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ICARE Newsletter Summer 2020

Treatment Advances Among BRCA1/2 Carriers

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There continue to be ongoing advances in treatment studies among those with inherited cancer gene mutations, which are rapidly being followed by FDA approval for specific cancer treatments. Select studies and advances are summarized below:

BRCA1/2 Carriers: 

Breast Cancer: For those with later stage or metastatic breast cancer, the FDA currently has approvals for the use of PARP inhibitors, yet the impact of combination therapy is still under investigation. A recent study suggested veliparib (a PARP inhibitor) in combination with chemotherapy showed benefit [1]. For those with early stage breast cancer, a recent study suggested benefit from talazoparib (another PARP inhibitor) [2]. New research suggests that platinum-based agents, which have been suggested to be of particular benefit to treat BRCA1/2-related breast cancer, are less effective than previously thought in the neoadjuvant setting (treatment given before surgery) [3], and among those with early stage triple negative breast cancer in the neoadjuvant setting [4].

Ovarian Cancer: For those with advanced ovarian cancer, the FDA recently approved niraparib (a PARP inhibitor) as first-line maintenance treatment. Among those with platinum-sensitive relapsed ovarian cancer who had received at least two prior lines of platinum-based chemotherapy, olaparib (another PARP inhibitor) showed potential benefit [5]. Subsequently, the FDA approved olaparib as first-line maintenance treatment in those with complete or partial response to first-line platinum-based chemotherapy.

Prostate Cancer: Among those with metastatic castration-resistant prostate cancer, a recent study suggested that rucaparib (a PARP inhibitor) may have antitumor activity [6], which then provided data to support FDA approval of rucaparib among those treated with anti-androgens and/or other treatments. Olaparib (another PARP inhibitor) also received FDA approval recently for a similar indication.

Pancreatic Cancer: Among BRCA1/2 or PALB2 carriers with stage 3 or 4 pancreatic cancer, the addition of veliparib (a PARP inhibitor) did not provide additional benefit over cisplatin and gemcitabine alone [7].

[1] Dieras, et al. ESMO 2019 Congress. 2019 Sep. Available at: https://tinyurl.com/dieras2019; [2] Litton, et al. J Clin Oncol. 2020 Feb. PMID: 31461380; [3] Tung, et al. J Clin Oncol. 2020 May. PMID: 32097092; [4] Pohl-Rescigno, et al. JAMA Oncol. 2020 Mar. PMID: 32163106; [5] Penson, et al. J Clin Oncol. 2020 Feb. PMID: 32073956; [6] Abida, et al. J Clin Oncol. 2020 Aug. PMID: 32795228; [7] O’Reilly, et al. J Clin Oncol. 2020 May. PMID: 31976786; 

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