Bridging therapeutic opportunities: a survey by the Italian molecular tumor board workgroup of Alliance Against Cancer

Abstract

Background: Molecular tumor boards (MTBs) match molecular alterations with targeted anticancer drugs upon failure of the available therapeutic options. Special and local needs are most likely to emerge through the comparative analysis of MTB networks, but these are rarely reported. This manuscript summarizes the state-of-art of 16 active Italian MTBs, as it emerges from an online survey curated by Alliance Against Cancer (ACC).

Main text: Most MTBs (13/16) are exclusively supported through local Institutional grants and meet regularly. All but one adopts a fully virtual or a mixed face-to-face/virtual calling/attendance meeting model. It appears that the ACC MTB initiative is shaping a hub-and-spoke virtual MTB network reminiscent of non-redundant, cost-effective healthcare organization models. Unfortunately, public awareness of MTB opportunities presently remains insufficient. Only one center has a website. Dedicated e-mail addresses are for the exclusive use of the MTB staff. More than half of ACC members consider a miscellanea of most or all solid and hematological malignancies, and more than one-third consider neoplasms arising at any anatomical location. The average number of Staff Members in MTBs is 9. More than 10 staff members simultaneously attend MTB meetings in 13 MTBs. A medical oncologist is invariably present and is in charge of introducing the clinical case either with (45%) or without previous discussion in organ-specific multidisciplinary Boards. All but two MTBs take charge of not only patients with no standard-of-care (SoC) therapy option, but also cases receiving NGS profiling in SoC settings, implying a larger number of yearly cases. All MTBs run targeted NGS panels. Three run whole-exome and/or RNAseq approaches. ESCAT-ESMO and/or Onco-KB levels of evidence are similarly used for diagnostic reporting. Most MTBs (11) provide a written diagnostic report within 15 days. Conclusions are invariably communicated to the patient by the medical oncologist.

Conclusions: MTB networking is crucial not only for molecular diagnosis and therapy assignment, but also for healthcare governance. Survey results show that MTBs review therapeutic opportunities at the crossover between standard-of-care with off-label, the former task being much beyond their scope. Societal and scientific implications of this beyond-the-scope MTB function may be relevant for healthcare in Italy and abroad.

Keywords: Alliance against Cancer; MTB; Molecular alterations; Molecular tumor boards; Targeted anticancer drugs.

Fig. 1

The ACC MTB network. A Most frequently discussed neoplasms. Respondents were given the option to tick more than one in a series of multiple choices. B MTB staff members ranked by frequency. C Frequently appointed discussants. D Case-mix: MTBs assigning treatment both in indication (SoC) and off-label (blue), and off-label only (orange). E numerosity and case-mix: MTBs (n. 1–16) were ranked by the number of cases discussed per year (descending order; shades of blue). Each MTB is also pseudo-colored in shades of red (color intensity proportional to case-mix as defined in D). F Confidence in liquid biopsy. G Complexity (n. of genes) of clinical NGS panels used for tissue and blood. H Failure to administer MTB-recommended off-label treatment and causes thereof. I Funds to support off-label treatment (J) Top three international scales of actionable biomarkers (levels of evidence) adopted by the ACC MTB Workgroup