (NGS) Bioinformatics Labor team bioinformatician molecular tumor board clinical evaluation validation clinical oncologists, human geneticists, biologists, study physicians MTB-treatment recommendations
13 Workflow in the Molecular Tumor Board Report of molecular diagnostics data collection and preparation Supplement to relevant data from the clinic Search for similar cases in the literature Search for available therapy options (studies) clinical oncologists, human geneticists, biologists, study physicians MTB conference follow-up individual case validation MTB-treatment recommendations Review
14 The challenge: Make globally distributed knowledge... diagnostics molecular tumor board personalized therapy personalized follow up... available for local patient care
15 Today: manual search in various databases
16 Teleconference with national and international experts
17 Virtual Tumor Board as an IT tool set data collection and preparation Report of molecular diagnostics Supplement to relevant data from the clinic Search for similar cases in the literature Search for available therapy options (studies) dynamic integration of information, queries as needed source independent search tool MTB conference follow-up individual case validation MTB-treatment recommendations Review Teleconference Follow-up workflow
18 From digital data to digital workflows
19 Connected health data - "just" big data?... Analysis Connected data Machine learning Integration of knowledge Data clinical data lifestyle molecular diagnostics
20 Case-based Reasoning - an approach with history Corpus Hippocraticum Von medieval author - 2d copy, Gemeinfrei, Von Baumeister: Denkmäler des klassischen Altertums Band I., Seite Übertragen aus de.wikipedia nach Commons., Gemeinfrei,
21 paradigm data Paradigm shift to precision medicine past today tomorrow symptom-based modell-based algorithm-based intuitive medicine evidence-based medicine precision medicine application of rules, algorithms and reference databases enable traceable clinical decision-making aids and precise and efficient care clinical information lifestyle molecular diagnostics ( ) + big data analyzes reference databases (rules & algorithms) source vgl.: Wilkens 2016 precision medicine (Prevention, diagnosis, treatment)
22 The digital revolution in medicine is just beginning Genomics Gene Transcriptomics Transkripte Proteomics 1, Proteine Metabolomics Metaboliten
23 Tumor board - central element for collaborative workflows Patient individual model Integration of new knowledge Patient Reported Outcome Individual treatment Patient-doctor conversation Tumor board Expert involvement personalized therapy
24 MOLIT Framework an interoperable toolbox MOLIT Framework Platform for Patient generated data Study platform Virtuelle Tumorkonferenz (VITU) Order entry communication Knowledge Management Toolset 24
25 Gracias
26 From digital data to digital workflows
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