Effectiveness of a Molecular Tumor Board in Making Personalized Treatment Recommendations for Patients with Advanced Cancer

ABSTRACT BACKGROUND: Next-generation sequencing (NGS) and the development of targeted therapies have revolutionized cancer treatment. Molecular Tumour Boards (MTB) serve as collaborative platforms to integrate individual clinical and molecular information to make recommendations for personalized treatment. METHOD: This is a single-center, retrospective cohort study of patients presented at the Jewish General Hospital (JGH) MTB between July 2018 and Dec 2022. Clinical, molecular/pathologic data, MTB recommendations, and treatment details were collected. Treatment response was determined by radiological evaluation and physician clinical assessment. Fishers exact test and Log-rank tests were used to assess differences between groups. RESULTS: A total of 328 patients were presented to the MTB, including 23 with repeat presentations, resulting in 355 case reviews. Tumour-agnostic biomarkers were detected in 18.9% of cases, most commonly high tumour mutational burden (TMB, 9.5%) and HER2 amplification (4.3%). The most frequent actionable mutations were PIK3CA (19.8%) and PTEN (13.1%), often leading to recommendations for mTOR inhibitor therapy (26.0%). Overall, therapeutic recommendations were issued in 84.5% (300/355) of cases, and implemented in 43.3% (130/300). Patients who received MTB-recommended therapies achieved significantly higher objective response rates (ORR) (14.2% vs. 4.2%; P = 0.047), longer real-world progression-free survival (rwPFS) (5.6 vs. 3.5 months; HR 0.57; 95% CI 0.390 - 0.828; P = 0.003), and improved median overall survival (OS) (12.8 vs. 5.2 months; HR 0.60, 95% CI 0.452 - 0.793; P < 0.001) compared with those treated without MTB guidance. CONCLUSION: MTB is effective in identifying biomarker-matched therapeutic recommendations for advanced malignancies where limited standard-of-care treatment option is available.