Multicenter Comparison of Molecular Tumor Boards in The Netherlands: Definition, Composition, Methods, and Targeted Therapy Recommendations

Background: Molecular tumor boards (MTBs) provide rational, genomics-driven, patient-tailored treatment recommendations. Worldwide, MTBs differ in terms of scope, composition, methods, and recommendations. This study aimed to assess differences in methods and agreement in treatment recommendations among MTBs from tertiary cancer referral centers in The Netherlands. Materials and Methods: MTBs from all tertiary cancer referral centers in The Netherlands were invited to participate. A survey assessing scope, value, logistics, composition, decision-making method, reporting, and registration of the MTBs was completed through on-site interviews with members from each MTB. Targeted therapy recommendations were compared using 10 anonymized cases. Participating MTBs were asked to provide a treatment recommendation in accordance with their own methods. Agreement was based on which molecular alteration(s) was considered actionable with the next line of targeted therapy. Results: Interviews with 24 members of eight MTBs revealed that all participating MTBs focused on rare or complex mutational cancer profiles, operated independently of cancer type–specific multidisciplinary teams, and consisted of at least (thoracic and/or medical) oncologists, pathologists, and clinical scientists in molecular pathology. Differences were the types of cancer discussed and the methods used to achieve a recommendation. Nevertheless, agreement among MTB recommendations, based on identified actionable molecular alteration(s), was high for the 10 evaluated cases (86%). Conclusion: MTBs associated with tertiary cancer referral centers in The Netherlands are similar in setup and reach a high agreement in recommendations for rare or complex mutational cancer profiles. We propose a “Dutch MTB model” for an optimal, collaborative, and nationally aligned MTB workflow. Implications for Practice: Interpretation of genomic analyses for optimal choice of target therapy for patients with cancer is becoming increasingly complex. A molecular tumor board (MTB) supports oncologists in rationalizing therapy options. However, there is no consensus on the most optimal setup for an MTB, which can affect the quality of recommendations. This study reveals that the eight MTBs associated with tertiary cancer referral centers in The Netherlands are similar in setup and reach a high agreement in recommendations for rare or complex mutational profiles. The Dutch MTB model is based on a collaborative and nationally aligned workflow with interinstitutional collaboration and data sharing

The relational ontology of technical artifacts

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De brugfunctie van ingenieurs : standaardbeeLd van technici als bètawetenschappers onjuist

Het standaardbeeld van ingenleurs als bètawetenschappers slaat de plank half mis, omdat ingenieurs bij uitstek een brugfunctie vervullen tussen het beta- en alfa gammadomein. Prof.dr.ir. A.W.M. Meijers stelt daarom in zijn oratie Wat maakt een ingenieur?, die hij op 6 maart in Delft uitsprak, dat het onjuist is de technische wetenschappen als toegepaste wetenschappen in te delen in het bètadomein. Dit essay is een verkorte versie van de oratie

Engineering Knowledge

This chapter seeks to advance our understanding of engineering knowledge. The authors distinguish existing views of engineering knowledge as subordinating, contrasting, or assimilating it to (natural-)scientific knowledge. After identifying shortcomings and useful elements of each view, the authors offer ingredients for an alternative analysis, focusing on knowledge produced in the design of high-tech systems. This analysis builds on elements of existing views of engineering knowledge, as well as recent work in the philosophy of science. The authors argue that such design involves sets of epistemic activities, resulting in a variety of rules, where both activities and rules are governed by a distinctive set of epistemic and non-epistemic values. To illustrate this analysis, the authors use the development of the nuclear-fusion test reactor ITER as a running example

Introduction

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