Role of the Molecular Tumor Board for the Personalized Treatment of Patients with Metastatic Breast Cancer: A Focus on the State of the Art in Italy

Abstract

Molecular tumor boards (MTBs) are multidisciplinary groups that combine molecular and clinical data from cancer patients in order to formulate treatment recommendations for precision medicine. To date, there is insufficient data to support the use of singleplex or next-generation sequencing (NGS) technologies to select first-line therapy for patients with metastatic breast cancer (MBC), but considering the high number of level II alterations, according to the ESMO scale for clinical actionability of molecular targets (ESCAT), it is suggested to include patients in molecular screening programs in order to be able to offer targeted therapies for specific genomic alterations. This article aims at reviewing the most recent literature related to the most used methodologies/approaches for molecular diagnostics and variants’ classification, summarizing the internationally published molecular screening studies in support of MTB activity and, in the end, discussing MTBs’ current position and role in Italy, the number of which is increasing, also thanks to the thrust of institutions.

NGS-Guided Precision Oncology in Breast Cancer and Gynecological Tumors—A Retrospective Molecular Tumor Board Analysis

“…For example, Pernas et al, in the SOLTI-1301 AGATA study, and Aftimos et al, in the AURORA study, reported that only 5% and 7% of patients, respectively, received MMT [56,57]. In contrast, the rates of patients who finally received MMT therapy reported by Parker and Walter et al (42% each) and Bruzas and Fukada et al (36% and 26%, respectively) were comparable to those in our study [24,52,54,58,59]. In the literature, the reasons given for declining the recommended MTT are the doctor's or patient's preference for another therapy, the lack of reimbursement, the unavailability of medication, and progression of the disease, resulting in a poor performance status or death by the time MMT actually became available for a given patient [24,60,61].…”

“…For example, Sultova et al reported actionable alterations in 41 of 95 patients (43.2%) with BC and gynecological malignancies, whereas Bruzas et al reported that 63 patients (66.3%) in their mBC cohort were suitable for MMT [23,24]. In cohorts including more extended spectra of different tumor entities, the fraction of patients with actionable alterations varies from 39.5% in Le Tourneau et al [19] to a maximum of 87% in Walter et al [52], influenced by the heterogeneity of the study population in terms of their different tumor entities and their diverse mutational landscapes [53,54].…”

Agnostic Administration of Targeted Anticancer Drugs: Looking for a Balance between Hype and Caution

“…The feasibility of using ESCAT has been confirmed in clinical studies [133]. Still, treatment decisions for individual patients are almost always associated with significant level of complexity; therefore, the majority of cancer centers utilize Molecular Tumor Boards (MTBs) for the personalization of treatment choices [13,137,148,149,154]. MTBs are compatible with general attitudes in cancer medicine, which rely on tight interaction of physicians with complementary expertise.…”

Bridging the Divide – a Review on the Implementation of Personalized Cancer Medicine

“…Several studies have demonstrated the impact of MTB on the implementation processes for personalised cancer medicine [95]. MTBs were shown to improve the accuracy of genomic data interpretation and increased the proportion of patients who received targeted therapy [96][97][98]. This also includes improvement of the capacity to communicate with patients by facilitating the presentation of genomic information [99].…”