From the Journals

POSH study: BRCA mutations did not influence survival in young onset breast cancer

Publish date: January 16, 2018
By
Andrew D. Bowser

View on the News

Young patients with BRCA mutations at increased risk

The POSH prospective cohort study, which showed no significant difference in survival for BRCA-positive versus BRCA-negative young onset breast cancer patients, has contributed to the understanding of this patient population, providing “comprehensive data about patient, tumor, and treatment characteristics, along with extensive follow-up data,” wrote Peter A. Fasching, MD, in accompanying editorial.

“Understanding prognosis in young patients is important because patients with BRCA mutations are at increased risk of developing specific conditions, such as secondary cancers,” Dr. Fasching said. “These risks determine treatment, and knowing that BRCA1 or BRCA2 mutations do not result in a different prognosis might change the therapeutic approach for these risks.”

Moreover, in retrospective analyses, bilateral mastectomy conferred an overall survival benefit for BRCA mutation carriers: “This important topic needs more prospective research, as preventive surgical measures might have an effect on what might be a very long life after a diagnosis of breast cancer at a young age,” said Dr. Fasching. “The data from POSH deliver a rationale for prospective studies to address these questions.”

Dr. Peter A. Fasching is with Friedrich-Alexander University Erlangen-Nuremberg, Germany. These comments are based on his editorial appearing in Lancet Oncology (2018 Jan 11. doi: 10.1016/S1470-2045(18)30008-1). Dr. Fasching declared grants from Novartis, along with personal fees from Novartis, Pfizer, Roche, Teva, and Amgen.


 

FROM LANCET ONCOLOGY

For women with young-onset breast cancer, presence of a BRCA mutation did not significantly impact survival, according to results of the Prospective Outcomes in Sporadic versus Hereditary breast cancer (POSH) study.

BRCA-positive and BRCA-negative women had similar overall survival at 2 years, 5 years, and 10 years after diagnosis, according to lead author Ellen R. Copson, MD, a senior lecturer in medical oncology in the cancer sciences division, University of Southampton (England) and her study coauthors.

Based on the findings, “decisions about timing of risk-reducing surgery should take into account primary tumor prognosis and patient preference,” Dr. Copson and her coauthors wrote in Lancet Oncology.

Currently, young women with breast cancer and a BRCA mutation frequently are offered bilateral mastectomy, the authors noted.

The prospective cohort study by Dr. Copson and her colleagues included 2,733 women with breast cancer who were aged 40 years or younger at first diagnosis. Of those patients, 338 (12%) had either a BRCA1 or BRCA2 mutation, according to investigators.

At 2 years after diagnosis, overall survival was 97.0% and 96.6% for BRCA-positive and BRCA-negative patients, respectively, the report said. Similarly, overall survival was 83.8% and 85.0% for the two groups at 5 years after diagnosis, and 73.4% vs. 70.1% at 10 years.

Multivariable analysis accounting for known prognostic factors including ethnicity and body mass index showed there was no significant difference between groups (hazard ratio, 0.96; 95% confidence interval, 0.76-1.22; P = .76), the authors wrote.

Triple-negative breast cancer patients with a BRCA mutation might have a survival advantage in the first few years following diagnosis,compared with non-BRCA carriers, the POSH study also found. Researchers reported a significant difference at 2 years (95% for BRCA-positive vs. 91% for BRCA-negative patients; P = .047), but there was no significant difference between arms at 5 or 10 years.

POSH is believed to be the largest prospective cohort study to compare breast cancer outcomes for patients with BRCA mutations to those with sporadic breast cancer. Previous studies, primarily retrospective, have suggested “better, worse, or similar outcomes” for BRCA-positive versus BRCA-negative patients, the authors wrote. Dr. Copson reported receiving honoraria from Roche, while her coauthors reported honoraria from GSK, Pfizer, AstraZeneca, and Pierre Fabre. Funding for the study was provided by the Wessex Cancer Trust, Cancer Research UK, and Breast Cancer Now.

Recommended Reading

ERBB2 expression predicts pCR in HER2+ breast cancer
MDedge ObGyn
Axillary node dissection can be avoided with limited SLN involvement
MDedge ObGyn
Pertuzumab approved for HER2-positive breast cancer
MDedge ObGyn
Enzalutamide plus exemestane improves PFS in HR+ breast cancer subset
MDedge ObGyn
EndoPredict results reflected tumor response to neoadjuvant therapy
MDedge ObGyn
New tool predicts late distant recurrence of postmenopausal ER+ breast cancer
MDedge ObGyn
Trial updates will help tailor endocrine therapy for premenopausal breast cancer
MDedge ObGyn
Modeling study: Screening, treatment effects on breast cancer mortality vary by subtype
MDedge ObGyn
Pain after breast surgery may not be caused by the operation
MDedge ObGyn
FDA approves PARP inhibitor for BRCA+ advanced breast cancer
MDedge ObGyn