Key Takeaways:

• An analysis of real-world data showed low rates of homologous recombination repair (HRR) testing among patients with metastatic castration-resistant prostate cancer (mCRPC).
• HRR testing varied according to clinical risk, race and ethnicity, and age. Closing these gaps requires standardizing workflows and aligning them with biomarker testing guidelines.
• Improving electronic health records (EHRs) could help inform clinical pathways and enhance data platforms, supporting clinical decision making.

In this interview, Andy Osterland, PharmD, MS, a research scientist at Ontada, discusses findings from the study “Real-World Patterns of Homologous Recombination Repair Testing of Patients with Metastatic Castration-Sensitive Prostate Cancer (mCSPC) in the US Community Oncology Setting.” The study examined the characteristics of patients with mCSPC who underwent HRR mutation testing. Dr Osterland explains how the study’s findings highlight multiple gaps in HRR testing that must be addressed in order to improve patient care and outcomes.

Please introduce yourself by stating your name, title, organization, and relevant professional experience.

Andy Osterland, PharmD, MS: My name is Andy Osterland. I’m a research scientist with Ontada, where I conduct real-world evidence studies from a US oncology perspective. I am a pharmacist by training, with a completed fellowship in health economics and outcomes research.

Can you give some background about your study and what prompted you to undertake it?

Dr Osterland: The purpose of this study was to conduct a landscape analysis of patients who initiated frontline systemic therapy for mCSPC with a focus on testing for alterations in the HRR pathway. We explored predictors of HRR testing in patients, building off previous real-world studies of patients with mCRPC. We found that testing is more likely among patients with high-risk clinical features, such as a family history of prostate cancer or a Gleason Score of 8 or more, and then less likely among older patients, those with poor performance status, or those facing socioeconomic barriers, including disparities associated with insurance type and income.

HRR testing rates were under 30% in this study. Why do you think testing remains so low in patients with mCSPC despite guideline recommendations?

Dr Osterland: It is important to note that this study includes a long observation period dating back to 2019, and that likely reflects earlier practice patterns that may not represent current testing rates. Additionally, HRR testing may be under documented within structured fields of the EHR. Ensuring that results are recorded in these clickable fields within the EHR is important for informing treatment selection.

The study found older patients and Hispanic patients were less likely to receive HRR testing. What steps can oncology practices take to reduce these testing gaps?

Dr Osterland: Practices can help reduce disparities by standardizing testing workflows and enhancing patient access and awareness of biomarker testing. Ensuring consistent implementation across patient populations is going to be important for addressing these gaps.

With a high percentage of tested patients showing HRR mutations, should oncologists be thinking about biomarker testing earlier in the treatment pathway?

Dr Osterland: Absolutely. Earlier testing aligns with current National Comprehensive Cancer Network (NCCN) guidelines, which recommend testing for HRR mutations in all patients with metastatic prostate cancer, along with patients with high risk of localized or regional disease. Additionally, patients with a family history of certain cancers, including prostate cancer or a familiar cancer risk mutation, are recommended to receive testing. This ensures that providers have the information they need to make timely informed treatment decisions, particularly around the use of targeted therapies and eligibility for clinical trials.

The data showed differences in HRR testing rates across regions and practice settings. How important is it to standardize molecular testing pathways in community oncology?

Dr Osterland: Standardized workflows that align with guideline-concordant biomarker testing will be an important step in consistent and timely identification of these actionable mutations across practice settings. This will ensure that patients have access to treatments that can ultimately improve outcomes.

The authors noted that incomplete EHR documentation may underestimate actual testing rates. How can better biomarker documentation improve patient care and treatment planning in prostate cancer?

Dr Osterland: Improved documentation of biomarker results within the structured fields of the EHR will help inform treatment pathways and ensure results are consistently available to guide clinical decision-making. It also supports real-world evidence generation, improving the ability to evaluate treatment patterns, outcomes, and areas of potential unmet need.