ESMO Develops Molecular Tumor Boards Guidelines to Standardize Practice

Although the primary function of MTBs is to provide systemic interpretation of genomic profiling data, the guidelines suggest that MTBs can assist in interpreting confirmed and putative germline genetic alterations.

The ESMO Precision Oncology Task Force has developed recommendations to facilitate the implementation of molecular tumor boards (MTBs), consisting of a multidisciplinary panel of experts, according to an article published in the Annals of Oncology.1 Furthermore, the task force aimed to define standards for MTBs to expedite the integration of precision oncology into clinical practice.

Initially, the guidelines outlined in the article specified the role of MTBs in clinical practice. Although the primary function of MTBs is to provide systemic interpretation of genomic profiling data, the guidelines suggest that MTBs can assist in interpreting confirmed and putative germline genetic alterations. According to the recommendations outlined in the article, MTBs should:

• provide a systemic, clinically oriented interpretation of genomic profiling;
• strive to provide biomarker-informed, meaningful treatment recommendations;
• include an educational component;
• offer support with germline genomic variant interpretation;
• and offer support through use of diagnostic tools.

Furthermore, the guidelines touched upon patient selection for MTB discussion, emphasizing cases in which interdisciplinary case discussions can hold the highest potential benefit for patients. Additionally, patients’ selection for MTB discussions include:

1. cases with complex genomic alterations and diagnostic challenges;
2. rare cancers or ones with limited treatment options;
3. cases with greater availability and affordability of diagnostic and therapeutic resources;
4. cases with biomarkers assessed with limited clinical actionability evidence;
5. and cases with educational value.

These guidelines also suggest that MTBs may assist primary care teams in genomic profiling reports or cases in which profiling is used to identify treatments deemed not standard-of-care.

“MTBs implementation varies due to differences in health care systems, institutional resources, expertise, access to genomic technologies, and workflow structures,” Benedikt Westphalen, MD, of the Comprehensive Cancer Center at the University of Munich, and chair of the ESMO Precision Oncology Task Force, said in a news release on the TMB guidelines.2“While some [centers] have well-established MTBs within dedicated precision oncology [programs], others face challenges in terms of specialists’ availability, case selection, and [standardization] of recommendations. As a result, patients may experience varying levels of access to molecular-guided treatment decisions and clinical trials, which can impact their care pathways.”

Additional guidelines encompassed: patient referrals to MTBs, including from external institutions; informed consent in the setting of an MTB; and informed consent in the setting of an MTB. Regarding referrals, the article suggested that specialists involved in managing patients with cancers should be encouraged to refer cases meeting the requisites for discussion to MTBs, with institutional standard operating procedures (SOPs) defining a path to referral. For external institutions, MTB availability should be made for patients meeting the requisites, with SOPs defining guidelines for case submission, and guarantees put in place for the protection of patients’ privacy.

The guidelines further outlined the composition of an MTB, which recommends that, at a minimum level, should include:

1. a medical oncologist with genomic expertise;
2. a pathologist with dedicated molecular training;
3. and a clinical geneticist.

Additionally, the guidelines recommended the inclusion of an MTB administrator or coordinator, a bioinformatician with next-generation sequencing and genomic expertise, and a clinical trial team with additional expert insights for individual case discussions. At an optimal level, the recommendations suggest the inclusion of a surgical oncologist, radiation oncologist, radiologist, pharmacist, pharmacologist, and data manager.

Furthermore, guidelines covered the composition of an MTB report, discussing treatment recommendations, the assessment of potential germline alterations, and factors determining consensus in MTB recommendations. Also, sections outlining follow-up procedures for patients discussed by MTBs and indicators to assess MTB quality were included. Of note, benchmarks denoted minimum, recommended, and optimal suggest that 10%, 25%, and 33% of patients should receive an MTB-guided therapy.

Despite a paucity of prospective randomized controlled trials, one article published in the Journal of Clinical Oncology Precision Oncology concluded that MTBs appear to improve outcomes for patients with cancer, with a group receiving MTB-recommended therapy attaining greater progression-free survival rates than those receiving conventional therapy.3

References

1. Westphalen CB, Bielo LB, Aftimos P, et al. ESMO Precision Oncology Working Group recommendations on the structure and quality indicators for molecular tumour boards in clinical practice. Ann Oncol. Published online April 6, 2025. doi:10.1016/j.annonc.2025.02.009
2. An ESMO roadmap for implementing molecular tumour boards. News release. ESMO Daily Reporter. April 7, 2025. Accessed April 7, 2025. https://tinyurl.com/mrx3jufd
3. Larson KL, Huang B, Weiss HL, et al. Clinical outcomes of molecular tumor boards: a systematic review. JCO Precis Oncol. 2021;5:1122-1132. doi:10.1200/PO.20.00495