By: Ami Patel MD

Introduction:

CancerRx could be a useful app in the oncology world if one was looking for a quick list of possible therapy options targeting molecular profiles of certain tumors. This app currently includes only lung cancer, metastatic breast cancer, melanoma and colorectal cancer with plans to expand the scope at a later date. The app also provides a list of potential clinical trials that could be utilized based on the molecular profile of an individual tumor.

User Interface:

The app opens with a therapy finder look up menu which asks the user to identify the type/histology of the tumor. It then prompts the user to input the stage and molecular testing results largely based from the pathology report of the specific tumor i.e. EGFR/ALK mutation status of lung tumors. The first step is to choose the type of cancer you are interested in.

For example, let’s choose metastatic breast cancer. Our patient is Mrs. Smith, a 65 yr old female recently diagnosed with invasive ductal carcinoma of the right breast metastatic to bone.

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The next screen asks for the tumor’s receptor status. Mrs. Smith’s breast tumor is ER+/PR+/HER2-.

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Next, her menopausal status needs to be entered. Mrs. Smith is post-menopausal.

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Then, the app asks for the sites of metastases. Mrs. Smith currently has evidence of only bone metastases.

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Furthermore, in the app’s algorithm is family history and BRCA1/BRCA2 status. Mrs. Smith’s maternal aunt had breast cancer and her BRCA1/BRCA2 receptor status is negative.

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We are then prompted for more history about the extent of the disease at the time of presentation and any treatments that the patient may have already received. Mrs. Smith initially presented with metastatic breast cancer to the bone and has not yet received any treatment.

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On CT Chest/Abdomen/Pelvis, Mrs. Smith does not have any evidence of organ damage related to metastases. Further, the blood counts, renal function and liver function are within normal limits.

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Based on the patient’s history, tumor characteristics and family history entered, the app provides suggestions regarding further molecular testing which may be relevant–BRCA1/BRCA2 receptor status if it has not already been done. It also explains the relevance of these tests.

If all the relevant molecular testing results have been entered, the app generates a list of possible therapy options in addition to currently enrolling clinical trials that may be appropriate for the patient.

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The therapy options includes a list of drugs and basic information about them i.e. mechanism of action, route of administration and important prescribing information such as rare and common side effects and important things to take into consideration before prescribing the drug.

This is the section of the app that could be improved upon by providing further guidance as to which drug should be used first. From clinical experience, usually anastrozole, which is an aromatase inhibitor, is used first in postmenopausal women with ER+/PR+/HER2- invasive ductal carcinoma but the app does not provide sufficient guidance in this regard.

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Therefore, this app can be used on the floor or in the clinic as a quick guide to determine the overall approach to a patient with metastatic breast cancer, melanoma, lung cancer or colon cancer. Some information is cited with references which is helpful for corroboration i.e. the significance of BRAF mutation analysis in metastatic melanoma as shown below.

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For early stage diseases where molecular testing and targeted therapies have less of a role, users are referred to other reputable sites, such as NCCN, NCI, ASCO. The app provides links to these reputable sources, making them easy to access from your device.

Healthcare providers that would benefit from the app

  • Physicians, Oncology Fellows, Residents
  • Price
    • Free
    • Provides a comprehensive list of relevant clinical trials and treatment options that might be appropriate based on tumor characteristics.
    • Provides more information on relevant molecular tests and their significance for particular tumors.
    • The above characteristics make it a great starting point when considering further molecular testing and investigational therapies for patients.
    • The app is maintained by leading experts in the fields of genomics and medical oncology with regular updates to reflect current guidelines.
    • Link at the bottom of the title page to interesting health articles in the news related to cancer epidemiology and diagnosing/treating cancer.
  • Dislikes
    • Does not rank therapy options as first-line, second-line, third-line, fourth-line, etc.
    • Does not provide an algorithmic approach to work up/treatment of different malignancies.
    • Does not provide a sufficient amount of treatment guidance for early stage disease.
  • Overall
    • At this point, CancerRx is not a replacement for referencing NCCN guidelines. NCCN guidelines provide a much clearer and specific algorithmic approach to treatment of cancer of all types, including relevant clinical trials and targeted molecular therapies.
    • However, CancerRx may be a useful adjunct tool that recommends appropriate molecular testing based on tumor type and provides detailed information on indicated molecular tests and use of their results to guide therapeutic choices.
    • The app may be more useful if it widened its scope to include all major types of cancers and gave some guidance in terms of ranking treatments as first-line therapies, second-line therapies, third-line, fourth-line and so on instead of just generating a list of all possible therapies without any direction.
  • Overall Score
  • User Interface

    Easy to use and navigate by answering simple multiple choice questions.

  • Multimedia Usage

    Easy transition step-by-step.

  • Price

    Free.

  • Real World Applicability

    The scope of the app is currently limited in that it includes just a few types of cancers. Furthermore, the last step does not provide sufficient guidance in regards to ranking possible treatment options once the list is generated based on tumor profiles.

  • Device Used For Review

    iPhone 5

  • Available for DownloadiPhoneiPad