First treatment approved for breast cancer with BRCA genetic mutation

The actress Angelina Jolie had a pre-emptive mastectomy after finding out that she had a BRCA gene mutation

It is also approved in the US for advanced ovarian cancer patients who have received at least three prior lines of chemo and maintenance treatment of ovarian cancer in patients who are in complete or partial response to platinum-based chemo, both BRCA-positive.

The FDA has approved olaparib (Lynparza, AstraZeneca/Merck) for use in patients with deleterious or suspected deleterious germline BRCA-mutated (gBRCAm), human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer who have been previously treated with chemotherapy in the neoadjuvant, adjuvant, or metastatic setting.

A study of nearly 3,000 British women found that preventative surgery - like a double mastectomy - straight after being diagnosed with this type of breast cancer did not improve survival over 10 years.

Mutations in these genes stop DNA repairing itself and increase the risk of cancer developing.

On Thursday, research led by the University of Southampton concluded that BRCA-mutated breast cancer is no more risky or aggressive than any other form of the disease.

The BRCA1 and BRCA2 genes usually produce molecules inside cells that help to fix DNA.

Most early-stage breast cancer patients have either a lumpectomy or a mastectomy, and many of them get chemotherapy or radiation afterward to destroy any remaining abnormal cells and reduce the risk of cancer coming back.

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The FDA has approved the first treatment for breast cancer with a BRCA gene mutation.

The findings come amid a slew of research in recent months into the gene, which could make BRCA-related cancer more manageable, and treatment or preventative measures less invasive.

An expert said women should take time to decide if surgery was for them.

About a third of those with the BRCA mutation had a double mastectomy. At that time, BRCA testing and risk-reducing surgery were not routine for early breast cancer. There was no significant difference in overall survival between patients who were BRCA positive and those who were BRCA negative at 2 years (97% vs 96.6%, respectively), 5 years (83.8% vs 85%), or 10 years (73.4% vs 70.1%; hazard ratio, 0.96; 95% CI, 0.76-1.22; P = 0.76).

"However, our findings suggest that this surgery does not have to be immediately undertaken along with the other treatment".

"In light of their findings the authors suggest that women with triple-negative breast cancer and a BRCA mutation who choose to delay additional surgery for one-two years to recover from their initial treatment should be reassured that this is unlikely to affect their long-term survival", the statement said.

Decision aids can help women clarify their personal values and preferences, for example by focusing on whether they want to avoid radiation or concentrate on preserving their breasts, said Dr. Clara Lee, a cancer researcher at The Ohio State University Wexner Medical Center in Columbus.

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