By: Dr. Simon Blanc, Sr. Medical Director and Clinical Lead of Quality Research Initiatives
September is Prostate Cancer Awareness Month and Ovarian Cancer Awareness Month: a time to focus attention on two highly challenging cancers of the reproductive system, and encourage people to learn more about these difficult illnesses.
Awareness months typically focus on educating the public about prevention and screenings to catch cancers early. Doing so can help lead to more impactful treatment and positive patient outcomes. For example, the five-year relative survival rate for Stage 2 or Stage 3 ovarian cancers is 72.9 percent, yet the rate drops dramatically to just 31.5 percent for Stage 4 ovarian cancer.
But since not all cancers can be prevented or caught in their early stages – especially in cancer types with few overt symptoms – we also need to raise awareness of how to get the best possible care for every patient’s unique cancer type, stage, and associated clinical circumstances.
Explosive innovation in cancer research has led to the identification of hundreds of mutations and other biomarkers that can guide the selection of precision therapies for individuals, yet patients aren’t always getting tested for these biomarkers. As a result, patients may not be able to take advantage of the latest breakthrough treatments that could improve their quality of life or overall length of survival.
Let’s look at metastatic castrate resistant prostate cancer (mCRPC), for example. Recent FDA approvals have expanded the available options for patients with homologous recombination repair (HRR) mutations, yet we are finding in our real-world data set is that since the approval of PARP inhibitors in mCRPC since May of 2020, only 56% of patients who are mCRPC are being tested for HRR mutations.
Furthermore, only 23% of patients are receiving full panels that assess all of the respective HRR mutations (BRCA1, BRCA2, ATM, ATR, BARD1, BRIP2, CDK12, CHEK1, CHEK2, FANCA, FANCL, MLH1, MRE11A, NBN, PALB2, RAD51B, RAD51C, RAD51D, RAD54L) with actionable treatment, even though HRR mutations are estimated in 28% of mCRPC patients.
“We use real-world data and our AI-reporting dashboards to identify opportunities for providers to improve care and understand how they are doing against the guidelines. This ultimately enables them to take action. Furthermore, we partner with the clinicians at these practices to generate real-world evidence that can be used to support important research studies into patient care and raise awareness around improving patient outcomes,” said my colleague Mike Gart, Lead for Quality Research Initiatives.
There are similar gaps in testing for ovarian cancer. A key part of treatment in Stage 2 to Stage 4 cancers is maintenance therapy, which has proven effectiveness in improving overall survival, particularly in those with BRCA and HRD mutations. However, we are finding that only 79% of newly diagnosed Stage 2, Stage 3, and Stage 4 ovarian cancer patients received BRCA testing and just 31% received HRD testing.
The healthcare industry as a whole must make it a priority to offer appropriate biomarker testing to people with ovarian, prostate, and all other types of cancers for which precision therapies are available.
To do so, we have to address barriers to closing the gaps – whether that’s education, insurance coverage, or decision support tools at the point of care. Oncologists need an easier process for ensuring patients are tested and the results can be best utilized in care decision making – whether that’s swiftly connecting their patients to clinical trials designed for people with specific mutations or getting them on to the best available therapy.
Real-world data and analytics can build these bridges between patients, payers, providers, and life science companies sponsoring relevant clinical trials. Clinicians need personalized insights built into intuitive workflows at the point of care, while trial sponsors need seamless ways to collaborate with oncologists to identify and enroll eligible patients into the latest trials.
As we continue to develop these connections between members of the care continuum, we can simultaneously promote awareness and enable meaningful actions to expand the use of appropriate testing, bring precision therapies to patients, and achieve better outcomes for people with prostate cancer, ovarian cancer, and many other cancer types.