Molecular Tumor Board

Overview:
  By the aid of new technologies such as next-generation sequencing (NGS) and liquid biopsy, we had entered the era of precision medicine with individual treatment plans for every patient. These genomic technologies specifically focus on testing tumor tissue for mutations and using these results to guide therapy, and are now already considered standard of care for many cancer types. As the growing trend of availability and affordability for newly developed immunotherapy and targeted therapies, the use of precision medicine still remains low because of insufficient support to guide clinicians in interpreting NGS and liquid biopsy results. 

Features Summary:
  The Molecular Tumor Board(MTB) in Taipei Veteren General Hospital consist of a multidisciplinary team, including medical oncologists, surgeons, pathologists, genetic counselors, pharmacists, and basic scientists. The MTB aim to discuss personalized options for individual patients, based on the genomic alterations present in the genomic result. We use the results of molecular assays to help address diagnostic, prognostic and therapeutic questions to aid providers in making the best possible clinical care decisions for their patients. The MTB helps to ensure cancer patients treated in VGHTPE are receiving updated medical care utilizing genomic data with clinical features. Precision oncology requires an understanding of the sensitivity, specificity and limitations of genomic tests, to interpret every single data to be clinically "relevant" or "actionable" for treatment.

Procedure:
  We gathered VGHTPE health care providers for the forum once a month, including attendings, clinical fellows, residents, interns and clerks, for the implementation of precision oncology. Health care providers from VGHTPE-affiliated hospitals are also welcomed. We generally discuss 1-3 cases per meeting. A short clinical summary briefing was presented by requesting clinician, then the molecular results were verbally reviewed. Our pathologist who signed out the patient's report will provide commentary on the findings. Clinical experts will then present their analysis on the actionability of the findings. After that, the case is open for further discussion by meeting participants. A formal recommendation report is written and issued usually within one week after the MTB meeting.

Notification:
  Molecular Tumor Board currently meets on the first Friday of each month, starts from 4:00pm. The meeting still remain virtually due to the COVID-19 pandemic.

Estimated Cost:
  NGS or liquid biopsy usually costs about 30,000 to 130,000 NTD each time, the best kit for every patient should be discussed under certain circumstances and doctor's advices.

※ OncoKB Therapeutic Levels of Evidence, developed by Memorial Sloan Kettering Cancer Center (MSKCC)