Closing the Gap: Implementation of a Novel Interactive Virtual Tumor Board to Improve Expert Knowledge Sharing in Malignant Hematology

While national guidelines exist to support physicians in determining optimal treatment, many patients require tailored treatment based on clinical or molecular factors. This is especially true in myeloma and lymphoma, where a variety of novel targeted agents and cell-based immunotherapies have gained recent adoption. Consultation with colleagues is helpful to tailor how therapies are chosen and sequenced in myeloma and lymphoma, but these consultations are limited by the depth of one's network. Tumor boards (TB), such as those at National Cancer Institute-designated comprehensive cancer centers (NCI-CCC), are used widely in solid oncology to allow multi-disciplinary discussions. We expanded the concept of a TB to malignant hematology using theMednet.org, a moderated, online knowledge-sharing platform of over 15,000 oncologists wherein physicians can discuss complex clinical challenges via a question-and-answer format. Here we review our experience and characterize the impact of this novel approach to knowledge dissemination. In the era of rapid growth in therapy, this represents a unique way to expand knowledge with the goal of improving patient outcomes.

We invited expert faculty treating multiple myeloma and lymphoma at NCI-CCC programs to participate. Each program designated several expert physicians and a site leader whose job was to identify a key clinical question from TB discussion for which no guidelines exist. After review, questions were sent to other participating NCI-CCC faculty. Answers were peer-reviewed and disseminated on a virtual feed that could be accessed asynchronously by oncologists. Following review of answers, a voluntary survey asked how the discussion impacted the readers' practice (agree, disagree, learned something new, or may change practice). We assessed the number of questions submitted, views of each question, and the impact of the answer. Correlations among hematology and oncology data sets were estimated by the Fisher's exact test.

A total of 12 NCI-CCC sites participated in the myeloma and lymphoma virtual TB program. Data were collected from July 2021 to July 2022. A total of 40 questions (22 myeloma, 18 lymphoma) and 55 total peer-reviewed answers (36 myeloma, 19 lymphoma) were submitted. A total of 67 literature references were included in 32 answers. Answers had broad engagement reaching 1,116 oncologists from 848 institutions across the US. Answers were viewed 6,612 times. Demographics were consistent with real-world practice distribution, with a make-up of 17% academic (n=189), 60% community (n=665), and 16% fellows (n=179) with remainder not identified. The median time from question post to first answer was 4 days. Of the 185 responses to the post-review survey, 35% (n=64) reported the Q&A confirmed current practice, 30% (n=55) indicated answers contributed to new knowledge, 33% (n=62) reported it may change future practice, 2% (n=4) reported other as a response. As an exploratory analysis, we collected similar data from users of virtual TBs in solid oncology from this website. Of 1063 responses from solid TB, 61% (n=646) reported confirmation of current practice, 20% (n=214) reported new knowledge gained, 15% (n=163) reported answers would change practice and 4% (n=40) answered other. Those differences were statistically significant indicating the use of malignant hematology TB was more likely to result in learning something new (p=0.005) and more likely to change their practice (p<0.001), whereas oncology TB was more likely to confirm current practice (p<0.001).

Implementation of a virtual NCI-CCC malignant hematology TB program allows for real-time access to a searchable repository which expands access to specialty expertise, permits broader collaboration, impacts patient care, and serves as an avenue for new knowledge acquisition and dissemination of relevant literature. In contrast to TB data from solid tumors, readers of malignant hematology were less likely to report that the answers confirmed their practice and more likely to state that they learned something new. These findings may signal a higher level of virtual TB impact in hematologic malignancies, which are less frequently encountered in the community given lower incidence compared to solid tumors. With rapidly expanding treatment approaches in hematologic care, virtual TBs represent an innovative approach to education and can break down silos in oncologic care.

Housri:theMednet: Current Employment, Current equity holder in private company. Banerjee:Clinical Care Options: Honoraria; Curio Science: Honoraria; Eradigm Consulting: Consultancy; Guidepoint Global: Consultancy; i3 Health: Consultancy; Pack Health: Research Funding; Sanofi: Consultancy; SparkCures: Consultancy. Brem:BeiGene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pharmacyclics/Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Morphosys/Incyte: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; ADC Therapeutics: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; KiTE Pharma: Membership on an entity's Board of Directors or advisory committees; SeaGen: Speakers Bureau; TG Therapeutics: Consultancy. Derman:COTA Healthcare: Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy; Sanofi: Consultancy. Hill:Novartis: Consultancy, Honoraria, Research Funding; Kite, a Gilead Company: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support, Research Funding; BMS: Consultancy, Honoraria, Research Funding. Hofmeister:Sanofi: Research Funding; GlaxoSmithKline: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Research Funding; BlueBird Bio: Honoraria; Genzyme: Membership on an entity's Board of Directors or advisory committees. Lunning:AbbVie: Consultancy; Acrotech: Consultancy; Seattle Genetics: Consultancy; CURIS: Research Funding; Diiachi-Sankyo: Consultancy; ADC Therapeutics: Consultancy; Pharmacyclics: Consultancy; Astra-Zeneca: Consultancy; Nurix Therapeutics: Consultancy; Genmab: Consultancy; Kite, a Gilead Company: Consultancy; Janssen: Consultancy; BMS: Consultancy, Research Funding; Genentech: Consultancy; Fate Therapeutics: Consultancy; EUSA: Consultancy; Morphosys: Consultancy; Astellas: Consultancy; TG Therapeutics: Consultancy. Matasar:F. Hoffmann-La Roche Ltd.: Consultancy, Honoraria, Research Funding; Genentech, Inc.: Consultancy, Honoraria, Research Funding; Daiichi Sankyo: Consultancy; Juno Therapeutics: Consultancy; Merck: Consultancy, Current equity holder in private company; Epizyme: Consultancy, Honoraria; AstraZeneca: Consultancy; Takeda: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria, Research Funding; Teva: Consultancy; GlaxoSmithKline: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Pharmacyclics: Honoraria, Research Funding; ImmunoVaccine Technologies: Honoraria, Research Funding; ADC Therapeutics: Consultancy, Honoraria; Rocket Medical: Consultancy, Research Funding; IMV Therapeutics: Consultancy, Honoraria; Karyopharm: Consultancy; TG Therapeutics: Consultancy; IGM Biosciences: Research Funding. Phillips:Pharmacyclics: Consultancy; AbbVie: Consultancy, Research Funding; Xencor: Consultancy; ADC Therapeutics: Consultancy; Beigene: Consultancy; Genentech: Consultancy, Research Funding; Bayer: Consultancy; Eli Lilly: Consultancy; Gilead: Consultancy; Genmab: Consultancy; Epizyme: Consultancy; Incyte: Consultancy, Other: Travel Expenses ; AstraZeneca: Consultancy. Rutherford:Karyopharm: Consultancy, Research Funding; Genentech: Research Funding; Dova: Consultancy; Kite Pharma: Consultancy; Celgene/Juno: Consultancy; ADC Therapeutics: Consultancy.