Precision oncology is making headway, with a groundbreaking systematic 

review and meta-analysis published in npj Precision Oncology (Vol. 9, Article 96)  revealing compelling evidence for the clinical value of Molecular Tumor Boards (MTBs). Yet, alongside the promising survival data, researchers are sounding the alarm on the urgent need for standardized evaluation and reporting practices.

Led by Beryl Primrose Gladstone and colleagues, the study analyzed data from 34 studies published between 2020 and January 2024, encompassing over 12,000 patients and 26 major cancer types. The core takeaway: MTBs are significantly improving patient outcomes. However, the review also uncovers glaring gaps in how these benefits are measured and reported.

Survival Boost from MTB-Guided Therapies

The analysis found that 20.8% of patients received MTB-recommended therapies, achieving a median overall survival (OS) of 13.5 months and a progression-free survival (PFS) of 4.5 months. In head-to-head comparisons between MTB-guided and other treatments, 36 out of 38 comparisons favored MTBs, with 67% showing statistical significance.

Importantly, the study found a 54% lower hazard of death in patients treated per MTB guidance compared to controls. The intra-patient analysis—comparing outcomes before and after MTB-guided treatment—also showed a significant 30% increase in PFS2 over PFS1, a widely accepted marker of therapy benefit.

Data Heterogeneity Highlights Need for Standardization

Despite the promising survival statistics, the researchers faced major challenges due to heterogeneity in outcome reporting. "We found wide variation in how studies defined and measured outcomes such as stable disease or response rates," the authors reported. For instance, the time frames used to define “stable disease” ranged from six weeks to six months, contributing to inconsistent conclusions.

• Disease control rates (DCR) were reported in only 68% of studies.

• Objective response rates (ORR) were available in just 59%.

• Only 62% of the studies provided patient-level outcome data.

The authors emphasize the need for a unified framework for reporting, noting that the current inconsistencies obscure true clinical benefit and hinder efforts to compare across studies or regions.

Defining the Right Control Group Remains a Challenge

Another central issue: selecting appropriate control groups for comparison. The study found 19 out of 34 studies included control groups, but these ranged widely—from patients not referred to an MTB to those receiving best supportive care. This inconsistency poses a major obstacle to robust inter-study comparisons.

The authors advocate for the use of external or synthetic control arms derived from real-world data and statistical matching methods like propensity scores, which are gaining traction in oncology research.

Actionability Scores Matter—But Are Underutilized

Another key insight is that “actionability scales”—such as ESCAT or NCT/DKTK—were mentioned in 19 studies, but only 7 analyzed their relationship to outcomes. Those that did showed that patients with higher evidence levels experienced better outcomes, reinforcing the need to integrate structured evidence scoring into MTB workflows.

Implications for Health Systems & Global Oncology

The study notes that most data comes from high-income countries, potentially limiting generalizability but reflecting current global disparities in precision medicine. It also emphasizes the importance of standardized reimbursement and molecular testing protocols, pointing to models like Germany’s Centers for Personalized Medicine as potential blueprints.

Moreover, the authors call for the inclusion of quality-of-life metrics, and evaluations from both provider and patient perspectives, to round out the picture of MTB effectiveness.

Conclusion: Standardization is the Next Frontier

While the study confirms that MTBs positively impact survival and treatment responses in advanced solid tumors, it also underlines the pressing need for consensus on how to evaluate and report these benefits. The authors recommend convening an interdisciplinary international panel to define a core set of outcome parameters, enabling future research to be more comparable, transparent, and actionable.

In the words of the researchers:

"Our findings underline the need for a structured evaluation and reporting of MTB benefits, which requires particular focus. A consensus on standardized assessment could tremendously improve MTB research and its clinical translation worldwide."

RFA