QLTI-16. Feasibility and utility of upfront methylation array testing and multidisciplinary genomic tumor boards

INTRODUCTION Molecular markers are increasingly incorporated into clinical care in neuro-oncology. Variability exists between utilization of testing modalities and workflows. This project assesses the feasibility and utility of adding upfront comprehensive molecular tumor testing and multidisciplinary genomic tumor boards (mGTB) in clinical care in a rural oncology setting. METHODS The study is open to all patients with primary non lymphomatous brain tumors that undergo surgery. We compare testing turn-around-time (TAT) and feasibility of two workflows: Standard of care (SOC) testing using in-house and vendors sequentially, versus an integrated, comprehensive brain tumor profile (BTP) using targeted next-generation sequencing and genome-wide methylation analysis during initial clinical work-up. TAT is calculated from the time tests are ordered to time of final test results. Clinician perceptions are measured by surveys. RESULTS To date, 37 patients have been approached about the study and 18 enrolled (49%). This includes 11 meningiomas, 4 gliomas, and 3 “others.” Initial barriers to enrollment include the requirement for timely consent; limited means of contact during hospitalization; and emotional stress of new diagnosis. Mean SOC testing TAT was 18.3 days. Mean BTP testing TAT was 10.1 days for methylation array and 18.8 days for next generation sequencing. Eighteen mGTBs (100%) were completed; 10 (55.6%) were attended by the treating physician with 6 completed surveys. These physicians reported the mGTBs confirmed the original diagnosis in 4 cases (67%); changed prognosis in 3 cases (50%); confirmed original treatment plans in 3 cases (50%); and increased physicians’ certainty of how to manage patients in 5 cases (83%). Discussion: This study shows feasibility of upfront comprehensive testing in primary brain tumors in a rural oncology setting. This is most applicable to gliomas but may also be useful for other tumor types. Clinicians report utility of upfront testing and mGTBs in most cases.