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A fully virtual and nationwide molecular tumor board for gynecologic cancer patients: the virtual experience of the MITO cooperative group
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  1. Michele Bartoletti1,
  2. Alice Bergamini2,
  3. Gaia Giannone3,4,
  4. Camilla Nero5,
  5. Lucia Musacchio5,
  6. Alberto Farolfi6,
  7. Anna Passarelli7,
  8. Elisabetta Kuhn8,9,
  9. Daniele Castaldo10,
  10. Valentina Lombardo11,
  11. Teresa Di Palma12,
  12. Domenica Lorusso5,13,
  13. Fabio Puglisi1,14,
  14. Ugo De Giorgi6,
  15. Giorgio Valabrega3,
  16. Clorinda Schettino15,
  17. Giovanni Scambia5,13,
  18. Ettore Capoluongo16 and
  19. Sandro Pignata7
  1. 1Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico, Aviano, Italy
  2. 2Department of Obstetrics and Gynecology, IRCCS, San Raffaele Hospital, Ospedale San Raffaele, Milan, Italy
  3. 3Department of Oncology, University of Turin, Torino, Piemonte, Italy
  4. 4Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
  5. 5Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  6. 6Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Emilia-Romagna, Italy
  7. 7Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
  8. 8Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy
  9. 9Division of Pathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  10. 10Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO) Group Secretariat, Napoli, Italy
  11. 11Department of Medical Oncology, Azienda Ospedaliera per l'Emergenza Cannizzaro, Catania, Italy
  12. 12Oncologia Medica, Ospedale S Maria Goretti, Latina, Italy
  13. 13Department of Life Science and Public Health, Policlinico Universitario Agostino Gemelli Dipartimento Scienze della Salute della Donna e del Bambino, Rome, Lazio, Italy
  14. 14Department of Medicine, University of Udine, Udine, Italy
  15. 15Clinical Trials Unit, National Cancer Institute IRCCS Pascale Foundation, Napoli, Italy
  16. 16Department of Clinical Pathology, Azienda Ospedaliera per l'Emergenza Cannizzaro, Catania, Italy
  1. Correspondence to Professor Sandro Pignata, Gynaecological Oncology, National Cancer Institute Napels, 07103 Naples, Italy; s.pignata{at}istitutotumori.na.it

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Even if molecular biomarkers that are impacting clinical practice in gynecologic oncology are limited, our community is living in the precision medicine era where the number of patients undergoing tumor genomic profiling is increasing, as is the number of new drug approval for cancers with specific genetic alterations. In this complex scenario, molecular data must be interpreted on a case-by-case basis, and the presence of molecular tumor boards in leading the decision-making process are crucial.

In fact, molecular tumor boards can identify possible therapeutic strategies based on tumor genomic alteration in patients for which the effectiveness of standard therapies is suboptimal or a standard approach does not exist. On the other hand, molecular tumor boards can avoid the use of anticancer drugs with an insufficient level of evidence, limiting unnecessary adverse effects and unjustified costs for the public healthcare system. Moreover, molecular tumor boards can play a pivotal role in the spreading of new concepts of cancer genomics, flattening the learning curve of precision medicine, making clinicians more comfortable with molecular concepts, like allelic fraction, tumor molecular drivers, and pathogenic versus non-pathogenic genetic variants. Notwithstanding the importance of molecular tumor boards is recognized and many efforts have been made to implement this tool in high volume cancer centers, limitations due to the absence of molecular tumor boards in general rural hospitals and geographical barriers are undermining the access of clinicians to these facilities. Furthermore, routine molecular tumor boards need to consider sub-specializations in oncology; thus, sub-specialists should attend the selective board, a factor that makes molecular tumor board organization more elaborate for a single institution.

To overcome the limits of conventional molecular tumor boards taking advantage of the yet established network between the gynecologic oncology community in Italy, the MITO group has recently inaugured the virtual molecular tumor boards by MITO, a fully virtual and nationwide molecular tumor board focused on gynecologic cancers. The project has been matched with the GYNecological cancers GEnetic profile Registry (GYNGER), an observational, retrospective–prospective clinical study aimed at collecting clinical and molecular data from patients, with a focus on those suffering from rare gynecological cancers.

The molecular tumor board by MITO is reserved for the MITO group’s members. Launched in June 2021, to date the project totals approximately 50 fellows, including medical oncologists, gynecologists, pathologists, molecular biologists, geneticists, and clinical study coordinators. Virtual meetings are scheduled every 2 weeks on the videoconferencing platform Zoom, which the invited-only members can access via computer or mobile device. Until 72 hours before the planned meeting, members can submit anonymized clinical cases using the platform Navify Tumor Board (NTB, Roche Molecular Systems, Santa Clara, CA). All members are allowed to enter the Navify Tumor Board to study and prepare clinical case(s) days before the scheduled meeting. When a case is discussed for molecular data interpretation, the board’s final decision can be the ranking of a molecular alteration and its matched drug using the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT), the patient’s referral to a biomarker-driven trial or expanded access program active in Italy (Table 1), and finally, the patient’s enrollment in the GYNGER study (Figure 1).

Table 1

Main tumor agnostic/biomarker driven clinical trials based on NGS analysis active in Italy (December 2021)

Figure 1

Data flow and organization of the virtual molecular tumor board by MITO. ESCAT, ESMO scale for clinical actionability of molecular targets; GYNGER, GYNecological cancers GEnetic profile Registry; NGS, next generation sequencing.

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Ethics approval

This study does not involve human participants.

Footnotes

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  • Contributors Conceptualization, MB and SP; writing—original draft preparation, MB; writing—review and editing, all authors; supervision, SP; funding acquisition, SP. All authors have read and agreed to the published version of the manuscript.

  • Funding The National Cancer Institute Fondazione G. Pascale has received Navify Tumor Board (Roche Molecular Systems, Santa Clara, CA) free of charge.

  • Competing interests This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Others potential conflicts of interest outside the submitted work: SP has received honoraria from AZ, MSD, Roche, GSK, Pfizer, Clovis Oncology, Pharmamar and research funding from MSD, Roche, AZ, Pfizer. GS has received grant/research support from MSD Italia S.r.l., consultant for TESARO Bio Italy S.r.l, speakers bureau/honoraria from Clovis Oncology Italy S.r.l, consultant from Johnson & Johnson. FP reports grants from AstraZeneca, grants, personal fees and other from Roche, personal fees and other from Eli Lilly, personal fees from Amgen, personal fees from Ipsen, personal fees from MSD, personal fees from Takeda, grants and other from Eisai, other from Novartis and Pfizer. DL has declared from Amgen, other, personal, consultancy; from AstraZeneca, Advisory Board, personal, invited speakers, Principal Investigator; from Clovis Oncology, invited speaker, personal, institutional, financial interest, grant; from GSK, Advisory Board, personal, invited Speaker, Principal Investigator; from MSD, Advisory Board, personal, invited speakers, funding, institutional, financial interest; from Genmab, Coordinating PI, institutional, financial interest. The other authors have nothing to disclose.

  • Provenance and peer review Commissioned; internally peer reviewed.

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