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The Emerging Importance of the Breast Molecular Tumor Board

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This year the 2023 San Antonio Breast Cancer Symposium showcased the emerging importance of the Breast Molecular Tumor Board, a special multidisciplinary session during which information from genetic and molecular testing was discussed and incorporated into the clinical decision making, guiding treatment decisions for our breast cancer patients.

The moderator of this extremely well attended session, Pedram Razavi, MD, PhD, a medical oncologist and Director of Liquid Biopsy and Genomics at Memorial Sloan Kettering Cancer Center in New York, led a multidisciplinary team of medical oncologists, radiologists, radiation oncologists, and surgical/molecular pathologists in the discussion of challenging clinical breast cancer cases in a powerful demonstration on how the integration of molecular pathology data can help optimize therapy decisions for these complex patients.

Four breast cancer patients with long breast cancer journeys were discussed and, in every case, the incorporation of the molecular analysis of the patient’s primary and the metastatic lesions gave the clinicians additional understanding of the patient’s disease process and opened avenues for individualized treatment that were not considered, given what was known up to that point. 

The most striking of the four cases that were presented was, in my view, case #3, describing the journey of a patient with a history of treated early stage breast cancer who was recently diagnosed with a metastatic neuroendocrine tumor in the liver, of what was thought to be pancreatic origin. Pancreatic primary appropriate chemotherapy was initiated, but paradoxically worsening axillary adenopathy was noted. Of interest, when further immunoprofiling and genomic analyses of the patient’s initial primary breast tumor, the axillary mass and the current neuroendocrine carcinoma were obtained, it was noted that the patient’s current tumor was consistent with breast cancer and not pancreatic cancer. Although uncommon, this case is an example of histologic transformation of one tumor type into another more aggressive subtype. This molecular information allowed the treating clinicians to offer the patient different, breast cancer-appropriate treatment modalities and clearly illustrated the value of obtaining and incorporating molecular pathology data into state-of-art individualized therapies for our patients.

Molecular Tumor Boards are starting to play a pivotal role in the multidisciplinary breast cancer clinical practice, supplementing and occasionally replacing the traditional Breast Tumor Boards that currently operate in many Breast Cancer Centers in the U.S. The key role of the genomic/molecular analyses in correctly subclassifying the tumors and selecting and refining treatment protocols also emphasizes the central role breast pathologists and molecular pathologists play in obtaining and interpreting these vital results and helping advance the promise of precision breast oncology.

Popi Siziopikou, MD, PhD is a professor of pathology and medicine and director of breast pathology at Northwestern University, Chicago, IL. Dr. Siziopikou reports no conflicts of interest.

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