Health Care

Leveraging Evidence-based Oncology Pathways to Inform Multidisciplinary Tumor Board Decisions in Melanoma

AdventHealth Cancer Institute’s (AHCI) Tarek Mekhail, MD, and Michael McPhee, MD, recently published a partner spotlight article in the Journal of Clinical Pathways highlighting the establishment of a Cutaneous Oncology Consortium (COC) in 2020 designed to improve the outcomes of Central Florida patients with malignant melanoma.

The Food and Drug Administration’s approval of ipilimumab for the treatment of metastatic melanoma in 2011 helped to revolutionize the care of metastatic melanoma patients. New treatments have continued to emerge over the past decade, advancing the care delivery model. Because most melanomas are treated in the community setting, AHCI decided to engage with these providers to ensure a more seamless approach to care and specialist referrals for patients with systemic disease.

As a result, the COC is comprised of physician members representing all specialties who share expertise in the care of patients with malignant melanoma. Its foundation has been a dedicated Multidisciplinary Melanoma Tumor Board (MMTB) that began in January 2021. The MMTB provides second opinion reviews on pathology, prospective treatment plans, clinical trial screenings, and navigation support for patients.

Cancer Research Unit

Each COC meeting includes discussion and evaluation of the latest evidence using a hierarchy of efficacy, toxicity and cost. In addition, in 2018, AdventHealth implemented Elsevier’s ClinicalPath (formerly Via Oncology) evidence-based, multidisciplinary oncology pathways which are developed by leading oncologists throughout the country. The MMTB users both of these resources to guide evidence-based decision-making for melanoma patients in an effort to improve outcomes.

Recently, the MMTB discussed a patient with cutaneous squamous cell carcinoma, with locally advanced unresectable disease. Because this was a presentation not often seen at AHCI, the MMTB consulted the pathways, which indicated that treatment with neoadjuvant cemiplimab was supported by the literature.  

Future plans for the COC include further enhancing the referral process for melanoma patients to ensure more seamless continuity of care.

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