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The 2020 joint US guideline for breast cancer in people who carry an inherited fault in BRCA1, BRCA2 or another risk gene: breast-conserving surgery is allowed, bilateral mastectomy should be discussed, platinum beats taxanes in advanced disease and PARP inhibitors beat single-agent chemotherapy.
Guideline from ASCO, ASTRO and SSO by Tung, Boughey, Pierce, Robson and colleagues, based on 58 articles for local therapy and six randomised trials of systemic therapy. Recommendations: patients with newly diagnosed breast cancer and BRCA1/2 mutations may be considered for breast-conserving therapy with local control similar to non-carriers; the risk of contralateral and new ipsilateral cancers, especially in young women, warrants discussion of bilateral mastectomy; nipple-sparing mastectomy is reasonable; there is no evidence of increased toxicity or contralateral cancers from radiation in BRCA1/2 carriers; radiation should not be withheld in ATM carriers; mastectomy is advised and radiation contraindicated except at high locoregional risk for germline TP53 carriers. Platinum agents are recommended over taxanes for advanced disease in BRCA carriers; routine platinum is not supported in the adjuvant or neoadjuvant setting; PARP inhibitors (olaparib, talazoparib) are preferable to non-platinum single-agent chemotherapy for advanced disease; data were insufficient for early-setting PARP inhibition or moderate-penetrance carriers.
Sets the surgical and systemic rules for the roughly one in five triple-negative patients who carry a germline BRCA variant; the adjuvant gap it named was filled by OlympiA the following year.
Shares A UK audit of trial access and germline testing uptake in triple-negative breast cancer, Inherited risk is mostly unidentified, BRCA1 / BRCA2 (HRD), Germline (hereditary) testing and the tag tnbc-evidence.
Shares A UK audit of trial access and germline testing uptake in triple-negative breast cancer, OlympiA, PARP inhibitors, Olaparib and the tag tnbc-evidence.
Shares OlympiA, PARP inhibitors, Olaparib, BRCA1 / BRCA2 (HRD) and the tag tnbc-evidence.
Shares Inherited risk is mostly unidentified, BRCA1 / BRCA2 (HRD), Germline (hereditary) testing, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem and the tag tnbc-evidence.
Shares American Society of Clinical Oncology (ASCO), BRCA1 / BRCA2 (HRD), Germline (hereditary) testing, Journal of Clinical Oncology and the tag tnbc-evidence.
Shares Germline (hereditary) testing, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Platinum agents, Carboplatin and the tag tnbc-evidence.
Shares Inherited risk is mostly unidentified, BRCA1 / BRCA2 (HRD), Germline (hereditary) testing, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem and the tag tnbc-evidence.
Shares American Society of Clinical Oncology (ASCO), Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Journal of Clinical Oncology, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.