Determinants Affecting the Clinical Implementation of a Molecularly Informed Molecular Tumor Board Recommendation: Experience from a Tertiary Cancer Center

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Editors,

Precision oncology (PO)is a rapidly growing field and  MTBs that aim to translate the results of genomic tests into clinical practice in order to set-up the most appropriate therapeutic strategy for the individual patient,  represent an important section of PO. Positive impact MTB-guided treatment among solid cancers is successfully demonstrated by some studies. [Writers encouraged to read recent work and analysis on MTBs and solid adveanced tumors by Helali et al.,_ The lancet Regional Health Westen Pacific _jul2023 https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00093-7/fulltext ]

Current article provides a convincing argument and working framework for a multidisciplinary approach toward MTBs. Accordingly, the authors did a nice job! The manuscript provides a useful overview on the current understanding of the MTB therapeutic recommendations in a real-world scenario.   It is very well written, and the introduction provides a good, generalized background of the topic that quickly gives the reader an appreciation of the application of MTBs.

Thank you!

All the best

 

Author Response

Re: Manuscript cancers-2746831, Revision

“Determinants affecting the clinical implementation of a molecularly-informed Molecular Tumor Board recommendation: experience from a tertiary cancer center

 

Response to Reviewer #1

Comments and Suggestions for Authors:

Dear Editors,

Precision oncology (PO)is a rapidly growing field and  MTBs that aim to translate the results of genomic tests into clinical practice in order to set-up the most appropriate therapeutic strategy for the individual patient,  represent an important section of PO. Positive impact MTB-guided treatment among solid cancers is successfully demonstrated by some studies. [Writers encouraged to read recent work and analysis on MTBs and solid adveanced tumors by Helali et al.,_ The lancet Regional Health Westen Pacific _jul2023 https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00093-7/fulltext ]

Current article provides a convincing argument and working framework for a multidisciplinary approach toward MTBs. Accordingly, the authors did a nice job! The manuscript provides a useful overview on the current understanding of the MTB therapeutic recommendations in a real-world scenario.   It is very well written, and the introduction provides a good, generalized background of the topic that quickly gives the reader an appreciation of the application of MTBs.

Thank you!

All the best

Authors Response: We thank the Reviewer for the evaluation of the manuscript and the very positive acknowledgment of our current study. No specific concerns were raised. As suggested by the assessor, we have read the interesting work by Helial et al., which clearly demonstrates and nicely underscores the capability of MTBs to improve the clinical benefit for cancer patients by guiding clinical decision-making. In addition, it also highlights the implementation of MTBs and their success story on a global scale.  

Reviewer 2 Report

Comments and Suggestions for Authors

This study aimed to identify factors influencing the clinical implementation of molecular tumor board (MTB) treatment recommendations in cancer patients, utilizing real-world data from a German comprehensive cancer center. A retrospective analysis of 554 cancer cases discussed at the MTB from 2016-2020 was conducted, with comprehensive genomic profiling performed. Out of 332 evaluable cases, MTB recommendations were provided for 139, and implementation occurred in 31.7% of cases. High implementation rates were observed for recommendations involving PARP, PIK3CA, and IDH inhibitors. The primary reasons for non-implementation were the use of non-matched treatments or the patient's worsening condition. The study highlights insights into factors affecting the implementation of MTB recommendations, providing valuable information for guiding clinical decision-making.

Some suggestions:

1. Perform additional subgroup analyses:

• Compare outcomes based on disease stage at time of MTB recommendation
• Outcomes stratified by patient performance status
• Compare patients with 1st line vs. later lines of therapy

2. Correlate genomic findings with outcomes:

• Do patients with driver mutations have higher implementation rates or treatment duration?
• Are there differences for actionable mutations vs variants of unknown significance?

3. Expand the analysis of drug classes:

• Beyond PARP/PIK3CA/IDH inhibitors, analyze additional categories like I/O agents
• Compare targeted therapy vs. immunotherapy recommendations

4. Evaluate consistency:

• Compare recommendations and outcomes across MTB panel members
• Assess inter-rater reliability of recommendation decisions

Author Response

Please see the attachment

Author Response File: Author Response.docx