Neviere Z, De La Motte Rouge T, Floquet A, Johnson A, Berthet P, Joly F. How and when to refer patients for oncogenetic counseling in the era of PARP inhibitors.
Ther Adv Med Oncol 2020;
12:1758835919897530. [PMID:
32165926 PMCID:
PMC7052467 DOI:
10.1177/1758835919897530]
[Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 11/18/2019] [Indexed: 01/05/2023] Open
Abstract
Poly(ADP-ribose)polymerase (PARP) inhibitors are targeted therapy for cancers
with homologous repair deficiency (HRD). They were first approved for ovarian
cancer and have changed current treatment strategies. They have also
demonstrated efficacy in HER2-negative metastatic breast cancer and advanced
prostate cancer with BRCA1/2 or ATM mutations.
Patients with somatic and/or germline BRCA1/2 mutations benefit
more from these treatments than other patients. Nowadays, the diagnosis of HRD
is largely based on germline genetic testing, which is performed after an
in-person genetic counseling session, even for patients without any family
history of cancer. However, with the increasing number of PARP inhibitor
indications across different tumor types, rapid access to oncogenetic
consultations will become a challenge. To meet this demand, tumor genomic
testing could be offered at initial diagnosis. Telephone counseling and other
referral systems could replace in-person consultations for certain subgroups of
patients deemed to have a low risk of harboring a germline mutation. This
article reviews international guidelines for genetic counseling testing. We
herein propose new care pathways for breast, prostate and ovarian cancers,
including tumor genomic testing at initial diagnosis in order to help triage
genetic counseling referrals.
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