Background: The Inova Schar Cancer Institute Molecular Tumor Board (ISCI MTB) is a multi-disciplinary group that meets biweekly to discuss molecular test results for patients with advanced cancer to inform potential targeted therapy and clinical trial options. Previous work analyzing the racial distribution of patients in the ISCI MTB compared to the institutional cancer registry (CR) demonstrated that self-identified Black/African American patients were under-represented in the MTB. We next sought to evaluate the association between race and the implementation of MTB-recommended therapy. Methods: We evaluated ISCI MTB records from 1/1/16 to 12/31/21 and identified patients with at least one treatment recommendation informed by molecular biomarker results, including clinical trials, targeted medications, immunotherapy, and chemotherapy. Patient data were extracted from the EMR using the Epic Slicer/Dicer Tool and integrated with the MTB REDCap database. Manual chart review was used to fill missing data and identify patients for whom at least one MTB recommendation was implemented. Recommendation implementation was defined as treatment with or prescription of a recommended therapy or evaluation for a clinical trial. Results: 244 of 530 patients (46%) had one or more MTB recommendations implemented. There was no clear distinction in age at MTB presentation (64 vs 65) or sex (45% of males and 47% of females vs 55% of males and 53% of females) between patients who had recommendations implemented and those who did not. 45% of White/Caucasian, 41% of Asian, 56% of Black/African American, and 58% of Hispanic/Latino patients had MTB recommendations implemented. No statistically significant differences in implementation of recommendations were observed for age, sex, or race. Conclusions: Fewer than half of patients with advanced cancer receive biomarker-directed or investigational therapies recommended by an institutional MTB. White and Asian patients are less likely than Black/African American and Hispanic/Latino patients to be treated with MTB-recommended therapy, although these differences did not reach statistical significance. Further investigation of confounding variables including payor status and care fragmentation is necessary to clarify potential disparities and barriers to accessing innovative cancer care.