US real-world biomarker testing differences and treatment choice in advanced ovarian cancer: results of a retrospective study

Aims Describe trends in real-world BRCA and homologous recombination deficiency (HRD) testing rates among patients with advanced epithelial ovarian cancer (EOC).Methods In this US-nationwide electronic health record-derived deidentified database study, eligible adult patients diagnosed with OC on/after 1 January 2016 had stage III/IV EOC at diagnosis, and initiated 1L platinum-based chemotherapy (1 January 2017–30 June 2023 [index date]). Results were descriptive.Results Among 2135 patients, 66.0% received BRCA and/or HRD testing before the final 1L chemotherapy dose. BRCA/HRD testing was higher among patients receiving chemotherapy-bevacizumab (78.6%) versus chemotherapy alone (60.6%). BRCA/HRD testing rates increased from 2017 to 2023. BRCA/HRD testing rates were lower among patients who were older (aged ≥75 years), had stage IV disease at diagnosis, were Black/African American, had nonserous epithelial histology, had an Eastern Cooperative Oncology Group performance status score of ≥2, and had no evidence of cytoreductive surgery.Conclusions Real-world BRCA/HRD testing rates increased from 2017 to 2023 among US patients with EOC. Subgroups often underserved in US healthcare settings had lower testing rates, possibly preventing some from receiving optimal treatments. Increasing provider education and support for biomarker testing and improving patient access may help reduce differences and improve treatment outcomes.