FORCE has a strong commitment to promoting research to benefit our community. We advocate for more research funding, educate people about available studies, and report findings back to our community.
by Lisa Rezende, PhD
The 2014 San Antonio Breast Cancer Symposium was held December 9-13. FORCE joined over 7000 experts on breast cancer to learn the latest research. Below are significant highlights for the HBOC community.
Carboplatin effective in treating triple negative breast cancer in BRCA mutation carriers
Past studies in early-stage and advanced breast cancer patients have strongly suggested that cancers in BRCA mutation carriers respond well to platinum chemotherapy drugs, such as carboplatin. Dr. Andrew Tutt of Kings College, London presented results from the Triple Negative Breast Cancer Trial (TNT), a phase III clinical trial which compared the drug carboplatin to the drug docetaxel as first line treatment in 376 patients with metastatic triple negative breast cancer and/or with a mutation in BRCA1 or BRCA2. Patients with BRCA mutations and ER/PR positive breast cancer were also included in this study.
Researchers compared how well each drug worked on treating the cancers. When they compared the two drugs in all patients, the response rate was similar with 31.4% responding to carboplatin and 35.3% responding to docetaxel. However, when they examined the results for the 43 patients who had mutations in either BRCA1 or BRCA2, they found that 68.0% of carriers responded to carboplatin compared with 33.3% who received docetaxel. The results of this study strongly suggest knowing the BRCA mutation status of patients with triple negative breast cancer can be useful in determining which chemotherapy to use.
Studies on the use of platinum containing drugs in BRCA mutation carriers are still on going. For example, the INFORM study is evaluating whether cisplatin is better than currently used standard chemotherapy (cyclophosphamide/doxorbucin) for treating BRCA mutation carriers with newly diagnosed breast cancer. For this and other studies, see the FORCE HBOC research search tool.
Heart function in BRCA mutation carriers treated with anthracyclines
Anthracyclines are potent chemotherapy agents used to treat many breast cancers. Commonly used anthracyclines include Adriamycin and Doxil. Unfortunately, chemotherapy with anthracyclines can increase the risk of heart disease. Research in animals suggests that BRCA genes may play a role in protecting cardiac function after treatment in anthracyclines. To see if this is true in humans, researchers at the Georgetown University School of Medicine and MedStar Heart and Vascular Institute studied cardiac function in women who had been treated with anthracyclines for breast cancer.
Echocardiograms were used to measure heart function in patients an average of 45 months after completing anthracycline treatment. The data presented at the San Antonio Breast Cancer Symposium focused on the women who had normal blood pressure, including 34 women in with a mutation in BRCA1 or BRCA2, and 23 women who did not have a BRCA mutation. The researchers found impaired heart function in 12% of BRCA mutation carriers and 17% of women who did not have a BRCA mutation. The results from this small study suggest that for women with normal blood pressure, BRCA mutation carriers have the same risk of heart damage from anthracycline treatment as women who do not have BRCA mutations. Larger studies will be needed to confirm this result and see if it extends to patients with high blood pressure or other indicators of heart disease.
Nipple-sparing mastectomy in BRCA mutation carriers
Women considering risk-reducing mastectomy are often given the choice to preserve their nipple and areola through nipple sparing mastectomy. Researchers at Memorial Sloan Kettering Cancer Center presented data from 89 patients with either BRCA mutations (82) or variants of uncertain significance (7) who underwent nipple-sparing mastectomy. Twenty-six of these patients were known to have breast cancer at the time of mastectomy, while the remaining 63 patients did not. Previously undetected cancers were found in 8 of the women at the time of mastectomy. Patients were followed for an average of 2.15 years after surgery and no new breast cancers were detected. Complications reported include peeling skin (44.9% of patients), necrosis (14.6% of patients), infection (7.9% of patients), and removal of implant or expander (6.7%). The researchers conclude that nipple-sparing mastectomy is an acceptable option for BRCA mutation carriers. Long term follow-up of BRCA mutation carriers treated with nipple sparing mastectomy will be important to document the long term safety of this approach compared to conventional mastectomy.
These new findings highlight the importance of research for helping people with HBOC make medical decisions. Larger studies following more people for longer periods of time are needed to provide the answers that experts need to make new recommendations about patient care. FORCE’s ABOUT Network Research Registry is enrolling 10,000 people with HBOC to answer these types of questions about long-term outcomes. ABOUT will conduct studies on long-term effects of hereditary treatment and risk management decisions, including studying outcomes with different chemotherapy agents, incident of heart disease in people with BRCA mutations, and risks and benefits of nipple-sparing surgery. Anyone from a family affected by hereditary cancer including breast, ovarian, prostate, pancreatic, or melanoma is invited share their experiences by enrolling.
February 10, 2015