Assessing the Value of Sequential Next-Generation Sequencing and Multiple Molecular Tumor Board Reviews for Patients...

Multidisciplinary molecular tumor boards (MTBs) have demonstrated improved clinical outcomes in various malignancies. Sequential next-generation sequencing (NGS) is widely performed at the time of recurrence, which may lead to multiple MTB reviews. This study assessed the clinical benefit of multiple MTB reviews for sequential NGS.

A retrospective cohort review was performed to compare patients reviewed once at a single-institution MTB and those reviewed multiple times for the same diagnosis with sequential NGS between January 2016 and December 2023. Demographics were compared, and regression and survival analysis was performed.

In all, 3,702 patients were included, 3,446 (91.6%) were reviewed once, and 256 (8.4%) were reviewed multiple times. Patients reviewed once had higher proportion of actionable findings (52.7% v 44.5%, P = .01) compared with those reviewed multiple times at initial review. Approximately half of the patients at their second (47.3%) and third or more (62.5%) reviews had actionable findings. The mean time on recommended targeted therapy for patients reviewed multiple times was 8.24 months (standard deviation [SD], 9.34; range, 0.07-42.4), and the mean time on recommended immunotherapy was 7.02 months (SD, 9.47; range, 0.1-39.2). Patients with multiple MTB reviews had a 30% lower risk of death compared with those reviewed once, even after controlling for primary site, age, presence of actionable NGS findings, and stage (hazard ratio, 0.7, 95% CI, 0.55 to 0.89; P = .004).

Sequential NGS identified actionable findings in approximately 50% of those with multiple reviews, and many patients stay on recommended therapy for at least 6 months. Patients with sequential NGS and multiple reviews have a survival advantage, and although this may be due to therapy sensitivity, it reflects the importance of NGS testing and usefulness of MTB in interpreting those results.