Ways to accelerate the local implementation and adoption of the homologous recombination deficiency (HRD) testing in India.

Abstract

e17596 Background: AssessingHomologous Recombination Deficiency (HRD) is crucial for ovarian cancer patients to benefit from poly(ADP-ribose polymerase) inhibitor (PARPi) therapy. The commercially available, USFDA approved HRD test had access challenges due to lack of experiences and knowhows among the healthcare practitioners (HCPs). This translated to an unmet need of a local, reliable HRD test and optimized scientific understanding among the HCPs. An online educational series, IMBIBE, was launched to improve awareness and initiate an AstraZeneca Patient Support Program (PSP) to provide HRD test access to the HCPs. Methods: The IMBIBE meetings were closed group interactive online meetings with the local HCPs, moderated by a global expert with other scientific faculties from the local test implementation laboratories and kit suppliers to highlight the unmet need of HRD testing, addressing how to test, when to test, where to test and interpretation of the test result. Pre- and post-meeting online surveys were conducted by the moderator to assess participants’ baseline knowledge and the impact of IMBIBE sessions. The HRD test was implemented with two partner laboratories, using kit-based and later a laboratory-developed test (LDT) by ensuring local test kit availability and funding a local laboratory to develop and validate the LDT, through the PSP and tests results were analyzed from October 30, 2021, to December 31, 2023. Results: A total of 11 IMBIBE sessions were conducted involving 98 HCPs. The IMBIBE survey outcome indicated that the majority (84%) of HCPs believed a next-generation sequencing (NGS)-based gene panel test is appropriate however, post-IMBIBE the perception changed and 92% responded that a DNAscar test is required to assess HRD to identify eligible patients for PARPi therapies. The survey result also reflected improved HCPs’ understanding of patient selection in HRD testing from pre-IMBIBE (47%) to post-IMBIBE (56%). The number of HRD tests ordered increased gradually, with at least 10% of new HCPs placing orders each month. Overall, 567 HCPs ordered 3315 HRD tests through the PSP. Of the samples tested, 72% yielded conclusive results, with 54% identified as HRD-positive. LDT showed a marginally improved rate of conclusive results (82%) with 59% HRD-positive and a marginally lower turnaround time (TAT) of 22 working days when compared with the kit-based method (23 working days). Conclusions: The IMBIBE sessions improved the scientific understanding and implementation of an easily accessible, validated local testing among the HCPs helped to increase the rapid adoption of HRD test to identify eligible ovarian cancer patients who can get benefit from PARPi therapies.