BRCA1+ and chemo
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Forum Name: Let's Talk About Chemotherapy
Forum Description: A place to discuss Chemotherapy
URL: http://forum.tnbcfoundation.org/forum_posts.asp?TID=11573
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Topic: BRCA1+ and chemo
Posted By: BDelli
Subject: BRCA1+ and chemo
Date Posted: Oct 08 2013 at 6:10pm
I'm stage IIA triple negative with a BRCA1 mutation. I've had a bilateral mastectomy and 4 DD AC. I'm currently doing 12 weekly taxol (done with #6 today!).
I asked my oncologist about the possibility of including a platinum drug (e.g. cisplatin or carboplatin) because they've shown some efficacy especially for people with BRCA mutations. She said I was receiving the standard of care and we never really discussed it further.
As I get closer to completing treatment (I don't need radiation), I'm starting to worry I should have pushed harder on the platinum agent.
Anyone here have a platinum agent for initial treatment of BC? Anyone whose Dr. recommended platinum agents because of known BRCA mutation?
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Replies:
Posted By: Lee21
Date Posted: Oct 09 2013 at 2:10pm
I don't have the precise answer to your dilemma but I will share what I know.
First, BRCA mutation carriers can be very sensitive to adriamycin - I know of at least one member (Mindy) who has a BRCA1 mutation who achieved pCR. Sensitivity to adriamycin is also mentioned in the literature.
In terms of who have had a platinum drug for their primary BC, I remember two who fall in that category (dmwolf and another member who had ACT+platinum) but I don't know their BRCA status. The member who had 4 drugs reported that she had two tumors, the smaller disappeared but the larger one did not go away completely and she enrolled in a clinical trial that offered cisplatin and a PARP inhibitor.
Unfortunately the cisplatin/PARPi trial is now closed : in any case, it was for women who had residual disease following neoadjuvant chemo.
DianeEE who recently passed away was a BRCA2 mutation carrier and was enrolled in the cisplatin/PARPi trial but recurred while on the trial.
So you see, cisplatin even with a PARPi is not a magic bullet -- I suspect a lot depends on the type of BRCA mutation one has and the other mutations found in the tumor.
There was a study showing that 10 out of 12 women with BRCA1 founder mutations treated with cisplatin monotherapy achieved pCR ( http://www.ncbi.nlm.nih.gov/pubmed/20008645" rel="nofollow - http://www.ncbi.nlm.nih.gov/pubmed/20008645 ) -- but it is a very small study.
I'm sorry I have not simplified things for you.
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12/9/11 @59,IDC,grade3, TNBC,3cm(MRI),SLNB0,stage IIA, BRCA1 variant
1/30/12 DD AC-T, 6/7/12 Lumpectomy, ypT1b(0.8 cm), 7/9/12 Rads x 30
11/9/12, clinical trial cisplatin/rucaparib, cisplatin-only arm
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