University of California, Irvine, Orange, CA
Dalia Kaakour , Nataliya Mar
Background: The armamentarium of therapies for metastatic prostate cancer (PCa) has now expanded to include genomically targeted agents and CPIs. Men with both somatic and germline alterations in the DNA damage repair (DDR) pathway, most commonly BRCA2, are candidates for PARP inhibitors. Recent data from the PROPEL and MAGNITUDE trials led to approval of PARP inhibitors in combination with novel hormonal therapies earlier in the PCa continuum, in the first-line metastatic castrate-resistant space. Some PCas harbor genomic alterations, such as TMB>10 m/Mb and MSI high, which predispose to increased responses to CPIs, leading to tumor agnostic approval of pembrolizumab in these patient populations. However, it is imperative to perform timely genomic testing to assess for presence of these alterations. Methods: We conducted a 15-question survey using the Qualtrics XM software to assess genomic testing patterns of various providers in academic and community settings managing PCa patients. The survey link was distributed electronically to providers predominantly in the Western United States. Results: A total of 47 survey responses were received, with 59.6% (28/47) self-identifying as medical oncologists (Onc), 21.3% (10/47) as urologists (Uro), 4.3% (2/47) as radiation oncologists, 8.5% (4/47) as advanced practitioners, and 6.4% (3/47) as other. Academic Onc comprised 23.4 % (11/47), community Onc comprised 36.2% (17/47), academic Uro comprised 17.0% (8/47), and community Uro comprised 4.6 % (2/47) of providers. Timing of ordering of germline and somatic genomic testing by selected provider type is outlined in the Table. Conclusions: Given availability of targeted therapies in PCa management, ordering germline and somatic germline genomic testing is imperative. Despite the small sample size, several trends emerge from this dataset. Oncs at academic centers tend to order genomic testing earlier than Oncs at community practices, while Uros were less likely to order genomic testing when compared to Oncs in general.
Type of genomic testing | Provider type | Localized PCa | Biochemical recurrence | Locally advanced PCa | mCSPC | mCRPC | Only if high risk based on family history | Never order | Other | N/A |
---|---|---|---|---|---|---|---|---|---|---|
Germline | Academic Onc | 18.2% (2/11) | 0% (0/11) | 36.4% (4/11) | 9.1% (1/11) | 9.1% (1/11) | 9.1% (1/11) | 0% (0/11) | 18.2% (2/11) | 0% (0/11) |
Community Onc | 0% (0/17) | 17.6% (3/17) | 0% (0/17) | 47.1% (8/17) | 5.9% (1/17) | 17.6% (3/17) | 0% (0/17) | 5.9% (1/17) | 5.9% (1/17) | |
Academic Uro | 12.5% (1/8) | 0% (0/8) | 12.5% (1/8) | 12.5% (1/8) | 0% (0/8) | 25% (2/8) | 25% (2/8) | 12.5% (1/8) | 0% (0/8) | |
Somatic | Academic Onc | 18.2% (2/11) | 0% (0/11) | 27.3% (3/11) | 36.4% (4/11) | 18.2% (2/11) | 0% (0/11) | 0% (0/11) | 0% (0/11) | 0% (0/11) |
Community Onc | 0% (0/17) | 0% (0/17) | 5.9% (1/17) | 41.2% (7/17) | 35.3% (6/17) | 0% (0/17) | 11.8% (2/17) | 0% (0/17) | 5.9% (1/17) | |
Academic Uro | 12.5% (1/8) | 0% (0/8) | (25.0% (2/8) | (25.0% (2/8) | 0% (0/8) | 0% (0/8) | 37.5% (3/8) | 0% (0/8) | 0% (0/8) |
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2024 ASCO Genitourinary Cancers Symposium
First Author: David Joseph Benjamin
2024 ASCO Genitourinary Cancers Symposium
First Author: Muhammad Ali Khan
2023 ASCO Annual Meeting
First Author: Jared Cohen
2023 ASCO Annual Meeting
First Author: Aditya Kulkarni