Advanced Ovarian Cancer: New Perspectives on Systemic Therapy - Episode 3
Bradley J. Monk, MD, FACS, FACOG: Katie, a correlate of that is that BRCA testing is germline and HRD [homologous recombination deficiency] testing is tumor. You gave us this wonderful SOLO1 opportunity, but that also includes somatic BRCA. What do you think the uptake has been in the last year since the FDA approval on December 19, 2018, of somatic BRCA? I know we all test for germline. Has somatic testing for BRCA been an uphill battle, or do you think that’s been widely adopted? If we can’t do that in a year with a hazard ratio of 0.3, we’re probably not going to be able to do HRD.
Kathleen Moore, MD: I’ve seen the data for this just from market research. There has been an uptick in the last year. I would not say it has been widely adopted as of yet. I think that practitioners are very interested in it. They’re still struggling a bit with the order in which to do things. Do they send that 1 first? If it’s negative, they’re done. If it’s positive, then they reflex the germline. Do they start with germline and then go?
Bradley J. Monk, MD, FACS, FACOG: What’s the answer to that?
Kathleen Moore, MD: We need both ways. Unless 1 is positive, you need both tests. If it’s germline, it’s positive and you’re done. If it’s somatic and it’s positive, then you still need to do a germline to know if it’s germline and cascade testing.
Bradley J. Monk, MD, FACS, FACOG: Yes, as well as the panel.
Kathleen Moore, MD: Yes, and the panel. If you do germline and it’s negative, then you have to do somatic testing to find that 7% to 10% who have somatic BRCA who will benefit from a PARP inhibitor.
Bradley J. Monk, MD, FACS, FACOG: But it’s basically both.
Kathleen Moore, MD: You really need both. If they could come together, it would make it easier.
Bradley J. Monk, MD, FACS, FACOG: Michael, or Rob, either one.
Robert L. Coleman, MD, FACOG, FACS: This is a challenge, right?
Bradley J. Monk, MD, FACS, FACOG: Right. If we can’t get somatic right, how in the heck are we going to get HRD?
Robert L. Coleman, MD, FACOG, FACS: Well, right. It’s also about the timing, right? Right now, germline tests can be turned around pretty quickly. In VELIA, we were able to get it as a stratification package. We’ll be able to do it in 4 randomizations before treatment. The somatic testing is variable, right? You can do BRCA-specific map testing, and you can do next-generation sequencing.
Bradley J. Monk, MD, FACS, FACOG: Is 1 quicker? No.
Shannon N. Westin, MD, MPH: Exactly. We have this time frame differential, and so if you’re trying to make decisions based on that particular information, there may be a little bit of a time sequence to make those decisions.
Bradley J. Monk, MD, FACS, FACOG: All right.
Michael J. Birrer, MD, PhD: The data I’ve seen suggest strongly that SOLO-1 is really having an impact on this. Prior to SOLO-1, despite NCCN [National Comprehensive Cancer Network] and ASCO [American Society of Clinical Oncology] saying that all ovarian cancer patients can be sequenced, we can sequence only around 25%.
Bradley J. Monk, MD, FACS, FACOG: I know.
Robert L. Coleman, MD, FACOG, FACS: Even in the academic centers.
Michael J. Birrer, MD, PhD: I’m told now that it’s getting closer to 50%, so that’s really been helpful.
Bradley J. Monk, MD, FACS, FACOG: Wow, 50% of ovarian cancer patients are getting standard-of-care treatment.
Robert L. Coleman, MD, FACOG, FACS: All true.
Michael J. Birrer, MD, PhD: Hold on.
Bradley J. Monk, MD, FACS, FACOG: Wow, that’s impressive. Listen, it took 5 years to get ALK integrated into the lung cancer algorithm. Our patients can’t afford to wait 5 years. If it’s been 50% in 1 year, that’s great. Let’s pivot from that 50% in somatic to now start HRD not at 0% but at 50%, and continue to build momentum.
Transcript Edited for Clarity