Bringing together cutting-edge science and multidisciplinary collaboration, the Duke Molecular Tumor Board (MTB) is transforming cancer care at Duke and beyond.
A collaboration between Duke Cancer Institute and the Duke University Department of Pathology, the MTB was established to ensure patients with advanced or metastatic solid tumors receive evidence-based precision therapies and clinical trial access. Since launching in 2017, the MTB has reviewed over 18,000 patient cases.
Genomic data is integrated into a centralized database known as PathPrime. Every molecular testing report across the Duke system is reviewed, with as many as 100 cases evaluated weekly.
Select cases are then discussed in a weekly meeting attended by a multidisciplinary team of around 40 experts, including pathologists, genetic counselors, pharmacists, oncologists, surgeons, and clinical trials staff.
“It’s a robust discussion about cases where we share knowledge,” said medical oncologist John Strickler, MD, leader of the MTB. “Our goal is to ensure that each patient receives the most informed, up-to-date treatment recommendations possible.”
For patients, the MTB also offers a level of personalized care that goes beyond standard practice. Unlike traditional systems where genomic data may be buried in medical records, the MTB ensures results are accessible, actionable, and continuously reviewed. As new therapies and trials emerge, eligible patients can be flagged by the PathPrime system and their physicians notified — sometimes within hours of an FDA approval.
“Because the patient is seen at Duke and has their profiling done at Duke, we’re able to provide that concierge-level precision cancer medicine support,” Strickler said.
Looking Forward & Expanding Access Beyond Duke
In 2024, Duke launched a two-year partnership with Eli Lilly and Company and the National Comprehensive Cancer Network to address disparities in molecular testing in rural communities. Through this initiative, patients at smaller, non-Duke hospitals that are staffed by Duke physicians and part of the Duke Cancer Network can consent to have their data reviewed by the MTB. This effort is on track to include 500 patients by the end of the first two years, significantly expanding access to precision medicine.
“In the community setting, timely testing is happening less frequently, and patients are not getting access to precision cancer medicine therapies or trials in the same way that academic center patients are,” Strickler said. “The Molecular Tumor Board has established a relationship with these hospitals so those patients can access our precision cancer medicine services.”
Duke is also pioneering new approaches to accelerate diagnosis and treatment. One such innovation is a pre-diagnosis testing program for lung cancer, designed to ensure genomic results are available at the patient’s first clinical visit by pairing molecular profiling with diagnostic biopsies. This minimizes delays and avoids unexpected costs for patients.
Plans are underway to deploy a digital molecular navigator powered by artificial intelligence. This tool will streamline patient identification and support rapid testing, helping match patients to FDA-approved therapies or clinical trials as quickly as possible.
Strickler credits the MTB’s success to support from the DCI and key external sponsors.
“This is a commitment by the DCI to ensure that we are offering the highest level of support,” he said. “This level of teamwork and collaboration by highly specialized thought leaders across multiple disciplines is not something that is easily reproducible.”
