Differences in HRD Testing for Ovarian Cancer Worldwide

Eric Pujade-Lauraine, MD, discusses the differences in testing for homologous recombination repair deficiency in patients with ovarian cancer throughout countries.

Eric Pujade-Lauraine, MD, PhD, head of the Medical Oncology Department at Hôpital Hôtel-Dieu in France, discusses the differences regarding testing for homologous recombination repair deficiency (HRD) in patients with ovarian cancer in France compared with other countries.

PARP inhibitors, including olaparib (Lynparza), niraparib (Zejula), and rucaparib (Rubraca), are an effective treatment option for patients with ovarian cancer. Based on findings from the phase 3 PAOLA-1 trial (NCT02477644), the combination of olaparib and and bevacizumab (Avastin) as a first-line maintenance therapy in adult patients with ovarian cancer was approved by the FDA and European Medicines Agency.

This trial sought to discover whether patients received any benefit from this combination regardless of BRCA mutation status. Participants were tested for tumor HRD status using the Myriad myChoice CDx test and demonstrated patients with HRD positivity to benefit most from the regimen, regardless of BRCA mutation status.

Additionally, HRD testing with gene panels is another approach which works to identify patients with high-grade ovarian cancer who have mutations in homologous recombination repair pathway genes than the Myriad test.


0:08 | The process is quite different according to countries, of course. In Europe, we have the Myriad test available for only a few months. In France, what we propose is at diagnosis of a high-grade ovarian cancer, to look for Myriad HRD test. In these tests, you have both the results of the BRCA mutation in the tumor and the genomic instability score. With these tests, you can recognize those patients who are HRD positive and can benefit the most from a PARP inhibitor, and those who are HRD negative, who [may not] benefit from a PARP inhibitor.

1:26 | Then when you have the results of these tests, you can choose if you want to give bevacizumab or not, in addition to the perspective of offering the patient a PARP inhibitor. This is currently the way we are doing it in Europe and particularly in France, for all patients with high-grade ovarian cancer and advanced disease.

1. Ray-Coquard I, Pautier P, Pignata S, et al; PAOLA-1 Investigators. Olaparib plus Bevacizumab as First-Line Maintenance in Ovarian Cancer. N Engl J Med. 2019;381:2416-2428. doi:10.1056/NEJMoa1911361
2. Pujade-Lauraine E. Homologous recombination repair mutation gene panels (excluding BRCA) are not predictive of maintenance olaparib plus bevacizumab efficacy in the first-line PAOLA-1/ENGOT-ov25 trial. Presented at: 2021 Society of Gynecologic Oncology Annual Meeting; March 19-25; Virtual.
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