Homologous Recombination Deficiency (HRD)-positive high-grade serous ovarian carcinoma (B...

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

ID	`RF-OVARIAN-HRD-POSITIVE-ACTIONABLE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-OVARIAN`
Sources	`SRC-ESMO-OVARIAN-2024` `SRC-NCCN-OVARIAN-2025` `SRC-NOVA-MIRZA-2016` `SRC-PRIMA-GONZALEZ-MARTIN-2019`

Red Flag Origin

Definition	Homologous Recombination Deficiency (HRD)-positive high-grade serous ovarian carcinoma (BRCA1/2 mutation OR Genomic Instability Score ≥42). PARPi maintenance after platinum-based induction is treatment-defining: niraparib (PRIMA — mPFS 21.9 vs 10.4 mo HRD-pos), olaparib + bevacizumab (PAOLA-1 — mPFS 37.2 vs 17.7 mo HRD-pos).
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-OVARIAN-ADVANCED-1L, ALGO-OVARIAN-2L

Trigger Logic

{
  "any_of": [
    {
      "finding": "hrd_status",
      "value": "HRD-positive"
    },
    {
      "finding": "hrd_status",
      "value": "positive"
    },
    {
      "comparator": ">=",
      "finding": "genomic_instability_score",
      "threshold": 42
    }
  ],
  "type": "biomarker"
}

Notes

HRD assays: Myriad myChoice CDx (companion for olaparib + bev, niraparib), FoundationOne CDx HRD. GIS captures BRCAness (LOH + TAI + LST signatures) in tumors WT for BRCA1/2. HRD-negative HGSC has minimal PARPi maintenance benefit (PRIMA mPFS 8.1 vs 5.4 mo) — bev maintenance preferred. Coexists with RF-OVARIAN-BRCA-MUT-ACTIONABLE (BRCA-mut subset is HRD-positive by definition); RF-OVARIAN-HRD-ACTIONABILITY is the older composite version.

Used By

Algorithms

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