Division of Molecular Oncology, Netherlands Cancer Institute, Amsterdam.
Division of Medical Oncology, Radboud University Medical Center, Nijmegen.
Ann Oncol. 2017 Dec 1;28(12):3070-3075. doi: 10.1093/annonc/mdx528.
Due to rapid technical advances, steeply declining sequencing costs, and the ever-increasing number of targeted therapies, it can be expected that extensive tumor sequencing such as whole-exome and whole-genome sequencing will soon be applied in standard care. Clinicians will thus be confronted with increasingly complex genetic information and multiple test-platforms to choose from. General medical training, meanwhile, can hardly keep up with the pace of innovation. Consequently, there is a rapidly growing gap between clinical knowledge and genetic potential in cancer care. Multidisciplinary Molecular Tumor Boards (MTBs) have been suggested as a means to address this disparity, but shared experiences are scarce in literature and no quality requirements or guidelines have been published to date.
Based on literature review, a survey among hospitals in The Netherlands, and our own experience with the establishment of a nationally operating MTB, this article evaluates current knowledge and unmet needs and lays out a strategy for successful MTB implementation.
Having access to an MTB can improve and increase the application of genetics-guided cancer care. In our survey, however, <50% of hospitals and only 5% of nonacademic hospitals had access to an MTB. In addition, current MTBs vary widely in terms of composition, tasks, tools, and workflow. This may not only lead to variation in quality of care but also hinders data sharing and thus creation of an effective learning community.
This article acknowledges a leading role for MTBs to govern (extensive) tumor sequencing into daily practice and proposes three basic necessities for successful MTB implementation: (i) global harmonization in cancer sequencing practices and procedures, (ii) minimal member and operational requirements, and (iii) an appropriate unsolicited findings policy. Meeting these prerequisites would not only optimize MTB functioning but also improve general interpretation and application of genomics-guided cancer care.
由于技术的快速进步、测序成本的急剧下降以及靶向治疗的数量不断增加，可以预见广泛的肿瘤测序，如全外显子组和全基因组测序，将很快应用于标准护理。因此，临床医生将面临越来越复杂的遗传信息和多种可供选择的测试平台。与此同时，一般的医学培训几乎跟不上创新的步伐。因此，癌症治疗中临床知识和遗传潜力之间的差距迅速扩大。多学科分子肿瘤委员会（MTB）已被提议作为解决这一差距的一种手段，但文献中共享经验很少，迄今为止也没有发布任何质量要求或指南。
本文基于文献回顾、荷兰医院的调查以及我们在建立全国性 MTB 方面的经验，评估了当前的知识和未满足的需求，并制定了成功实施 MTB 的策略。
能够获得 MTB 可以改善和增加基于遗传学的癌症护理的应用。然而，在我们的调查中，不到 50%的医院和只有 5%的非学术医院能够获得 MTB。此外，目前的 MTB 在组成、任务、工具和工作流程方面差异很大。这不仅可能导致护理质量的差异，还可能阻碍数据共享，从而阻碍有效的学习社区的建立。
本文承认 MTB 在将（广泛的）肿瘤测序纳入日常实践中的主导作用，并提出了成功实施 MTB 的三个基本要求：（i）癌症测序实践和程序的全球协调，（ii）最小的成员和运营要求，以及（iii）适当的非请求发现政策。满足这些前提条件不仅可以优化 MTB 的功能，还可以提高基因组学指导的癌症护理的一般解释和应用。
