54PD - Multidisciplinary molecular tumour board: a tool to improve clinical practice and selection accrual for clinical trials in cancer patients

Abstract

Personalized medicine, based on the discovery of druggable targets through Next-Generation Sequencing (NGS) and other molecular profiling techniques, is changing the clinical practice in Oncology. In this setting, Molecular Tumour Board (MTB) became a crucial multidisciplinary tool for results interpretation in order to better select the treatment for our patients, including the inclusion in clinical trials. We analysed, retrospectively, a cohort of patients with several advanced solid tumours and no candidate for standard treatment consulted in Phase I – Early Clinical Trials Unit of the Antwerp University Hospital with molecular profile (MP) that were discussed in the MTB. Patients with in house and commercial NGS platforms were included. A subgroup of those patients were analysed also based in immunochemistry (IHC) and/or in situ hybridization (ISH). In this study, 141 tissue samples of 133 national and international patients were included. The median age was 59 years old (18 – 85). The majority of the patients were women (56%). A total of 75.9% samples (n = 107) had genomic alterations with an average of 3.44 alterations; of which 80.4% (n = 86) correspond to gene mutations in the NGS panel. About 58.1% (n = 50) had more than one mutated gene. TP53 (32%), KRAS (13%), PIK3CA (8%) and APC (7%) were the more frequent mutated genes. In the subgroup analysis of patients with additional MP information (IHC = X: CISH = 4: FISH = 6) the more common alterations were: TOPO1 (9%), TOP2A (9%), MGMT (8%) and PTEN (8%). By primary tumour site, lung (14.9%), colon (12.1%), pancreas (9.2%) and breast (7.8%) were the most frequent. In 55% (n = 78) of the cases MTB suggested treatment: 70.5% (n = 55) matched therapy and 29.5% (n = 23) non-matched therapy. Almost 37% (n = 29) were included in clinical trials and 6.4% (n = 5) with compassionate use. With Multidisciplinary MTB a considerable number of patients with advanced cancer could be offered targeted therapy or clinical trials based on molecular profiling. National programs for reimbursement and access to suitable target drugs and clinical trials are crucial to guarantee a step forward in cancer treatment.