American Society of Clinical Oncology, Alexandria, VA.
JCO Precis Oncol. 2024 Mar;8:e2300615. doi: 10.1200/PO.23.00615.
With the advent of precision medicine, molecular tumor boards (MTBs) were established to interpret genomic results and guide decision making for targeted therapy in oncology patients. There are currently no universal guidelines for how MTBs should operate and thus variance can be seen depending on which MTB is reviewing the case. This study assesses the concordance of MTB recommendations when a participant case is reviewed by two different MTBs, establishes potential reasons for discordance, and advocates for the establishment of standard MTB operating guidelines.
Participants with advanced cancer, who had exhausted all standard treatment options were screened for the Targeted Agent and Profiling Utilization Registry (TAPUR) Study. Cases were submitted for MTB review if the treatment proposal was outside the protocol genomic matching rules, or if multiple treatment options were identified. Of the 306 cases submitted for review by the TAPUR MTB from 2016 to 2018, 107 were randomly selected for secondary review by a different MTB group. Recommendations from the original review were not disclosed. Concordance between MTB group recommendations was assessed. Concordance was defined as agreement between MTB reviews on the genomic alteration and study drug match proposed by the clinical site. Thematic qualitative analysis was conducted for the discordant cases to assess reasons for discordance.
Complete or partial concordance was observed in 79% of cases (95% CI, 70 to 86; one-sided = .25). Most discordant analyses were due to disagreements on the strength of evidence regarding efficacy of the proposed treatment (32%).
When presented with identical participant cases, different MTB review groups make the same or similar treatment recommendations approximately 80% of the time.
随着精准医学的出现，建立了分子肿瘤委员会（MTB），以解释基因组结果并为肿瘤患者的靶向治疗决策提供指导。目前尚无关于 MTB 应如何运作的通用指南，因此，根据审查病例的 MTB 不同，可能会出现差异。本研究评估了当一名参与者的病例由两个不同的 MTB 审查时，MTB 建议的一致性，确定了不一致的潜在原因，并主张制定标准的 MTB 操作指南。
对已用尽所有标准治疗方案的晚期癌症患者进行了靶向药物和基因谱分析利用登记处（TAPUR）研究的筛选。如果治疗方案超出方案基因组匹配规则，或如果确定了多种治疗方案，则将病例提交 MTB 审查。在 2016 年至 2018 年期间，TAPUR MTB 共审查了 306 例病例，其中随机选择了 107 例由另一个 MTB 小组进行二次审查。原始审查的建议并未披露。评估了两个 MTB 小组的建议是否一致。一致性定义为原始审查的 MTB 小组对临床站点提出的基因组改变和研究药物匹配的建议的意见是否一致。对不一致的病例进行了主题定性分析，以评估不一致的原因。
79%（95%CI，70 至 86；单侧=.25）的病例观察到完全或部分一致性。大多数不一致分析是由于对拟议治疗的疗效证据强度存在分歧（32%）。
当提供相同的参与者病例时，不同的 MTB 审查小组大约 80%的时间会做出相同或类似的治疗建议。
