25. Enhancing precision oncology: The value of open-source knowledgebase integration

Precision oncology relies on advanced sequencing technologies to guide treatment strategies, yet effectively translating genomic data into actionable insights remains a critical challenge. The Personalized OncoGenomics (POG) program at BC Cancer utilizes whole genome and transcriptome analysis (WGTA), providing a comprehensive view of the molecular biology of advanced cancer patient tumours, with over 1200 patients enrolled to-date. This analysis relies on curated clinical knowledgebases linking cancer variants and their clinical relevance, but the breadth and utility of these can be limited by access restrictions or missing information. CIViC (Clinical Interpretation of Variants in Cancer; civicdb.org) is an open-access, expert moderated, crowd-sourced knowledgebase of clinically relevant cancer variants that aims to address these limitations and is one of several sources used for variant interpretation in POG. Based on a retrospective cohort of POG cases, we evaluated the knowledgebase coverage of genes and variants involved in treatment recommendations from the molecular tumour board (MTB) as well as those suggested by genome analysts. We also considered the impact of quality of evidence on MTB recommendations and patient treatments. We found more than 95% of patients had an alteration considered clinically actionable by the MTB, demonstrating the benefit of WGTA paired with open-source automated variant matching and reporting software. Clinical interpretations derived from CIViC represented nearly 50% of therapeutic evidence reported at the MTB, emphasizing the role of open-access knowledge in precision oncology. Additionally, we identified genome signatures as a critical area with clinical implications requiring further curation efforts and evidence model development.