The impact of targeted therapies on molecular alterations identified by an institutional molecular tumor board: an approach based on ESCAT classification

Abstract

Background: The European Society of Medical Oncology Scale for Clinical Actionability of Molecular Targets (ESCAT) classification system provides a standardized framework for categorizing genomic alterations (GAs) of patients with recurrent, metastatic, or rare cancer. This study aimed to present outcomes of patients discussed at the molecular tumor board (MTB) in general and according to ESCAT. Patients and methods: We included 1226 patients with recurrent and/or metastatic cancer presented at the MTB from 2018 to 2022. Clinical and demographic data collected included age, gender, type of specimen, tumor type, number of prior treatments received, techniques used for molecular analyses, GAs identified, MTB recommendations, and inclusion or not into a clinical trial. The clinical endpoints collected were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS), and were correlated with ESCAT. Results: Successful molecular profiling was carried out in 895 of 1226 (73%) patients. Actionable GAs were found in 595 (49%) patients, and 206 (17%) patients were oriented to matched therapies. Eventually, 101 (8%) patients received a matched therapy. For these patients, PFS and OS were significantly longer for GAs classified as ESCAT tiers I/II, compared with tiers III/IV (P = 0.009 and P = 0.014, respectively). Conclusions: Detection of actionable GAs through MTB molecular screening enabled to treat 8% of patients with matched therapy. Patients treated with matched therapy based on ESCAT tiers I/II had statistically longer PFS and OS, compared with ESCAT tiers III/IV.

Keywords

• precision medicine
• molecular tumor board
• actionable genomic alteration
• ESCAT classification
• clinical trial