Precision oncology for adult patients at the University Hospital Brno is provided by the Internal Hematology and Oncology Department (IHOK) of University Hospital Brno and the Faculty of Medicine, Masaryk University, where a multidisciplinary Molecular Tumor Board (MTB) for adult patients was established on May 10, 2021 (more information). Over its four years of existence, the committee has reviewed more than 650 patients with solid tumors. These patients were treated at IHOK for various advanced-stage oncological diseases, and for most of them, further treatment options were significantly limited. Tumor examination using advanced molecular-genetic methods, in cooperation with the Laboratory of Molecular Pathology at the Department of Pathology, University Hospital Brno, and the Faculty of Medicine, Masaryk University (more information), allowed to be recommended individually formulated treatment plans for 60 % of these patients. Since most of the recommended targeted therapies are not yet reimbursed by health insurance for specific indications, access to precision therapy is still partially limited. At our center, as of March 2025, therapy based on MTB recommendations has been initiated in 17 % of all patients tested. This outcome is comparable to those of oncology centers in Western Europe, as the issue of availability of recommended innovative biological therapies is similar worldwide. Despite significant pre-treatment and advanced stages of the disease, we already see admirable treatment responses in some patients who have started the recommended treatment.
The Center for Precision Medicine at University Hospital Brno focuses on selected patients with advanced and metastatic oncological disease, for whom standard therapy is no longer effective, who have limited additional treatment options, and who have a good performance status to undergo potential further therapy. The conditions are that the disease is incurable, and the patients are not planned for or already in hospice care.
The following points characterize precision therapy in oncology:
- Testing by next-generation sequencing (NGS) is available at several centers in the Czech Republic (including University Hospital Hradec Králové, University Hospital Plzen, Masaryk Memorial Cancer Institute in Brno, General University Hospital in Prague, University Hospital Motol in Prague, Thomayer Hospital in Prague, University Hospital Olomouc, and University Hospital Ostrava). Hospitals where NGS is not available often cooperate with centers that offer NGS.
- All centers indicate NGS under the conditions mentioned above. Most targeted drugs are approved by the insurance only after standard therapy options have been exhausted. Therefore, most center do not indicate NGS testing at the early phases of advanced disease therapy.
- For some types of cancers, the yield of NGS testing is minimal, and the probability of indicating targeted therapy is in the low single digits of one percent. In contrast, for other diseases, the yield is very high, and NGS testing is often already done as a standard procedure at several centers in the Czech Republic. The European Society for Medical Oncology (ESMO) recommends testing the following cancers: breast cancer, non-small cell lung cancer, bile duct cancer, ovarian cancer, colorectal cancer, neuroendocrine tumors, thyroid tumors, cancers of unknown origin, certain types of sarcomas, and gastrointestinal stromal tumors. Currently, ESMO is also newly recommended to test for any type of cancer if tumor-agnostic therapy is available in the country, where we do not look at the localization or histology of the tumor but only focus solely on the presence of selected gene aberrations or immuno-predictors. So far, in the Czech Republic, there are currently six targets that we are able to target with available therapies. This group of preparations is likely to be increased soon with additional targeted drugs.
- The vast majority of targeted therapies must be approved by the reviewing physician of the insurance company with which the patient is insured after a prior request for reimbursement by your treating oncologist. This process takes approximately 1 month.
From the above, it follows that precision therapy in oncology is not intended for every cancer patient, and it is necessary to first consult with your treating oncologist. At the Center for Precision Medicine in Brno, we primarily offer testing to patients who are under our long-term care. However, we can also offer testing to patients being treated at other oncology centers within the Czech Republic if testing cannot be arranged otherwise and the conditions mentioned above are met.
Testing the tumor sample at our Centre is not a prerequisite for the start of the targeted therapy at the University Hospital Brno, and this treatment can be initiated at the oncology department where you have been treated so far.
New European ESMO Recommendations for Precision Medicine
More information about the ESMO Precision Medicine Working Group and the expanded indications for NGS testing in advanced cancer is available for download here and simultaneously at this link: Recommendations for the use of next-generation sequencing (NGS) for patients with advanced cancer in 2024: a report from the ESMO Precision Medicine Working Group - Annals of Oncology.
Contact person:
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Michal Eid, M.D.Physician of Internal Hematology and Oncology Department, University Hospital Brno and Faculty of Medicine, Masaryk University Email: |