Differences in interpretation and lack of a standardized workflow results in conflicting recommendations from molecular tumor boards, reports a study published in JCO Precision Oncology

The hope of precision oncology is that genomic biomarkers can lead to tailored patient-specific treatments. To aid providers in evaluating the increasing number of patient-specific molecular profiles and provide treatment recommendations, interdisciplinary tumor boards were formed at many academic institutions. However, the recommendation process of molecular tumor boards is ill-defined and remains to be thoroughly investigated.

In this study, researchers created 4 fictional patient profiles based on real cases with genomic information on mutation, fusion, copy numbers, and gene expression. They gave the profiles to 29 different tumor boards from 9 different countries worldwide and asked them to provide treatment recommendations. Additionally, the boards were given a questionnaire to evaluate the workflow of their recommendation process. 

Five molecular tumor boards from 4 countries responded. For one patient, 3 tumor boards provided identical recommendations. For the remaining 3 patients, 2 tumor boards had identical treatment strategies. Each board interpreted tumor and germline aberrations differently and provided different prioritization strategies. 

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“We believe that a standardization of information is required not only for variant reporting, but also for variant interpretation,” write the authors. “We conclude that the interpretation process needs more research if the goal of an effective personalized therapy for a larger patient population and eventually an improved outcome is to be achieved.” 

Reference

Rieke DT, Lamping M, Schuh M, et al. Comparison of treatment recommendations by molecular tumor boards worldwide[published online October 16, 2018]. JCO Precision Oncology. doi: 10.1200/PO.18.00098