Clinical Impact of Molecular Tumor Board Inclusion on Treatment Outcomes in Neuroendocrine Neoplasms
Maryam Barsch1, Linda Gräßel2,3,4, Patrick Metzger5
1Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, maryam.barsch@uniklinik-freiburg.de.
Introduction:
Neuroendocrine neoplasms (NENs) are rare and biologically heterogeneous tumors with limited evidence-based systemic treatment options, particularly in advanced disease stages. Molecular Tumor Boards (MTBs) offer an interdisciplinary framework for interpreting genomic alterations and identifying personalized treatment strategies.
Methods:
We conducted a retrospective two-center analysis of patients with NENs discussed at the MTBs of the University Medical Center Freiburg and the Technical University of Munich between 2019 and 2024. Clinical characteristics, molecular profiling results, MTB-based therapy recommendations, treatment implementation, and outcomes were evaluated. Overall survival (OS) was analyzed using a predefined 6-month landmark approach to account for immortal time bias. Treatment efficacy was further assessed using progression-free survival (PFS) and PFS2/PFS1 ratio.
Results:
A total of 87 patients were discussed at both MTBs, 74 of whom underwent molecular profiling. Actionable therapy recommendations were issued for 58 patients, and 20 patients ultimately received MTB-guided therapy. Molecular alterations frequently involved DNA damage repair pathways, immune-related biomarkers, and signaling cascades relevant to targeted therapy. 6-month landmark OS analysis demonstrated significantly improved OS for patients receiving MTB-guided therapy. At the individual level, 8 of 20 treated patients achieved a PFS2/PFS1 ratio >1.3.
Conclusion:
Molecular-guided precision oncology can provide clinically meaningful benefit for selected patients with NENs, despite limited overall implementation rates. Earlier integration of molecular profiling may increase the feasibility and impact of personalized treatment approaches in these rare tumor entities.
Insights
Molecular Tumor Boards (MTBs) guided therapy for neuroendocrine neoplasms (NENs) showed improved survival. Precision oncology benefits selected NEN patients, suggesting earlier molecular profiling integration for better outcomes.
Area of Science:
- Oncology
- Genomics
- Precision Medicine
Background:
- Neuroendocrine neoplasms (NENs) are rare, heterogeneous tumors with limited systemic treatment options for advanced stages.
- Molecular Tumor Boards (MTBs) provide an interdisciplinary approach to interpret genomic data and guide personalized cancer therapy.
Purpose of the Study:
- To evaluate the effectiveness of MTB-guided therapy in patients with neuroendocrine neoplasms.
- To assess the impact of molecular profiling and personalized treatment on patient outcomes in NENs.
Main Methods:
- Retrospective analysis of 87 NEN patients discussed at two MTBs (2019-2024).
- Molecular profiling performed on 74 patients; therapy recommendations and implementation tracked.
- Overall survival (OS) analyzed using a 6-month landmark approach; progression-free survival (PFS) and PFS2/PFS1 ratio assessed.
Main Results:
- Actionable therapy recommendations were made for 58 patients, with 20 receiving MTB-guided treatment.
- Molecular alterations commonly affected DNA repair, immune markers, and signaling pathways.
- MTB-guided therapy was associated with significantly improved OS; 8/20 patients had a PFS2/PFS1 ratio >1.3.
Conclusions:
- Molecular-guided precision oncology offers significant clinical benefits for select NEN patients.
- Limited implementation rates highlight the need for earlier integration of molecular profiling.
- Personalized treatment approaches can enhance outcomes in rare NEN tumor entities.
