Morocco builds local HRD testing for ovarian cancer, cutting reliance on foreign labs

Researchers at the National Institute of Oncology in Rabat have shown that homologous recombination deficiency (HRD) testing for advanced high-grade serous ovarian carcinoma (HGSOC) can be carried out locally in Morocco rather than sent to commercial laboratories abroad. In a real-world cohort of 215 patients enrolled between March 2024 and March 2026, the team used an in-house next-generation sequencing pipeline, the Oncomine Comprehensive Assay Plus, on formalin-fixed paraffin-embedded tumor tissue, and reported an average turnaround time of three weeks. The study, published in Diagnostic Pathology, is presented as a feasibility evaluation of a decentralized testing platform in North Africa, where centralized commercial assays have posed logistical and financial barriers.

Quality control before analysis failed in 57 of the 215 samples, or 26.5 percent. DNA degradation accounted for 40 of these failures, 70.2 percent of the total, which the authors attribute to real-world pre-analytical variability in decentralized workflows. The remaining 17 failures, 29.8 percent, were linked to small core needle biopsies with low tumor cellularity or extensive stromal fibrosis. Samples were accepted only after strict histopathological selection requiring tumor cellularity of at least 20 percent and necrosis below 30 percent, and HRD positivity was defined by a genomic instability metric score of 16 or higher.

Among the 158 evaluable patients, 87, or 55.1 percent, were HRD-positive. Of these, 57.5 percent, 50 of 87, harbored BRCA1/2 mutations, while 42.5 percent, 37 of 87, were BRCA wild-type. HRD prevalence was significantly associated with age, with a p-value of 0.017, peaking at 69.4 percent in patients aged 50 to 59 years and falling to 32.1 percent in those aged 70 or older. The study also confronted TP53 sequencing data with immunohistochemical reflex testing on the 27 cases that were wild-type by sequencing, identifying 19 cases with aberrant p53 staining patterns and raising the total rate of p53 abnormalities to 94.9 percent, 150 of 158.

The economic context is a central part of the findings. The authors report that a single test represented 37.1 percent of Morocco’s annual Gross Domestic Product per capita and more than 400 percent of the monthly minimum wage, figures that illustrate why centralized commercial testing has been difficult to access in low- and middle-income settings. The team concludes that local, decentralized testing is clinically viable in resource-limited settings, while stressing that addressing pre-analytical tissue processing quality and conducting formal health-economic evaluations are essential steps toward sustainable access to precision oncology across such countries. As a single-center cohort study, the findings describe implementation at one Moroccan institution and do not by themselves establish treatment outcomes, since the reported results concern testing feasibility, failure modes and molecular prevalence rather than the efficacy of poly (ADP-ribose) polymerase inhibitor therapy, which HRD testing is intended to guide.

Subject of Research: Decentralized HRD testing implementation and molecular profiling in advanced high-grade serous ovarian carcinoma in Morocco

Article Title: Decentralized homologous recombination deficiency (HRD) testing in advanced high-grade serous ovarian carcinoma: real-world implementation and molecular profiling from Morocco

Article References: Mahdi, Y., Mounjid, C., Midouane, D., Akdim, S., Ech-charif, S., Sassi, S., Boujida, I., & El Khannoussi, B. (2026). Decentralized homologous recombination deficiency (HRD) testing in advanced high-grade serous ovarian carcinoma: real-world implementation and molecular profiling from Morocco. Diagnostic Pathology. https://doi.org/10.1186/s13000-026-01847-y

Image Credits: AI Generated

DOI: 10.1186/s13000-026-01847-y

Keywords: HRD testing, high-grade serous ovarian carcinoma, Morocco, next-generation sequencing, BRCA mutations, TP53, decentralized diagnostics, precision oncology, low- and middle-income countries, PARP inhibitors, turnaround time, pre-analytical quality