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.
The aim was to evaluate genomic testing practice and subsequent use and outcomes of olaparib monotherapy in a real-world BRCAm mCRPC population.
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).
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.
Genomic testing application remained limited and uneven across centers. Most eligible patients received olaparib; TN patients seemed to benefit most.
Drugs - real world outcomes. 2026 May 09 [Epub ahead of print]
Dianne Bosch, Kim J M van der Velden, Aart Beeker, Hendrik P van den Berg, André M Bergman, Maarten J van der Doelen, Alfons J M van den Eertwegh, Mathijs P Hendriks, Thomas M A Kerkhofs, Addy C M van de Luijtgaarden, Niven Mehra, Reindert J A van Moorselaar, Metin Tascilar, Walter L Vervenne, Nir I Weijl, Carin A Uyl-de Groot, Peter F A Mulders, Malou C P Kuppen, Inge M van Oort
Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. ., Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands., Department of Medical Oncology, Spaarne Gasthuis, Haarlem, The Netherlands., Department of Medical Oncology, Tergooi Medical Center, Hilversum, The Netherlands., Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands., Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands., Division of Medical Oncology, Department of Internal Medicine, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands., Department of Medical Oncology, Reinier de Graaf Hospital, Delft, The Netherlands., Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands., Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands., Department of Medical Oncology, Isala, Zwolle, The Netherlands., Department of Medical Oncology, Deventer Hospital, Deventer, The Netherlands., Department of Medical Oncology, Haaglanden Medical Center, The Hague, The Netherlands., Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands., Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands., Department of Urology, University Medical Center Groningen, Groningen, The Netherlands.