Real world trends in biomarker testing in U.S. advanced ovarian cancer patients

Objectives: Since the first FDA approved indication for PARP inhibitors in the treatment of advanced ovarian cancer (OC), biomarkers have begun to play a growing role in treatment decision making. Germline and tumor molecular BRCA testing and HRD genomic instability are prognostic for the response to, and beneficial effect of, PARP inhibitor in both the recurrent and, particularly the front line, maintenance setting. In light of emerging data and use of PARP inhibitors, the objective of this study was to describe trends in biomarker testing over time in women with advanced OC. Methods: We conducted a retrospective analysis of advanced ovarian cancer patients with commercial or Medicare Advantage claims data in the Optum Research Database. Patients’ index date was set as the earliest diagnosis of OC between 2010 and 2019. Patients with at least one treatment line were followed until death, loss to follow up, or the end of the study period (10/31/2019). Information on germline BRCA tests, tumor BRCA tests, and other biomarker tests were collected from the claims data. Tests were not considered mutually exclusive and patients could receive more than one test. Trends in biomarker testing over time were evaluated using descriptive statistics. Download : Download high-res image (86KB) Download : Download full-size image Results: During the study period, 5,899 eligible patients were identified and a total of 4,641 biomarker tests were performed in 2,996 patients. Of the eligible patients, 2,996 (50.8%) received at least one biomarker test and 2,857 (48.4%) received at least one BRCA test (germline or somatic). Biomarker testing rates increased significantly over time from 24.1% in 2010 to 73.0% in 2019. The majority of biomarker testing conducted was for germline or somatic BRCA1 or BRCA2 mutations, however 882 (19.0%) test claims were for an unlisted molecular pathology procedure, targeted genomic sequence analysis panel, or a commercial comprehensive genomic profiling (CGP) test (15.0%, 2.9% and 1.1% respectively). In addition to the rate of testing increase, BRCA testing moved into earlier lines of therapy over time. In 2010, 12.6% of all patients received a BRCA test before or during the first line of therapy compared to 58.6% by 2019. Conclusions: Consistent with the evolution of PARP inhibitors moving to earlier lines of therapy, the implementation of biomarker testing has increased over time in women with OC. Insurance claims data provide useful information, but may understimate testing for patients diagnosed prior to entering a plan. While we have demonstrated a positive trend in the rate and earlier timing of testing, education is still needed to ensure rates of appropriate and timely testing continues to rise.