BRCA screening, treatment patterns and response among patients with ovarian cancer in the second line treatment setting: results from a real world survey

Objective : Although BRCA gene testing of patients diagnosed with ovarian cancer (OC) is now recommended, the level of testing undertaken in various countries is largely unknown. This study describes BRCA mutation screening patterns and results, demographics, clinical characteristics and the use of poly (ADP-ribose) polymerase inhibitors (PARPi) as maintenance treatment within a real-world sample of patients with advanced OC in the second-line (2L) treatment setting. Methods : Data were collected using the Adelphi Real World OC Disease Specific Programme (DSP)™, a point-in-time survey of physicians and their consulting patients with OC in clinical practice, undertaken across Europe (EU5: France, Germany, Italy, Spain and United Kingdom) and the United States (US) between December 2017–March 2018. Physicians completed a detailed patient record form for their next eight consecutively consulting patients, capturing data on their clinical history and treatment. All analysis was descriptive. Results : Of 1315 patients identified, 1096 (83%) were receiving 2L treatment and 219 (17%) were receiving 2L maintenance treatment; either PARPi (olaparib, rucaparib or niraparib, n = 103) or a non-PARPi (n = 116). BRCA screening rates varied between countries, increased with each line of therapy and were higher in the EU5 (55%) than the US (44%). 28% of patients receiving 2L treatment had a BRCA1/2 mutation. Patients receiving PARPi maintenance treatment had better Eastern Cooperative Oncology Group (ECOG) performance status, higher BRCA screening rates and higher proportions of serous epithelial OC than those receiving 2L treatment or non-PARPi maintenance. Common reasons for choosing 2L treatments were progression-free/overall survival benefit and improvement of quality of life. Conclusions : Despite guidelines recommending BRCA testing in patients with OC, many OC patients undergoing 2L treatment were not screened for BRCA mutations. Decisions related to PARPi use in 2L maintenance appeared to be driven by BRCA status, histology and response to first-line treatment.