In a research letter by Pedro C. Barata, Jonathan Assayag, Benjamin Li and colleagues, published in JAMA Oncology, patterns of genetic testing for homologous recombination repair (HRR) gene mutations in men with metastatic castration-resistant prostate cancer (mCRPC) were analysed. The study highlights the underutilization and disparities in HRR testing, which is crucial for guiding treatment decisions, particularly with the use of poly(ADP-ribose) polymerase inhibitors (PARPi).
The retrospective cross-sectional study utilised data from the Flatiron Health Enhanced Datamart, covering patients diagnosed with mCRPC from January 2014 to December 2022. It examined the rate of HRR mutation testing and identified factors associated with testing. Of the 9395 patients (median age 74 years), only 37.7% received HRR testing. Testing rates peaked in 2020 but saw a decline in 2022, potentially due to the impact of the COVID-19 pandemic.
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Several factors were linked to lower odds of HRR testing, including a diagnosis before 2018, absence of prior localised disease treatment, poorer performance status, and de novo disease. Additionally, socioeconomic disparities were evident, with lower testing rates among patients with lower socioeconomic scores and those on Medicaid. Most patients were treated in community settings, where testing rates were generally lower compared to academic centres.
The study underscores the need to improve HRR testing rates to ensure eligible patients can benefit from targeted therapies. Addressing the identified barriers and disparities is crucial for enhancing treatment outcomes in mCRPC.
Paper: Barata PCAssayag JLi BSiu GNiyazov A. Genetic Testing in Men With Metastatic Castration-Resistant Prostate Cancer. JAMA Oncol. Published online May 02, 2024. doi:10.1001/jamaoncol.2024.0851. Access online here.
