CGE22-100: Community Oncologists’ Current and Future Patterns of Germline Testing for Patients With Early-Stage Breast Cancer

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  • 1 Cardinal Health, Dublin, OH
  • | 2 The Lockwood Group, Stamford, CT

Background: Germline mutations such as BRCA 1/2 contribute to approximately 5-10% of breast cancer (BC) and are associated with a more aggressive and higher-risk disease. The phase III OlympiA study presented at the ASCO 2021 Annual Meeting assessed the role of adjuvant olaparib among patients with high-risk early-stage HER2-negative BC who harbor BRCA 1/2 mutations. Interim analysis results showed that 85.9% of patients treated with olaparib were alive and free of recurrent cancer at 24 months, compared to 77.1% of patients on placebo. If incorporated into routine clinical practice, germline testing can significantly impact cancer management with the use of PARP inhibitors and other emerging therapeutic options. The present study surveyed community hematologists/oncologists (cH/O) on their perceptions of the OlympiA trial data and the potential impact on their BRCA 1/2 testing habits in patients with early-stage BC. Methods: Between June and October 2021, practicing U.S. cH/O were invited to attend a virtual meeting and complete a web-based survey designed to collect information on treatment decision-making and prescribing habits. All data were summarized using descriptive statistics. Results: Participating cH/O (N=287) have 18 years of clinical experience, spend 86% of their working time in direct patient care, and see 20 patients per day on average. Regarding their patients with non-metastatic BC: BRCA1/2 is tested at initial diagnosis, irrespective of stage (36%) or after diagnosis if family history suggests hereditary predisposition (32%). Most (75%) test less than 50% of early-stage BC for germline mutations. After reviewing the OlympiA trial data, 28% indicated that they would now order germline testing for all their BC patients, irrespective of disease stage, while 20% would only test patients with stage II disease or higher. The lack of significant overall survival benefit was cited as a major limitation of the trial by 42% of cH/O. While 57% plan to prescribe olaparib per label once approved, 30% believe payer adoption will limit their decisions. Conclusions: cH/O germline testing for BRCA1/2 remains highly variable, but many cH/O in our survey found the OlympiA results compelling enough to change their current pattern of care albeit if consistent with patients’ insurance benefit design. Similarly, compelling cost and resource use observational research may be needed to align payer policy.

Corresponding Author: Yolaine Jeune-Smith, PhD
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