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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
  1. Bich Doan Nguyen-Sträuli1,2,
  2. Joanna Baum2,3,
  3. Philipp Meyer-Wilmes2,4,
  4. Anne Kreklau2,5,
  5. Christina Buschmann2,6,
  6. Nabila El Ouardi2,
  7. Christina Fotopoulou7,
  8. Michael Hummel8,
  9. Radoslav Chekerov3,
  10. Elena Braicu3,
  11. Jalid Sehouli3 and
  12. Klaus Pietzner2,3
  1. 1University Hospital Zurich, Department of Gynecology, Zurich, ZH, Switzerland
  2. 2Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany
  3. 3Department 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. 4University Hospital Aachen, Department of Gynaecology and Obstetrics, Aachen, Nordrhein-Westfalen, Germany
  5. 5University Hospital Leipzig, Department of Obstetrics and Gynaecology, Leipzig, Sachsen, Germany
  6. 6University Hospital Munich, Department of Gynecology and Obstetrics, Grosshadern Campus, Munchen, Bayern, Germany
  7. 7Department of Gynaecologic Oncology, Imperial College London, Faculty of Medicine, London, London, UK
  8. 8Charite Universitatsmedizin Berlin, Institut für Pathologie, Berlin, Berlin, Germany
  1. Correspondence to Dr. Bich Doan Nguyen-Sträuli, University Hospital Zurich, Department of Gynecology, Zurich, ZH, Switzerland; bichdoan.nguyen{at}usz.ch

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.

  • ovarian cancer
  • BRCA1 protein
  • BRCA2 protein
  • homologous recombination
  • medical oncology

Data availability statement

Data are available upon reasonable request. from: klaus.pietzner@charite.de.

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Data availability statement

Data are available upon reasonable request. from: klaus.pietzner@charite.de.

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Footnotes

  • BDN-S and JB contributed equally.

  • Contributors BDN-S and JB share first authorship. Both authors contributed equally to this study. BDN-S and JB contributed substantially to conception of the work, data acquisition, data interpretation, and drafting of the manuscript. PM-W contributed substantially to conception, data acquisition, and critical revision of the manuscript. AK contributed substantially to data acquisition, data analysis, data interpretation, and critical revision of the manuscript. CB contributed substantially to data acquisition and critical revision of the manuscript. NEO, CF, MH, RC, EB contributed substantially to critical revision of the manuscript. JS contributed substantially to conception, data interpretation, and critical revision of the manuscript and was responsible for the overall content as the guarantor. KP contributed substantially to conception and design of the work, interpretation of data, drafting of the manuscript, and critical revision of the manuscript. All authors gave final approval of the version published and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.