Q&A: Advancing HRR Genetic Testing Equity in Metastatic Prostate Cancer

As precision oncology continues to reshape the treatment landscape for metastatic prostate cancer, growing emphasis has been placed on biomarker-driven care and equitable access to genetic testing that can help guide targeted treatment decisions.

In an interview with Pharmacy Times, Helen Latimer, MPH, discusses new real-world data evaluating trends in homologous recombination repair (HRR) genetic testing among patients with metastatic prostate cancer in community oncology settings across the United States. Latimer explores how advances in electronic health record (EHR) infrastructure and standardized testing workflows may help improve equity in access to precision oncology, particularly among historically underserved patient populations. She also highlights the growing importance of HRR testing in identifying patients who may benefit from PARP inhibitor therapies and the broader role of technology in supporting biomarker-driven cancer care.

Pharmacy Times: What initially prompted your team to examine racial trends in homologous recombination repair (HRR) genetic testing among patients with metastatic prostate cancer?

Helen Latimer, MPH: I think in general we know that there are well-documented racial disparities in both the incidence and outcomes of patients with prostate cancer. Specifically, we know that Black men tend to be diagnosed at later stages and have higher rates of mortality than White patients. One of the drivers here is that there is underlying disease biology that does influence this, but another important feature is that inequality in access to care and treatments can also exacerbate these poor outcomes and mortality rates that we're seeing. That was something we wanted to dig into.

At the same time, in recent years, we've seen substantial improvements in the treatment landscape, especially for metastatic prostate cancer, moving toward a more genomic-focused treatment pathway. In particular, the HRR pathway and genomic testing can identify patients who would benefit most from new targeted therapies like PARP inhibitor therapies. It's important to evaluate access to testing generally among patients with metastatic prostate cancer and, more importantly, evaluate whether racial disparities exist in access to genetic testing as well as treatment.

Pharmacy Times: Your study spans nearly a decade of data from 2015 to 2024—what were some of the most notable trends or changes you observed in HRR testing over time?

Latimer: What we found in the study was a really positive result. We saw a substantial increase in the uptake of HRR testing overall during the study period. Before 2019, HRR testing was about 5% or lower. Then we saw an increase beginning in 2020 and a peak in testing in 2023 at about 40% overall, with similar findings in 2024 at the end of our observation period.

We are seeing that patients are accessing genetic testing more broadly in the community setting. It's also important to note that this reflects not only increased access to testing, but also system improvements in the availability of these results within electronic health record (EHR) data as well.

Pharmacy Times: Were there any disparities in testing rates among racial groups that particularly stood out to you, and what factors may be contributing to those differences?

Latimer: We know that there have been documented racial disparities in the treatment and outcomes for patients diagnosed with prostate cancer. When looking at White versus Black patients, what we noticed, surprisingly, in this study is that the testing rates were fairly similar, or substantially aligned, for most of the study observation period between White and Black patients in our community oncology setting. We saw that patients were having equitable access to genetic testing, which I think is a really important finding from these results.

One thing I will note is that the data we analyzed for this study were based on a large EHR network that has structural infrastructure emphasizing a precision medicine aspect to treating patients. Outside of this specific network, it's not to say that these racial disparities don't exist. However, in addition to treatments improving over time, we're also seeing technology improve over time, and that's helping improve equitable access to genetic testing and, hopefully, these targeted treatments as well.

Pharmacy Times: Why is HRR genetic testing becoming increasingly important in the management of metastatic prostate cancer, particularly as targeted therapies expand?

Latimer: I think what we're seeing across all therapeutic areas is a shift toward biomarker-driven oncology, so treatment decisions are increasingly based on these molecular characteristics, and that's especially true in metastatic prostate cancer as well. There's a huge emphasis on timely testing to avoid missed treatment opportunities in this patient population.

Speaking about HRR genetic testing, we know from clinical trials that these PARP inhibitor-based therapies are best suited for patients with these HRR alterations, specifically BRCA mutations. These patients respond particularly well to these targeted therapies with improved survival. It's incredibly important to incorporate genetic testing into routine care.

Pharmacy Times: What practical steps can oncology practices, pharmacists, and health systems take to help improve equitable access to biomarker and genetic testing?

Latimer: Like I mentioned before, I think there is a huge opportunity with the technology that we have and using EHRs not only to document treatment characteristics and diagnosis information, but also to incorporate clinical pathways directly into the structured EHR to provide education for patients and providers alike and ensure that a standardized approach toward genetic testing is being used across all patients to mitigate potential biases.

Also, documentation of testing orders can help prevent duplicate testing and make sure there is shared information across all providers involved in the patient's treatment journey. I think that technology is a really important piece of this and something we found in our study as a successful case study in how this technology can be used.

Pharmacy Times: How do you hope these findings influence future clinical workflows, policy discussions, or broader conversations around health equity in oncology care?

Latimer: I think these findings demonstrate that equitable testing is achievable, particularly in community oncology settings with integrated infrastructure in the EHR and by utilizing standardized processes. Certainly, it's important to incorporate testing into clinical guidelines because that helps move things forward from a policy perspective.

Also, ensuring that patients are covered by insurance and have access to genetic testing is particularly important in addressing potential disparities. One of my colleagues at ISPOR, Andy Osterland, has done a lot of great research in this field as well. I think a natural continuation of the work we did in this study is looking not only at temporal trends in HRR testing overall and by race, but also at treatment patterns among patients who were tested.

It's incredibly important not only that patients have access to genetic testing, but also understanding how that information is being used and whether patients are able to access the therapies that they would benefit from most.