Personalized Clinical Decision Making Through Implementation of a Molecular Tumor Board: A German Single-Center Experience

Purpose Dramatic advances in our understanding of the molecular pathophysiology of cancer, along with a rapidly expanding portfolio of molecular targeted drugs, have led to a paradigm shift toward personalized, biomarker-driven cancer treatment. Here, we report the 2-year experience of the Comprehensive Cancer Center Freiburg Molecular Tumor Board (MTB), one of the first interdisciplinary molecular tumor conferences established in Europe. The role of the MTB is to recommend personalized therapy for patients with cancer beyond standard-of-care treatment. Methods This retrospective case series includes 198 patients discussed from March 2015 through February 2017. The MTB guided individual molecular diagnostics, assessed evidence of actionability of molecular alterations, and provided therapy recommendations, including approved and off-label treatments as well as available matched clinical trials. Results The majority of patients had metastatic solid tumors (73.7%), mostly progressive (77.3%) after a mean of 2.0 lines of standard treatment. Diagnostic recommendations resulted in 867 molecular diagnostic tests for 172 patients (five per case), including exome analysis in 36 cases (18.2%). With a median turnaround time of 28 days, treatment recommendations were given to 104 patients (52.5%). These included single-agent targeted therapies (42.3%), checkpoint inhibitors (37.5%), and combination therapies (18.3%). Treatment recommendations were implemented in 33 of 104 patients (31.7%), of whom 19 (57.6%) showed stable disease or partial response, including 14 patients (7.1% of the entire population) receiving off-label treatments. Conclusion Personalized extended molecular-guided patient care is effective for a small but clinically meaningful proportion of patients in challenging clinical situations. Limited access to targeted drugs, lack of trials, and submission at late disease stage prevents broader applicability, whereas genome-wide analyses are not a strict requirement for predictive molecular testing.

Download Full-text

Implementation and impact of the first two years of a systemwide molecular tumor board at Henry Ford Health System (HFHS).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19266 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19266-e19266

Author(s):

Igor I. Rybkin ◽

Nadia Z Haque ◽

Kristen Collins ◽

Louisa Laidlaw ◽

Tom Mikkelsen

Keyword(s):

Clinical Trial ◽

Clinical Trials ◽

Performance Status ◽

Tumor Board ◽

Molecular Testing ◽

Precision Oncology ◽

Ecog Performance Status ◽

Off Label ◽

Molecular Tumor Board ◽

The Impact

e19266 Background: HFHS implemented clinically-oriented Precision Medicine Program (PMP) in 2016. As part of the program, multidisciplinary molecular tumor board (MTB) was created to review complex molecular cases, providing guidance to treating medical oncologist in selecting targeted therapies and clinical trials. In some cases MTB recommended genetic counseling or recommended against/for additional molecular testing. MTB consists of oncologists, molecular pathologists, clinical trial staff, and genetic counselors. MTB was designed as teaching platform engaging hematology-oncology fellows into cases analysis and presentation. Here we present preliminary analysis of the impact of the MTB on the HFHS oncology practice. Methods: From 09/08/2017 to 12/31/2019 MTB reviewed 120 cases, 116 cases were used for this analysis. Data was abstracted using Syapse precision oncology platform, MTB recommendation note, electronic medical record (EMR), and molecular test results. Results: Out of 116 pts 83 (72%) were Caucasian, 25 (22%) African American, 4 (3%) Asian, 1 (1%) American Indian. Fifty-two % (n = 21) had an ECOG performance status of 1. Most common primary disease sites were lung (39%, n = 45) brain (12%, n = 15), and hematologic cancers (9%; n = 10), followed by breast (5%, n = 6), prostate (4%, n = 5), colon (3%, n = 4), and others (28%, n = 31). The most common genetic abnormalities discussed were atypical EGFR (n = 15), non-V600 BRAF (n = 10), KRAS (n = 8), BRCA2 (n = 5), NF2 (n = 4), PTEN (n = 4), CSF3R (n = 3), IDH1 (n = 3), TP53 (n = 3), and 29 less common mutations. Thirty five (30%) pts out of 116 total were recommended clinical trials, although only 3 patients (10% of recommended) were enrolled into trials. 31 pts (27%) were recommended off-label therapy, although trials were preferred. 18% of pts (n = 21) were recommended genetics referral, although only 3 have seen Geneticist, with two undergoing germline testing. One pt was discovered to have a germline RET V804M mutation which was originally detected in the cancer. Conclusions: The first two years of data demonstrate the utility of the MTB and provide a basis for ongoing analysis. Through multidisciplinary approach, MTB encourages care coordination and collaboration. MTB resulted in genetics referrals, clinical trial recommendations, and identification of targeted therapy options, including off label. In many cases, MTB recommendations prevented futile therapies and/or additional molecular testing.

Download Full-text

Implementation of a Molecular Tumor Board in Clinical Decision Making at the Medical Center University of Freiburg

Blood ◽

10.1182/blood.v128.22.3579.3579 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3579-3579

Author(s):

Rainer Claus ◽

Lisa Lutz ◽

Hauke Busch ◽

Leman Mehmed ◽

Agnes Csanadi ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Molecular Data ◽

Treatment Recommendations ◽

Tumor Board ◽

Treatment Recommendation ◽

Off Label ◽

Organ Specific ◽

Molecular Tumor Board ◽

Made In

Abstract Introduction: In-depth knowledge about molecular pathogenesis of malignant diseases and rapidly increasing availability of targeted treatment options enables molecularly guided decision-making. We have established a Molecular Tumor Board (MTB) that focuses on patient management based on specific molecular data at the individual patient level. Methods: The MTB has its main focus on hematologic and solid neoplasias progressing during standard treatment, on rare entities and on patients with treatment resistance. The biweekly MTB supports the work of organ-specific boards and external cooperation partners. The MTB multidisciplinary team consists of expert physicians from Hematology, Medical Oncology, Gynecology, Dermatology, Pediatrics and Radiation Oncology as well as Pathology, Molecular biology, Computational Biology and Genetics. Diagnostic and therapeutic recommendations are based on customized diagnostics and a case-by-case literature review. Recommendations are communicated back to the treating physician. Results: In the first year after implementation of the MTB, a total of 92 pts have been discussed in 155 case discussions during 25 MTB meetings. Referred patient cases covered the entire range of malignancies seen by the organ-specific boards including hematologic malignancies. 132 diagnostic recommendations were made in 80/92 (87%) pts, including IHC, ISH or panel sequencing with diagnostic reporting (n=96/72 pts) and exome, genome, transcriptome and/or methylome analysis (n=24/22 pts.). 43 treatment recommendations were made in 39/92 (42%) pts with an implementation rate of 47% (20/43 recommendations in 19/39 pts). Treatment recommendations mainly comprised off-label antibody and tyrosine kinase inhibitor (TKI) therapy (40%) and trial inclusions (28%). Major reasons for non-adherence to recommendations included patient will, death of pts and medical reasons. Objective responses were observed in 5/19 (26%) pts to TKI in- and off-label and antibody off-label treatments. Disease stabilization was achieved in 3/19 (16%) pts. Specifically, the use of PD-(L)1 inhibiting antibodies was suggested in 13 cases (11 off-label) and implemented in 6 cases. Here, 2/6 pts responded or exhibited stable disease upon PD-(L1) blockage. Conclusion: Implementation of a Molecular Tumor Board serves as an interdisciplinary platform for integrating comprehensive molecular data sets as predictive biomarkers in molecular guided, individualized patient care. Our experience demonstrates that individualized treatment recommendation is feasible and effective for a substantial proportion of patients in challenging clinical situations. Disclosures Claus: Roche: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Janssen-Cilag: Consultancy, Honoraria, Other: Travel Funding.

Download Full-text

Impact of molecular tumor board on late-stage gastrointestinal malignancies at a tertiary center.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.483 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 483-483

Author(s):

Timothy Lewis Cannon ◽

Jo-Ellen Murphy ◽

Jennifer Carter ◽

Donald L. Trump ◽

Sheryl Krevsky Elkin ◽

...

Keyword(s):

Targeted Therapies ◽

Disease Stage ◽

Tumor Board ◽

Molecular Testing ◽

Tier 2 ◽

Gastrointestinal Malignancies ◽

Tier 1 ◽

Molecular Tumor Board ◽

Recommended Therapy ◽

Guided Therapy

483 Background: Inova Schar Cancer Institute formed a molecular tumor board in early 2016 to identify treatment options for patients with gastrointestinal malignances based on molecular testing and to track outcomes. Methods: From March 2016 to June 2017, 78 patients with advanced gastrointestinal malignancies were presented at our molecular tumor board. The most common mutations, the percentage of patients who received targeted therapies, responded to targeted therapies, died or went on hospice prior to receiving a recommended therapy, and had an available Association of Molecular Pathology Tier 1 or Tier 2 recommendation available were reviewed retrospectively. We also compared the overall survival of patients who received a new treatment after MTB compared to those who did not. N-of-One, Inc. provided curation of molecular testing and participated in the MTB. Results: 78 patients with gastrointestinal cancers were presented between March 2016 and June 2017. Thirteen (19%) patients received targeted therapy and 31% had partial response, 15% had Stable Disease, and 54% had progression of disease. 12 patients (15%) died or went on hospice before recommendations could start and 11 patients (14%) are waiting to start recommended therapy. 38 (49%) patients did not have a mutation that prompted a MTB recommendation. Median OS of the 33 patients who started a new therapy (including chemotherapy or unrelated clinical trials) after MTB was 15.3 months vs. 11.5 months in 40 patients who continued current therapy (P = 0.016 Wilcoxon). The three most common mutations detected were TP53, KRAS, and APC. The majority of cases had more than one variant. 18% of cases had a variant classified as Tier 1; 74% of cases had a variant with the highest AMP classification of Tier 2. Conclusions: The majority of patients with Gastrointestinal malignancies presented to the Inova MTB had a finding that supported a molecularly-guided therapy, with a small but meaningful number of partial responses. Barriers to the use of molecular guided therapy included molecular testing and presentation at a late disease stage, and alternative chemotherapeutic options.

Download Full-text

Personalized Medicine in the Oncology Clinic: Implementation and Outcomes of the Johns Hopkins Molecular Tumor Board

JCO Precision Oncology ◽

10.1200/po.16.00046 ◽

2017 ◽

pp. 1-19 ◽

Cited By ~ 12

Author(s):

W. Brian Dalton ◽

Patrick M. Forde ◽

Hyunseok Kang ◽

Roisin M. Connolly ◽

Vered Stearns ◽

...

Keyword(s):

Clinical Trials ◽

Targeted Therapy ◽

Targeted Therapies ◽

Progression Free Survival ◽

Molecular Profiling ◽

Tumor Board ◽

Free Survival ◽

Off Label ◽

Tumor Boards ◽

Molecular Tumor Board

Purpose Tumor genomic profiling for personalized oncology therapy is being widely applied in clinical practice even as it is being evaluated more formally in clinical trials. Given the complexities of genomic data and its application to clinical use, molecular tumor boards with diverse expertise can provide guidance to oncologists and patients seeking to implement personalized genetically targeted therapy in practice. Methods A multidisciplinary molecular tumor board reviewed tumor molecular profiling reports from consecutive referrals at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins over a 3-year period. The tumor board weighed evidence for actionability of genomic alterations identified by molecular profiling and provided recommendations including US Food and Drug Administration–approved drug therapy, clinical trials of matched targeted therapy, off-label use of such therapy, and additional tumor or germline genetic testing. Results One hundred fifty-five patients were reviewed. Actionable genomic alterations were identified in 132 patients (85%). Off-label therapies were recommended in 37 patients (24%). Eleven patients were treated off-label, and 13 patients were enrolled onto clinical trials of matched targeted therapies. Median progression-free survival of patients treated with matched therapies was 5 months ( 95% CI, 2.9 months to not reached), and the progression-free survival probability at 6 months was 43% (95% CI, 26% to 71%). Lack of locally available clinical trials was the major limitation on clinical actionability of tumor profiling reports. Conclusion The molecular tumor board recommended off-label targeted therapies for a quarter of all patients reviewed. Outcomes were heterogeneous, although 43% of patients receiving genomically matched therapy derived clinical benefit lasting at least 6 months. Until more data become available from precision oncology trials, molecular tumor boards can help guide appropriate use of tumor molecular testing to direct therapy.

Download Full-text

A virtual molecular tumor board to improve efficiency and scalability of delivering precision oncology to physicians and their patients

JAMIA Open ◽

10.1093/jamiaopen/ooz045 ◽

2019 ◽

Vol 2 (4) ◽

pp. 505-515 ◽

Cited By ~ 11

Author(s):

Michael J Pishvaian ◽

Edik M Blais ◽

R Joseph Bender ◽

Shruti Rao ◽

Simina M Boca ◽

...

Keyword(s):

Treatment Plan ◽

Critical Role ◽

Tumor Board ◽

Care Process ◽

Molecular Profile ◽

Molecular Testing ◽

Precision Oncology ◽

Therapy Options ◽

Scoring Model ◽

Molecular Tumor Board

Abstract Objectives Scalable informatics solutions that provide molecularly tailored treatment recommendations to clinicians are needed to streamline precision oncology in care settings. Materials and Methods We developed a cloud-based virtual molecular tumor board (VMTB) platform that included a knowledgebase, scoring model, rules engine, an asynchronous virtual chat room and a reporting tool that generated a treatment plan for each of the 1725 patients based on their molecular profile, previous treatment history, structured trial eligibility criteria, clinically relevant cancer gene-variant assertions, biomarker-treatment associations, and current treatment guidelines. The VMTB systematically allows clinician users to combine expert-curated data and structured data from clinical charts along with molecular testing data to develop consensus on treatments, especially those that require off-label and clinical trial considerations. Results The VMTB was used as part of the cancer care process for a focused subset of 1725 patients referred by advocacy organizations wherein resultant personalized reports were successfully delivered to treating oncologists. Median turnaround time from data receipt to report delivery decreased from 14 days to 4 days over 4 years while the volume of cases increased nearly 2-fold each year. Using a novel scoring model for ranking therapy options, oncologists chose to implement the VMTB-derived therapies over others, except when pursuing immunotherapy options without molecular support. Discussion VMTBs will play an increasingly critical role in precision oncology as the compendium of biomarkers and associated therapy options available to a patient continues to expand. Conclusion Further development of such clinical augmentation tools that systematically combine patient-derived molecular data, real-world evidence from electronic health records and expert curated knowledgebases on biomarkers with computational tools for ranking best treatments can support care pathways at point of care.

Download Full-text

Targetable mutations in gastrointestinal malignancies: A comparison of RAS mutant and RAS wild type tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.129 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 129-129

Author(s):

Jamie Randall ◽

Hongkun Wang ◽

Sheryl Krevsky Elkin ◽

Gail Payne ◽

Sarah Mullaly ◽

...

Keyword(s):

Stage Iv ◽

Predictive Biomarker ◽

Tumor Board ◽

Driver Mutations ◽

P Value ◽

Molecular Testing ◽

Wild Type ◽

Level Of Evidence ◽

Gastrointestinal Malignancies ◽

Molecular Tumor Board

129 Background: KRAS and NRAS (RAS) mutations are considered driver mutations in gastrointestinal malignancies such as colorectal and pancreatic cancer. Our institution obtains broad molecular testing (commercial panels with full exon coverage of at least 300 genes) for all stage IV gastrointestinal malignancies that are reviewed at an internal molecular tumor board (MTB). The MTB subjectively felt there was less benefit from comprehensive molecular testing in RAS mutant tumors and wished to quantify this using standardized analysis according to validated guidelines. Methods: We performed a retrospective cohort study of 209 consecutive genomic sequencing results of advanced gastrointestinal malignancies at our institution dating from March 2016 until December 2019. We compared the number of “targetable” mutations in the RAS mutant and wild type (WT) malignancies, as analyzed by an interpretation service according to the Association of Molecular Pathology (AMP) guidelines. A lower AMP score corresponds to a higher level of evidence as a predictive biomarker. We also compared molecular tumor board specific recommendations for each group (excluding recommendations regarding RAS such as EGFR mAbs). Results: There were 134 RAS mutant and 75 RAS WT cases. Alterations with AMP scores of 1A,1B, and 1C were more commonly seen in the RAS WT population 18/75 and 9/134 respectively (24.0% versus 6.7% p-value=0.0004). 39 of 75 cases in RAS WT and 27/134 in RAS mutant (52.0 versus 20.1%, p-value <0.0001) cohort had at least one alteration that was deemed actionable by our institution’s current MTB criteria. Conclusions: Actionable mutations were significantly less common in the RAS mutant versus RAS WT population, and further studies assessing the value of comprehensive genomic testing in RAS mutant gastrointestinal malignancies may be warranted. [Table: see text]

Download Full-text

Transitioning the Molecular Tumor Board from Proof of Concept to Clinical Routine: A German Single-Center Analysis

Cancers ◽

10.3390/cancers13051151 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1151

Author(s):

Rouven Hoefflin ◽

Adriana Lazarou ◽

Maria Elena Hess ◽

Meike Reiser ◽

Julius Wehrle ◽

...

Keyword(s):

Treatment Adherence ◽

Objective Response ◽

Tumor Board ◽

Treatment Recommendation ◽

Comprehensive Cancer Center ◽

Precision Oncology ◽

Single Center ◽

Clinical Routine ◽

Molecular Tumor Board ◽

Over Time

Molecular precision oncology faces two major challenges: first, to identify relevant and actionable molecular variants in a rapidly changing field and second, to provide access to a broad patient population. Here, we report a four-year experience of the Molecular Tumor Board (MTB) of the Comprehensive Cancer Center Freiburg (Germany) including workflows and process optimizations. This retrospective single-center study includes data on 488 patients enrolled in the MTB from February 2015 through December 2018. Recommendations include individual molecular diagnostics, molecular stratified therapies, assessment of treatment adherence and patient outcomes including overall survival. The majority of MTB patients presented with stage IV oncologic malignancies (90.6%) and underwent an average of 2.1 previous lines of therapy. Individual diagnostic recommendations were given to 487 patients (99.8%). A treatment recommendation was given in 264 of all cases (54.1%) which included a molecularly matched treatment in 212 patients (43.4%). The 264 treatment recommendations were implemented in 76 patients (28.8%). Stable disease was observed in 19 patients (25.0%), 17 had partial response (22.4%) and five showed a complete remission (6.6%). An objective response was achieved in 28.9% of cases with implemented recommendations and for 4.5% of the total population (22 of 488 patients). By optimizing the MTB workflow, case-discussions per session increased significantly while treatment adherence and outcome remained stable over time. Our data demonstrate the feasibility and effectiveness of molecular-guided personalized therapy for cancer patients in a clinical routine setting showing a low but robust and durable disease control rate over time.

Download Full-text

Framework for Implementing and Tracking A Molecular Tumor Board at an NCI‐Designated Comprehensive Cancer Center

The Oncologist ◽

10.1002/onco.13936 ◽

2021 ◽

Author(s):

Neha M. Jain ◽

Lauren Schmalz ◽

Christopher Cann ◽

M.B.A. Adara Holland ◽

D.O. Travis Osterman ◽

...

Keyword(s):

Tumor Board ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Molecular Tumor Board

Download Full-text

Development and feasibility of virtual molecular tumor board.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18334 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18334-e18334

Author(s):

Amit Verma ◽

Jatinder Kaur ◽

Amit Gupta ◽

Aakriti Aggarwal ◽

Arpana Kushwaha ◽

...

Keyword(s):

Treatment Options ◽

Tumor Board ◽

Molecular Diagnostic ◽

Precision Oncology ◽

Consensus Document ◽

Treatment Naïve ◽

Molecular Tumor Board ◽

Smart Mobile ◽

User Friendly ◽

Clinical Case Scenarios

e18334 Background: Practicing precision oncology is challenging due to the complex molecular interpretation and its implications in deciding pertinent treatment options. This is addressed by institutional Molecular Tumor Board (MTB) which is presided by all oncology sub-specialists including molecular biologist and bioinformatician, doing a meticulous job in untwining the intricacies but fail to obtain experiences across institutes. Further, meeting of all MTB members is neither always feasible nor accessible for the community oncologists. We hereby offer a virtual formation of MTB that is easily accessible and remotely attended by various experts across institutes, giving their opinion objectively at their ease that can be documented and archived. Methods: Virtual MTB (vMTB), a mobile cloud-based application was developed for both android and iOS platforms. The vMTB process involves submission and review of cases, whereby assigned members can opine blindly and rate different treatment options. Followed by averaging of rating score and then a final recommendation generated by the vMTB case-convener within 7 days, based on clinical context. A pilot study (2 months duration) was carried out where clinical cases bearing molecular information were invited from various oncology centers across India. Results: 21 cases were submitted (19 relapsed refractory, 3 treatment naïve) that included Breast (6), Lung (5), Leukemia/Lymphoma (3), Gall bladder (2), Uterine (2), Urinary bladder (1), GBM (1) and Sarcoma (1) cancers. The molecular query was based on 18 somatic (8 FoundationOne & 10 Others) and 3 germline testing. Cases assigned to vMTB members (~7 members/case) had ~ 6 treatment options/case with a response turn-around time ~4 days. Therapeutic final recommendation(s) were given for all cases with 95% concordance among the members; 6 cases where multiple options were advised, discordance rate was 14%. Additional molecular diagnostic workup was advised in 3 cases. vMTB recommendations including 10 off label treatment options were accepted by majority of the submitting physicians (82%). Clinical benefit was observed in 5 (24%) cases within the stipulated analysis duration. Conclusions: vMTB is a user-friendly, feasible, acceptable mobile solution alternate to MTB for objectively generating clinically meaningful consensus document for complex molecular clinical case scenarios, where guidelines are limited. To best of our knowledge, this is a first smart mobile solution connecting various oncology experts and have an immediate utility for the practicing community oncologists globally.

Download Full-text

The impact of clinical decision making in a molecular tumor board at a tertiary care center.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.3128 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 3128-3128

Author(s):

Meena Sadaps ◽

Kathryn Demski ◽

Ying Ni ◽

Vicky Konig ◽

Brandie Leach ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Genetic Counselors ◽

Tumor Board ◽

Treatment Recommendation ◽

Precision Oncology ◽

Off Label ◽

Tumor Boards ◽

Molecular Tumor Board

3128 Background: Multidisciplinary molecular tumor boards were first established with the onset of precision oncology (PO), as many clinicians were unfamiliar with the interpretation and incorporation of the information into clinical practice. PO has since rapidly evolved and integrated itself into standard of care practices for most cancer patients, yet molecular tumor boards have not grown accordingly and in fact some have been discontinued. There remains a paucity of data in regards to the value and impact of molecular tumor board discussions themselves. We previously reported on our longitudinal experiences in PO ( Sadaps et al, 2018), focusing on the therapeutic impact of matched therapy. Here, we report on the utility of our molecular tumor board in clinical decision making. Methods: We conducted a retrospective review of patients seen at Cleveland Clinic with a solid tumor malignancy who had large panel, next-generation-sequencing (NGS) performed via any commercial platform from November 2019-January 2021. Cases were filtered through a local therapeutic algorithm and then reviewed individually. Initial review was performed by a core genomics committee comprised of 2 oncologists and 2 genetic counselors. Interesting and/or complex cases were flagged for discussion at our bimonthly molecular tumor board, which is regularly attended by medical oncologists, pathologists, genetic counselors, bioinformaticians, and patient care coordinators. Data analyzed included categorization of treatment recommendations and the percentage of cases for which initial recommendations were changed based on tumor board discussion. Results: Of 782 total cases, 575 (73.5%) had a clinically relevant genomics tumor board (GTB) recommendation as compared to 51.7% from our previously reported study. 16.7% of patients had on label recommendation(s) and 86.4% had off label/ clinical trial recommendation(s). 179 (22.9%) patients were recommended for genetic counseling (GC). During our bimonthly GTB, we discussed 173 (22.1%) of these cases. Of the discussed cases, the most common tumor types were hepatobiliary (18.5%), lower gastrointestinal (17.3%), and breast (16.2%). Topics of discussion at GTB included such things as pathologic/histologic/molecular testing, prioritization of available trials, appropriateness of an off label therapy, and need for a genetics consult. Discussion at GTB resulted in a change in treatment recommendation in 63 (36.4%) cases. Conclusions: Discussions from multidisciplinary molecular tumor board impacted treatment decisions for our patients. Referral to GC was also common and should be considered an integral part of somatic sequencing review. Molecular tumor boards remain a crucial platform for treatment guidance and clinical management, especially given the increase in “actionability” over the years due to newly discovered targets and targeted therapies in this rapidly evolving field.

Download Full-text