Cancer treatment for people with inherited BRCA1 mutations

People with an inherited BRCA1 mutation who have been diagnosed with cancer may have different treatment options than people who do not have an inherited mutation. For example, PARP inhibitors are a type of targeted therapy used to treat cancers in people with certain mutations, including BRCA1. To learn more about standard of care treatment options for specific types of cancer, visit our section on Cancer Treatment by Cancer Type. 

If you have an inherited BRCA1 mutation, have been diagnosed with cancer and any of the situations below apply, you may want to speak to your doctor about your medical options. You may also consider enrolling in a clinical trial studying which treatments work best for people with an inherited BRCA1 mutation.

• You have breast cancer
• You have advanced ovarian, fallopian tube or primary peritoneal cancer
• You have pancreatic cancer
• You have prostate cancer

Breast cancer

• Surgical decisions: Because of the very high risk for a second (or third) breast cancer diagnosis, women who are diagnosed with breast cancer who test positive for an inherited mutation in BRCA1 often choose bilateral mastectomy rather than lumpectomy and radiation. Mutation carriers who undergo mastectomy are less likely to develop a second breast cancer. 
• Treatment for metastatic breast cancer: The PARP inhibitors, Lynparza (also known as olaparib) and Talzenna (also known as talazoparib) both have received FDA approval for treating metastatic breast cancer caused by a BRCA mutation.
• Treatment for early-stage breast cancer: Although not yet FDA approved for early stage breast cancer, PARP inhibitors are being studied in this setting to learn if they improve outcomes. 
• Other considerations: Women with an inherited BRCA1 mutation are more likely to be diagnosed with a type of breast cancer known as triple-negative breast cancer. Women with an inherited BRCA1 mutation and early stage breast cancer appear to have similar prognosis and outcomes as women with a similar diagnosis who do not have a mutation. 

Ovarian, fallopian tube and primary peritoneal cancer

Research has shown that women an inherited BRCA1 mutation and ovarian cancer appear to have better prognosis and outcomes than women with a similar diagnosis who do not have a mutation.

There are three PARP inhibitors with FDA approval for treating advanced ovarian, fallopian tube and primary peritoneal cancer. Lynparza (olaparib), Rubraca (rucaparib) and Zejula (niraparib). 

• Advanced recurrent ovarian cancer:  All three PARP inhibitors have FDA approval for treating advanced recurrent ovarian, fallopian tube and primary peritoneal cancer in women with a BRCA mutation, although the approvals differ slightly. 
  • Rubraca is approved for women who have received two or more prior lines of treatment, and have an inherited BRCA mutation or an acquired BRCA mutation found by testing their tumor.
  • Lynparza is approved for women who have received three or more prior lines of treatment, and have an inherited BRCA mutation or an acquired BRCA mutation found by testing their tumor.
  • Zejula is approved for women who have received three or more prior lines of treatment, and have an inherited BRCA mutation or a type of biomarker found by a test known as HRD.
• Maintenance therapy: Maintenance therapy is a type of treatment that is given after chemotherapy treatment has been completed to try to keep the cancer from returning. The goal of maintenance therapy is to extend the length of time before a new recurrence emerges or even to turn a temporary remission into a long-term cure. All three PARP inhibitors have all been approved by the FDA for treating ovarian, primary peritoneal and fallopian tube cancer in the maintenance setting.  
  • Lynparza has been approved for front-line maintenance therapy in women with advanced ovarian cancer caused by BRCA mutation. This means that women with a BRCA mutation who have completed their first course of chemotherapy for ovarian cancer may use Lynparza as maintenance therapy to delay recurrence.
  • Lynparza in combination with bevacizumab has been approved as maintenance therapy after front-line platinum chemotherapy in women with a BRCA mutation.
  • Lynparza, Rubraca, and Zejula have all received FDA approval as maintenance therapy for women with recurrent ovarian cancer, who had either a complete or partial response to the most recent line of recurrence therapy. These PARP inhibitors have been approved for maintenance therapy in women with, and women without a BRCA mutation. However, research suggests that the agents work particularly well in women with a BRCA mutation.

Pancreatic cancer

• Treatment for advanced pancreatic cancer: People with pancreatic cancer and an inherited BRCA mutation may respond better to treatment that includes a type of chemotherapy known as platinum. Oxaliplatin is a platinum-containing drug used in some pancreatic cancer regimens. 
• Maintenance therapy: Lynparza is a PARP inhibitor which is FDA approved for maintenance treatment of pancreatic cancer in people with a BRCA mutation whose disease has not progressed after completing first-line platinum-based chemotherapy.

Prostate cancer

Prostate cancers tend to be slow-growing in most men, but prostate cancers in men with a BRCA mutation may be more aggressive than in men without a mutation. Two PARP inhibitors have received FDA approval for treating advanced prostate cancer in men with BRCA mutations. 

• Lynparza may be used to treat men with metastatic, castration-resistent prostate cancer, who have a mutation in BRCA or another gene linked to DNA damage repair. Lynparza may be used to treat men whose prostate cancer has progressed on enzalutamide (Xtandi) or abiraterone (Zytiga).

• Rubraca may be used to treat men with a BRCA mutation who have metastatic castration-resistant prostate cancer and who have been treated with androgen receptor-directed therapy and a taxane-based chemotherapy.