Presentation (CTI)

OBJECTIVES: Poly (ADP-ribose) polymerase inhibitors (PARPi) provide meaningful benefit for patients with castration-resistant mPC with homologous recombination repair (HRR) deficiency, particularly loss of function alterations in BReast CAncer gene 1 (BRCA1), BReast CAncer gene 2 (BRCA2) ataxia telangiectasia mutated (ATM) protein, and Partner And Localizer of BRCA2 (PALB2). Because PARPi eligibility requires timely Next Generation Sequencing (NGS), disparities in testing may lead to inequitable access. Although racial differences in NGS utilization have been reported, real-world evidence on HRR testing rates by race remains limited. This study aims to quantify HRR testing patterns by race among patients with mPC treated in community oncology practices.
METHODS: This retrospective, observational analysis utilized structured data within electronic health records sourced from The US Oncology Network and non-Network practices. The cohort included adult patients diagnosed with mPC from January 2015 to December 2024. Evidence of HRR genetic testing (HRR, BRCA1/2, ATM, and PALB2) was assessed via NGS or other assay within 24 months after mPC diagnosis.
RESULTS: Overall, there were 26,789 adult patients with mPC. Majority of patients with documented race were White (n=17,335; 79.3%), followed by Black/African American (2,897; 13.2%), or Other (1,634; 7.5%). Median age at diagnosis was 69 (IQR: 63, 76) for Black/African American patients and 74 (IQR: 67, 81) for White patients. HRR testing has increased from < 5% before 2019 to a high of 42.0% in 2023 and 39.1% in 2024. Testing rates were similar among Black/African American (0.0% to 39.0%) and White patients (0.1% to 41.1%) from 2015 to2022, respectively. White patients had slightly higher testing rates (47.1% and 45.0%) than Black/African American patients (38.9% and 42.0%) in 2023 and 2024, respectively.
CONCLUSIONS: HRR genetic testing in the community oncology setting has increased substantially over time with the adoption of PARPi targeted therapies, with encouragingly similar uptake in testing by patient race.