Critical evaluation of molecular tumour board outcomes following 2 years of clinical practice in a Comprehensive Cancer Centre

Abstract

Background Recently, molecular tumour boards (MTBs) have been integrated into the clinical routine. Since their benefit remains debated, we assessed MTB outcomes in the Comprehensive Cancer Center Ostbayern (CCCO) from 2019 to 2021. Methods and results In total, 251 patients were included. Targeted sequencing was performed with PCR MSI-evaluation and immunohistochemistry for PD-L1, Her2, and mismatch repair enzymes. 125 treatment recommendations were given (49.8%). High-recommendation rates were achieved for intrahepatic cholangiocarcinoma (20/30, 66.7%) and gastric adenocarcinoma (10/16, 62.5%) as opposed to colorectal cancer (9/36, 25.0%) and pancreatic cancer (3/18, 16.7%). MTB therapies were administered in 47 (18.7%) patients, while 53 (21.1%) received alternative treatment regimens. Thus 37.6% of recommended MTB therapies were implemented (47/125 recommendations). The clinical benefit rate (complete + partial + mixed response + stable disease) was 50.0% for MTB and 63.8% for alternative treatments. PFS2/1 ratios were 34.6% and 16.1%, respectively. Significantly improved PFS could be achieved for m1A-tier-evidence-based MTB therapies (median 6.30 months) compared to alternative treatments (median 2.83 months; P = 0.0278). Conclusion The CCCO MTB yielded a considerable recommendation rate, particularly in cholangiocarcinoma patients. The discrepancy between the low-recommendation rates in colorectal and pancreatic cancer suggests the necessity of a weighted prioritisation of entities. High-tier recommendations should be implemented predominantly.

Determinants Affecting the Clinical Implementation of a Molecularly Informed Molecular Tumor Board Recommendation: Experience from a Tertiary Cancer Center

“…Compliance with MTB therapy recommendation was observed in 44 (31.7%) of these 139 cases. These numbers are in line with results of comparable previous studies in which the proportion of CGP-informed MTB therapeutic recommendations ranged between 39.3 and 88% of all cases (median 54.1%) with a median implementation rate of 22.6% (min: 16.2%, max: 31.8%) of cases with MTB recommendations [6,[8][9][10]12,14,33]. The comparably high compliance rate of the present study emphasizes, in particular, the quality and therapeutical relevance of CGP-informed MTB recommendations, and demonstrates the capability and feasibility to translate therapeutic recommendations into the clinic at the present institution, as well as at associated external medical centers.…”

“…CGP is available to cancer patients within different settings, either by commercial providers [5] or embedded within an academic clinical context [6][7][8]. For the latter approach, Molecular Tumor Boards (MTBs) have been implemented in most academic tertiary clinical centers in Germany within the last few years, to provide CGP for cancer patients within a framework of clinical interpretation of molecular alterations [9][10][11][12][13]. The clinical benefit for cancer patients who have undergone CGP in the framework of an MTB has been repeatedly demonstrated [6][7][8]14].…”

“…Therefore, it is of high importance to identify factors contributing to successful implemen-tation of therapeutically relevant MTB recommendations by treating physicians. Currently, there is a significant difference between the percentage of MTB patients with therapeutic recommendations and MTB patients who in fact receive the recommended therapy [6][7][8][9][10][11][12][13][14]. The current study analyzes genomic and clinical follow-up data generated in the context of an MTB of an academic tertiary clinical comprehensive cancer center, to identify factors correlative to the adherence to MTB therapeutic recommendations by the treating physician in a real-world scenario.…”

The WERA Cancer Center Matrix: Strategic Management of Patient Access to Precision Oncology in a Large and Mostly Rural Area of Germany

“…We merged postal code areas of the residences of WERA´s MTB patients between 2020 and 2022. Following harmonized standard operating procedures, our MTBs discuss patients diagnosed with an advanced cancer disease and no or limited treatment options left according to guideline recommendations [15,16]. Eligible for analysis were MTB patients with known postal code areas and residences in Germany.…”