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2022-RA-1519-ESGO Biomarker testing and first line maintenance treatment patterns in a real-world US cohort of patients with advanced ovarian cancer
  1. Dan S Veljovich1,
  2. Richard T Penson2,
  3. Michael J Birrer3,
  4. Gráinne Long4,
  5. Graham Wetherill5 and
  6. Stephanie Volpe6
  1. 1Gynecologic Oncology and Pelvic Surgery, Swedish Medical Center, Seattle, WA
  2. 2Harvard Medical School, Massachusetts General Hospital, Boston, MA
  3. 3Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR
  4. 4Global Medical Affairs, Global Real World Evidence Strategy, Oncology RandD, AstraZeneca Pharmaceuticals LP, Cambridge, UK
  5. 5Global Medical Affairs/Payer Biometrics, Oncology RandD, AstraZeneca Pharmaceuticals LP, Cambridge, UK
  6. 6Global Medical Affairs, Epidemiology, Oncology RandD, AstraZeneca Pharmaceuticals LP, Cambridge, UK


Introduction/Background With the approval of the first poly-(adenosine diphosphate-ribose) polymerase inhibitor (PARPi), olaparib therapy has demonstrated efficacy in first-line (1L) maintenance for Breast Cancer gene mutated (BRCAm) advanced ovarian cancer (AOC) patients in 2018 and in combination with bevacizumab for Homologous Recombination Deficient (HRD+) AOC patients in 2020. This study describes biomarker testing and treatment patterns in a representative AOC patient sample.

Methodology A retrospective observational study utilizing the electronic health record-derived de-identified US-based Flatiron Health database was performed including women aged ≥18 years at AOC diagnosis between July 2018 and December 2021 with ≥2 clinical visits. Patients were followed from diagnosis until 31 December 2021, cessation of dataset coverage, or death, whichever occurred first. Biomarker testing was defined as evidence of a test for BRCA or HRD.

Abstract 2022-RA-1519-ESGO Table 1

Patient demographics by biomarkers status and overall

Results Of the 1,107 patients included, most (88%, n=976/1,107) were BRCA tested, and 22.5% (n=249/1,107) were HRD tested. In BRCA-tested patients 25.3% (n=247/976) were additionally HRD tested. Among patients receiving either a BRCA or HRD test (n=978) 56.4% (n=552/978) were tested between AOC diagnosis and initiation of 1L systemic therapy. With respect to 1L maintenance: among BRCAm patients (n=139), 33.1% (n=46/139) were treated with olaparib monotherapy vs. 6.5% (n=9/139) with other PARPi therapy. Among HRD+ patients, including those with a pending HRD result who were BRCAm (n=115), 20.0% (n=23/115) were treated with olaparib monotherapy, 13.9% (n=16/115) were treated with olaparib/bevacizumab combination therapy vs. 17.4% (n=20/115) with other PARPi therapy.

Conclusion Although the majority of patients were tested for BRCA, a large majority of patients were not tested for HRD. Following testing, few patients received PARPi as 1L maintenance therapy despite actionable biomarker results. This study demonstrates the need for improved education surrounding genetic testing to optimize therapeutic decisions for AOC patients.

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