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Review
. 2025 Jul 7:S1556-0864(25)00831-7.
doi: 10.1016/j.jtho.2025.07.009. Online ahead of print.

Molecular Tumor Boards: A Consensus Statement From the International Association for the Study of Lung Cancer

Affiliations
Review

Molecular Tumor Boards: A Consensus Statement From the International Association for the Study of Lung Cancer

Mihaela Aldea et al. J Thorac Oncol. .

Abstract

Context: Molecular tumor boards (MTBs) are multidisciplinary meetings of specialists dedicated to analyzing biomarker test results to provide personalized treatment recommendations. However, global disparities in the successful implementation of MTBs exist, driven by unequal access to molecular diagnostics and supportive multidimensional expertise.

Objective: To establish recommendations for MTB implementation, outline practical frameworks for their operation, and address disparities in expertise and resources between new and established MTBs.

Design: A modified Delphi method involved 37 international experts in three survey rounds and online meetings, with consensus defined as more than or equal to 75% agreement.

Results: The panel identified a molecular biologist or pathologist with expertise in molecular diagnostics and tumor-specific medical oncologists as indispensable MTB members. Case selection should reflect institutional expertise and volume, with newer MTBs reviewing less selected cases to gain experience. Regular meetings are advised to avoid delays beyond 14 days from result availability to discussion. Reporting should be standardized to include clinicopathologic data (tumor characteristics, treatment history), biomarker findings (testing results, sample details), and recommendations (treatment, retesting, genetic counseling). Treatment options should be ranked by the level of evidence for actionability and may include options not available locally. Performance evaluation should consider changes in patient management based on MTB input and matched therapy rates.

Conclusions: These MTB consensus recommendations are applicable across tumor types, despite being developed by lung cancer and molecular specialists and initiated by the International Association for the Study of Lung Cancer. They provide a structured framework for MTB implementation, report standardization, case selection, and quality assessment, aiming to standardize practice and address gaps in expertise for personalized cancer care.

Keywords: Artificial intelligence; Biomarker; ESCAT; Molecular tumor board; Next-generation sequencing; OncoKB.

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Conflict of interest statement

Disclosure Dr. Aldea reports receiving research funding (institution) from Amgen, AstraZeneca, Sandoz, and Owkin. Dr. Rotow reports receiving consulting fees or honoraria from Amgen, AstraZeneca, BioAtla, Bristol Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Genentech, G1 Therapeutics, Guardant Health, Johnson and Johnson, Jazz Pharmaceuticals, Merus, Novocure, Pfizer, Sanofi-Genzyme, Summit Therapeutics, and Takeda; receiving travel support from AstraZeneca, Bristol Myers Squibb, J&J, and Merus; and having contracted for research (institutional) with Altor Bioscience, AstraZeneca, Bicycle Therapeutics, BioAtla, Blueprint Medicines, Enliven Therapeutics, EpimAb, Black Diamond, Duality, LOXO Oncology, ORIC Pharmaceuticals, AbbVie, RedCloud Bio, Summit, Synthekine, Immunity Bio, and Regeneron. Dr. Arcila reports having consulting or advisory role from AstraZeneca, Roche, Bristol Myers Squibb, Janssen, and Biocartis. Dr. Sholl reports receiving research funding from Genentech and Bristol Myers Squibb; receiving consultant income from Genentech and Lilly. Dr. Rolfo reports having consulting or advisory role from Archer, Inivata, Merck Serono, Bristol Myers Squibb, Novartis, Boston Pharmaceuticals, Eisai, Mirati Therapeutics, EMD Serono, ONCLIVE, Daiichi Sankyo Europe GmbH, Physicians' Education Resource, Physicians' Education Resource, Intellisphere, Genzyme, BostonGene, Cor2Ed, ROCHE, Clinical Education Alliance, AstraZeneca, EMD Serono, Bayer, General Dynamics Information Technology (GDIT), Regeneron, Diverse Health Hub, Guardant Health, MJH Live Events, Janssen Scientific Affairs, MedStar Health, Amgen, LUNGEVITY, and Boehringer Ingelheim; serving on the speakers' bureau of Merck Sharp & Dohme, AstraZeneca, Guardant Health, and Roche Molecular Diagnostics; receiving research funding from Lung Cancer Research Foundation; receiving travel support, accommodations, and expenses from AstraZeneca; and having uncompensated relationships from Guardant Health. Dr. Tagliamento reports receiving grants to his institution from AIRC; consulting fees from Oncotech; personal honoraria from Roche, Novartis, and Takeda; travel support from Eli Lilly, Takeda, and OSE Immunotherapeutics; and institutional support for sponsored clinical research from OSE Immunotherapeutics. Dr. Subbiah reports receiving grants/having contracts from AbbVie, Inc., AgenSys, Alfa-Sigma, Altulm, Amgen, Bayer HealthCare Pharmaceuticals Inc., Blueprint Medicines, Berghealth, Boston Biomedical, Boston Pharmaceuticals, Celgene Corporation, Dragonfly Therapeutics, Exelixis Inc., F. Hoffmann-La Roche AG, FUJIFILM Medical Systems USA, Inc., Genentech USA, Inc., GlaxoSmithKline, LLC, Idera Pharma, Incyte Corporation, Inhibrx, LOXO Oncology, MedImmune, LLC, Multivir, Nanocarrier, the National Comprehensive Cancer Network, the National Cancer Institute, Novartis Pharma, OncLive, Oncusp, PERS, Pfizer, PharmaMar, Relay Therapeutics, and Takeda Oncology; receiving personal/consulting fees from AbbVie, Bayer HealthCare, Pharmaceuticals Inc., F. Hoffmann-La Roche AG, Illumina, Incyte Corporation, Jazz Pharmaceuticals Inc., LabCorp (aka Lab Corporation), Regeneron Pharmaceuticals, Inc., and Relay Therapeutics; receiving support for other professional activities from Aadi Biosciences, Clinical Care Communications, Illumina, Jazz Pharmaceuticals Inc., Med Learning Group, Medscape, and Phenon Therapeutics; and receiving travel support from the American Society of Clinical Oncology, the European Society for Medical Oncology, Helsinn Healthcare SA, and Incyte Corporation outside the submitted work. Dr. Roden reports serving on the advisory boards of AstraZeneca and Agilent; receiving royalties from UpToDate; and serving as a President of ITMIG (2023–2024). Dr. Malapelle reports providing consulting and receiving honoraria from Boehringer Ingelheim, Roche, Merck Sharp & Dohme, Amgen, Thermo Fisher Scientific, Eli Lilly, Diaceutics, GlaxoSmithKline, Merck, AstraZeneca, Janssen, Diatech, Novartis, and Hedera. Dr. Manochakian reports serving on the advisory boards for: AbbVie, Bristol Myers Squibb, AstraZeneca, Janssen, Novocure, DSI, and Oncohost. Dr. Linardou reports receiving personal fees for lectures from Roche, AstraZeneca, Pfizer, Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, and Amgen; receiving support for attending meetings from Pfizer and Roche; receiving personal fees for advisory board participation from Roche, AstraZeneca, Merck Sharp & Dohme, GlaxoSmithKline, Bristol Myers Squibb, Novartis, Pfizer, and Amgen; having unpaid leadership roles in the Hellenic Cooperative Oncology Group, Hellenic Foundation of Cancer Research, Fairlife Lung Cancer Non-Profit Organisation, W4O-Hellas, and ESMO Council (including Chair of the ESMO W4O Committee); and receiving fees as Principal Investigator of international pharmacy-sponsored clinical trials from Amgen, Novartis, Merck Sharp & Dohme, Bristol Myers Squibb, GlaxoSmithKline, AbbVie, Boehringer, Miratti, Lilly, and Roche. Dr. Novello reports serving on the advisory board and receiving honoraria from Bristol Myers Squibb, Lilly, Takeda, Roche, Pfizer, AstraZeneca, BI, Merck Sharp & Dohme, AbbVie, Sanofi, Pharmamar, Beigene, Daiichi Sankyo, and GlaxoSmithKline. Dr. Greystoke reports serving as Clinical Director for Cancer North East England and Yorkshire North East Genomic Medicine Service; receiving consultancy and speaker fees from AstraZeneca, Amgen, Boehringer-Ingelheim, Bristol Myers Squibb, Janssen/J and J, Merck Sharp & Dohme, Novartis, Pfizer, Lilly, Takeda, and Roche; and receiving research funding from AstraZeneca. Dr. Saqi reports receiving grants to her institution from Genentech and Boehringer Ingelheim; consulting fees from Genentech, AbbVie, and Gilead; honoraria from NYU, MSK, Bronx Lebanon, ASCO, Medscape/WebMD, and others; travel support from the College of American Pathologists, IASLC, and Gilead; having patent disclosures for a cell block device and MPR calculator; and having equity in Link Biosystems. Dr. Lantuejoul reports receiving personal fees for lectures from Janssen, Roche, Merck Sharp & Dohme, and Lilly; having advisory board participation for Janssen, Sanofi, Pierre Fabre, Bristol Myers Squibb, AbbVie, and Daiichi Sankyo. Dr. Hwang reports receiving consulting fees and honoraria from Amgen, AstraZeneca, Boehringer Ingelheim, Merck, Novartis, and Roche. Dr. Waqar reports serving on the consulting/advisory board for Pfizer, AstraZeneca, Gilead, Daiichi Sankyo, Boehringer Ingelheim, and Janssen (self); receiving honorarium from ASCO SEP, OncLive, DAVA Oncology, and Karmanos Cancer Center (self); receiving funding from SWOG-clinical trials partnership for role as Lung-MAP Vice Chair (institution); receiving research funding to institution (study site PI role) from AbbVie, Gilead, Immunomedics Inc., Daiichi Sankyo, Verastem Inc., Janssen, Elevation Oncology, Genentech, AstraZeneca, Advenchen, Ribon, Loxo Oncology, Takeda, and Nuvalent; receiving support for attending meetings/travel from SWOG and IASLC; and having participation in data safety monitoring board for Hoosier Cancer Research Network Study. Dr. Yatabe reports receiving consultancy and speaker fees from AstraZeneca, Merck Sharp & Dohme, AbbVie, Novartis, Amgen, Daiichi Sankyo, Janssen Pharma, Konica-Minolta REALM, and Daiichi Sankyo; having contracted studies with Merck Biopharma, Chugai-Pharma, Konica-Minolta REALM, Optieum Biotechnologies, and Eizai-Pharma. Dr. Hirsch reports having compensated advisory board participation for Bristol Myers Squibb, Genentech/Roche, AstraZeneca/Daiichi, Merck, Novartis, Regeneron/Genzyme/Sanofi, OncoHost, OncoCyte, Amgen, Nectin Therapeutics, NextCure, Merus Therapeutics, G1 Therapeutics, and Agilent/DAKO; having patents for EGFR Protein and/or EGFR Copy Number as Biomarkers for EGFR-directed therapy (University of Colorado). Dr. Hayashi reports receiving speaker fees from AstraZeneca, Chugai-Pharma, Novartis, Amgen, AbbVie, and Merck Sharp & Dohme. Dr. Kim reports receiving consultancy and speaker fees from AstraZeneca, Amgen, AbbVie, Beigene, Boehringer-Ingelheim, Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, Ono, Pfizer, Lilly, and Takeda. Dr. Chang reports receiving honoraria from AstraZeneca and Boehringer Ingelheim; serving as consultant for Ascendo Biotechnology. Dr. Schalper reports serving as consultant and advisor for or receiving speaker fees from Clinica Alemana Santiago, Shattuck Labs, AstraZeneca, EMD Serono, Takeda, Torque/Repertoire Therapeutics, CSRlife, Agenus, Genmab, OnCusp, Sanofi, Parthenon Therapeutics, Bristol Myers Squibb, Roche, Molecular Templates, Merck, Dynamicure, Indaptus, Moderna Inc., NexPoint Therapeutics, DAINA, Merus, PeerView, PER, and Forefront Collaborative; receiving research funding from Tesaro/GlaxoSmithKline, Takeda, Surface Oncology, Merck, Bristol Myers Squibb, AstraZeneca, Ribon Therapeutics, Eli Lilly, Boehringer-Ingelheim, Roche, Akoya Biosciences, and NextPoint Therapeutics. Dr. Leighl reports receiving institutional research funding from AstraZeneca, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Takeda, Guardant Health, and Inivata/Neogenomics; receiving support for independent CME lectures from AstraZeneca, Merck Sharp & Dohme, Roche, Janssen, Sanofi, and Guardant Health; and having participated in uncompensated advisory boards for Mirati Therapeutics and Daiichi Sankyo, unrelated to this work. Dr. Drilon reports receiving honoraria from 14ner/Elevation Oncology, AstraZeneca, Amgen, AbbVie, AnHeart Therapeutics, ArcherDX, AstraZeneca, Beigene, BergenBio, Blueprint Medicines, Bristol Myers Squibb, Boehringer Ingelheim, Chugai Pharmaceutical, EcoR1, EMD Serono, Entos, Exelixis, Helsinn, Hengrui Therapeutics, Ignyta/Genentech/Roche, Janssen, Loxo/Bayer/Lilly, Merus, Monopteros, MonteRosa, Novartis, Nuvalent, Pfizer, Prelude, Regeneron, Repare RX, Springer Healthcare, Takeda/Ariad/Millennium, Treeline Bio, TP Therapeutics, Tyra Biosciences, Verastem, and Zymeworks; having advisory board participation for Bayer, Monte Rosa, AbbVie, EcoR1 Capital, LLC, Amgen, Helsinn, Novartis, Loxo/Lilly, and AnHeart Therapeutics; receiving consulting fees from MonteRosa, Innocare, Boundless Bio, Treeline Bio, Nuvalent, 14ner/Elevation Oncology, Entos, Prelude, Bayer, Applied Pharmaceutical Science, Bristol Myers Squibb, Enlaza, Pfizer, Roche/Genentech, Nuvalent, Two River, and Lilly/Loxo; having associated research paid to institution from Foundation Medicine, GlaxoSmithKline, Teva, Taiho, and PharmaMar; having equity in mBrace and Treeline; having copyright from Selpercatinib-Osimertinib (US 18/041,617, pending); receiving royalties from Wolters Kluwer and UpToDate; recieivng food/beverage support from Merck, Puma, Merus, and Boehringer Ingelheim; receiving CME honoraria from Answers in CME, Applied Pharmaceutical Science, Inc., AXIS, Clinical Care Options, Doc Congress, EPG Health, Harborside Nexus, I3 Health, Imedex, Liberum, Medendi, Medscape, Med Learning, MedTalks, MJH Life Sciences, MORE Health, Ology, OncLive, Paradigm, PeerView Institute, PeerVoice, Physicians Education, Projects in Knowledge, Resources, Remedica Ltd., Research to Practice, RV More, Targeted Oncology, TouchIME, and WebMD; and receiving open payments CMS Log (paid to institution, associated research) from Pfizer, Exelixis, GlaxoSmithKline, Teva, and Taiho. Cooper reports receiving travel support from AstraZeneca. Dr. Dacic reports receiving consulting fees from AstraZeneca and having advisory board participation for AstraZeneca and Genentech/Roche. Dr. Mohindra reports serving on the Co-chair Education Committee of IASLC; receiving travel/lodging support from IBA Proton Inc., 2024. Dr. Pavlakis reports serving on the Co-chair Education Committee of IASLC; receiving grants/contracts from Bayer, Pfizer, and Roche; having consulting/advisory roles for BI, Merck Sharp & Dohme, Merck, Bristol Myers Squibb, AstraZeneca, Takeda, Pfizer, Roche, Amgen, Beigene, Gilead, Zymeworks, BioNTech, Daiichi, DUO Oncology, and J&J; and receiving honoraria from Merck, Pfizer, Roche, Takeda, Illumina, Bayer, Merck Sharp & Dohme, and Gene Solutions. Dr. Lopez-Rios reports serving on the Deputy Chair Pathology Committee of IASLC; serving as consultant, advisor, or speaker for AbbVie, AstraZeneca, Bayer, Bristol Myers Squibb, Daiichi Sankyo, Janssen, Lilly, Merck, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Takeda, and Thermo Fisher; and receiving research funding (to institution) from AstraZeneca, Janssen, Lilly, Pfizer, Roche, and Thermo Fisher. The remaining authors declare no conflict of interest.

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