Targeted therapies mean that gBRCAm testing and genetic counselling are becoming routine in ovarian cancer management. ENGAGE is the first real-world study to evaluate an oncologist-led testing model first used at the Institute of Cancer Research and Royal Marsden Hospital, London, UK.
This ongoing prospective, observational study was conducted across sites in the US (11), Italy (8) and Spain (7), enrolling 710 adult patients with epithelial ovarian, fallopian tube or primary peritoneal cancer. Baseline demographic, clinical and therapeutic data, and primary outcome data (gBRCAm testing turnaround time [TAT], outcome of BRCAm test, and patient and oncogenetic counsellor's satisfaction surveys on the model), were collected. Physicians completed training on BRCAm counselling.
This interim analysis evaluated data from 444 patients (US 297; EU 147) with mean age 63.7 (SD 10.6) years, of whom 38% were newly diagnosed and 38% had family history of breast or ovarian cancer. Median time since diagnosis was 0.8 years. Pre-BRCA test counselling was provided by oncologists (40%) or nurses (56%) in the US and by oncologists in Europe. Only 1 patient requested additional pre-test counselling. Mean TAT from initial counselling to BRCA test results/oncogenetic counselling was 6.7 (SD 4.5) weeks: 5.1 (SD 3.7) weeks in the US and 10.0 (SD 4.2) weeks in the EU. BRCA testing was mainly performed in a central laboratory (91%). BRCAm was identified in 10% of patients. Mean patient-reported fulfilment of expectations and overall satisfaction with counselling were both >3.7/4 pre-/post-BRCA testing. 92% were satisfied to have the genetic test at an existing rather than a separate visit. Over 80% of oncologists considered the BRCA-testing process to work well and that counselling patients on BRCA testing was an efficient use of their time.
Interim results showed that the novel testing model results in reduced timelines and high acceptance and satisfaction levels in both patients and staff, with potential for quicker treatment decisions and better use of resources. The time to receive BRCAm test results was the major variable.
Clinical trial identification
Legal entity responsible for the study
E. Chalas: Honoraria, speakers bureau, research funding, travel, accommodation, expenses – AstraZeneca. N. Colombo: Advisory boards and symposia speaker – AstraZeneca. S. Pignata: Honoraria – AstraZeneca. P. Huot-Marchand: Mapi - subcontractors for AstraZeneca. S. Karve, C. Blakeley: Employee of AstraZeneca and own AstraZeneca stock. All other authors have declared no conflicts of interest.