A recent study, conducted by the Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed) and the Division of Clinical Pathology & Molecular Pathology, Hong Kong Sanatorium & Hospital (HKSH), has shown that patients with heavily pretreated advanced solid tumors and who had undergone treatment guided by the multidisciplinary molecular tumor board (MTB) exhibited a significantly longer overall survival (OS) than those who were treated with non-MTB-guided therapy.¹ The study demonstrated the practicability of next-generation sequencing (NGS) comprehensive genomic profilings (CGPs) in day-to-day clinical settings.¹

The advent of NGS CGPs has improved patient outcomes by detecting actionable genetic alterations, enabling genome-guided therapy and personalized approach.¹ In 2018, HKUMed and HKSH collaborated to establish a monthly multidisciplinary MTB.¹ This initiative aimed to assist frontline oncologists by incorporating NGS CGPs into their clinical practice.¹ As NGS testing in Hong Kong is carried out through various commercial platforms, each with their respective testing scope.¹ The MTB harmonizes treatment recommendations by thoroughly examining identified genomic alterations using an evidence-based approach.¹

A multicenter retrospective study was conducted to assess the impact of the HKU-HKSH MTB-guided therapy on the survival outcomes of patients with heavily pretreated advanced solid tumors.¹ Patients who had their NGS CGP reports reviewed at the HKU-HKSH MTB from August 2018 to June 2022 were eligible.¹ The primary endpoints were the proportion of patients who underwent MTB-guided therapy and OS.¹ The secondary endpoints were the percentage of patients with actionable genomic alterations, objective response rate (ORR), and disease control rate (DCR).¹ By the data cutoff on October 31, 2022, the study recruited 122 patients.¹ The most common tumor types among these patients were primary central nervous system (CNS), hepato-biliary-pancreatic (HBP), and thoracic cancers.¹ The most frequently mutated gene was tumor protein 53 (TP53) (44.3%), cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B) (26.2%), phosphatase and tensin homolog (PTEN) (16.4%), Kirsten rat sarcoma viral oncogene homolog (KRAS) (15.6%), and serine/threonine kinase 11 (STK11) (15.6%).¹ A high tumor mutation burden (TMB-H) was detected in 13.9% of patients.¹

The results showed that 63% (n=77) of patients in this MTB study adopted the treatment strategies recommended by the HKU-HKSH MTB.¹ The primary reasons for not implementing MTB recommendations were either the patient’s personal choice (n=4) or the financial strain of the treatment strategy (n=7).¹ Among the MTB population, the 12- and 24- months OS rates were 50.9% and 32.8%, respectively.¹ For patients who followed the MTB recommendations, the median OS was significantly higher at 12.7 months, compared with 5.2 months for patients who did not receive the MTB-guided therapy (HR=2.7; 95% CI: 1.4-5.1; p=0.0073).¹ Furthermore, patients who followed the MTB recommendations achieved an ORR of 28.6% and a DCR of 65.0%.¹ Those who reached ORR or DCR had an OS of 25.1 months (95% CI: 15.6-NR) and 32.7 months (95% CI: 15.8-NR), respectively.¹

The HKU-HKSH MTB is the first multicenter pan-cancer precision oncology service predominantly that caters for the Chinese population.¹ This study showed a significant improvement in survival outcomes for patients with heavily pretreated advanced solid tumors. ¹ The integration of NGS CGPs into the cancer care pathway by implementing a multidisciplinary MTB is therefore advocated.¹ Nevertheless, there remains a need for further refinement of the genomic profiling and the MTB platform. ¹