WIN-MTB-2024017 - WIN International Molecular Tumor Board: A 48-year-old female with multiple primary cancers

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Wafik S. El-Deiry1,2,*, Alberto Hernando-Calvo3, Don Dizon4, Shai Magidi1, Catherine Bresson1, Liang Cheng2, Jia Liu5,6,7, Zhihuang Hu8, Crystal Hattum9, Tobias Meissner9, Ricky Grisson2, Liu Liu2, Arjun Oberoi3, Naftali Z. Frankel10, Fanny Wunder1 and Razelle Kurzrock1,11,* 1 Worldwide Innovative Network (WIN) Association - WIN Consortium, Chevilly-Larue 94550, France 2 Legorreta Cancer Center at Brown University, Providence, RI 02912, USA 3 Vall d’Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona 08035, Spain 4 Tufts Medical Center, Boston, MA 02111, USA 5 The Kinghorn Cancer Centre, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia 6 Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia 7 School of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia 8 Fudan University Shanghai Cancer Center, Shanghai 200032, China 9 Avera Cancer Institute, Sioux Falls, SD 57105, USA 10 Chaim Medical Resource, Monroe, NY 10950, USA 11 Medical College of Wisconsin, Milwaukee, WI 53226, USA * These authors contributed equally to this work Correspondence to: Wafik S. El-Deiry, email:wafik_el-deiry@brown.edu Keywords: cancer; precision oncology; molecular tumor board Received: December 04, 2025 Accepted: May 07, 2026 Published: July 21, 2026 Copyright: © 2026 El-Deiry et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. ABSTRACT Multiple primary cancers (MPC), the occurrence of two or more distinct malignancies in the same patient, pose significant clinical challenges due to their complexity and the need for individualized treatment strategies. This case, discussed at the WIN Consortium International Molecular Tumor Board, illustrates the clinical journey of a 48-year-old female with a BRCA1 germline mutation who developed multiple primary cancers: breast, skin, high-grade serous carcinoma of the ovary, colon and small bowel cancers. Her treatment history included doxorubicin and cyclophosphamide for breast cancer, Mohs surgery for basal cell carcinoma, and carboplatin and paclitaxel for ovarian cancer. After participating in the PRIMA trial with niraparib, she was diagnosed with PIK3CA-mutated colon cancer, leading to resection and CAPOX chemotherapy. A subsequent diagnosis of small bowel adenocarcinoma, molecularly resembling her colon cancer, along with a unique BRCA1-STARD3 fusion in inguinal lymph nodes prompted a comprehensive MTB review. The panel discussed several precision strategies, including combinations of cetuximab, niraparib, and temsirolimus; FOLFIRI with anti-EGFR inhibitors; anti-CTLA-4 and anti-PD-1 (botensilimab and balstilimab); regorafenib with anti-CTLA-4 and anti-PD-1 (ipilimumab and nivolumab); trifluridine/tipiracil with bevacizumab; regorafenib alone; aspirin for potential benefits in patients with PIK3CA mutations; therapies targeting PIK3CA and EGFR alterations; regular imaging and liquid biopsies assessments for monitoring disease progression and guide future treatment decisions; and vaccines targeting PIK3CA, STARD3 and TP53. This case underscores the complexity of managing MPC and highlights the essential role of international molecular tumor boards in generating innovative, tailored treatment recommendations for patients with rare and multifaceted disease courses.

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