blue DNA helix blue DNA helix mobile

How to Put
HRR Testing into Action

How to order and perform an HRRm test

HRR testing process overview

The process of HRR testing requires close coordination between the care team and pathologist. Learn more about the stages of the HRRm testing process below.1

Style
ord-test, subhead

1

Specimen
acquisition
and handling

Biopsy Acquisition

  1. Involve pathologists at the biopsy collection stage so they are aware of potential future uses of the specimens2
  2. While fresh samples are preferred, formalin-fixed, paraffin-embedded (FFPE) tissue blocks can be used for future genomic testing if stored appropriately1
  3. Consider collecting and testing fresh samples of both tissue and liquid (ctDNA) biopsies at the time of diagnosis when possible2

Specimen Acquisition

  1. The National Accreditation Board for Testing and Calibration Laboratories (NABL) and College of American Pathologists (CAP) offer guidelines on sample collection and storage2
  2. Again, consider DNA extraction from tissue samples at the time of diagnosis, as they take up minimal space in a freezer and can last for decades, if appropriately extracted and stored1

2

Specimen
processing
and evaluation

Specimen Processing

  1. Implement standard operating procedures and tumor cell content quality assurance processes during the diagnostic workup2
  2. Optimize protocols for minimal hands-on time2
  3. Use validated DNA extraction protocols for FFPE samples1

Specimen Evaluation

  1. Use a validated NGS assay that includes entire coding regions1
  2. Consider requesting a multigene NGS test or panel for the following HRR gene alterations: ATM, ATR, BARD1, BRCA1, BRCA2, BRIP1, CDK12, CHEK2, FANCA, FANCL, MLH1, MRE11A, NBN, PALB2, RAD51B, RAD51C, RAD51D, and RAD54L1,3

3

Test
reporting

Support of Clinical Decision Systems

  1. Ensure the format of test results works with your EHR system and that it’s possible to search for specific biomarkers2

4

Treatment
decision-making

Treatment Decisions

  1. Review test results for potential targeted treatment options to address actionable mutations2

Multidisciplinary Team Coordination

  1. Integrate pre- and post-test genetic counseling services2,4
  2. Look to pathologist and genetic counselor partners to stay current on new validated biomarker tests as they become available2
Style
Cards-acc

EHR, electronic health records; ctDNA, circulating tumor DNA; HRR, homologous recombination repair; HRRm, homologous recombination repair gene-mutated; NGS, next-generation sequencing.

Gonzalez D, Mateo J, Stenzinger A, et al. Practical considerations for optimising homologous recombination repair mutation testing in patients with metastatic prostate cancer. J Pathol Clin Res 2021;7(4):311-25.
Tsimberidou AM, Sireci A, Dumaniois R, Pritchard D. Strategies to address the clinical practice gaps affecting the implementation of personalized medicine in cancer care. JCO Oncol Pract 2024;20(6):761-66.
Catalano M, Generali D, Gatti M, et al. DNA repair deficiency as circulating biomarker in prostate cancer. Front Oncol 2023;13:1115241.
Scott RJ, Mehta A, Macedo GS, Borisov PS, Kanesvaran R, El Metnawy W. Genetic testing for homologous recombination repair (HRR) in metastatic castration-resistant prostate cancer (mCRPC): challenges and solutions. Oncotarget 2021;12(16):1600-14.
Style
Reference, ref-ord-test