From Recommendation to Implementation: Clinical Outcomes of a Single-Center Molecular Tumor Board

BACKGROUND: Molecular tumor boards (MTBs) support precision oncology by translating genomic profiling into evidence-based treatment recommendations, for example according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT). Their clinical utility in real-world care depends on effective implementation within healthcare systems. OBJECTIVES: To evaluate the implementation rate of MTB recommendations, associated determinants, and clinical outcomes in a real-world single-center cohort. PATIENTS AND METHODS: At a single-center MTB, 582 consecutive cases (2020-2023) were retrospectively analyzed, with last survival follow-up in August 2025. Patient demographics, tumor characteristics, genomic alterations, ESCAT and ZPM (Zentrum für Personalisierte Medizin) evidence levels, targeted therapy recommendation and implementation rates, survival outcomes, and barriers to implementation were evaluated using descriptive and inferential statistics, as appropriate. RESULTS: Of 582 patients (median age 61 years, 48.5% female, 78.2% UICC stage IV), 55.6% (n = 324) received a targeted therapy recommendation, most based on ESCAT I-II evidence (59.9%). Among patients with a therapy recommendation, implementation status was unknown in 83 cases, but at least 23.5% (n = 76) received the proposed therapy. Major barriers included continuation of alternative systemic therapy (n = 89, 53.9%) and best supportive care or death before initiation (n = 54, 32.7%). Stronger levels of evidence (ESCAT per level increase: OR 1.22, 95% CI 1.08-1.39, p = 0.003; ZPM per level increase: OR 1.43, 95% CI 1.19-1.75, p < 0.001) and lower gastrointestinal cancer (OR 2.39, 95% CI 1.13-4.93, p = 0.020) were positively associated with increased likelihood of therapy implementation, while extramural molecular profiling showed a trend toward lower uptake (OR 0.61, 95% CI 0.36-1.03, p = 0.062). Overall survival (OS) from the date of MTB discussion in the full cohort (n = 563) was 11.1 months (95% CI 9.7-12.8). In patients who received at least one prior therapy before MTB discussion (n = 202), OS was 20.1 months (95% CI 12.3-NA) in patients who received the MTB-recommended therapy (n = 62) versus 7.7 months (95% CI 6.5-12.5) in those who did not (n = 140; p < 0.001). Among 31 patients with paired data, PFS under MTB-guided therapy was significantly longer than in the prior line (p = 0.036), with 54.8% achieving a PFS2/PFS1 ratio ≥ 1.3. CONCLUSIONS: In this real-world analysis, implementation of MTB recommendations was associated with improved survival outcomes. However, systemic, clinical, and logistical barriers substantially limited uptake. Earlier integration of MTBs into treatment planning and targeted strategies to address these barriers may help increase their potential benefit for patients.