What Separates a Next-Generation Liver Tumor Board From the Traditional Model?

As treatment for hepatobiliary cancers grows more complex, multidisciplinary tumor boards are evolving from case-review forums into coordinated systems of care that span navigation, molecular testing, and survivorship.

At The Liver Meeting® 2026, CancerNetwork® spoke with Pierre Gholam, MD, professor of medicine at Case Western Reserve University School of Medicine and director of the Multidisciplinary Hepatobiliary Tumor Board at University Hospitals Cleveland, about what defines a next-generation liver tumor board.

Gholam began by describing how tumor boards have evolved and how combining locoregional and systemic therapy from the outset, which he calls planned multimodality therapy, places new demands on coordination. He then explained his institution’s approach to mandatory molecular profiling in biliary tract cancers (BTCs) and weighed the strengths and limits of hub-and-spoke and virtual tumor board models. Gholam also discussed why tumor board recommendations can break down at implementation, how cancer centers measure tumor board quality, and where artificial intelligence may fit in the coming years.

CancerNetwork: As director of the Multidisciplinary Hepatobiliary Tumor Board at University Hospitals Cleveland, what separates a next-generation liver tumor board from the traditional model? Which disciplines are now essential at the table?

Gholam: Tumor boards have evolved over the past 3 or 4 decades from fairly modest efforts to coordinate care to a much more sophisticated effort that involves tumor navigation, components of survivorship, and multidisciplinary care for complex cancers, including hepatobiliary cancers. What separates tumor boards, if there is such a thing, is the depth of expertise, the breadth of specialists, and, quite honestly, the resources at hand to help patients. In an ideal world, every small hospital would have a tumor board, but the magnitude of the resources needed is such that it cannot happen.

With immunotherapy moving into earlier-stage hepatocellular carcinoma, including combinations with locoregional therapy, how should hepatology, interventional radiology, surgery, and medical oncology decide together on treatment sequencing?

At a tumor board conducting patient coordination and care in an ideal manner, all these stakeholders should already be at the table. The difference now is that instead of what we call sequential therapy, whereby you try something first, such as locoregional therapy delivered by an interventional radiologist, and then perhaps systemic therapy delivered by a medical oncologist, there now appears to be a signal for improved outcomes if you combine these from the get-go. I like to call this planned multimodality therapy, and it requires a greater degree of coordination.

You need to make sure that all these treatments are available in a timely manner. These are drugs that typically need prior authorization, the procedure itself needs prior authorization, and coordinating the timing of both treatments requires more extensive navigation. If anything, it puts more onus on the tumor board navigator to take ownership of this process to make it more seamless and efficient.

For BTCs, how should tumor boards build molecular profiling, such as testing for FGFR2 fusions and IDH1 mutations, into the first discussion? Who should be responsible for ensuring that testing happens early?

It has become clear that identifying actionable mutations through molecular profiling of BTC tumors is critically important because, depending on who you ask, up to a quarter of patients may have actionable mutations that would lead to precision medicine or targeted therapies.¹

Who should take ownership of this? The simple answer is all of us. However, we have a performance benchmark at our institution whereby every tumor that is sampled, either when it is removed at surgery or when it is biopsied, undergoes mandatory molecular profiling. This is done exclusively through 1 vendor to streamline efficiency, and ownership of the result typically belongs to the physician who ordered it. That generally falls into 2 broad categories of providers: hepatobiliary surgeons, and medical oncologists or hepatologists. All of these results are discussed at our tumor board, where decisions are made about first-line therapy and, if there is progression, about targeting specific alterations such as FGFR2 fusions or BRAF mutations, among the many others that can occur in this setting.

Many patients with liver cancer are treated in community settings without a dedicated tumor board. What role can virtual or hub-and-spoke tumor boards play in widening access, and what makes them work?

A hub-and-spoke tumor board means 1 centralized tumor board at the main hospital of a large health care system, with many smaller hospitals calling in or presenting cases, typically virtually. It is a valuable solution to the shortage of resources in the community. This is the model we have used since 2009, and it has worked well for us. There are some challenges, including the potential for patients not making it to the centralized tumor board because there is no mandate. We do not track every patient with BTC in the system and compel the treating physician to present the patient.

A virtual tumor board, which I would define as a tumor board not necessarily affiliated with the patient’s institution but willing to take on cases to adjudicate a plan of care, has not been as successful. There are many challenges, including logistics and aspects of patient privacy and Health Insurance Portability and Accountability Act [HIPAA] regulations that have to be overcome, so these have largely not worked. If we were to scale up care coordination more effectively, this is probably something we would need to do more often, but historically, it has not worked out well.

Many patients evaluated by tumor boards never receive the recommended treatment for their liver cancer. What drives that gap, and how can nurse navigators, pharmacists, and social workers help close it?

It is important to remember that tumor board recommendations are, by definition, nonbinding. They are not binding on the physician presenting the case, who takes ownership of the plan of care, so that physician may or may not choose to pursue the plan as outlined by the tumor board. In my experience of almost 15 to 16 years leading a tumor board, that is the road less traveled. Usually, people follow the tumor board’s recommendations to a T, and this is not a widespread issue.

What more frequently happens is that the plan of care breaks down at the implementation phase. Unless a navigator is present and takes ownership of the plan, including scheduling the patient with various providers and scheduling any additional procedures, such as additional chest or abdominal imaging or a PET scan, these steps might fall through the cracks. The patient may not end up receiving the full plan of care as the tumor board outlined it, or they might receive it, but with a delay. There is no easy solution. A tumor board navigator is an critical piece of this and the only sure solution to make this happen efficiently.

How should teams measure whether their tumor board improves patient outcomes?

At National Cancer Institute [NCI]–designated comprehensive cancer centers, there are certain benchmarks that cancer centers typically measure. These include adequacy of staging, which is closely linked to imaging quality and interpretation, a good handle on the number of patients treated, and a clear survivorship program. These ensure that a certain quality of care is delivered and that the benchmarks the tumor board, or the cancer center more holistically, sets out are met.

There is plenty of room for improvement. One area is what you already alluded to: ensuring that a plan of care is not only outlined but also implemented. Another relates to outcomes. What is the outcome of any treatment, and does it meet certain benchmarks based on the available literature? Do we do a good job of not only ensuring that patients have good outcomes from a cancer standpoint but also addressing their other symptoms, quality of life, and mental health? Those are intangibles that are sometimes much harder to get a handle on than measuring overall survival, progression-free survival, or disease control rate.

What role will artificial intelligence (AI) play in the future of tumor boards?

The future of tumor boards, and some might argue the future of medicine, involves AI and machine learning in some way, shape, or form. This is already implemented fairly widely in some tumor boards with a more algorithmic approach. Lung cancer stands as a clear example, in contrast with hepatobiliary disease, where there are forks in the road largely driven by local expertise and other factors. This may take a little more time, but there is no doubt in my mind that we are already taking early steps to implement it. Thoughtful AI implementation in tumor boards is going to be a reality, probably in the next 3 to 5 years.

Reference

1. Yamada D, Kobayashi S, Doki Y, Eguchi H. Genomic landscape of biliary tract cancer and corresponding targeted treatment strategies. Int J Clin Oncol. 2025;30(6):1069-1079. doi:10.1007/s10147-025-02761-x