Fig. 1

The six-step IRE MTB workflow. Step 1: informed consent. Step 2: case presentation during the first round of collegial discussion. Step 3: genomic profiling, mostly involving NGS on tDNA and ctDNA, either de novo or as a complement to the available genomic profiling. Step 4: joint appointment of two case discussants, providing distinct pieces of expertise, clinical and molecular. Step 5: case review in a second discussion round (typically 15 days later) and MTB recommendations. Step 6: treatment recommendation. Therapy is ultimately decided by the oncologist (usually the clinical discussant) and agreed with the patient