BRCA Carriers Slicing Breast Cancer Odds: Does Surgery Really Lead to Longevity Leaps? Text: @OncoAlert @oncology @BreastCancerNow @SABCS @ProfMatteoLambertini #SABCS24 #BRCA #CancerPrevention #BreastCancerSurvival #RiskReducingSurgery #OncologyResearch #BRCAmutation… pic.twitter.com/2XZofthBCC
— Oncology Tube (@oncologytube) December 17, 2024
Introduction:
Prof. Matteo Lambertini presented the findings from the international BRCA BCUI collaboration study during SABCS 2024. The study focuses on the impact of risk-reducing surgeries in young BRCA mutation carriers with a history of breast cancer. “The risk of relapse of the primary breast cancer should be balanced with the risk of developing a second primary malignancy.” – Prof. Matteo Lambertini
Background:
BRCA gene mutations are known to significantly increase the risk of breast and ovarian cancers. While risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) are typically recommended for BRCA carriers to lower these risks, their benefits in patients already diagnosed with breast cancer, especially at a young age, have been less explored.
Video Chapters:
0:00 – Background: HER2+ and ER+ Breast Cancer
0:09 – Why CDK4/6 Inhibitors? Scientific Rationale
0:30 – Overview of the Phase 3 Patina Trial Design
1:06 – Patient Population and Baseline Characteristics
1:30 – Key Results: Progression-Free Survival (PFS)
2:20 – Subgroup Analysis and Secondary Objectives
3:00 – Confirmed Overall Response and Clinical Benefit Rate
3:50 – Overall Survival Data (Immature)
4:15 – Toxicity Profile and Safety Signals
5:10 – Clinical Implications and New Standard of Care
5:45 – Future Steps: FDA and Regulatory Plans
6:40 – Conclusion: Delaying Chemotherapy While Maintaining Quality of Life
Study Overview:
The BRCA BCUI collaboration included 5,290 young BRCA carriers diagnosed with stage 1-3 breast cancer at or before age 40 from 190 centers in 33 countries. The study excluded those with stage 4 cancer at diagnosis, prior ovarian cancer, or no data on the timing of risk-reducing surgeries.
Study Design:
- Participants: Patients were from multiple centers worldwide.
- Surgery: 55% of participants underwent RRM, and 52.6% underwent RRSO post-breast cancer diagnosis.
- Statistical Analysis: A comprehensive statistical plan was prepared to mitigate potential biases, ensuring the reliability of the findings.
Results:
- Risk-Reducing Mastectomy (RRM):
- RRM was linked to a 35% lower risk of death and a 42% reduced risk of breast cancer recurrence or second primary breast cancer events. These benefits were observed across both BRCA1 and BRCA2 mutation carriers.
- The median follow-up after RRM was 5.1 years.
- Risk-Reducing Salpingo-Oophorectomy (RRSO):
- RRSO showed a 42% lower risk of death and a 32% lower risk of recurrence or new breast cancer events.
- The benefits were more significant in BRCA1 carriers and those with triple-negative breast cancer, likely due to their higher risk profile for ovarian cancer.
Clinical Implications:
The study’s findings suggest that for young BRCA carriers with early-onset breast cancer, both RRM and RRSO can enhance survival outcomes. These results should guide oncologists in counseling patients, considering the effects on fertility and quality of life. “Our results show that undergoing the surgical procedure was associated with improved overall survival, disease free survival, and breast cancer free interval.” – Prof. Matteo Lambertini
Conclusion:
While these findings are relevant for young BRCA carriers with early-onset breast cancer, they should not influence counseling for BRCA healthy carriers or those diagnosed with breast cancer later in life. The study provides oncologists with data to aid in informed discussions about risk-reducing surgeries with their patients.
Future Directions:
Further research could explore the optimal timing for these surgeries, particularly in relation to menopause, and the implications of hormone replacement therapy post-RRSO. Additionally, the possibility of delaying RRSO in BRCA2 carriers, due to their lower risk for ovarian cancer at younger ages, warrants investigation.
Questions and Discussion:
The presentation concluded with an invitation for questions, aiming to facilitate a discussion on integrating these findings into clinical practice, focusing on the implications for counseling BRCA carriers with early-onset breast cancer.
Acknowledgments:
The study team expressed gratitude to all collaborators, institutions, and funding bodies for their support in conducting this research, emphasizing the collaborative effort behind the study.
End Notes:
For more detailed insights or to discuss specific clinical scenarios, contact Dr. [Name] or members of the study team. This presentation was aimed at informing oncologists about the latest in cancer risk management strategies for high-risk populations.