Challenges and Obstacles in Applying Therapeutical Indications Formulated in Molecular Tumor Boards

Simple Summary Precision oncology is gaining a great deal of interest as it aims to administer the right drug to the right patient at the right moment, overcoming the classical paradigm of "one drug fits all". Molecular tumor boards (MTBs) are multidisciplinary groups instituted to formulate the most up-to-date therapeutical or diagnostic indication for cancer patients performing genomic analyses. Unfortunately, MTBs must face many issues in applying the indications formulated and only a small percentage of patients effectively receives the targeted treatment. In this review, we aim to describe the most common issues that impede the implementation of MTB indications and the solutions that have been developed. Considering the rapid improvement of cancer drugs' efficacy and the discovery of new molecular targets, the formulation of therapeutical indications based on the multidisciplinary approach of MTB is becoming increasingly important for attributing the correct salience to the targets identified in a single patient. Nevertheless, one of the biggest stumbling blocks faced by MTBs is not the bare indication, but its implementation in the clinical practice. Indeed, administering the drug suggested by MTB deals with some relevant difficulties: the economical affordability and geographical accessibility represent some of the major limits in the patient's view, while bureaucracy and regulatory procedures are often a disincentive for the physicians. In this review, we explore the current literature reporting MTB experiences and precision medicine clinical trials, focusing on the challenges that authors face in applying their therapeutical indications. Furthermore, we analyze and discuss some of the solutions devised to overcome these difficulties to support the MTBs in finding the most suitable solution for their specific situation. In conclusion, we strongly encourage regulatory agencies and pharmaceutical companies to develop effective strategies with medical centers implementing MTBs to facilitate access to innovative drugs and thereby allow broader therapeutical opportunities to patients.