Molecular tumor board for gynecologic malignancies: the real-world experience from the Department for Gynecology and Gynecologic Oncology of Kliniken Essen-Mitte.

Objective: Advances in cancer research are leading to a shift from the traditional "organ-centric" therapies to a personalized tumor biology-based approach. Here, we report outcomes in patients who underwent molecular tumor profiling for gynecologic malignancies.

Methods: We prospectively recorded clinical and pathologic characteristics, follow-up data, next-generation sequencing results, and tumor board recommendations of all patients who underwent molecular tumor board at the Department for Gynecologic Oncology, Kliniken Essen-Mitte, from March 2019 to March 2024. Progression-free survival ratio was calculated to evaluate the benefit of the molecular tumor board-recommended treatment (progression-free survival after molecular tumor board/progression-free survival on previously received treatment).

Results: Altogether, 237 patients with the median number of previous lines of 3 were discussed at the molecular tumor board. High-grade serous ovarian cancer was the most common diagnosis (n = 148, 62.4%). In 220 patients (93%), genomic tumor alterations were found and classified according to the European Society for Medical Oncology Scale for Clinical Actionability of Molecular Targets: tier-X (lack of evidence for actionability) n = 94, tier-I (ready for routine use) n = 36, tier-II (investigational) n = 32, tier-III/IV (hypothetical target) n = 37, and tier-V (combination development) n = 6. The most common alterations were found in TP53 (n = 142), BRCA1 (n = 22), KRAS (n = 16), PIK3CA (n = 15), FOXL2 (n = 15), GSTP1 (n = 11), PTEN (n = 8), CDKN2A/B (n = 7), and others (n = 126). The next-generation sequencing results affected the molecular tumor board decision in 65 patients (27.4%), with 9 patients (3.8%) receiving a biomarker-based therapy; 8 patients (88.9%) experienced disease control lasting for more than 3 months, and 6 of these (66.7%) showed a progression-free survival ratio ≥1.3. The most common causes of not following the molecular tumor board decision were best supportive care or death (n = 21), no progression (n = 14), or starting another treatment (n = 6).

Conclusions: Molecular tumor profiling provided additional treatment strategies in a meaningful number of patients. Earlier inclusion in the molecular tumor board might lead to increased applicability of results for patients.