Molecular Tumor Boards in Pediatric Oncology: An Argument for a Multidisciplinary Approach

Purpose: Although precision oncology has been shown to improve patient outcomes, it remains challenging to apply results from molecular tumor profiles to clinical decision making, since accurate interpretation of these complex molecular findings requires expertise from various fields of medicine. To aid in interpretation of increasingly complex biomarkers, molecular tumor boards (MTBs) have been established across the nation. This study provides a convincing argument for a multidisciplinary approach toward MTBs. Methods: Molecular profiling of tumor specimens was accomplished through Foundation One Medicine, Inc. to detect genomic alterations in DNA and RNA, microsatellite status, tumor mutation burden (TMB), and programmed death ligand-1 (PDL-1) expression. Cases were evaluated by a multidisclipinary MTB consisting of pediatric oncologists, pathologists, clinical pharmacists, geneticists, and nurse coordinators. If targetable mutations were present, clinical pharmacists led in weighing treatment options and exploring the logistics and feasibility of drug access. Results: From March 2016 to September 2021, 115 cases were evaluated by the MTB. In 85% of cases, the MTB recommended targeted therapy based on evaluation of patient history and genetic alterations detected by Foundation One testing. Treatable alterations most frequently occurred in the cell cycle/DNA processing pathway, specifically involving the genes TP53 (21, 11%) and MLL (21, 11%). The MTB was able to provide treatment recommendations based on detected genomic mutations for the majority of cases. However, only three patients received MTB-recommended targeted therapy, one of whom experienced improved clinical outcomes. Conclusion: The most common reason that MTB-recommended treatment was not administered was that the molecular profiling was not performed until late disease stages. For the three patients who received MTB-recommended therapy, it was not administered until months after diagnosis, demonstrating a deviation from MTB recommendations in favor of physician preference. Educating providers on demonstrated clinical benefit of molecular-matched precision therapy may increase acceptance of these novel targetable therapies, improving patient survival and quality of life.