Advancing molecular tumour boards: highly needed to maximise the impact of precision medicine

Abstract

Nine per cent of patients with metastatic cancer harbour genomic alterations that are recognised as biomarkers for optimal treatment selection in current standard of care. An additional 27% carries genomic aberrations for which compelling clinical evidence exists supporting the use of these alterations as predictive biomarkers for drug response outside the registered indication.1 As novel molecular and genomic treatment indications are explored in rapid pace, the generation and correct interpretation of molecular tumour profiles are quickly becoming a necessity for offering optimal cancer treatment. The complexity and vast amounts of data generated through molecular profiling techniques, like next-generation sequencing, make expert review an absolute requirement in order to translate molecular profiles into clinical benefit for our patients. Leading cancer care providers are currently trying to address this by developing the so called ‘molecular tumour boards’ (MTBs), which comprise experts of various disciplines who help clinicians to interpret the molecular profiles of their patients. This is a challenging task and many uncertainties about the optimal implementation of these boards remain. Among different institutions, implementations can differ on various grounds: technically (eg, the used sequencing techniques, bioinformatics pipelines), composition wise (eg, which types of specialists are involved) or organisationally (eg, centralised vs localised). Recently, Moore and colleagues share how they implemented an MTB in the UK: the Sarah Cannon Research Institute (SRCI) UK/UCL Genomics Review Board (GRB). The paper describes the molecular profiling results, given recommendations and clinical trial enrolment of 895 patients reviewed by the GRB. In addition to these prospective data, the authors share the challenges encountered during the establishment of the GRB. A multidisciplinary team comprising physicians, a molecular oncologist, …