REAL-WORLD PATTERNS OF HOMOLOGOUS RECOMBINATION REPAIR TESTING OF PATIENTS WITH METASTATIC CASTRATION-SENSITIVE PROSTATE CANCER (MCSPC) IN THE US COMMUNITY ONCOLOGY SETTING
Author(s)
Andrew Osterland, PharmD, MS1, Suvina Amin, BSc, MPH2, Saamir Pasha, MPH1, Wei Dai, MS1, Melissa Kirker, PharmD, MPH2, Neo Su, MPH, MS, PharmD2, Benjamin Li, PhD2, Sarah Hanson, MD, PhD2, Gregory Patton, MD, MS, MBA1, Manojkumar Bupathi, MD3.
1Ontada, Boston, MA, USA, 2Pfizer, New York, NY, USA, 3Rocky Mountain Cancer Centers, Littleton, CO, USA.
1Ontada, Boston, MA, USA, 2Pfizer, New York, NY, USA, 3Rocky Mountain Cancer Centers, Littleton, CO, USA.
OBJECTIVES: Multigene tumor testing for alterations in homologous recombination repair (HRR) genes is recommended in patients with high-/very high-risk localized, regional, or metastatic prostate cancer (PC). However, real-world studies of HRR testing patterns in the metastatic castration-sensitive PC (mCSPC) setting are needed as effective management becomes increasingly tailored by HRR status.
METHODS: This was a retrospective observational cohort study of patients initiating systemic therapy for mCSPC (index) between 1/1/2019-3/31/2024 in The US Oncology Network or non-Network practices. Baseline characteristics within 60 days pre-index and HRR results documented through the end of follow-up (3/31/2025) were sourced from structured electronic health record data. Descriptive analyses were conducted with predictors of HRR testing assessed using multivariable logistic regression.
RESULTS: Overall, 5,973 patients with mCSPC were included with median (IQR) follow-up of 21 (12-35) months and median (IQR) age 72 (65-79) years. Among patients with available data at baseline, most were ECOG 0-1 (93% of n=1,118), Gleason ≥8 (66% of n=1,020) and PSA >4 ng/mL (74% of n=3,826). Testing for ≥1 BRCA/non-BRCA HRR gene prior to the end of follow-up was documented in 1,715 (29%) patients, and the HRR mutation rate was 36% (n=615/n=1,715). BRCA1 and BRCA2 testing were documented in 24% overall, and the mutation-positive rates were 7% (n=97/n=1,447) and 15% (n=213/ n=1,454), respectively. Non-BRCA HRR testing was documented in 17% overall, and the non-BRCA HRR mutation rate was 44% (n=446/n=1,014). Predictors of HRR testing included Stage IVB/IV-NOS (OR: 1.68, 95%CI: 1.49-1.90, P<0.0001) and PSA >4 ng/mL (OR: 1.47, 95%CI: 1.23-1.77, P<0.0001), whereas age ≥70 years (OR: 0.59, 95%CI: 0.52-0.67, P<0.0001) and Hispanic ethnicity (OR: 0.72, 95%CI: 0.54-0.96, P=0.0242) were associated with less testing.
CONCLUSIONS: Documentation of HRR testing among patients with mCSPC was low, highlighting the need for earlier and broader guideline-concordant HRR testing to better understand the prognosis of mCSPC and eligibility for HRR-targeted treatments.
METHODS: This was a retrospective observational cohort study of patients initiating systemic therapy for mCSPC (index) between 1/1/2019-3/31/2024 in The US Oncology Network or non-Network practices. Baseline characteristics within 60 days pre-index and HRR results documented through the end of follow-up (3/31/2025) were sourced from structured electronic health record data. Descriptive analyses were conducted with predictors of HRR testing assessed using multivariable logistic regression.
RESULTS: Overall, 5,973 patients with mCSPC were included with median (IQR) follow-up of 21 (12-35) months and median (IQR) age 72 (65-79) years. Among patients with available data at baseline, most were ECOG 0-1 (93% of n=1,118), Gleason ≥8 (66% of n=1,020) and PSA >4 ng/mL (74% of n=3,826). Testing for ≥1 BRCA/non-BRCA HRR gene prior to the end of follow-up was documented in 1,715 (29%) patients, and the HRR mutation rate was 36% (n=615/n=1,715). BRCA1 and BRCA2 testing were documented in 24% overall, and the mutation-positive rates were 7% (n=97/n=1,447) and 15% (n=213/ n=1,454), respectively. Non-BRCA HRR testing was documented in 17% overall, and the non-BRCA HRR mutation rate was 44% (n=446/n=1,014). Predictors of HRR testing included Stage IVB/IV-NOS (OR: 1.68, 95%CI: 1.49-1.90, P<0.0001) and PSA >4 ng/mL (OR: 1.47, 95%CI: 1.23-1.77, P<0.0001), whereas age ≥70 years (OR: 0.59, 95%CI: 0.52-0.67, P<0.0001) and Hispanic ethnicity (OR: 0.72, 95%CI: 0.54-0.96, P=0.0242) were associated with less testing.
CONCLUSIONS: Documentation of HRR testing among patients with mCSPC was low, highlighting the need for earlier and broader guideline-concordant HRR testing to better understand the prognosis of mCSPC and eligibility for HRR-targeted treatments.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD112
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology, STA: Personalized & Precision Medicine