Implementation of a molecular tumour board in LATAM: the impact on treatment decisions for patients evaluated at Instituto Alexander Fleming, Argentina.

Martín Osvaldo Angel,Yamil Damián Mahmoud,Claudio Martín,Romina Girotti,Federico Losco,Mariano Leiva,Florencia Tsou,Romina Luca,Juan Manuel O'Connor,Fernando Petracci,Federico Esteso,Tomas Soule,Matías Chacón,Carmen Pupareli

doi:10.3332/ecancer.2021.1312

Abstract

BackgroundThe role of the molecular tumour board (MTB) is to recommend personalised therapy for patients with cancer beyond standard-of-care treatment. A comprehensive molecular analysis of the tumour in a molecular pathology laboratory is important for all targeted therapies approaches. Here we report the 1-year experience of the Instituto Alexander Fleming Molecular Tumour Board.Patients and methodsThe MTB of the Instituto Alexander Fleming was launched in December 2019 in a monthly meeting. In each interactive monthly session, five cases were presented and discussed by the members. These cases were referred by the treating oncologists. The MTB recommendations were sent to each physician individually, and to the rest of the meeting participants. This was discussed with the patients/families by the treating oncologist. The final decision to choose therapy was left to the treating physicians. Of the 32 patients presented at MTB, 28 (87.5%) had potentially actionable alterations and only 4 (12.5%) had no actionable mutation. Six (19%) patients received a local regulatory agency approved drug recommendation, nine (28%) patients received an off-label approval treatment recommendation and three (9%) patients did not receive the treatment due to access and reimbursement of the drug.ConclusionIn most of the cases evaluated, the MTB was able to provide treatment recommendations based on targetable genetic alterations. Molecular-guided extended personalised patient care is effective for a small but clinically significant proportion of patients in challenging clinical situations. We believe that the implementation of a MTB is feasible in the Latin America (LATAM) region.

Highlights

The role of the molecular tumour board (MTB) is to recommend personalised therapy for patients with cancer beyond standard-of-care treatment
In most of the cases evaluated, the MTB was able to provide treatment recommendations based on targetable genetic alterations
We believe that the implementation of a MTB is feasible in the Latin America (LATAM) region

Summary

Introduction

The role of the molecular tumour board (MTB) is to recommend personalised therapy for patients with cancer beyond standard-of-care treatment. The identification of molecular targets has allowed the personalisation of medicine. The first example arises from the discovery of the c-Kit activation pathway in gastrointestinal (GI) tumours and the use of imatinib for its treatment [1]. With advances in the understanding of tumour biology and the discovery of oncogenic activation pathways, the oncologist began to implement biomarker-based treatment strategy. Different tumour models have followed this molecular characterisation strategy and multiple therapeutic targets have been identified [4]. Some examples of malignant melanoma arise with the identification of activating mutations in the BRAF oncogene, being one of the most frequent genetic alterations in melanoma (50%). Treatment with BRAF and MEK inhibitors has increased overall survival in melanoma

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Conclusion