Implementation of Molecular Tumor Boards in Europe: a policy brief in the CAN.HEAL consortium

Abstract Background Molecular Tumour Boards (MTBs) are groups of specialists whose role is to interpret molecular alterations and recommend therapies in oncologic patients. This policy brief aims to collate the latest evidence and gain insights from experts to support the implementation of the MTBs in the context of the EU project Building the EU Cancer and Health Genomics platform (CAN.HEAL). Methods This policy brief followed a three-step methodology. We conducted a systematic review to quantify the clinical impact of MTBs and a narrative review on implementation aspects. Then, to identify actionable, consensus-based recommendations we conducted a 2-round Delphi process involving 17 experts from 10 EU countries. Results Therapies recommended by MTBs were associated with a reduction in the risk of disease progression (17% to 39%) and in mortality risk (10% to 40%). The review found unequal access to MTBs due to geographic and socioeconomic disparities, lack of coverage for therapies and sequencing, and technical barriers for testing and interpretation. The recommendations focus on 3 domains: organization, testing, and clinical aspects. For organizational aspects, the MTB meetings should be held weekly and include oncologists, pathologists, biologists, geneticists, and the treating physician. Each case should be presented jointly by the referent clinician and the case manager. The ideal turnaround time should be 28 days. Regarding genomic testing, NGS is the recommended method, while the actionability should be based on consultation of various databases (e.g., COSMIC, OncoKB). For the clinical criteria, patients with good performance status, rare cancers, or in therapeutic failure should be included; however, patients showing strong molecular targets may be considered. MTB may also recommend clinical trial enrolment and further testing. Conclusions The recommendations outlined in this policy brief provide a practical guidance for the harmonized implementation of MTBs in Europe. Key messages • MTBs-guided therapy reduce cancer progression and mortality risks, however their implementation is hetergoeneus and face a number of challenges, from infrastructure to funding. • This policy brief guides the effective and equitable implementation of MTBs across Europe, establish standards for its functioning, including members, gahterings and clinical criteria.