156P Molecularly driven therapy recommended by a molecular tumor board: Accessible option or privilege for a minority of patients? A single-center experience from the Czech Republic

The accessibility to drugs recommended by dedicated molecular tumor board (MTB) varies across countries, mainly due to different health insurance policies. In the Czech Republic, reimbursement of comprehensive genomic profiling (CGP) is available to all patients with advanced and pretreated solid tumors with no further therapeutic options, regardless of the type of public health insurance. We present the rate of accessibility to the therapy recommended by MTB and its effectiveness. Between February 2021 and June 2023, 309 patients with different advanced and pretreated solid tumors were presented at the MTB at University Hospital Brno. If indicated, tumor tissues were analyzed by use of the combined DNA/RNA sequencing panel (TSO500 assay, Illumina). Additionally to CGP, immunohistochemistry results were also discussed, and MTB recommendations were graded according to the Joint consensus recommendation for reporting genetic variants in cancers (AMP TIER classification). The CGP was performed in 259 (83.8%) presented patients. Alterations classified as TIER IA/B or IIC were detected in 123 (47.5%) cases. CPS > 1, TMB > 10 mut/Mb or MSI – high status, were detected in 72 (27.8%) cases. Therapy was recommended by MTB in 157 (60.6%) patients. Reimbursement was requested from insurance providers in 54 cases with 41 approvals and 13 refusals (3 received therapy anyway thanks to external funding or covering costs themselves). In another 8 patients, the recommended therapy had already been reimbursed. Progression-free survival 2 (on recommended therapy, PFS2) and 1 (on prior standard therapy, PFS1) ratio > 1.3 was observed in 16 (39%) from 41 evaluable heavily pretreated patients. In the Czech Republic, CGP in advanced solid tumors is reimbursed regardless of the type of public health insurance. At our university center, 62 patients were indicated to start the recommended therapy by MTB. Reimbursement was secured in 49 (79%) cases. PFS2/PFS1 ratio > 1.3 was not met in 61% of patients. As the main reason we consider the late initiation of molecularly driven therapy in the overall management of our patients (median treatment line was 3).