20% of prostate cancer (PC) patients harbor germinal or somatic alterations in homologous recombination repair (HRR) genes, including BRCA1/2. BRCA mutations represent predictive biomarkers for treatment with polyadenosine diphosphate-ribose inhibitors (PARPi). Olaparib has shown efficacy in metastatic castration-resistant PC (mCRPC) and is currently approved in Italy for mCRPC with BRCA1/2 mutations. National and international guidelines strongly recommend BRCA testing in PC. However, genetic testing presents challenges in clinical practice that may limit access to PARPi.
we conducted a survey directed towards members of the Italian Association of Medical Oncology to highlight the level of implementation of national recommendations and issues associated with genetic testing. Through an anonymous questionnaire, the survey collected clinical data of PC patients undergoing BRCA testing and the main difficulties to face in conducting the analysis.
The survey was completed by 108 participants (5% of AIOM members). 52.8% of respondents test BRCA in all metastatic PC patients. If tissue analysis is invalid, only 17% use liquid biopsy, and 15.7% always consider a re-biopsy of a metastatic lesion. A quarter of respondents have to outsource genetic testing to another center and 17.6% have a split process between different institutions. Long timelines, lack of a predefined procedure, and unavailability of liquid biopsy represent the main issues based on respondents' opinions.
BRCA testing in PC still presents several difficulties in clinical practice that can limit access to PARPi treatment. Better implementation of molecular testing to identify BRCA-mutated patients is crucial for tailored treatment in mCRPC.
Clinical genitourinary cancer. 2024 Nov 01 [Epub ahead of print]
Isabella Saporita, Mariangela Calabrese, Stefano Poletto, Fabio Turco, Rosario Francesco Di Stefano, Orazio Caffo, Antonio Russo, Ugo De Giorgi, Marcello Tucci, Massimo Di Maio, Saverio Cinieri, Consuelo Buttigliero
Department of Oncology, University of Turin, AOU San Luigi Gonzaga, 10043 Orbassano, Italy., Department of Oncology, University of Turin, AOU San Luigi Gonzaga, 10043 Orbassano, Italy. Electronic address: ., Ente Ospedaliero Cantonale-Istituto Oncologico della Svizzera Italiana, 6500 Bellinzona, Switzerland., Medical Oncology Unit, Santa Chiara Hospital, 38122 Trento, Italy., Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori-IRST-Dino Amadori, 47014 Meldola, Italy., Department of Medical Oncology, Cardinal Massaia Hospital, 14100 Asti, Italy., Department of Oncology, University of Turin, Molinette Hospital, 10126 Turin, Italy., Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy.