gms | German Medical Science

Background/research question: Molecular sequencing could provide new inputs once guideline-based therapy or routine diagnostics in cancer patients (pts) are exhausted. Yet, the merit of an interdisciplinary Molecular Tumor Conference (iMTC) is still a matter of debate. We evaluated the value added by an iMTC.

Methods: The monthly iMTC of the DKG-certified university Krukenberg Cancer Center Halle (KKH) includes a panel of experts from molecular genetics, pathology, human genetics, hematology, and oncology disciplines. The board is actually and virtually open to internal and external physicians. In accordance with the KKH-iMTC guideline, pts with advanced disease and/or exhausted diagnostic and/or treatment options could be registered. Importantly, approved/standard testing and molecular-driven therapies per national guidelines are excluded as these are discussed within the eleven weekly regular tumor-boards. Outcome is documented in digital iMTC-files and communicated to attending physicians.

Results: Since its introduction in 2019, 42 discussions for 38 pts were conducted from hematology (n=20), visceral and thoracic oncology (n=11), gynecology (n=3), sarcoma-center (n=2), neuro-oncology (n=1), and head and neck cancer-center (n=1). Nine external pts were referred for second opinion. On average, iMTC was the third board per patient after two entity-specific boards. Median age was 57 (range 9-79) years. Objectives of presentations were diagnostic sequencing (31%), opinion about molecular procedures after treatment failure (29%), recommendations for targeted-therapies based on sequencing results (29%), and interpretation of molecular reports (7%.). A median of three iMTC recommendations per case were made. Interestingly, in pts with ambiguous hematological findings, conditions such as erythrocytosis with rare point mutations in the beta-globin-chain were diagnosed. Overall, 65% of diagnostic and/or experimental treatment proposals were beyond guideline recommendations including inclusions in clinical trials. Generally, the adherence rate was 72%. Reasons for noncompliance were ongoing reimbursement applications or death of pts.

Conclusion: The KKH-iMTC is a well-established platform where biology-driven diagnostic and experimental therapeutic potentials beyond national guidelines for advanced malignancies could be discussed and proposed to external and internal colleagues. Time-consuming reimbursement issues impede rapid implementation and need to be addressed nation-wide.

Competing interests: Keine