Related Experiment Video
Updated: May 11, 2026
Testing Targeted Therapies in Cancer using Structural DNA Alteration Analysis and Patient-Derived Xenografts
Published on: July 25, 2020
From Genomic Testing to Olaparib Treatment: Real-World Utilization and Outcomes in BRCA-Mutated Metastatic
Dianne Bosch1, Kim J M van der Velden2, Aart Beeker3
1Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. Dianne.Bosch@radboudumc.nl.
Background:
In November 2020, olaparib became the first approved poly adenosine diphosphate (ADP)-ribose polymerase inhibitor (PARPi) for metastatic castration-resistant prostate cancer (mCRPC) with BRCA1/2 mutations (BRCAm) in the Netherlands. As randomized clinical trials include fitter patients, their findings may not fully reflect real-world outcomes.
Objective:
The aim was to evaluate genomic testing practice and subsequent use and outcomes of olaparib monotherapy in a real-world BRCAm mCRPC population.
Methods:
Data were derived from ten hospitals in the Dutch CAPRI-3 registry, including mCRPC patients diagnosed between 2016 and 2021. Those receiving olaparib in standard-of-care treatment after its national approval (from November 2020) were analyzed and grouped as taxane-naïve (TN) or post-taxane (PT). The primary endpoint was overall survival (OS).
Results:
Among 1996 mCRPC patients, genomic analysis (somatic and/or germline) was performed in 23.4% (range 3.8-63.2% across hospitals), identifying BRCAm in 11.3% of patients. Tested patients differed significantly in age, comorbidities, and prior treatment. Among 35 eligible BRCAm patients, 27 (77.1%) received olaparib. TN patients (8/27) were significantly older and initiated olaparib at an earlier line of therapy. Median OS was 28.7 months (95% confidence interval (CI) not reached) in TN versus 10.5 months (95% CI 9.6-11.5) in PT patients (p = 0.003). Limitations include the retrospective design and small subgroups.
Conclusions:
Genomic testing application remained limited and uneven across centers. Most eligible patients received olaparib; TN patients seemed to benefit most.
Insights
Genomic testing for prostate cancer with BRCA mutations remains limited. Olaparib monotherapy showed better overall survival in taxane-naïve patients, suggesting a benefit in earlier treatment lines.
Area of Science:
- Oncology
- Genetics
- Pharmacology
Background:
- Olaparib, a PARP inhibitor, was approved in the Netherlands in November 2020 for metastatic castration-resistant prostate cancer (mCRPC) with BRCA mutations (BRCAm).
- Real-world outcomes may differ from clinical trial data due to patient selection.
Purpose of the Study:
- To assess genomic testing practices for BRCAm in mCRPC.
- To evaluate the real-world use and outcomes of olaparib monotherapy in this population.
Main Methods:
- Retrospective analysis of the Dutch CAPRI-3 registry (2016-2021) from ten hospitals.
- Included mCRPC patients receiving olaparib post-approval (November 2020).
- Grouped patients into taxane-naïve (TN) and post-taxane (PT) cohorts; primary endpoint was overall survival (OS).
Main Results:
- Genomic testing was performed in 23.4% of 1996 mCRPC patients, identifying BRCAm in 11.3%.
- Of 35 eligible BRCAm patients, 27 received olaparib.
- Median OS was significantly longer in TN (28.7 months) versus PT (10.5 months) patients (p=0.003).
Conclusions:
- Genomic testing for BRCAm in mCRPC is limited and varies between centers.
- Most eligible patients received olaparib.
- Taxane-naïve patients demonstrated a greater benefit from olaparib monotherapy.
Related Concept Videos
02:56Treatment Resistant Cancers
01:21Cancer Survival Analysis