The Duke Molecular Tumor Board (DMTB) is a collaboration between the Duke Pathology Department and the Duke Cancer Institute (DCI). It was developed to foster precision medicine within the DCI. The goal of this effort is to match the most effective and safest therapy to each patient in real-time.
About
Events
News
None
The field of precision cancer medicine is rapidly evolving, with an ever-growing list of targeted therapies approved for use in advanced cancer patients harboring specific genetic alterations. The Molecular Tumor Board is a robust and rapidly expanding clinical tumor sequencing program, which offers our patients the highest quality and most comprehensive genomic profiling test available.
In addition, the Duke Molecular Tumor Board provides molecular decision-making support to advance biomarker-based clinical research and to foster precision cancer medicine within the Duke Cancer Institute. Its members meet weekly and include a diverse group of pathologists, oncologists, scientists, medical geneticists, and clinical trial teams.
The Duke Molecular Tumor Board analyzes the results of clinical next-generation sequencing (NGS) tests and shares its insights with the patient’s care team. Discussions include clinical best practices, clinical recommendations based on specific mutational profiles, clinical trial matching, and referrals to medical genetics.
Molecular profiling data is kept in a secure registry maintained by the Duke Molecular Tumor Board, and updated recommendations are disseminated to patient care teams as clinical best practices evolve and novel therapeutic options emerge.
Contact Us
If you are a DukeHealth provider, please send an email to DukeMolecularTumorBoard@dm.duke.edu to learn more about the DTMB meetings, or to request a patient be reviewed.
Charlotte-area resident Vickie Johnson, 72, was diagnosed with colon cancer in 2018 after seeking care twice for abdominal pain. First, she was diagnosed with appendicitis and had her appendix out. Then, when her pain persisted beyond the recovery period, she received a new diagnosis. A scan at the ER showed a possible tumor. She went back to her appendix surgeon, had the mass in her colon removed, and was referred to a hospital oncologist. He referred her to a second surgeon who performed an even more aggressive surgery to remove all the remaining cancer in her colon and got her started on chemotherapy.Unfortunately, after each chemotherapy infusion she experienced severe chest pain. As she described it, “terrible spasms like I was having a heart attack.” Her oncologist didn’t have a plan b. “Finally, he said ‘I'm sorry, there's nothing I can do. We'll just test your blood every so often and get a scan every six months,’” Johnson shared. She wasn’t ready to give up, and as it turned out she didn’t need to.Johnson’s next area oncologist — Justin Favaro, MD, PhD — who'd done his medical training at Duke, brought a cardio-oncologist onboard the care team. The two providers tweaked the chemotherapy regimen she’d been on with the first oncologist; adjusting the dosage so her heart would be able to tolerate it. That worked, but successive treatments didn’t make any headway against her cancer.Johnson had begun 2019 in treatment for newly diagnosed colon cancer and ended that year with the death of her husband and progression of her cancer. During 2020, she’d endured another chemotherapy regimen but with no success. Cancer metastases remained in her liver and her lungs.Patients with metastatic colorectal cancer who have progressed on standard chemotherapy receive limited benefit from the available standard of care options. Johnson had genomic testing done and it turned out her cancer was hardwired with a KRAS G12C mutation, an alteration found in 3 to 4% of all metastatic colorectal cancer cases. Favaro said there was one more option.In the summer of 2021, he referred Johnson for enrollment in CodeBreaK 101, an early-stage clinical trial (phase 1b/2) at Duke Cancer Institute testing a new approach to treating KRAS G12C-mutated solid tumor cancers — a new KRAS G12C inhibitor drug (sotorasib) in combination with other anti-cancer therapies of choice, including FDA-approved antibodies, immunotherapy, and chemotherapy drugs. DCI was one of the first institutions worldwide to open this trial, which had launched in December 2019.Duke Cancer Institute GI medical oncologist and Associate Professor of Medicine John Strickler, MD, was Duke site principal investigator. Strickler is a colon cancer specialist who co-leads the DCI Precision Cancer Medicine and Investigational Therapeutics Research Program and the Molecular Tumor Board.Johnson said she had “no hesitation” about her decision and was grateful when she qualified for recruitment to the study under the care of Strickler.“This was the option. Nothing else was working,” Johnson recalled.
Duke Cancer Institute Blog
DCI member Jose Ramon Conejo-Garcia, MD, PhD, (left), worked with co-authors Mostafa Eysha, PhD; Luis Bailon, PhD; and co-senior author Carmen Anadon, PhD, on an antibody approach for precision cancer treatment. (Photo by Les Todd)
New Mexico, Texas, Kansas, Oklahoma, Arkansas, Louisiana, Missouri, Alabama, Georgia, Florida, South Carolina, and North Carolina, make up the Southern Division of the National Cancer Institute Cooperative Human Tissue Network's Southern Division. Duke University is the headquarters of the Southern Division.
The Cooperative Human Tissue Network was created by the National Cancer Institute in 1987 to support a coordinated national effort to collect and distribute high-quality, pathologist-validated human tissues for cancer research.
Since then, the network has expanded to provide different types of tissue samples, blood and body fluid samples, immunohistologic and molecular sample preparations, tissue microarrays, and clinical datasets inclusive of biomarkers and molecular testing. From inception through the end of 2021, the network has distributed 1,375,041 bio-specimens. It served 889 active investigators in 2021.
In a new article in Molecular Cancer Therapeutics, CHTN Southern Division leader Shannon McCall, MD (corresponding author), together with the other 5 CHTN Division leaders and NCI staff, breaks down the advances of the past 15 years, including the shift from molecular biomarker testing of individual genes to panels of hundreds of genes to the increased use of whole-exome and whole-genome sequencing, and steps they are taking to optimize the representation of diverse communities among the distributed biospecimens.
Duke has been the CHTN Southern Division Headquarters since 2019.
This division encompasses the states of North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, Kansas, Texas, and New Mexico. Operational and scientific highlights of the CHTN Southern Division (page 7 of the review) include: the Frameshift Molecular Registry of Tumors and leading-edge technologies like whole-slide imaging, nucleic acid extraction, digital spatial profiling/transcriptomics via the NanoString GeoMx platform, multiplexed IHC stains for standard immune markers, and more.
READ THE REVIEW IN FULL
Duke Cancer Institute Blog
When Eleanor Scott Bell needed cancer care her doctor sent her to see Duke Cancer Network doctors at Gibson Cancer Center in Lumberton, close to where she grew up as a member of the Lumbee Tribe of North Carolina, "People of the Dark Water."
Eleanor Scott Bell, 79, was born and raised in Lumberton, the capital of Robeson County in North Carolina.One of her earliest memories is of picking tobacco to supplement the family income. They were a family of nine with a large extended family — part of the Lumbee Tribeof NC, "People of the Dark Water."“My daddy was in construction. He did brickwork, but he let us work with the local farmers. I started when I was probably 9 years old standing up on a cinder block handing tobacco to my momma,” she said.Her first full-time job, once she turned 18, was at a local linen supply company. She began working for Temptation Hosiery Mills in Lumberton — maker of L’eggs pantyhose and other Hanes products — after it opened in 1974. Her sister Carolynworked at the large Converse factory in Lumberton, which had opened in a former B.F. Goodrich tire manufacturing facility in 1972 to makeChuck Taylor All-Star shoesand other sneaker styles.In 1970, Eleanor Scott married Travis Bell, also a member of the Lumbee community.In 1977, the couple moved out of their single trailer in a Lumberton mobile home park and bought land and a double-wide further north in St. Pauls — a “Small Town with a Big Heart” located closer to the Fort Bragg U.S. Army base where Travisworked as a barber.St. Pauls and Lumberton were part of the late 19th/early 20th-century textile boom that created mill communities across the Piedmont region of the state. The communities’ prosperity really took off in the 1940s when a big textile corporation purchased several area cotton mills. By 1953, North Carolina was a manufacturing powerhouse,leading the nation in hosiery production.Textiles (including hosiery, clothing, and footwear) were woven into the fabric of many lives in the region. But beginning in the mid-1980s and through the 1990s production shifted to Latin America, China, and Southeast Asia — leaving thousands of workers, including in the Lumberton area, jobless. As noted in theOur Statemagazine article“Heart & Soles,”“if you grew up in the Piedmont in the half-century prior to the mid-’90s, chances are good that someone in your family — your grandfather or grandmother, your mom or dad, your aunts or uncles, your siblings or cousins — worked in a hosiery mill.These days it’s common to find mentions of Temptation Hosiery (bought by the Sara Lee Corporation, then closed in 1994), Kaiser Roth Mills, Converse (whichclosed their Lumberton plant in 2001), and other prominent factories of that era inThe Robesoniannewspaper obituary pages.In 1980, at the age of 37,Eleanor Bell was forced to resign from Temptation for medical reasons. She had developed rheumatoid arthritis in her legs at around age 35 and stayed active — working and attending church on a regular basis — for as long as she could. But after undergoing surgery on her legs,her ankles then hips started “giving out.” She began using a walker, and one day fell and broke her knees. In 1999, she started using a wheelchair off and on to get around and in 2007, at age 64, became a full-time wheelchair user.Her churchprocured her a bed with a remote control that helps lift her up and out of the bed into her electric wheelchair each morning, which has allowed her to stay active.
Part of a Special Report by Duke Cancer Institute & the Department of Pathology, Duke University School of Medicine — as featured in the 2021-22 Department of Pathology Annual Report (pdf)Oncologists today have a wider range of anti-cancer drugs to reach for, many of which target the molecular alterations believed to contribute to the cancer’s development.Comprehensive genomic profiling, also known as next-generation sequencing (NGS), is used to identify these molecular alterations. Duke Cancer Institute (DCI) oncologists partner with Duke University Health System (DUHS) Clinical Labs and private diagnostics companies to test patients at diagnosis and/or after the cancer grows or spreads.While it can vary across cancer types, increasingly, targeted therapies that can save patients from needing toxic chemotherapy are becoming available at multiple points in a patient’s cancer treatment, from first line standard of care to subsequent treatment after progression on conventional therapies.Test results are entered into a Molecular Registry of Tumors known as Frameshift MRT. This centralized informatics tool — designed, built, and coded at Duke byMichael Datto, MD, PhD, (currently the medical director of DUHS Clinical Labs and vice chair for Clinical Pathology) and Christopher Hubbard (DUHS clinical informatics architect) — helps oncologists identify if anything in their patient’s mutational profile, even extremely rare targets, can be treated with any existing targeted therapies or immunotherapies.Duke Cancer Institute has been offering its patients NGS testing since 2014. Developing Frameshift MRT three years later to organize and optimize the growing volume and complexity of data, and the subsequent formation, in early 2018, of a weekly multidisciplinary Molecular Tumor Board to review complex patient cases was a perfectly timed great leap forward.The Precision Cancer Medicine Initiative — launched in 2017 by DCI, the BioRepository & Precision Pathology Center (BRPC), and the Clinical Labs — was the critical push behind it.“It had become increasingly clear that the needs of sophisticated cancer researchers were changing across all cancer types; moving away from generic, archived, cancer-tissue samples, to fresh samples, to samples with a specific molecular abnormality,” explains Shannon McCall, MD, director of the BRPC, a DCI and Duke University School of Medicine Shared Resource housed in the Department of Pathology. “This coincided with clinical advances. Providers, including at DCI, were utilizing these broad molecular profiling assays to direct the care of cancer patients. There was a need to harness all this molecular profiling data to support both cancer research and treatment. I was totally on fire to get this started. We have so many big thinkers at Duke who said, ‘Let’s think about data and what’s possible.’”In mid-2018, Executive Director of DCI Michael Kastan, MD, PhD, a noted cancer biologist, and Chair of the Department of Pathology Jiaoti Huang, MD, PhD, a prostate cancer researcher, signed a memorandum of understanding to co-fund the staffing necessary to further support the Molecular Tumor Board — co-directed by oncologists John Strickler, MD (for solid tumor cancers), and Matthew McKinney, MD (for blood cancers) — and to manage the Frameshift MRT database. This included hiring a bioinformatician/ data analyst (Jonathan Bell, PhD) and a savvy genetics scientist (Michelle Green, PhD).Green, fresh from a position in the molecular diagnostic testing industry, joined the Duke Pathology (with salary support from DCI) in the spring of 2019 as senior research program leader of the Molecular Tumor Board and main user and manager of Frameshift MRT. She tracks promising clinical trials and new FDA drug approvals and has configured Frameshift MRT to automatically send therapy alerts to providers when their patients' molecular profiles match any known anti-cancer drug(s). This match could include drugs that are already FDA-approved, drugs that are “emerging” with strong clinical evidence, drugs that are being tested in clinical trials, or drugs that are approved or being trialed in another cancer type.Over the course of the COVID-19 pandemic, Green has made several significant changes to Frameshift MRT that make it more user-friendly, interactive, and accessible for clinicians and researchers, who can access the Frameshift MRT dashboard when logged into the Duke VPN. Green is available to train and advise.
A special report by Duke Cancer Institute the Department of Pathology, Duke University School of Medicine — as featured in the 2021-22 Department of Pathology Annual Report
2012
TheDuke Cancer Institute (DCI) and the Duke University School of Medicine commit to a five-year, $3 million investment in a new Duke BioRepository & Precision Pathology Center (BRPC) — a clinical research and discovery entity with its administrative home in the Department of Pathology. Michael Datto, MD, PhD, is named director.
2013
Shannon McCall, MD, takes over as director of the BRPC and the BRPC receives CAP accreditation as a tissue, blood, and fluid biorepository, tissue procurement service, and research support core laboratory.
2014
The BRPC becomes an approved Duke University School of Medicine Service Center (also known as a Core Research Facility) and a DCI Shared Resource.
Duke Cancer Institute begins partnering with leading private diagnostics companies and the Duke University Health System Clinical Labs to screen the DNA of cancer cells in tumor tissue and blood for hundreds of potentially "druggable" (targetable with anti-cancer drugs) molecular alterations.
2016
Jiaoti Huang, MD, PhD, is named chair of the Department of Pathology.
The BRPC absorbs the Pathology Department’s Research Histology Laboratory (then led by Alan Proia, MD, PhD) and adds Histology and Immunohistochemistry services; laser capture microdissection tech; and a tissue microarrayer device.
2017
North Carolina Biotechnology Center infrastructure grant is awarded to Shannon McCall, MD, BRPC director, which allows for the addition of a Leica AT2 whole slide imager, dedicated image handling software, and the Visiopharm Oncotopix research image analysis software platform.
2017-2018
The BRPC leadership team expands with the addition of an associate director — Xiaoyin (Sara) Jiang, MD. (Jiang serves in that role throughout 2018 and early 2019 before becoming chief of the Head and Neck Pathology Service)
In-house Molecular Registry of Tumors called Frameshift MRT — the backbone of the Precision Cancer Medicine Initiative — is developed, designed, and programmed by Michael Datto, MD, PhD, with the assistance of Chris Hubbard and input from Shannon McCall, MD, at minimal cost (covered by Pathology). No outside software contracts or private programming services are required.
2018
The first multidisciplinary Molecular Tumor Board (MTB) meeting — co-led by DCI oncologists John Strickler, MD (a medical oncologist with solid tumor expertise) and Matthew McKinney, MD (a medical oncologist who specializes in hematologic malignancies) — is held on Jan. 29. The MTB meets weekly to discuss comprehensive genomic profiling results and promote the adoption of precision oncology at DCI.
Executive Director of DCI Michael Kastan, MD, and Chair of the Department of Pathology, Jiaoti Huang, MD, PhD, sign a memorandum of understanding to fund the positions necessary to support the growing Duke Precision Cancer Medicine Initiative.
The Duke Cancer Institute is invited to join a national consortium of institutions pooling their de-identified genomic data into a national molecular registry of tumors for the global good of cancer research and care [PROJECT GENIE (Genomics, Evidence, Neoplasia, Information, Exchange).
Shannon McCall, MD, Duke site PI, and her team of BRPC experts in histopathologic and molecular data annotation, partner with Michael Datto, MD, PhD, Chris Hubbard, computer programmers Jeremy Gresham and Michael Fox, and Kouros Owzar, PhD (director of the DCI Bioinformatics Shared Resource), prepare the first annual batch of 500 (de-identified) NGS test records from Frameshift MRT for upload into the GENIE system.
A bioinformatician/data analyst (Jonathan Bell, PhD) — split-funded by DCI and the Pathology Department — is hired to support the Duke Precision Cancer Medicine Initiative.
2019
The Duke University AI Health Initiative invests in a Leica GT450 whole slide imager and image server for the BRPC.
Genetics scientist Michelle Green, PhD, is hired by the Department of Pathology to serve as Senior Research Program Leader for the Molecular Tumor Board and main user of Frameshift MRT.
Three new sub-specialized associate director roles are created in the Department of Pathology: William Jeck, MD, PhD (for the Artificial Intelligence & Computational Pathology Service); Avani Pendse, MD, PhD (for the Immunohistochemistry Service and the Proteomics Service); and Jadee Neff, MD, PhD (for the Genomics Service and for the Digital Spatial Profiling Service).
A new BRPC position — liaison to the Autopsy Service — is created. This role is filled by Carolyn Glass, MD, PhD.
The BRPC, with Shannon McCall, MD, as principal investigator, is named the new site of the Southern Division of the National Cancer Institute-supported Cooperative Human Tissue Network (CHTN).
2020
The Duke University School of Medicine invests in a Nanostring GeoMx Digital Spatial Profiler for the BRPC service center, making spatially-resolved transcriptomics (a type of technology named 2020 "Method of the Year" by the journal Nature Methods) available to Duke researchers.
The V-Foundation awards a grant to a DCI clinical team led by Duke Cancer Network medical director Linda Sutton, MD — “Advancing Cancer Care in the Rural Southeast: Enhancing Precision Medicine and Institutional Collaboration in Community Cancer Centers.” The funding is used to train Duke Cancer Network providers in North Carolina on how to access and utilize next-generation sequencing (NGS) testing to expand treatment and clinical trial options for their patients and to educate patients about these tests.
2021
The V-Foundation awards a grant — “Implementing Evidence-Based Interventions to Enhance Equity in Oncology Genomic Testing” — to Tomi Akinyemiju, PhD, MS, DCI social and molecular cancer epidemiologist and associate director, DCI Community Outreach, Engagement, and Equity (COEE). Linking Frameshift MRT data with Tumor Registry data and interviewing oncologists and patients, she begins to assess differences in NGS testing use among cancer patients at DCI, the Duke Cancer Network, and other cancer clinics by race and cancer type, and to examine key socio-demographic, healthcare access-related and clinical drivers of potential disparities. (Preliminary results confirm that Black patients are less likely to receive genomic testing and associated targeted therapies)
Carolyn Glass, MD, PhD, is named BRPC liaison to the National Cancer Institute-Designated DCI Immuno-Oncology Research Program.
Shannon McCall, MD, and John Strickler, MD are named as co-leaders of the National Cancer Institute-designated DCI Precision Cancer Medicine & Investigational Therapeutics Research Program (together with Dorothy Sipkins, MD, PhD, director of the Sipkins Lab)
Duke Cancer Institute and the BRPC lay the groundwork for the expansion of NGS testing access, integration of test results into the Frameshift MRT database, and Molecular Tumor Board support, to Duke Cancer Network clinic sites in rural North Carolina and beyond. A team led by Michael Datto, MD, PhD, builds the software infrastructure, and two-year precision oncology fellow Bennett Caughey, MD, is brought on to help facilitate the workflow that this will require. Hereditary genetics counselor Nicholette T. Sloat, CGC, MA, MS, also joins the project team.
2022
In early January 2022, the National Comprehensive Cancer Network Oncology Research Program (NCCN-ORP), with support from Eli Lilly and Company, awards a two-year $300,000 grant to John Strickler, MD, co-leader of the Molecular Tumor Board, to “Expand the Duke Molecular Tumor Board to Community Oncology Sites Across the Southeast to Support Adoption of Comprehensive Genomic Profiling and Biomarker Driven Therapy Selection for Lung and Thyroid Cancer Patients.” The grant, which takes effect in November 2022, will give further support to the expansion that's already in progress. The team will track the rate of NGS tests ordered for lung and thyroid cancers compared to peer centers, the frequency at which actionable alterations are detected, and the rate at which patients receive molecularly-targeted therapies compared to peer centers.
Part of a Special Report by Duke Cancer Institute & the Department of Pathology, Duke University School of Medicine — as featured in the 2021-22 Department of Pathology Annual Report.
Part of a Special Report by Duke Cancer Institute the Department of Pathology, Duke University School of Medicine — as featured in the 2021-22 Department of Pathology Annual ReportThe Duke BioRepository & Precision Pathology Center (BRPC, a clinical research and discovery Shared Resource with its administrative home in the Department of Pathology, was launched in 2012 with a five-year three-million-dollar investment from Duke Cancer Institute and the Duke University School of Medicine. Spurred by key investments in technology, services, and personnel, the BRPC grew, thrived, and progressively built a national reputation.“It’s success,” notes BRPC director and DCI pathologist Shannon McCall, MD, “represents the evolution and extension of the Department of Pathology’s support and commitment to cancer research."The BRPC has served as the biospecimen/pathology core for several U.S. government-funded, multi-institutional, and homegrown studies at Duke Cancer Institute (DCI).The inclusion of at least one core, McCall notes, and often more than one core, is required for large program-level government grants.“A strong BRPC, plus a strong Biostatistics Core (another DCI/School of Medicine Shared Resource) and/or the Bioinformatics Core boosts the competitiveness of DCI for these big grants,” notes McCall.McCall herself is American Board of Pathology-certified in Clinical Informatics as well as Anatomic/Clinical Pathology and General Pathology and is chair of the Biorepository Accreditation Program Committee of the College of American Pathologists. She has been involved in numerous translational cancer research projects that rely on the study of human biological samples and data-driven research. With a research focus on upper GI tract carcinogenesis, she previously served as a member of the data analysis working group for The Cancer Genome Atlas (TCGA) esophageal and pan-GI projects.Under McCall's leadership,DCI joined a national molecular registry of tumors — the American Association for Cancer Research's PROJECT GENIE (Genomics Evidence Neoplasia Information Exchange) — and became the base for the National Cancer Institute-supported Southern Division of the Cooperative Human Tissue Network.Leading cancer pathologists with the BRPC, like McCall, have worked and continue to work hand in glove with other DCI investigators on several major cancer research grants, which are described below.
Tissue-Based Research & Precision Cancer Medicine Come of AgeA Special Report by Duke Cancer Institute & the Department of Pathology, Duke University School of Medicine — as featured in the 2021-22 Department of Pathology Annual Report
Duke Cancer Institute Blog
Duke University Marching Band Kicks Off the DCI 50th Celebration (photo by Drawbridge Media)
On Thursday, April 14, 2022, Duke Cancer Institute clinical providers, researchers, staff, and leadership came together to celebrate the 50th anniversary of the Duke Comprehensive Cancer Center (now called Duke Cancer Institute).As the DCI 50th kickoff celebration was gearing up on the grassy circle in front of Duke Cancer Center building in Durham, a few patients stopped by the adjacent Seese-Thornton Garden of Tranquility for some respite.A breast cancer patient of Susan Dent, MD, braced for a long day of chemotherapy infusions. A man with stage 3 melanoma, being treated by Brent Hanks, MD, chatted in the shade of a tree with his wife ahead of his next appointment. A woman on her way to the Duke South clinics, meanwhile, shared her worries over her brother’s recent esophageal cancer diagnosis, their strong family history of cancer, and the importance of keeping up with her mammograms.Joe Moore, MD — who hung up his DCI lab coat in 2019 after a 44-year Hematology /Oncology career — was admiring the newly-installed Sound of Hope bell (a gift of the J. Gordon Wright family in honor of Nancy Wright, a pancreatic cancer survivor) before Jana Wagenseller, RN, escorted him across the grass to a front-row seat, stage right. (Moore had begun his medical career at Duke in 1975 as a fellow and Wagenseller had begun her nursing career at Duke in 1976 and served in multiple leadership roles before retiring in 2004).The Duke University Marching Band made a jubilant entrance onto the green and briefly performed in front of a big-screen slideshow showcasing moments in DCI history before the official program began.