HRD testing for all advanced high-grade ovarian carcinoma in first line?

The main international guidelines strongly recommend the use of the homologous recombination deficiency (HRD) test in the selection of first-line maintenance therapy for patients with high-grade serous ovarian cancer. This test, in fact, has significant prognostic and, most importantly, predictive value for the response to poly (ADP-ribose) polymerase (PARP) inhibitors. However, in some situations the test is not available: in all cases it is crucial to know the BRCA status. Based on the data obtained from the PRIMA and ATHENA MONO studies, we can generally state that PARP inhibitors should be used in all the patients who have had a complete or partial response to first-line chemotherapy (and thus have shown sensitivity to platinum). Both niraparib and rucaparib have demonstrated statistically significant results across all subgroups.

Like any test, the HRD test is not perfect: in some cases, we obtain negative results despite the presence of alterations in the mismatch repair system. To overcome this obstacle, research is advancing towards the development of tests that can integrate genomic, functional information, even utilizing artificial intelligence systems.

CITA DEL ARTÍCULO  ESMO Open. 2024 Jul 17;9(7):103627.  doi: 10.1016/j.esmoop.2024.103627