881PD - Implementation of routine BRCA gene testing of ovarian cancer (OC) patients at Royal Marsden Hospital

Date 28 September 2014
Event ESMO 2014
Session Gynaecological cancers
Topics Ovarian Cancer
Pathology/Molecular Biology
Personalised Medicine
Presenter Angela George
Citation Annals of Oncology (2014) 25 (suppl_4): iv305-iv326. 10.1093/annonc/mdu338
Authors A. George1, F. Smith2, V. Cloke2, M.E. Gore3, H. Hanson2, S. Banerjee3, N. Rahman2
  • 1Gynaecology And Clinical Genetics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, SM2 5PT - Sutton/GB
  • 2Genetics And Epidemiology, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, SM2 5PT - Sutton/GB
  • 3Department Of Medicine, Royal Marsden Hospital NHS Foundation Trust, SW3 6JJ - London/GB

Abstract

Aim

The development of targeted agents such as PARP inhibitors has made germline BRCA mutation status vital for optimal OC patient management. ∼15% of OC pts carry a BRCA mutation, but many pts are not offered testing. We developed a new ‘oncogenetic’ testing model to allow BRCA testing to become routine clinical care of OC pts.

Methods

Pts with non-mucinous OC <65 years at The Royal Marsden Hospital were offered BRCA gene testing at their oncology appointment by oncology clinicians who had completed 30 min online training. Results were returned by the oncology clinician. All mutation carriers received a Genetics appointment for detailed discussions and to organise cascade testing for relatives. Pts could contact or be referred to Genetics at any time. Patients and clinicians were sent a questionnaire to assess their experience.

Results

119 OC pt were tested in 6 months; 101 serous, 18 endometroid. 6 had both breast and OC. Pts were tested during initial treatment (n = 32, 27%), relapse (n = 45, 38%) or follow-up (n = 42, 35%). 20 pts (17%) carried a mutation - 8 BRCA1 and 12 BRCA2. 12 had no family history of BC or OC. 8 met current genetic referral criteria but only 1 had been offered testing. 9/20 (45%) had a management change based on their BRCA result. No pt requested additional Genetics input prior to testing. Questionnaires were sent to 71 pts; 46/57 (81%) non-carriers (NC) and 11/14 (79%) carriers (C) responded. 100% were pleased to have had testing; no pt would have preferred referral to Genetics to have testing. Pts understood the results had implications for themselves (98% NC and 100% C); and their family (all). 25 clinicians undertook training. All felt confident in consenting and giving results to pts. All welcomed the opportunity to offer testing.

Conclusions

The Oncogenetic model of testing allows flexible, patient-centred, equitable, high throughput gene testing with considerable time and cost savings compared to model of referral to Genetics. It is now the standard pathway for BRCA testing in OC pts at Royal Marsden and roll-out to other centres is planned.

Disclosure

All authors have declared no conflicts of interest.