Excellent Practices

Molecular Tumour Board

Practice Category: Diagnosis

Centre: OncoZON Cancer Network

Lizza Hendrik

Pulmonologist

lizza.hendriks@mumc.nl

Challenge addressed by the practice

Physicians often find it difficult to interpret molecular results obtained with broad panel Next Generation Sequencing or Whole Genome Sequencing (tissue or liquid biopsy). Due to an expanding number of targeted treatments available for patients with specific genomic features in their tumour tissue, molecular diagnostic testing is becoming more mainstream in clinical oncology practice, both in academic and non-academic hospitals. Mutations are often rare and limited data is available guiding best practice and treatment. Additionally, it is often difficult to have a complete overview of all ongoing clinical trials and available early access/named patient programs for rare oncogenic drivers or resistance mutations. Therefore, a structure is needed where physicians can easily discuss these molecular results with experts in the field, and obtain advice on how to optimally treat their patient.

Solution

The weekly molecular tumour board (MTB), led by Maastricht UMC+, but accessible via videoconferencing for all OncoZON regional hospitals, enables timely discussion of molecular results. The MTB gives advice on the biological features of the molecular aberrations found in a tumour (i.e. effect on tumour growth, sensitivity to specific anti-cancer drugs) and advises on treatment options (both on- and off-label), (early phase) clinical trials, and expanded access/named patient programs (also outside of the region). There is a standardised format referring physicians need to fill in, and all patients are discussed at a specific time at the MTB, with referring physicians encouraged to attend the MTB to discuss their patient via secured video access. Specialist from clinical molecular biology, pathology, medical oncology and pulmonology always participate. Other experts such as clinical geneticists  can be consulted as necessary. For all cases, a standardised letter with advice is sent to the treating physician and stored within the electronic patient record.

Impact

Every week between 1–5 cases are discussed in the MTB. Physicians value the possibility to discuss these challenging cases. The MTB facilitates cohesion in the OncoZON region and fulfills an important role regarding education of physicians who are not (yet) trained in molecular diagnostics in oncology, or for colleagues who desire to deepen their understanding of molecular biology in cancer. Regularly, clinical trials, named patient, or early access programs are recommended, resulting in extra treatment options for patients. For quality control, MUMC+ participates in anonymous sharing of cases with other MTBs in the Netherlands, and high consensus is being achieved. Annual review of the uptake of treatment advice and clinical follow-up of the patient is performed.

Critical success factors

We work with a dedicated and ambitious team, with no cancellation of the MTB, a standardised format for referral, and structural registration of the advice, as well as trained molecular biologists and trial- minded pulmonologists and medical oncologists.

Next steps

  • Enabling rapid data extraction to support periodic evaluation of MTB performance (number and complexity of cases discussed, uptake of the advice, and follow-up of treatment responses) 
  • Creation of a shared Dutch database
  • Strengthening the educational role of the MTB for colleagues working in non-academic OncoZON hospitals