Implementation of Precision Oncology for Patients with Metastatic Breast Cancer in an Interdisciplinary MTB Setting

Abstract

The advent of molecular diagnostics and the rising number of targeted therapies have facilitated development of precision oncology for cancer patients. In order to demonstrate its impact for patients with metastatic breast cancer (mBC), we initiated a Molecular Tumor Board (MTB) to provide treatment recommendations for mBC patients who had disease progression under standard treatment. NGS (next generation sequencing) was carried out using the Oncomine multi-gene panel testing system (Ion Torrent). The MTB reviewed molecular diagnostics’ results, relevant tumor characteristics, patient’s course of disease and made personalized treatment and/or diagnostic recommendations for each patient. From May 2017 to December 2019, 100 mBC patients were discussed by the local MTB. A total 72% of the mBC tumors had at least one molecular alteration (median 2 per case, range: 1 to 6). The most frequent genetic changes were found in the following genes: PIK3CA (19%) and TP53 (17%). The MTB rated 53% of these alterations as actionable and treatment recommendations were made accordingly for 49 (49%) patients. Sixteen patients (16%) underwent the suggested therapy. Nine out of sixteen patients (56%; 9% of all) experienced a clinical benefit with a progression-free survival ratio ≥ 1.3. Personalized targeted therapy recommendations resulting from MTB case discussions could provide substantial benefits for patients with mBC and should be implemented for all suitable patients.

Lessons learned: the first consecutive 1000 patients of the CCCMunichLMU Molecular Tumor Board

“…Six years into the program, we feel that we have the obligation to share our early experiences with the scientific community to underscore the need to push for a more integrative precision oncology approach where diagnostic and therapeutic interventions, access to treatment, and meticulous follow-up are tightly interwoven. We see that in smaller subgroups, such as gynecological cancers, a dedicated, structured follow-up, including survival and efficacy endpoints, is feasible within our program (Sultova et al 2021a , b ). Other programs have shown that structured follow-ups regarding outcomes are possible in the setting of clinical trials (Horak et al 2021 ) as well as in structured programs (Bitzer et al 2020 ).…”

“…Patients were referred from 19 different clinical departments (excluding external referrals) and experts from more than 10 medical specialties regularly attend the meeting and contribute to shaping the program. This has resulted in several scientific collaborations that underscore the potential of a dedicated Precision Oncology Program to serve as an interdisciplinary platform to foster academic innovation (Rohrmoser et al 2020 ; von Baumgarten et al 2020 ; Rodler et al 2021 ; Sultova et al 2021a , b ). To facilitate cooperation with external partners, plans for a virtual MTB were made as early as 2018.…”

“…Second, the decision to include patients into the program was up to the treating physician, which might have led to a selection bias not only regarding primary diagnosis but also regarding the timing of testing. Third, due to the interdisciplinary management of patients from various department, follow-up has been challenging during the implementation phase of the program but has already been conducted within smaller subgroups (Sultova et al 2021a , b ). To provide high-quality, real world evidence, a dedicated follow-up program, including a prospective and retrospective registry, has been implemented, which will allow us to further evaluate the benefit to patients of such a program.…”

Identification of Disparities in Personalized Cancer Care—A Joint Approach of the German WERA Consortium

“…Various studies previously analyzed the organizational and technical setup of MTBs as well as its impact on clinical decision-making and its benefit for cancer patients [ 1 , 22 , 23 , 24 , 25 , 26 , 27 ]. Additionally, researchers examined findings and recommendations of MTBs, which discussed patients from community-based oncology practices [ 2 , 28 , 29 , 30 ].…”

Clinical Outcomes of Genotype-Matched Therapy for Recurrent Gynecological Cancers: A Single Institutional Experience

“…In one report on advanced gastrointestinal cancer, the disease control rate was 45% [20]. In another report on metastatic breast cancer, 56% of the patients experienced clinical benefits with a progression-free survival ratio ≥ 1.3 [21]. The MOSCATO 01 trial [15] showed improved outcomes in 33% of patients with advanced cancers.…”