Comprehensive Genomic Profiling in Lung Cancer in the Era of Immunotherapy Approaches: The Role of Molecular Tumour Boards

Prognosis of advanced lung cancer is still poor even with a 2% improvement, from 3–5% 5-year survival rate to 7% at the time of diagnosis, in the last 5 years. This evolution has been largely due to target therapies and immunotherapic approaches which created longer life expectancies for this disease. As more biomarkers will be validated, an increased need for systems able to guarantee efficient genetic evaluations to support personalized therapies will rise. For this reason, multidisciplinary molecular tumour boards (MTBs) have been conceived. The present analysis aims to highlight scientific advances about ICB across advanced non-small cell lung cancer (NSCLC) harbouring principal oncogenic alterations and to discuss effectiveness and limits of MTBs decision-making methodology in the era of immunologic approaches. A focus on relevant scientific experiences about NSCLC patients receiving treatments based on MTBs recommendations is provided as well as principal differences in methods and agreements among different MTBs. Including MTBs into standard-of-care diagnostics and therapeutics as well as a clear definition of professionals involved needs still to be defined. Timing (discussion about tissue samples and biomolecular data for a first-line choice versus molecular evaluation at progression) and mitigation of heterogeneity in achievable clinical data and molecular platforms are still important issues. Integrated professional skills are imperative, considering the complexity of precision medicine data, particularly those emerging from tumour heterogeneity through core and metastatic biopsies tied with liquid ones. MTBs role in thoracic oncology is to provide the finest treatment decision in those cases of NSCLCs harbouring rare or unknown somatic genomic alterations, to carefully integrate their assessment in the context of immunological approaches in order to improve treatment strategies for each discussed patient. For now, a clear definition of professionals and settings of discussion needs to be further clarified.