Precision oncology faces two major hurdles: rapidly pinpointing actionable molecular alterations and making such targeted interventions accessible to a wide patient population. We report a four-year experience of the Molecular Tumor Board (MTB) at the Comprehensive Cancer Center Freiburg, Germany, highlighting workflow refinements and practical implementation strategies. This retrospective study includes 488 patients evaluated from February 2015 to December 2018. The MTB provided personalized molecular diagnostics, therapy recommendations based on molecular profiles, monitored adherence to these recommendations, and tracked clinical outcomes, including overall survival. Most patients (90.6%) had advanced (stage IV) cancers and had received an average of 2.1 prior treatment lines. Nearly all patients (99.8%) received diagnostic guidance, and treatment suggestions were made for 264 cases (54.1%), with 212 cases (43.4%) involving therapies tailored to molecular findings. Recommendations were implemented in 76 patients (28.8%), resulting in stable disease in 19 patients (25.0%), partial response in 17 (22.4%), and complete remission in five (6.6%). Among those receiving MTB-guided therapy, 28.9% achieved an objective response, representing 4.5% of the total cohort. Optimization of MTB operations increased the number of cases reviewed per session without compromising adherence or outcomes. Our experience demonstrates that molecular-guided cancer therapy can be effectively integrated into routine clinical practice, yielding a modest but meaningful and durable disease control rate.
