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Collaborating with the BTTC Network to Improve Care

In a continuing effort to increase collaboration, the weekly Neuro-Oncology Tumor Board held at the NIH is now inclusive of BTTC doctors at remote institutions.

By Neuro-Oncology Branch Staff

June 25, 2020

 

The Brain Tumor Trials Collaborative (BTTC) network is comprised of 33 institutions from across the United States—each with expertise in neuro-oncology and goals to develop and perform state-of-the-art clinical trials to advance treatments for patients with brain and spine tumors. The consortium was established in 2003, and the NCI's Center for Cancer Research's Neuro-Oncology Branch (NOB) serves as the lead institution, providing administrative infrastructure, clinical databases, and oversight for the collaborative.

The NOB offers clinical trials for BTTC network participation so that patients can participate at a center close to their home. This encourages higher enrollment, so doctors can complete trials at a more rapid pace. Thus far, the BTTC network has completed several clinical trials investigating the effectiveness of novel treatment approaches.

As NOB Chief Mark Gilbert, M.D. explains, “Over the years, the BTTC has pioneered new ways to test novel treatments, utilizing innovative clinical trial designs that speed the completion and minimize the number of patients required to determine if the therapy is effective.”

The NOB's deputy chief, Terri Armstrong, Ph.D., pioneered the BTTC alongside Dr. Gilbert. “In addition to exploring innovative treatments for the brain tumors," she says, "trials within the BTTC incorporate measures that evaluate the impact on the person by inclusion of patient reported outcomes.”

The NOB works closely with BTTC colleagues to oversee patients enrolled in clinical trials, provide a second opinion on their disease, and perform molecular testing.  

Tumor Board Offers Opportunities for Collaboration

The Neuro-Oncology Tumor Board is a weekly meeting that brings together experts from neuro-oncology, neurosurgery, radiation oncology, and neuropathology to review and discuss patient cases. The weekly tumor boards are currently virtual and integrate BTTC institutions, incentivizing doctors to present and discuss patient cases with the entire multidisciplinary team of brain and spine tumor experts at NIH. This allows patients unable to travel to receive a comprehensive second opinion and still be treated at the BTTC center closest to their home.

“This was a natural evolution to strengthen the care we provide to patients seeking treatment at the BTTC sites, as well as solidify our collaborative efforts with their care providers,” says Marta Penas-Prado, M.D., a senior clinician at the NOB who has been leading the efforts to expand the tumor board in several ways.

Dr. Penas-Prado also emphasizes that this collaboration not only helps the physicians provide the best care for their patients, but also benefits the patients as well. “For those who have had a complex evolution of their disease, it is very important for all of us to put our heads together and come up with next steps that best suit the patient’s disease trajectory. This way, many experts have weighed in on a patient’s case before a care plan is initiated.”

The BTTC network’s participation in the tumor board also helps member get to know NIH staff more intimately and learn about upcoming or open clinical trials.

In addition to these tumor board meetings, NOB and BTTC staff interact with each other through an annual meeting, regular journal club meetings, and national conferences such as the Society for Neuro-Oncology's Annual Meeting.

Expanding the BTTC Network

Beyond providing a foundation for collaborations, the BTTC also hopes to serve as a resource for patients with rare brain and spine tumors. In 2018, the BTTC sites were invited to join the NCI-CONNECT (Comprehensive Oncology Network Evaluating Rare CNS Tumors) consortium, also managed at the NOB, to perform clinical trials focused on 12 rare brain and spine tumors. Using the BTTC multi-center infrastructure to expand rare tumor trials is valuable to this subset of patients who lack access to treatments for their specific tumor type.

“Including rare tumor clinical trials is a big step toward improving care for patients who struggle with access to treatments that work,” Dr. Penas-Prado says. “We hope to increase referrals to our trials and utilize this expansion to bring treatments to our rare tumor patients much faster.”

At the NOB, there are several active studies for rare brain and spine tumors, which have been expanded to the NCI-CONNECT network. The first of these trials, which launched in March 2020, is a retrospective tissue outcomes study that collects and analyzes tumor sample data. Another clinical trial is investigating whether the immunotherapy drug nivolumab is an effective treatment for rare brain and spine cancers.

As these collaborations continue to grow, there will be plans for more innovative clinical trials, making the BTTC a leader in brain and spine tumor clinical research. The goal is to continue providing the best care for clinical trial participants, while increasing referrals to the many existing and upcoming investigative studies that benefit patients.

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