What Biomarker Testing Is Required Up Front in Ovarian Cancer?

Biomarker testing for patients with ovarian cancer should be completed both in the upfront setting and through disease progression, explained Courtney R. Arn, APRN-CNP, a nurse practitioner at The James Gynecologic Oncology Mill Run at The Ohio State University’s Wexner Medical Center in Hilliard, Ohio.

After moderating a Case-Based Roundtable, Arn shared in an interview with Oncology Nursing News that germline and somatic testing should be completed upfront for patients with ovarian cancer in order to screen for genetic mutations that may have caused the patient’s cancer that may put their family members at risk of developing the same cancer. Further, it can aid treatment decision-making during maintenance.

While some institutions complete full genetic testing including next-generation sequencing (NGS) upfront depending on a patient’s diagnosis, other institutions only complete NGS at recurrence. BRCA via germline testing and homologous recombination deficiency (HRD) testing via somatic testing are the most essential biomarkers to test for up front, explained Arn.

Transcript

Biomarker testing is important in the upfront setting. At minimum, you want to make sure that the patient is getting germline testing. [The reason for this] is twofold. Firstly, you want to see if the patient has a genetic mutation that caused their cancer and if their family is at risk for also developing a cancer. It also can help determine treatment strategies in the maintenance setting, depending on the results.

You also want to make sure you’re doing somatic BRCA and HRD testing in the upfront setting too, because that also can help guide treatment options for your patient after completion of chemotherapy. Upfront setting, at minimum, the patient should be getting germline and somatic BRCA and HRD testing.

Some institutions are doing full testing upfront depending on their disease. A lot of providers, if patients have advanced disease, do full next-generation sequence testing at initial diagnosis to have all of that information up front. Other institutions wait until there’s a recurrence, and at that time, it’s recommended to do full next-generation sequence testing and look at those biomarkers for ovarian cancer.

You’re wanting to look at folate receptor alpha and HER2. This is assuming that the patient has already had BRCA and HRD testing, along with BRAF and KRAS mutation testing, especially if they have low-grade ovarian cancer. But, at minimum, somatic HRD/BRCA [testing is needed], and in the recurrent setting, it is generally recommended to do full testing.

This transcript has been edited for clarity and conciseness.