Episode 6: Bringing state-of-the-art molecular diagnostics to cancer patients through cross-sectoral networks - Prof. Dr. Hempel & Dr. Riedmann
In this episode of your ONCOmmunity podcast, we will debate the importance of networking and the increasing role of molecular tumour boards.
OnkoMedeor is a group of eight oncological day clinics which diagnose and treat tumour diseases as outpatient services. OnkoMedeor is part of a very strong network, where oncologists, surgeons, radiologists, pathologists and molecular pathologists regularly meet and take part in tumour boards.
Prof. Dr. Dirk Hempel, managing director, and Dr. Kristina Riedmann, leader of the molecular tumour boards of the Group, discuss the importance of networking.
“For oncologists in private practice and for routine care, it will be extremely important to organize a cross-sector network for the implementation of molecular diagnostics and molecular tumour boards. These (molecular tumour boards) are increasingly being offered virtually, so that precision oncology will find its way into broad, nationwide patient care and ultimately all patients, whether they live in the countryside or in the city, can benefit from such diagnostics and therapy.”
0:06 Welcome to “ONCOmmunity – the molecular oncology podcast” by OncoDNA. Today we’ll be talking about the topic of networking and the increasing importance of molecular tumour boards. We will be speaking with Professor Dirk Hempel, Oncologist and Managing Director of Onko-Medeor, and Dr. Kristina Riedmann, Oncologist and Head of the Molecular Tumour Board at Onko-Medeor and the Technical University of Munich. Welcome !
0:35 Hello and welcome.
Dr. Kristina Riedmann
0:37 Welcome and thank you very much for having us.
0:39 Professor Hempel, you run eight oncology centres in southern Bavaria and maintain very close relationships with the academic institutions in your region. Could you please describe how important networking is for your medical centres?
0:56 The Onko-Medeor Group is a group of eight oncological day clinics. Most of them are embedded in hospitals, whilst operating independently.
In these day units we diagnose and treat tumour diseases as outpatient services. We are part of a very strong network. For example, we are a member of the certified cancer centre in Dachau where we regularly take part in tumour boards in our capacity as oncologists along with surgeons, radiologists, pathologists and molecular pathologists.
Dr. Kristina Riedmann
1:38 I think one of the reasons why these networks are so important is that it must be possible for every patient, no matter whether they live in a big city or in the countryside, to have easy access to state-of-the-art diagnostics and to the latest therapies. These networks are also a great way to bring together oncologists in private practices - who are the patient’s trustworthy contact persons - with places like university centres, for example, which have Molecular Tumour Boards where experts from lots of different areas can come together and share their expertise.
2:16 You have already incorporated the latest molecular genomic testing into your routine cancer care. What has been your experience with this testing? And how do you explain these topics to your patients? That can’t be easy.
2:34 Well, three years ago we started to routinely incorporate molecular panel diagnostics into our standard diagnostic practice for metastatic tumour diseases. We now sequence around 1,000 samples per year and have seen some really positive developments using this state-of-the-art diagnostics.
It has become essential for our diagnosis and treatment management of metastatic diseases, and in fact we do molecular profiling for every patient with a metastatic disease relatively early in the course of the disease, actually during the diagnosis phase.
Naturally, the patients are informed ahead of any biopsy. We also explain the reasonable use of molecular diagnostics and discuss the possible options that might result from such diagnostic testing. A typical example is lung cancer, where this diagnostic is considered state of the art. We have two new major lines of treatment: on the one hand, immunological treatment with checkpoint inhibitors and, on the other, the treatment options that are based on the molecular diagnostics of the tumour tissue.
Dr. Kristina Riedmann
3:54 Exactly. We have to distinguish somewhat between molecular diagnostics which is done in the beginning, i.e. when the diagnosis is made. As Professor Hempel has already pointed out, we should mention non-small cell lung cancer where various molecular markers have a prevailing influence on the choice of treatment. Eventually, I would say that patients are only given detailed information about this when discussing their actual treatment plan. I don't think patients are told much about the diagnostics upfront in standard day-to-day practice.
Another example is when patients with advanced cancers have exhausted all of the standard of care treatment options. In such cases we enter into a direct dialogue with the patient and discuss the options of doing a new biopsy and molecular testing of the tumour tissue in order to possibly come up with some further treatment options that might go beyond the guideline therapies.
However, it is not easy to interpret the sequencing data that is derived from such molecular diagnostics. You need the relevant experts for that.
5:00 And where do you find these experts and partners?
5:07 By now, we have gained a pretty good level of expertise within our molecular tumour board group. We organise tumour boards every two weeks, where molecular pathologists, bioinformaticians, oncologists and physicians of all of the medical specialities get together.
Dr. Riedmann already briefly addressed the example of lung cancer where molecular profiling is already state-of-the-art when it comes to the diagnosis and treatment decisions of metastatic lung cancer.
However, we also know from the latest data and initiatives such as ESMO, that this kind of molecular diagnostic will now find its way into, for example, the field of gastrointestinal tumours or breast cancer rather quickly. We therefore believe that it will be extremely important to organise an interdisciplinary network for the implementation of molecular diagnostics and of molecular tumour boards as soon as possible. Of course, this will benefit oncologists in private practice and routine care as well.
From our point of view - and this is certainly a topic that gained much relevance during the current coronavirus pandemic – modern technology can play a big part in bringing this modern type of oncological care to a wider range of patients.
6:32 What are the most important pillars for other private practices to incorporate molecular genomic testing into their clinical routine?
6:44 I believe we need a good network – a network that includes both university institutions, but also the expertise and qualification of private practices and outpatient clinics. We believe that making molecular diagnostics widely available in this way will enable us to identify relevant patients who in turn can be referred to the university centres for specific clinical studies. This will only be possible if molecular diagnostics is widely available so that ultimately all patients, whether they live in the countryside or in the city, can benefit from such diagnostics and therapy.
Dr. Kristina Riedmann
7:37 Exactly, I completely agree. After all, it is now the case that almost every major university hospital has these interdisciplinary molecular tumour boards. Physicians also no longer need to drive in and take part in such a meeting in person as these boards are now also carried out virtually, so that smaller practices in rural areas can easily participate remotely.
These molecular tumour boards will play a big role in ensuring that every patient is in a position to benefit from molecular diagnostics.
8:15 Virtual is the right word. We are having this conversation virtually. It shows how good collaboration can look like without meeting on site.
Many thanks to you, Professor Hempel and Dr. Riedmann, for sharing your experience and explanations.
We hope that all our listeners enjoyed “ONCOmmunity – the molecular oncology podcast” by OncoDNA.