Panel-guided personalized medicine in metastatic breast and gynecological cancer: First experiences at the CCC Munich and clinically relevant changes over time

Background Some genomic alterations found in malignant tumours can be therapeutically addressed. Comprehensive genomic profiling identifying such alterations aims to offer personalized treatment to cancer patients. Here, we report first experiences of the Comprehensive Cancer Center Munich Molecular Tumor Board (MTB) for breast and gynecological malignancies. Our aim was to measure the impact of recommendations made by a multidisciplinary tumor board on overall survival of patients with breast or gynecologic cancers, who progressed under standard treatment.

Material and methods 95 patients diagnosed with metastatic breast or gynecologic malignancies underwent multi-gene panel testing (Oncomine Focus/Comprehensive Assay). From May 2017 through March 2019, our MTB reviewed the clinical cases considering the underlying malignancy and the genomic profile. Based on this assessment, further diagnostic and therapeutic recommendations were provided. All patients were enrolled into a prospective registry (The Informative Patient).

Results 95 patients with metastatic breast or gynecologic tumors were discussed in the MTB (68 % breast cancer, 20 % ovarian cancer, 12 % others). The most frequent alterations were found in PI3KCA and KRAS. 34 patients (36 %) received a biomarker-based therapy recommendation. Therapeutic recommendations were implemented in 9 patients of whom 4 experienced clinical benefit with partial response or disease stabilization lasting more than 4 months. Recently, the FDA approved the PIK3CA inhibitor alpelisib, which could have resulted in a therapeutic recommendation in additional 5 cases.

Conclusion In the setting of a multidisciplinary molecular tumor board, a small but clinically meaningful fraction of breast and gynecologic cancer patients may benefit from comprehensive genomic profiling.

Publication History

Article published online:
07 October 2020