Multidisciplinary molecular tumour board: a tool to improve clinical practice and selection accrual for clinical trials in patients with cancer

Abstract

BackgroundThe complexity of delivering precision medicine to oncology patients has led to the creation of molecular tumourboards (MTBs) for patient selection and assessment of treatment options. New technologies like the liquid biopsy are augmenting available therapeutic opportunities. This report aims to analyse the experience of our MTB in the implementation of personalised medicine in a cancer network.Materials and methodsPatients diagnosed with solid tumours progressing to standard treatments were referred to our Phase I unit. They underwent comprehensive next generation sequencing (NGS) of either tumour tissue or cell-free circulating tumour DNA (ctDNA) or both. The MTB expressed either a positive or negative opinion for the treatment of the patients with discovered druggable alterations inside a clinical trial, in an expanded access programme, with a compassionate use. Afterwards, discovered alterations were matched with OncoKB levels of evidence for the choice of alteration-specific treatments in order to compare MTB outcomes with a standardised set of recommendations.ResultsNGS was performed either on ctDNA or tumour tissue or in both of them in 204 patients. The MTB evaluated 173 of these cases. Overall, the MTB proposed alteration-specific targeted therapy to 72 patients (41.6%). 49 patients (28.3% of the total evaluated) were indicated to enter a clinical trial. In 29 patients with matched liquid biopsy NGS (lbNGS), tumour tissue NGS (ttNGS) and MTB evaluation, the MTB changed the treatment strategy coming from standardised recommendations based on lbNGS and ttNGS alone in 10 patients (34.5%), thanks to the evaluation of other clinical parameters. In our cohort, lbNGS was more likely, compared with ttNGS, to detect point mutations (OR 11, 95% CI 2.9 to 24.1, p<0.001) and all-type alterations (OR 13.6, 95% CI 5.5 to 43.2, p<0.001) from the same genes of matched patients.ConclusionsOur MTB allows patients with refractory cancer to be included in clinical trials and improves the precision of clinical decisions compared with a standardised set of mutation-driven recommendations.

“Balancing Expectations with Actual Realities”: Conversations with Clinicians and Scientists in the First Year of a High-Risk Childhood Cancer Precision Medicine Trial

“…If cancer predisposing germline variants are identified, family implications need to be considered [23]. Molecular tumour boards (MTB), which bring together various clinical and scientific specialties to facilitate knowledge exchange and enhance clinical decision-making, have emerged in response to the complexities of precision medicine [7,24]. The discussion of individual patient outcomes in the MTB is likely to be a particularly novel experience for scientists.…”

Molecular and Genomic Profiling of Lung Cancer in the Era of Precision Medicine: A Position Paper from the Italian Association of Thoracic Oncology (AIOT)

“…The conduction of a CGP test requires the introduction of the obtained results in the most appropriate clinical context. In this regard, it is necessary to implement molecular tumor boards (MTBs) for the collegial discussion of the results, especially for complex molecular data, in order to allow the identification of the best therapeutic approach in selected patients [27]. The MTB is a multidisciplinary team including treating physicians, and at least a molecular oncologist, a clinical geneticist and a molecular pathologist.…”

Non-Small Cell Lung Cancer from Genomics to Therapeutics: A Framework for Community Practice Integration to Arrive at Personalized Therapy Strategies

“…This is especially concerning as the majority of patients or approximately 85% with cancer are treated in the community setting and 50% of collaborative group trial accruals occur in the community [160]. Several models have been proposed to integrate community oncologists into the academic paradigm of personalized medicine, with the most promising being the establishment of interpersonal relationships between community oncologists and academic site physicians through molecular tumor board (MTB) teams [161][162][163][164][165]. The establishment of an MTB team would allow for the proper evaluation of imaging, histopathology, and genomic information that is required to make the appropriate therapeutic decision [166].…”

“…of collaborative group trial accruals occur in the community [160]. Several models have been proposed to integrate community oncologists into the academic paradigm of personalized medicine, with the most promising being the establishment of interpersonal relationships between community oncologists and academic site physicians through molecular tumor board (MTB) teams [161][162][163][164][165].…”