Molecular tumor board availability and organization in sarcoma referral centers in Italy: are we on the right track?

Background: With the rapid progress of molecular medicine, new target therapies for solid tumors have become available, leading to the creation of molecular tumor boards (MTBs) designated to evaluate potential individualized treatment options. Unlike other solid or liquid tumors, there is no standard and customized tool to analyze sarcoma. We analyzed the organization of MTB in referral centers for sarcomas treatment in Italy. Materials and methods: A 30-question survey was designed in 2021 by the Regina Elena National Cancer Institute and distributed among Italian referral centers for pediatric and adult sarcomas. This survey was developed as part of Alliance Against Cancer (Alleanza Contro il Cancro, ACC) project to provide a descriptive analysis of the availability and organization of MTBs as well as the propensity to offer genomic profiling to sarcoma patients. Results: A total of 6 out of 10 centers contacted answered the survey, and all stating centers declared to have an MTB. The composition of MTB was variable, with a dedicated oncologist in 83% of centers, although all cases discussed required the presence of the oncologist. 83% of centers met the ACC criteria for eligibility at MTB discussion. In 83% of cases both the primary and the metastases were analyzed, while in 17% only the metastasis were analyzed. The type of analysis available were target panel sequencing and whole exome sequencing (WES) in 100% of centers, whole genome sequencing (WGS) in 83%, RNA sequencing in 53%. Bioinformatics analysis software used were Illumina pipeline in 50% of centers; Ion Reporter (Thermo Fisher Scientific), QIAGEN CLC Genomics Variant Reporter and Archer Analysis in 33%, 17% and 33% of centers respectively. The knowledge base software for variant interpretation in precision oncology were Oncomine Reporter and Sophia, both in 17%. Other specific tools (e.g., CibersortX, GATK suite, and DEseq2) were used in 33% of centers. The time required for the analysis was ≤ 10 days in 33% of centers and > 10 days in 67%. In 83% of centers results are stored locally, and a database with clinical data and follow-up was recorded. Conclusion: MTBs were present in most sarcoma referral centers that answered the survey, albeit with different organizational arrangements. Although this survey should be regarded merely as a descriptive analysis of the early stages of MTB use in sarcomas, and is not representative of the national landscape as a whole, it highlights the clinical need to develop expertise in using MTB for rare cancers and to standardize the process and may serve as a basis for future larger-scale, prospective efforts aimed at harmonizing MTB practices across Italian sarcoma centers.