Multidisciplinary Tumour Boards in harmony: mission possible?

A virtual space where to discuss the latest achievements in precision oncology  - Authored by Elena Garralda. 

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Dr Garralda directs the Research Unit for Molecular Therapy of Cancer (UITM) – CaixaResearch, at Vall d' Hebron Institute of Oncology (VHIO), Barcelona, Spain. She is also Principal Investigator of VHIO’s Early Clinical Drug Development Group. 

As we all return back to practice after the busy and buzzing ESMO Congress 2021, myriad clinical questions have been addressed and debated, with many even solved. But, there is still much work to be done if we are to collectively deliver on the promise of precision medicine in oncology, and in so doing, continue to improve outcomes for our patients.

Among the many studies that made the headlines during the meeting were the results of a prospective analysis which reported a poor concordance of treatment recommendations between central consensus and multidisciplinary tumour boards (MTBs), particularly for tumours with less defined treatment options (519MO). Presented by Hidenori Kage, Next-generation Precision Medicine Development Laboratory, University of Tokyo, findings showed that less than two-thirds of MTBs from 12 leading cancer centers in Japan, showed agreement with consensus management for 50 simulated cancer cases.

Some tumour types fared better than others. As examples, high concordance was observed for cases of colorectal cancer (100%), and those with ROS1 fusion. According to multivariate analysis, a high level of evidence for recommendations was associated with a four-fold increase in the probability of concordance. Collectively though, the results shine a glaring light on just how we will need to pull together and up the ante in improving the quality of treatment recommendations.

MTBs are increasingly being integrated and implemented into the cancer care continuum. They exist to promote and ultimately deliver more precise, optimal treatment strategies for individual patients. In many cases, MTBs are also transitioning from face-to-face tumour boards to virtual ones, which has been expedited by the COVID-19 pandemic.

They are also at the centre of many studies assessing their efficacy, utility and potential impact on multidisciplinary care. Quite rightly so. Under current scrutiny, we are seeing degrees of discordance between treatment recommendations by MTBs and those of central consensus committees. The identified low concordance is consequently triggering much discussion on the multifactorial causes of these discrepancies. In a recent editorial first authored by Tayana Soukup, Center for Implementation Science, Health Service and Population Research Department, King’s College London (UK), the researchers propose the lack of patient-centeredness as a major one (JCO Oncol Pract. 2021 Mar 18:OP2000588). They discuss several strategies aimed at making MTBs more patient-centred including the inclusion of cancer nurses as core tumour board members as well as direct patient participation. Researchers also suggest a shift in terminology from ‘tumour boards’ to ‘care planning meetings for people with cancer’.

Whether it be about lexicon, who joins (how and when), or the added value that each participant brings to the ‘party’, MTBs will remain firmly under the lens. We must join together to identify and implement better strategies aiming at higher concordance, and do so on a larger scale, as well as advance insights that will ultimately translate in increasingly well-defined therapeutic strategies across all tumour types.

Where to next?

Returning to the Japanese study, which was also covered by the ESMO Daily Reporter, the authors propose that the sharing of data on matched therapies, particularly for those with low evidence levels, might improve the quality and clinical utility of MTB treatment recommendations. I couldn’t agree more.

I also firmly believe that current challenges in oncology translate into future opportunities. The rapidly emerging suite of powerhouse technologies including artificial intelligence (AI), coupled with the increased access of cancer centers to sophisticated gene sequencing platforms, will also enable us to optimize MTB decision-making, approaches and processes. Further, support systems including open access tools, such as Cancer Core Europe’s Molecular Tumor Board Portal, will help to more precisely guide clinical decision-making in oncology (Nat Med. 2020 Jul;26(7):992-994).

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