Platinum-based neoadjuvant chemotherapy may be best for BRCA1 gene carriers
MedWire News: Neoadjuvant chemotherapy with cisplatin is associated with a high rate of pathologic complete response (pCR) among BRCA1 mutation carriers, a study of Polish women with breast cancer has shown.
From a registry of 6903 patients, researchers identified 102 (1.5%) women (mean age 42 years) who carried a BRCA1 founder mutation and who had been treated for breast cancer with neoadjuvant chemotherapy. They estimated the rate of pCR among these women according to chemotherapy regimen.
As reported in the Journal of Clinical Oncology, 24 (23.5%) of the 102 BRCA1 mutation carriers experienced a pCR, defined as the absence of residual cancer cells in the breast or lymph nodes on pathology examination.
The response rate varied widely with treatment. The best result was observed among patients treated with cisplatin, with 10 (83%) of 12 women having a pCR. In contrast, a pCR was observed in only one (7%) of 14 women treated with cyclophosphamide, methotrexate, and fluorouracil and in two (8%) of 25 women treated with doxorubicin and docetaxel.
An intermediate response was observed for patients treated with doxorubicin and cyclophosphamide or fluorouracil, doxorubicin, and cyclophosphamide, with11 (22%) of 51 women achieving a pCR.
The researchers note that patients treated with cisplatin had significantly smaller tumors, which were more likely to be node negative and hormone receptor negative, compared with the other patients. All of these features were non-significantly associated with a better pCR.
However, “the absolute differences in the response rates were modest, and these differences were not sufficiently large to explain the high pCR rate among platinum-treated patients,” say Steven Narod (Women’s College Research Institute, Toronto, Canada) and colleagues.
“These early data suggest that chemotherapy regimens with doxorubicin and cyclophosphamide or platinum may show the best potential for benefit to patients with breast cancer and a BRCA1 mutation,” Narod et al conclude.
They advise that the relative benefits of doxorubicin and cyclophosphamide and platinum therapy need to be confirmed through follow-up of this and other cohorts before clinical recommendations can be made.
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By Laura Dean