Multicenter Comparison of Molecular Tumor Boards in The Netherlands: Definition, Composition, Methods, and Targeted Therapy Recommendations
Authors: Koopman Bart , Groen Harry J.M. , Ligtenberg Marjolijn J.L. , Grünberg Katrien , Monkhorst Kim , Langen Adrianus J. , Boelens Mirjam C. , Paats Marthe S. , Thüsen Jan H. , Dinjens Winand N.M. , Solleveld Nienke , Wezel Tom , Gelderblom Hans , Hendriks Lizza E. , Speel Ernst-Jan M. , Theunissen Tom E. , Kroeze Leonie I. , Mehra Niven , Piet Berber , Wekken Anthonie J. , Elst Arja , Timens Wim , Willems Stefan M. , Meijers Ruud W.J. , Leng Wendy W.J. , Lindert Anne S.R. , Radonic Teodora , Hashemi Sayed M.S. , Heideman Daniëlle A.M. , Schuuring Ed , Kempen Léon C. 
Published: October 2020

Abstract

Background
Molecular tumor boards (MTBs) provide rational, genomics-driven, patient-tailored treatment recommendations. Worldwide, MTBs differ in terms of scope, composition, methods, and recommendations. This study aimed to assess differences in methods and agreement in treatment recommendations among MTBs from tertiary cancer referral centers in The Netherlands.

Materials and Methods
MTBs from all tertiary cancer referral centers in The Netherlands were invited to participate. A survey assessing scope, value, logistics, composition, decision-making method, reporting, and registration of the MTBs was completed through on-site interviews with members from each MTB. Targeted therapy recommendations were compared using 10 anonymized cases. Participating MTBs were asked to provide a treatment recommendation in accordance with their own methods. Agreement was based on which molecular alteration(s) was considered actionable with the next line of targeted therapy.

Results
Interviews with 24 members of eight MTBs revealed that all participating MTBs focused on rare or complex mutational cancer profiles, operated independently of cancer type–specific multidisciplinary teams, and consisted of at least (thoracic and/or medical) oncologists, pathologists, and clinical scientists in molecular pathology. Differences were the types of cancer discussed and the methods used to achieve a recommendation. Nevertheless, agreement among MTB recommendations, based on identified actionable molecular alteration(s), was high for the 10 evaluated cases (86%).

Conclusion
MTBs associated with tertiary cancer referral centers in The Netherlands are similar in setup and reach a high agreement in recommendations for rare or complex mutational cancer profiles. We propose a “Dutch MTB model” for an optimal, collaborative, and nationally aligned MTB workflow.

Implications for Practice
Interpretation of genomic analyses for optimal choice of target therapy for patients with cancer is becoming increasingly complex. A molecular tumor board (MTB) supports oncologists in rationalizing therapy options. However, there is no consensus on the most optimal setup for an MTB, which can affect the quality of recommendations. This study reveals that the eight MTBs associated with tertiary cancer referral centers in The Netherlands are similar in setup and reach a high agreement in recommendations for rare or complex mutational profiles. The Dutch MTB model is based on a collaborative and nationally aligned workflow with interinstitutional collaboration and data sharing.