HRD-positive (BRCA1/2 mutation OR Genomic Instability Score ≥42) high-grade serous ovaria...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-OVARIAN-HRD-ACTIONABILITY`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-OVARIAN`
Sources	`SRC-ESMO-OVARIAN-2024` `SRC-NCCN-OVARIAN-2025`

Red Flag Origin

Definition	HRD-positive (BRCA1/2 mutation OR Genomic Instability Score ≥42) high-grade serous ovarian carcinoma. Treatment-defining for PARPi maintenance after platinum-based induction. Olaparib (SOLO-1 BRCA-only, PAOLA-1 with bev) + niraparib (PRIMA all-comer) substantially improve PFS in HRD-positive subset.
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-OVARIAN-ADVANCED-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "hrd_status",
      "value": "HRD-positive"
    },
    {
      "finding": "brca1_brca2_pathogenic",
      "value": true
    }
  ],
  "type": "biomarker"
}

Notes

HRD testing on FFPE tumor + paired germline. Reflex BRCA → if WT, proceed to GIS scoring. SOLO-1: BRCA-mut maintenance olaparib mPFS 56 vs 14 mo. PAOLA-1: HRD-positive (BRCA-mut OR GIS+) bev+olap mPFS 37 vs 22 mo. PRIMA: niraparib all-comer maintenance benefit weighted toward HRD+ subset.

Used By

Algorithms

ALGO-OVARIAN-2L - ALGO-OVARIAN-2L
ALGO-OVARIAN-ADVANCED-1L - ALGO-OVARIAN-ADVANCED-1L

Red flag

RF-OVARIAN-BRCA-MUT-ACTIONABLE - BRCA1 or BRCA2 pathogenic variant (germline OR somatic) in high-grade serous ovarian carc...
RF-OVARIAN-HRD-POSITIVE-ACTIONABLE - Homologous Recombination Deficiency (HRD)-positive high-grade serous ovarian carcinoma (B...