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

Bich Doan Nguyen-Sträuli; Joanna Baum; Philipp Meyer-Wilmes; Anne Kreklau; Christina Buschmann; Nabila El Ouardi; Christina Fotopoulou; Michael Hummel; Radoslav Chekerov; Elena Braicu; Jalid Sehouli; Klaus Pietzner

doi:10.1136/ijgc-2022-003637

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

Int J Gynecol Cancer. 2022 Jul 27:ijgc-2022-003637. doi: 10.1136/ijgc-2022-003637. Online ahead of print.

Authors

Bich Doan Nguyen-Sträuli^#^{1

2}, Joanna Baum^#^{2

3}, Philipp Meyer-Wilmes^{2

4}, Anne Kreklau^{2

5}, Christina Buschmann^{2

6}, Nabila El Ouardi², Christina Fotopoulou⁷, Michael Hummel⁸, Radoslav Chekerov³, Elena Braicu³, Jalid Sehouli³, Klaus Pietzner^{2

3}

Affiliations

¹ University Hospital Zurich, Department of Gynecology, Zurich, ZH, Switzerland bichdoan.nguyen@usz.ch.
² Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany.
³ Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charite-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany.
⁴ University Hospital Aachen, Department of Gynaecology and Obstetrics, Aachen, Nordrhein-Westfalen, Germany.
⁵ University Hospital Leipzig, Department of Obstetrics and Gynaecology, Leipzig, Sachsen, Germany.
⁶ University Hospital Munich, Department of Gynecology and Obstetrics, Grosshadern Campus, Munchen, Bayern, Germany.
⁷ Department of Gynaecologic Oncology, Imperial College London, Faculty of Medicine, London, London, UK.
⁸ Charite Universitatsmedizin Berlin, Institut für Pathologie, Berlin, Berlin, Germany.

^# Contributed equally.

PMID: 35896275
DOI: 10.1136/ijgc-2022-003637

Abstract

Background: Since the introduction of poly (ADP-ribose) polymerase (PARP) inhibitors, BRCA testing has evolved as a standard management in epithelial ovarian cancer.

Objective: To analyze the implementation of molecular testing and PARP inhibitor therapy in Germany.

Methods: The 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.

Results: A 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.

Conclusion: Adequate 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.

Keywords: BRCA1 protein; BRCA2 protein; homologous recombination; medical oncology; ovarian cancer.