Background

Life-prolonging targeted therapies based on underlying tumor genomic mutations have been approved for patients with mPC. For instance, the presence of homologous recombination repair alterations can render patients eligible to receive the combination of a poly(ADP) ribose polymerase inhibitor with an androgen receptor pathway inhibitor. Herein, we sought to assess the trends of NGS testing rates and the impact of social determinants of health on testing rates in a large real-world dataset of patients with mPC

Methods

Patient-data were extracted from the nationwide Flatiron Electronic Health Record (EHR)-derived de-identified database. Patients treated for mPC between March 2015 and December 2022 were included. NGS testing rates by year of mPC diagnosis were calculated using Clopper-Pearson two-sided 95% confidence intervals. Disparities in sub-distributional incidence of NGS testing were assessed by race/ethnicity, socioeconomic status (SES), region, and insurance using Fine and Gray’s modified Cox proportional hazard model, assuming different sub-distribution baseline hazards by year of mPC diagnosis.

Results

A total of 11,927 patients with mPC were eligible and included. The median age was 73. The rates of NGS testing increased from 19% (95% CI 16.8 – 21.3%) in 2015 to 27.1% (95% CI 24.5 – 29.8%) in 2022. Patients were less likely to undergo testing when they were Black (HR 0.75, 95% CI 0.67-0.84) or Hispanic (HR 0.70, 95% CI 0.60-0.82), had low SES (1, HR 0.74, 95% CI 0.66-0.83; or 2, HR 0.89, 95% CI 0.80-0.99), were covered by Medicaid (HR 0.53, 95% CI 0.38-0.74) or Medicare or other government programs (HR 0.89, 95% CI 0.82-0.98), or lived in the West (HR 0.81, 95% CI 0.70-0.94).

Conclusions

While NGS testing rates improved over time, the majority of patients did not undergo testing. These data may help in understanding current disparities associated with NGS testing and improving access to standard-of-care healthcare services.