Implementing Precision Cancer Medicine: organisational challenges, innovations, and the role of Molecular Tumour Boards

<p dir="ltr">Precision Cancer Medicine (PCM) has been heralded as a transformative approach in oncology, tailoring treatments to the molecular profiles of individual patients. While PCM offers the potential for improved outcomes and reduced side effects, its implementation in clinical practice remains fraught with challenges. This thesis investigates the organisational dimensions of PCM, aiming to uncover barriers and facilitators to its integration into healthcare. By examining the emerging organisational and translational research efforts surrounding PCM, it illustrates how precision and targeted treatments can be equitably delivered across diverse healthcare settings.</p><p dir="ltr">The thesis consists of three empirical studies. The first study describes the development of a clinical decision-support system for molecular profiling used in the Molecular Tumour Boards (MTBs) of a multicentre clinical trial designed to follow a PCM framework. This project provided insights into the practical and organisational conditions for implementing PCM within a translational research environment. The second study explores systemic and organisational hurdles to implementing PCM in the Stockholm healthcare system. Through qualitative interviews with healthcare professionals, researchers, and policymakers the study identified fragmented funding models, siloed organisational structures, and difficulties integrating genomic data into patient care as significant obstacles. The third study aimed to investigate how MTBs function as an emerging organisational form for PCM implementation. The study analysed MTBs at five comprehensive cancer centres and demonstrated their role in facilitating case discussions, educating clinicians about actionable molecular biomarkers, and fostering interdisciplinary collaboration.</p><p dir="ltr">The findings show that while PCM has the potential to revolutionise cancer care, its success is contingent on addressing systemic challenges, such as creating sustainable funding mechanisms, improving cross-disciplinary collaboration, and ensuring that omics technologies are integrated into clinical workflows. The thesis highlights MTBs as a pivotal organisational innovation that bridges translational research and clinical practice. By addressing these challenges, this thesis contributes actionable insights for policymakers, researchers, and clinicians, advocating for a more inclusive and adaptive approach to PCM implementation.</p><h3>List of scientific papers</h3><p dir="ltr">I. Tamborero, D., Dienstmann, R., Haj Rachid, M., Boekel, J., Lopez- Fernandez, A., Jonsson, M., Razzak, A., Braña, I., De Petris, L., Yachnin, J., Baird, R.D., Loriot, Y., Massard, C., Martin-Romano, P., Opdam, F., Schlenk, R.F., Vernieri, C., <b>Masucci, M.</b>, Villalobos, X., Chavarria, E., Cancer Core Europe consortium, Balmaña, J., Apolone, G., Caldas, C., Bergh, J., Ernberg, I., Fröhling, S., Garralda, E., Karlsson, C., Tabernero, J., Voest, E., Rodon, J., Lehtio, J. The Molecular Tumor Board Portal supports clinical decisions and automated reporting for precision oncology. Nat Cancer 3, 251-261 (2022). <a href="https://doi.org/10.1038/s43018-022-00332-x" rel="noreferrer" target="_blank">https://doi.org/10.1038/s43018-022-00332-x</a></p><p dir="ltr">II.<b> Masucci, M.</b>, Del Villar Pérez, J., Mazzocato, P., Ernberg, I., Brommels, M. Implementing Personalized Cancer Medicine: Insights from a Qualitative Interview Study. J. Pers. Med., 2025, 15, 150. <a href="https://doi.org/10.3390/jpm15040150" rel="noreferrer" target="_blank">https://doi.org/10.3390/jpm15040150</a><br><br></p><p dir="ltr">III. <b>Masucci, M.</b>, Pérez, J., Mazzocato, P., Ekman, S., Brommels, M., Ernberg, I. Molecular Tumour Boards in Precision Oncology: An Exploratory Case Study of Five Comprehensive Cancer Centres. (2025). [Manuscript]</p>