Dr Tracie Miles

10-15% of women with OC will have a BRCA gene mutation (Zhang et al 2011) Women with this gene mutation often have more aggressive, fast-growing tumours than women with ovarian cancer who lack these mutations (Hennessy et al 2009) Knowing the woman’s BRCA status can help define optimal treatment – Women with the mutation tend to respond better to platinum- based chemotherapy than those without (Bolton et al 2012) – Women with the mutation can now be prescribed a PARP inhibitor, olaparib (provided they meet the license and NICE criteria/are private patients) Knowing the BRCA status also helps identify family members and can lead to the possible prevention of cancers

A new treatment (olaparib) has recently been recommended by NICE (ID735 – final publication pending) This treatment is for platinum-sensitive relapsed women who have received three or more courses of platinum-based chemotherapy Studies show BRCA mutation-positive women given olaparib have a much longer time in remission than those who receive a placebo maintenance treatment (Ledermann et al 2014) To support testing of women with ovarian cancer the manufacturer is offering an interim germline BRCA testing service

Plan for oncology and genetic team to work in partnership to enable all relevant women in Bath are tested whilst funding available Would achieve this by calling each woman individually, explaining the rationale, and inviting her to either attend a group evening meeting or come in for a one-to-one discussion If woman attends the evening session, and wishes to take the test, she will be given the option to take away consent form and return for shorter one to one session and blood test in the following week If that woman attends a one-to-one, then she can be consented and the blood sample can be taken that day For both groups, results will then be provided in same manner as the “Marsden mainstreaming model”

TopicDetails Introduction Why we are having this discussion with the woman now The BRCA gene Explain why we are looking to see whether the woman carries the BRCA gene mutation Implications of testing The possible future treatment options available if the woman has the mutation or if they do not carry the mutation Explanation of the impact for family members who may have the gene – can then offer preventative option or monitor them on a regular basis Testing process Take woman through consent process Explain testing process (take blood sample and send to lab) How results will be given (waiting time: 4-6 weeks) Next steps If interested in being tested this is what we need to do next, consent, test, await results Q&A

Consent form Testing request form

All relevant women will know their BRCA status – This can help define future treatment – Can also help identify family members that may carry the gene – they can then consider preventative treatment Low cost – AZ is offering an interim germline BRCA testing service Provides time to establish our testing pathways and work up a business case for routine BRCA testing Opportunity to continue to establish South West Network members at the forefront of genetic oncology testing

Reach consensus on South West Network members testing process during this interim period Set up evening discussion meeting with women Agree process for business case for funding following closure of the supported service