How theMednet is Sharing Expert Knowledge from National Cancer Institute Cancer Center Tumor Boards

news Jul 01, 2020

Every day, oncologists are confronted with increasingly challenging clinical situations, and we often find that current research and practice guidelines cannot be applied to many of our patients. We look for guidance, affirmation, judgment, and feedback from experts when we catch them in hospital hallways, via emails, and or through phone calls. Valuable expert knowledge is often incredibly helpful in treating our patients, but those conversations we have with experts typically stay between two people, and don't benefit anyone who is not involved in the conversation or email chain.

This is where theMednet stepped in six years ago. We have been able to not only capture expert knowledge, but also share it with the entire oncology community, so that these one-on-one conversations can benefit physicians (and patients) everywhere.

What are tumor boards and why are they important?

Tumor boards are regular multidisciplinary conferences where challenging cancer cases are discussed and peer expertise is sought out. At National Cancer Institute Designated Comprehensive Cancer Centers (NCI-CCC), tumor boards are more than a place for decision-making. They are a place for knowledge dissemination from experts, ideas that lead to research projects, discussions of clinical trials, multidisciplinary education, and discussions of existing controversies in treatment alternatives. Unfortunately, tumor board insights from experts at NCI-CCCs are not systematically documented and disseminated in a way that is easily accessible to physicians in the community. This represents a lost opportunity to capture and share real world questions, thoughtful discussions, and clinical expertise that can impact patient care in community centers, as explained in this ASCO Post video below:

theMednet is bridging the knowledge gap between academic and community physicians across the country.

theMednet is, first and foremost, a knowledge sharing community. With over 11,000 oncologists ranging from every type of institution and oncology discipline, theMednet is in a unique position to disseminate tumor board discussion and information. In 2017, theMednet started working with NCI-CCCs to turn tumor board conversations into searchable Q&A online.

Here's how that process works: a faculty member from an academic institution is selected as a site leader (SI), who is then tasked with distilling a discussion about patient management into a question. Faculty at the participating NCI-CCs are then asked to respond to the question on theMednet. Answers are peer-reviewed, indexed, and stored on the platform. Finally, the entire discussion is sent via email newsletters to registered oncologists. Using this strategy, tumor board discussions at NCI-CCCS catapult from 15-20 oncologists who were present at a single tumor board conference, to over 11,000 on theMednet! Watch the full report here:

The program quickly expanded to 15 NCI designated cancer centers focused on breast, thoracic, and GI tumor boards across the US, including MD Anderson Cancer Center, Ohio State, Yale, Columbia, and UCLA. By the end of the pilot program, tumor board Q&A was viewed by oncologists nearly 60,000 times, with answers coming from 70 academic physicians and peer reviewed by 88. Viewership of tumor board Q&As on theMednet increased 419% over three years. Additionally, 90% of all tumor board Q&As are viewed every month, meaning there is a long-lasting potential benefit for these discussions.

Oncologists shouldn't have to digest new data and struggle through complex cases alone. theMednet connects experts at NCI-CCCs and community oncologists around the country. All of our patients benefit when expert knowledge is effectively documented and shared. Check out some of the latest tumor board questions below:

Will you recommend abemaciclib in combination with standard adjuvant endocrine therapy in patients with high risk hormone receptor positive, HER2 normal early breast cancer?

How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?

Are there circumstances where you would recommend every 6 week dosing schedule for pembrolizumab monotherapy?

What would you use as adjuvant endocrine therapy for a patient who developed an invasive, hormone receptor positive breast cancer while on raloxifene for almost a decade prior?

After WBRT, what systemic therapy would you favor for maximal CNS penetrance in a patient with triple negative metastatic breast cancer and multifocal CNS disease?

Would weak PR positivity make you consider adjuvant endocrine therapy for a young pre-menopausal woman with a HER2 positive ER negative breast cancer?

What neoadjuvant therapy would you choose for a post menopausal woman with ER negative, PR positive high grade node negative breast cancer?

What is your approach for endocrine therapy in young women (<35 years old) with HR+/HER2+ breast CA with residual disease after TCHP who will start adjuvant T-DM1?

What is your strategy for a patient who develops an enlarging ipsilateral axillary lymph node shortly after undergoing mastectomy and ALND for a pT2N3 ER+/HER2+ right breast cancer?

In light of the recent approval of Nivolumab and Ipilimumab for metastatic NSCLC with PDL1 >1%, what is your preferred first line treatment option for a fit patient who is PDL1 positive (<50%) with no driver mutations?

What is your strategy for ovarian suppression if unable to achieve goal estradiol levels with leuprolide 3.75mg monthly dose?

In which group of patients you would send for RNAseq for translocations/fusions that might be missed by NGS in advanced NSCLC?

Which adjuvant chemotherapy regimen would you recommend for a peri-menopausal woman with synchronous stage IA primary breast tumors, one that is ER+HER2+ and the second ER+HER2-?

Would you consider chemo-radiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?

How do you plan to use the data regarding abemaciclib in combination with standard adjuvant endocrine therapy in patients with high risk hormone receptor positive, HER2 normal early breast cancer?

Do you recommend routine surveillance MRI brain for asymptomatic patients with metastatic HER2+ breast cancer?

In the setting of COVID-19, would you perform a SLNB for a patient incidentally found to have microinvasive ER+ ILC in contralateral prophylactic mastectomy following neoadjuvant chemotherapy for a locally advanced triple positive breast cancer?

How do you approach a stage IIIC triple positive IDC, s/p neoadjuvant TCH and P, lumpectomy, and ALND with significant residual disease at the time of surgery?

How would you approach a stage 1 HR+/HER2- pre-menopausal patient <50 years old with Oncotype DX RS of 24?

How would you treat a patient with metastatic NSCLC on pembrolizumab with a sustained complete response, now with 2 isolated small liver lesions?

Nadine Housri

Dr. Nadine Housri is the Co-founder and Chief Medical Officer of theMednet and an Associate Professor of Radiation Oncology at Yale.