OTTAWA, ON – Society of Gynecologic Oncology of Canada (GOC) is proud to announce that the province of Saskatchewan has become the first in Canada to approve provincial funding for Homologous Recombination Deficiency (HRD) tumor testing for those with advanced ovarian cancer. This important decision ushers in a new era of precision oncology care and sets a precedent for the rest of the country.
HRD testing provides crucial information that aids in determining how beneficial treatment from a class of maintenance drugs called PARP inhibitors (PARPi), such as Niraparib, may be. These drugs are prescribed when patients are in a period of relative wellness, having completed and responded to their initial treatment with surgery and chemotherapy. The goals of the treatment are to delay recurrence and extend the period of time when patients are living disease free whilst maintaining a high quality of life.
Niraparib received funded approval based on its ability to delay visible progression of tumors on CT scans by 5.6 months with a range of 3 to 13 months in the different patient populations. However, the trial was not powered to show a difference in overall survival, and this was ultimately not demonstrated. Further, side effects can be significant—approximately 25% of patients experience treatment related serious complications, the majority within the first three months of treatment. Additionally, 1.2% of patients develop a secondary hematologic malignancy with grave implications. With the approval of Niraparib without the access to HDR testing, it was not initially possible to predict who would receive a shorter versus a longer benefit.
Now, with advanced molecular testing, HRD status can be determined to guide treatment:
- HRD-positive patients have an increased median PFS of 13-months. 4-yr PFS: 38% (Niraparib) vs 17% (Placebo)
- HRD-negative patients have an increased median PFS of 3 months. 4-yr PFS: approximately 10% in both arms.
This distinction matters. When the potential benefits and harms of treatment are closely matched, it is essential to support patients in making informed decisions based on their own values and preferences. HRD testing is the key to unlocking that clarity.
Dr. Laura Hopkins and her team at the Saskatchewan Cancer Agency have launched a pragmatic, multi-centre clinical trial integrating HRD testing with a patient decision aid. This resource helps patients understand the pros and cons of taking Niraparib based on their HRD status. Preliminary trial results are compelling: 60% of patients who tested HRD-negative and were shown to have only a 3-month benefit chose not to take Niraparib, demonstrating the power of informed, patient-centered decision-making.
Quality of life data is also being collected, and the trial remains open for enrollment. Preliminary economic analysis indicates that HRD testing is dramatically cost-effective, proving its value not only to patients but to society at large.
GOC urges all provincial and territorial jurisdictions across Canada to adopt funding for HRD testing for individuals with advanced ovarian cancer. In doing so, patients of all backgrounds are empowered to make more informed treatment decisions that reflect their values and enhance their quality of life.
This is a defining moment in oncology care—one where science, ethics, and compassion align to give patients greater control over their journey.
For more information, please visit The Society of Gynecologic Oncology of Canada – Voice of Gynecological Oncology or contact Dr. Laura Hopkins via the Saskatchewan Cancer Agency.
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