Survey on implementation of molecular testing in ovarian cancer and PARP inhibitor: a national North-Eastern German Society of Gynecologic Oncology/Young Academy of Gynecologic Oncology/Arbeitsgemeinschaft Gynäkologische Onkologie intergroup analysis

• Published in: International journal of gynecological cancer Vol. 32; no. 10; pp. 1297 - 1302
• Main Authors: Nguyen-Sträuli, Bich Doan, Baum, Joanna, Meyer-Wilmes, Philipp, Kreklau, Anne, Buschmann, Christina, El Ouardi, Nabila, Fotopoulou, Christina, Hummel, Michael, Chekerov, Radoslav, Braicu, Elena, Sehouli, Jalid, Pietzner, Klaus
• Format: Journal Article
• Language: English
• Published: United States BMJ Publishing Group Ltd 01.10.2022; Elsevier Inc; Elsevier Limited
• Subjects: Algorithms; BRCA1 protein; BRCA2 protein; Breast cancer; Consultants; Decision making; Demographics; Genetic counseling; Genetic testing; Gynecology; homologous recombination; medical oncology; Monoclonal antibodies; Mutation; Oncology; Original research; Ovarian cancer; Patients; Questionnaires; Society; Targeted cancer therapy; BRCA2 protein; medical oncology; BRCA1 protein; homologous recombination; ovarian cancer
• ISSN: 1048-891X; 1525-1438; 1525-1438
• DOI: 10.1136/ijgc-2022-003637

BackgroundSince the introduction of poly (ADP-ribose) polymerase (PARP) inhibitors, BRCA testing has evolved as a standard management in epithelial ovarian cancer.ObjectiveTo analyze the implementation of molecular testing and PARP inhibitor therapy in Germany.MethodsThe questionnaire contained 40 questions covering real-life data on genetic testing and the use of PARP inhibitors. It was divided into three main parts: basic demographics of respondents, genetic counseling and testing, and treatment with PARP inhibitors. The questionnaire was distributed via mail between August 2020 and May 2021.ResultsA total of 315 physicians participated in the survey, of whom 54.9% were specialized in the field of gynecologic oncology. Two-thirds of respondents (67.4%) stated that they tested more than 80% of patients with primary epithelial ovarian cancer for BRCA mutation; however, only 42.5% of gynecologists who performed genetic counseling had an additional qualification in subject-specific genetic counseling, which is mandatory for predictive genetic testing in Germany. The main reasons for failure of BRCA testing were patient refusal (54.6%) and organizational or logistical issues (31.7%). Only 13.7% of respondents felt sufficiently equipped with supportive information material on patient counseling, whereas a high need for information material was indicated by 86.3% of the respondents. Molecular tumor profiling to infer homologous recombination (HR) deficiency status was provided by only 53.3% of institutions. PARP inhibitors were applied on a regular basis by 62.1% of respondents. The most important criteria for selection of appropriate PARP inhibitor therapy were the side effect profile (78.2%) and efficacy (71.2%). The majority of respondents (66.5%) preferred a combination of olaparib and bevacizumab over PARP inhibitors alone in the frontline setting.ConclusionAdequate structure for BRCA/HR deficiency testing, and systematic education programs are needed to prevent delay in counseling and undertreatment of women with epithelial ovarian cancer. In Germany, a combination of olaparib and bevacizumab seems to be the preferred treatment in the first-line setting.