Key points are not available for this paper at this time.
Molecular Tumor Boards (MTBs) foster access to biomarker-based anticancer therapies and improve outcomes in patients (pts) with actionable genetic alterations. The effectiveness of MTBs in the management of metastatic breast cancer (mBC) remains to be proven. Clinical and genomic data of consecutive pts with mBCs referred to the IEO MTB were reviewed. Genetic alterations were classified by ESCAT. Outcomes of pts showing actionable alterations and receiving molecular-matched therapy (MMT) were compared to those receiving standard therapy (ST). Real-world progression-free survival (rwPFS) and overall survival (OS) were assessed by Kaplan-Meier method and Cox models From Aug 2019 to Dec 2023, 96 pts with mBC were discussed: 58 hormone receptor-positive (HR+), 37 triple-negative BC (TNBC) and 1 HER2+ cases. After MTB, genetic counseling was performed in 26/96 (27%) pts, while additional molecular analyses were requested in 24/96 (25%); 74 pts (77%) displayed at least one actionable alteration for whom a MMT was recommended. For pts with available follow-up (n=50), 32 (64%) received MMTs, including agents targeting biallelic inactivation of HRD genes (n=27), ERBB2 mutations (n=2), NF1 deletion (n=1), PIK3CAmutation (n=1) and TMB-high (n=1). Pts in the MMT group had a numerically higher proportion of TNBCs (45% vs 35%), brain (18% vs 6%) and liver (64% vs 41%) metastases. The median number of previous therapies was 4 (range 1-15) for both groups. At a median follow-up of 14.4 months (range 2.5-not estimable (NE)), no difference in median rwPFS and 12-month OS rate was observed between the MMT and ST groups (4.1 95%CI 2.1-8.3 vs 3.1 months 95% CI 1.5-NE, P=0.8; 58% 95%CI 43-78 vs 57% 95%CI 34-97), P=0.9). Pts who received a MMT according to ESCAT I had longer rwPFS (25/32, 5.8 months [95%CI 3.1-8.4) compared to those with ESCAT II (3/32, 2.1 months 95%CI 1.6-NE) and ESCAT III (4/32, 2.1 months 95%CI 2-NE; P=0.09). Median growth modulation index in pts receiving MMT was 0.69, with 24% of pts showing a PFS2/PFS1 ratio >1.3 MTB can provide additional treatment opportunities for pts with mBC, with higher ESCAT Tiers yielding the greatest clinical benefit. MTBs also has utility to identify cases for additional genetic counseling and molecular analyses
Marra et al. (Wed,) studied this question.