Cases from the Community: Investigators Provide Their Perspectives on the Practice Implications of Emerging Clinical Research — A Special Video SupplementTherapeutic options for a patient with high-risk ER-positive BC and a BRCA germline mutation
2:52 minutes.
TRANSCRIPTION:
DR LOVE: So just a couple more quick cases/questions. This is a 68-year-old patient who had — actually looks like 3 primary breast cancers, 2 on one side, 1 on the other. ER-positive, HER2-negative, has bilateral mastectomies. Sentinel node on one side was negative. On the other side, she’s got 18 of 19 positive nodes. So the patient is found to have a BRCA2 germline mutation. So the question is adjuvant therapy in this patient with very high-risk disease and a BRCA germline mutation. DR O’SHAUGHNESSY: The data that I have seen with regard to the prognostic impact of BRCA2 is, if anything, in the favorable direction, Neil. I think these cancers end up doing, in general, at least as well as a wild type does with our standard therapies, potentially a little better. There’s a little data that I even showed in your symposium in San Antonio, looking at the outcome of BRCA1 versus BRCA2 versus wild type in metastatic breast cancer patients. And BRCA2s appear to do a bit better in terms of their overall survival. So I would treat this patient with standard of care. I certainly would give the patient ACT and an aromatase inhibitor. The utilization of capecitabine, I would consider it in this super-duper high-risk patient, based on our own data where — but it would depend on the Ki-67. If the Ki67 — it would have to be elevated, at least 20%, 25%, for me to consider adding capecitabine to the taxane, giving the AC first. So I would be very, very aggressive. But BRCA2s — I don’t think in the BRCA2, ER-positive — I’m not aware of data, for example, showing that the addition of carboplatin or cisplatin would be of particular benefit to this patient. So I would not do that. DR LOVE: Just to clarify, are you saying that in terms of, at least at this point, the data we have, it looks like it’s BRCA1 specifically that benefits from platinum as opposed to BRCA2? DR O’SHAUGHNESSY: If you’re ER-positive. So the triple-negative BRCA2s, my read of Andrew Tutt, they benefit. They benefit. DR LOVE: I mean, I don't know how often you see ER-positive BRCA1. DR O’SHAUGHNESSY: Rarely. Rare. That’s quite rare. DR LOVE: But what you’re saying — it’s really the ER that’s — DR O'SHAUGHNESSY: Right. DR LOVE: Oh. That's interesting. |