1723P - Improving access to molecular tumour boards for complex genomic profiles: A healthcare policy from the Netherlands

Background

The role of Molecular Tumour Boards (MTBs) is becoming increasingly important in the interpretation of complex genomic profiles; for instance, in pinpointing the most optimal (targetable) therapy for rare or uncommon variants or in situations when more than one actionable aberration is detected, in rejecting suboptimal treatment strategies and in finding matched clinical trials based on genomic insights. In general, only academic hospitals and large cancer research institutes can facilitate an in-house MTB, as expertise in medical oncology, pathology, molecular biology, genetics and bioinformatics is required. As a result, patients treated in general hospitals may have limited or delayed access to expert interpretation of complex molecular diagnostics and relevant therapeutic guidance. One of the major barriers is the absence of reimbursement for such remote consultations.

Methods

In the Netherlands, health insurance companies have created a specific payment code for MTBs to be able to reimburse the consultations directly and monitor access.

Results

Empowering MTBs enhances their potential to gain and disseminate knowledge in the highly dynamic field of precision medicine due to an increased number of consultations. Moreover, it stimulates development and maintenance of guidelines and further standardisation of the recommendations for more frequent aberrations based on the evidence and the outcomes.

Conclusions

From a national health perspective, it is essential to ensure access to MTB’s recommendations, thereby providing equal treatment opportunities (including enrolment in clinical trials) but also reducing the unjustified costs and clinical burden of ineffective treatment strategies. Eventually, a national data infrastructure and an umbrella organisation of the MTBs will facilitate better and equal options for patients and creates a true learning health system for precision oncology.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

E. Schuuring: Financial Interests, Institutional, Advisory Board: MSD/Merck, AtraZeneca, Astellas Pharma, Roche, Illumina, Agena Biosciences, Lilly, Jansen Cilag, CC Diagnostics, Amgen, GSK, Novartis, Bayer; Financial Interests, Institutional, Invited Speaker: Biocartis, Illumina, Agena Biosciences, BioRAD, Lilly, SeraCare/LGT, Jansen Cilag; Financial Interests, Institutional, Research Grant, ZonMw: Predictive Analysis for Therapy: PATH to Optimizing Access to Personalised Cancer Therapy in the Netherlands; from Tissue to Therapy: Abbott, CC Diagnostics; Financial Interests, Institutional, Research Grant, ctKRAS testing using BioRad ddPCR in cfDNA from plasma as a predictive biomarkers for tumor response to Nivolumab in KRAS-mutated non-small cell lung cancer: BioRad; Financial Interests, Institutional, Research Grant, EU-IHI-Horizon: GUIDE.MRD - GUIding multi-moDal thErapies against MRD by liquid biopsies – steering committee/WP-leader: BMS; Financial Interests, Institutional, Funding, Roche/Ventana: Validation and implementation of pan-TRK immuno staining and RNA-based NTRK-fusion detection in a diagnostic setting: Roche; Financial Interests, Institutional, Research Grant, B-IO - Unraveling tumor response and resistance to combined chemotherapy and PD-L1 inhibition with minimal invasive techniques in patients with advanced NSCLC with targetable disease: Roche; Financial Interests, Institutional, Research Grant, ALPINE-study - Identification of resistant mechanisms in progressing lung cancer patients with an initial tumor response or with stable disease on immunotherapy using comprehensive ultrasensitive NGS biomarker analysis: Roche; Financial Interests, Institutional, Research Grant, CLINBASE - validation and implementation of Agena UltraSEEK using plasma cfDNA samples from NSCLC patients: Agena Biosciences; Financial Interests, Institutional, Research Grant, Alpe d’HuZes/KWF/ Agena Biosciences: GALLOP-11 study - treatment of gastrointestinal stromal tumors based on serial mutation analysis of circulating tumor DNA – WP-leader: Agena Biosiences; Financial Interests, Institutional, Research Grant, De validatie van Illumina’s TSO500 NGS panel voor DNA-analyse van HRD-genen in het kader van diagnostiek van prostaatkanker - (mede) projectleider: AstraZeneca; Financial Interests, Institutional, Research Grant, Evaluation of CIN2+ specific methylation markers as triage testing optimizing referral to gynecologist for colposcopy after primary hrHPV-positive test in the new Dutch population-based screening program - (mede) projectleider: CC Diagnostics; Financial Interests, Institutional, Research Grant, Imalife/Siemens: NEO-PUSH study - cfDNA from whole blood to detect lung cancer in high risk group of Imalife patients undergoing ULD-CT screening - (mede) projectleider: Siemens; Financial Interests, Institutional, Research Grant, Implementatie Invitae-ArcherDX fusiegendetectie tbv NTRK diagnostiek - (mede) projectleider: Archer/Bayer/Invitae:; Non-Financial Interests, Advisory Role: ZINL (Health Care Agency). K. Monkhorst: Financial Interests, Institutional, Advisory Board: AbbVie, AstraZeneca, BMS, Bayer, Boehringer Ingelheim, Lilly, MSD, Merck, Pfizer, Roche; Financial Interests, Institutional, Invited Speaker: AstraZeneca; Non-Financial Interests, Institutional, Product Samples: Roche SS. All other authors have declared no conflicts of interest.