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Yuan H, Xiu L, Li N, Li Y, Wu L, Yao H. PARPis response and outcome of ovarian cancer patients with BRCA1/2 germline mutation and a history of breast cancer. J Gynecol Oncol 2024; 35:e51. [PMID: 38246184 PMCID: PMC11262894 DOI: 10.3802/jgo.2024.35.e51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 11/24/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE The aim of this study was to determine the poly (ADP-ribose) polymerase inhibitors (PARPis) response and outcome of ovarian cancer (OC) patients with BRCA1/2 germline mutation and a history of breast cancer (BC). METHODS Thirty-nine OC patients with BRCA1/2 germline mutation and a history of BC were included. The clinicopathological characteristics, PARPis response and prognosis were analyzed. RESULTS The median interval from BC to OC diagnosis was 115.3 months (range=6.4-310.1). A total of 38 patients (38/39, 97.4%) received platinum-based chemotherapy after surgical removal. The majority of these patients were reported to be platinum sensitive (92.1%, 35/38). 21 patients (53.8%) received PARPis treatment with 16 patients (76.2%) for maintenance treatment and 5 patients (5/21, 23.8%) for salvage treatment. The median duration for PARPis maintenance and salvage treatment was 14.9 months (range=2.0-56.9) and 8.2 months (range=5.2-20.7), respectively. In the entire cohort, 5-year progression-free survival (PFS) and overall survival (OS) rate was 33.1% and 78.9%, respectively. Patients with BRCA1 mutation had a non-significantly worse 5-year PFS (28.6% vs. 45.8%, p=0.346) and 5-year OS (76.9% vs. 83.3%, p=0.426) than those with BRCA2 mutation. In patients with stage III-IV (n=31), first line PARPis maintenance treatment associated with a non-significantly better PFS (median PFS: NR vs. 22.4 months; 5-year PFS: 64.3% vs. 21.9%, p=0.096). CONCLUSION The current study shows that these patients may have a good response to platinum-based chemotherapy and a favorable survival. And these patients can benefit from PARPis treatment and will likely be suitable candidates for PARPis.
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Affiliation(s)
- Hua Yuan
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Xiu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yifan Li
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingying Wu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwen Yao
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Heemskerk-Gerritsen BAM, Hollestelle A, van Asperen CJ, van den Beek I, van Driel WJ, van Engelen K, Gómez Garcia EB, de Hullu JA, Koudijs MJ, Mourits MJE, Hooning MJ, Boere IA. Progression-free survival and overall survival after BRCA1/2-associated epithelial ovarian cancer: A matched cohort study. PLoS One 2022; 17:e0275015. [PMID: 36137114 PMCID: PMC9498928 DOI: 10.1371/journal.pone.0275015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Germline BRCA1/2-associated epithelial ovarian cancer has been associated with better progression-free survival and overall survival than sporadic epithelial ovarian cancer, but conclusive data are lacking.
Methods
We matched 389 BRCA1-associated and 123 BRCA2-associated epithelial ovarian cancer patients 1:1 to sporadic epithelial ovarian cancer patients on year of birth, year of diagnosis, and FIGO stage (< = IIA/> = IIB). Germline DNA test was performed before or after epithelial ovarian cancer diagnosis. All patients received chemotherapy. We used Cox proportional hazards models to estimate the associations between mutation status (BRCA1 or BRCA2 versus sporadic) and progression-free survival and overall survival. To investigate whether DNA testing after epithelial ovarian cancer diagnosis resulted in survival bias, we performed additional analyses limited to BRCA1/2-associated epithelial ovarian cancer patients with a DNA test result before cancer diagnosis (n = 73 BRCA1; n = 9 BRCA2) and their matched sporadic controls.
Results
The median follow-up was 4.4 years (range 0.1–30.1). During the first three years after epithelial ovarian cancer diagnosis, progression-free survival was better for BRCA1 (HR 0.88, 95% CI 0.74–1.04) and BRCA2 (HR 0.58, 95% CI 0.41–0.81) patients than for sporadic patients. Overall survival was better during the first six years after epithelial ovarian cancer for BRCA1 (HR 0.7, 95% CI 0.58–0.84) and BRCA2 (HR 0.41, 95% CI 0.29–0.59) patients. After surviving these years, survival benefits disappeared or were in favor of the sporadic patients.
Conclusion
For epithelial ovarian cancer patients who received chemotherapy, we confirmed survival benefit for BRCA1 and BRCA2 germline pathogenic variant carriers. This may indicate higher sensitivity to chemotherapy, both in first line treatment and in the recurrent setting. The observed benefit appears to be limited to a relatively short period after epithelial ovarian cancer diagnosis.
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Affiliation(s)
| | | | - Christi J. van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Irma van den Beek
- Department of Human Genetics, Amsterdam University Medical Center (University of Amsterdam), Amsterdam, the Netherlands
| | | | - Klaartje van Engelen
- Department of Clinical Genetics, Amsterdam University Medical Center (VUmc), Amsterdam, the Netherlands
| | - Encarna B. Gómez Garcia
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joanne A. de Hullu
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marco J. Koudijs
- Department of Biomedical Genetics, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Marian J. E. Mourits
- Department of Gynecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Maartje J. Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ingrid A. Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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3
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Michels J, Genestie C, Dunant A, Caron O, Lanoy E, Colomba E, Pommeret F, Rey A, Gouy S, Duvillard P, Teuff GL, Larue C, Savoye AM, Lhommé C, Leary A, Morice P, Pautier P. Impact of young age on platinum response in women with epithelial ovarian cancer: Results of a large single-institution registry. Gynecol Oncol 2020; 160:77-82. [PMID: 33059915 DOI: 10.1016/j.ygyno.2020.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/28/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE In young women, EOC is a rare disease with an uncertain genetic and biological substrate. METHODS We report a long follow-up of EOC patients treated at Gustave Roussy between 1990 and 2009. We matched young patients aged ≤30 years to randomly selected older patients aged ≥40 years according to known prognostic factors (i.e. FIGO stage, histology and surgical residual disease) and the date of diagnosis with a threshold at the year 2000 to balance the treatment procedures. RESULTS EOC was diagnosed in 68 patients aged ≤30 years matched with 111 patients aged ≥40 years. Low-grade (LG) (i.e. serous and endometrioid) (52%, n = 35) and mucinous (i.e. 23%, n = 16 infiltrative and 12% n = 8 expansile) tumors are prevalent. High-grade (HG) tumors are rare (7%, n = 5). Early stage diseases (53%, n = 36 FIGO I/II) are predominant. Response to platinum based chemotherapy is observed to be inferior in young patients as compared to matched older patients (ORR, 29 vs 84% p = 0.0002). For HG tumors the PFS is of 0% at 5 and 10 years in younger as compared to 30% in older patients. No difference in PFS (median 4.9 vs 9.8 ms, p = 0.58) and OS (not reached vs 15.3 ms, p = 0.47) is found overall among younger and older patients respectively. The median follow-up was 72 months (range, 11-288 months). No genetic abnormalities were found. CONCLUSIONS Young EOC patients are most often diagnosed at an early FIGO stage with LG serous or mucinous histology. Tumors are significantly more resistant to platinum-based chemotherapy in younger patients.
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Affiliation(s)
- Judith Michels
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France.
| | | | - Ariane Dunant
- Biostatistics and Epidemiology Unit, Gustave-Roussy, Villejuif, France
| | | | - Emilie Lanoy
- Biostatistics and Epidemiology Unit, Gustave-Roussy, Villejuif, France; Paris-Saclay University, Paris-Sud Univ., UVSQ, CESP, INSERM, Villejuif, France
| | - Emeline Colomba
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - Fanny Pommeret
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - Annie Rey
- Biostatistics and Epidemiology Unit, Gustave-Roussy, Villejuif, France
| | | | | | - Gwenael Le Teuff
- Biostatistics and Epidemiology Unit, Gustave-Roussy, Villejuif, France; Paris-Saclay University, Paris-Sud Univ., UVSQ, CESP, INSERM, Villejuif, France
| | - Christine Larue
- Biostatistics and Epidemiology Unit, Gustave-Roussy, Villejuif, France
| | | | - Catherine Lhommé
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | | | - Patricia Pautier
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
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4
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Ma YN, Bu HL, Jin CJ, Wang X, Zhang YZ, Zhang H. Peritoneal cancer after bilateral mastectomy, hysterectomy, and bilateral salpingo-oophorectomy with a poor prognosis: A case report and review of the literature. World J Clin Cases 2019; 7:3872-3880. [PMID: 31799317 PMCID: PMC6887594 DOI: 10.12998/wjcc.v7.i22.3872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/19/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary peritoneal cancer (PPC) patients with BRCA mutations have a good prognosis; however, for patients with BRCA mutations who are diagnosed with PPC after prophylactic salpingo-oophorectomy (PSO), the prognosis is poor, and survival information is scarce.
CASE SUMMARY We treated a 56-year-old woman with PPC after bilateral mastectomy, hysterectomy, and bilateral salpingo-oophorectomy. This patient had primary drug resistance and died 12 mo after the diagnosis of PPC. The genetic test performed on this patient indicated the presence of a germline BRCA1 mutation. We searched the PubMed, Scopus, and Cochrane databases and extracted studies of patients with BRCA mutations who developed PPC after PSO. After a detailed literature search, we found 30 cases, 7 of which had a history of breast cancer, 14 of which had no history of breast cancer, and 9 of which had an unknown history. The average age of PSO patients was 48.86 years old (range, 31-64 years). The average time interval between the diagnosis of PPC and preventive surgery was 61.03 mo (range, 12-292 mo). The 2-year survival rate for this patient population was 78.26% (18/23), the 3-year survival rate was 50.00% (9/18), and the 5-year survival rate was 6.25% (1/16).
CONCLUSION Patients with BRCA mutations who are diagnosed with PPC after preventative surgery have a poor prognosis. Prevention measures and treatments for these patients need more attention.
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Affiliation(s)
- Ya-Na Ma
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Hua-Lei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Cheng-Juan Jin
- Department of Obstetrics and Gynecology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201620, China
| | - Xia Wang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - You-Zhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Hui Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
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5
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Grill S, Yahiaoui-Doktor M, Dukatz R, Lammert J, Ullrich M, Engel C, Pfeifer K, Basrai M, Siniatchkin M, Schmidt T, Weisser B, Rhiem K, Ditsch N, Schmutzler R, Bischoff SC, Halle M, Kiechle M. Smoking and physical inactivity increase cancer prevalence in BRCA-1 and BRCA-2 mutation carriers: results from a retrospective observational analysis. Arch Gynecol Obstet 2017; 296:1135-1144. [DOI: 10.1007/s00404-017-4546-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/19/2017] [Indexed: 12/22/2022]
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6
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Hollis RL, Churchman M, Gourley C. Distinct implications of different BRCA mutations: efficacy of cytotoxic chemotherapy, PARP inhibition and clinical outcome in ovarian cancer. Onco Targets Ther 2017; 10:2539-2551. [PMID: 28546758 PMCID: PMC5436779 DOI: 10.2147/ott.s102569] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Approximately a fifth of ovarian carcinoma (OC) is associated with inherited germline mutations, most commonly in the DNA repair genes BRCA1 or BRCA2 (BRCA). BRCA1- and BRCA2-associated OCs have historically been described as a single subgroup of OC that displays a distinct set of characteristics termed the "BRCAness" phenotype. The hallmarks of this phenotype are superior clinical outcome and hypersensitivity to platinum-based chemotherapy and poly-(ADP-ribose) polymerase (PARP) inhibitors. However, growing evidence suggests that BRCA1- and BRCA2-associated OCs display distinct characteristics, most notably in long-term patient survival. Furthermore, recent data indicate that the site of BRCA1 mutation is important with regard to platinum and PARP inhibitor sensitivity. Here, we summarize the body of research describing the BRCAness phenotype and highlight the differential implications of different BRCA mutations with regard to clinicopathologic features, therapy sensitivity and clinical outcome in OC.
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Affiliation(s)
- Robert L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Edinburgh Cancer Research UK Centre, MRC IGMM, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Edinburgh Cancer Research UK Centre, MRC IGMM, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Edinburgh Cancer Research UK Centre, MRC IGMM, Western General Hospital, University of Edinburgh, Edinburgh, UK
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7
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Managing hereditary breast cancer risk in women with and without ovarian cancer. Gynecol Oncol 2017; 146:205-214. [PMID: 28454658 DOI: 10.1016/j.ygyno.2017.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/16/2017] [Accepted: 04/19/2017] [Indexed: 12/12/2022]
Abstract
Current guidelines recommend that all women with ovarian cancer undergo germline genetic testing for BRCA1/2. Increasingly, genetic testing is being performed via panels that include other genes that confer a high or moderate risk of breast cancer. In addition, many women with a family history of breast or ovarian cancer are not found to have a mutation, but may have increased risk of breast cancer for which surveillance and risk reduction strategies are indicated. This review discusses how to assess and manage an increased risk of breast cancer through surveillance, preventive medications, and risk-reducing surgery. Assessing and managing the increased risk of breast cancer in BRCA1/2 mutation carriers after a diagnosis of ovarian cancer can be challenging. For the first few years after an ovarian cancer diagnosis, BRCA1/2 mutation carriers have a relatively low risk of breast cancer, and their prognosis is largely determined by the ovarian cancer. However, if these women remain in remission after two years, the risk of breast cancer becomes comparable with, and in some cases exceeds, their risk of ovarian cancer recurrence. For these women, breast cancer surveillance and risk reduction becomes important to their overall health. Specifically, for BRCA1/2 carriers who are diagnosed with early-stage ovarian cancer, we recommend regular breast cancer surveillance and consideration of risk reduction with medication and/or prophylactic mastectomy. For women with advanced ovarian cancer who do not achieve remission, breast cancer surveillance or prophylaxis is not of value. However, among carriers with more favorable advanced disease, it is reasonable to initiate breast cancer surveillance. Patients with less favorable advanced stage disease who achieve sustained remission (>2-5years) should also consider more aggressive strategies for breast cancer screening and prevention. For mutation carriers who remain in remission after five years, prophylactic mastectomy can be considered.
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8
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Houben E, van Haalen HGM, Sparreboom W, Overbeek JA, Ezendam NPM, Pijnenborg JMA, Severens JL, van Herk-Sukel MPP. Chemotherapy for ovarian cancer in the Netherlands: a population-based study on treatment patterns and outcomes. Med Oncol 2017; 34:50. [PMID: 28224447 DOI: 10.1007/s12032-017-0901-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 12/28/2022]
Abstract
Information on treatment patterns for ovarian cancer (OC) is limited. The aim of this study was to describe current patterns of chemotherapy and other systemic treatments for OC in the Netherlands and evaluate survival outcomes following subsequent lines of treatment. Data from the Eindhoven Cancer Registry, including on newly diagnosed cancer patients, were linked to the PHARMO Database Network, including information on in- and out-patient drug use. Patients diagnosed with OC between January 2000 and December 2010 were selected. An algorithm was used to identify separate lines of treatment. Data were studied descriptively. Detailed data on systemic drug use were available for 261 patients (17%) with OC. In first-line treatment, 87% of the patients (227/261) received platinum-based chemotherapy. Of the 161 patients receiving second-line treatment, 101 patients (63%) received platinum-based chemotherapy. In third line, this was 51% (53/103). The median number of treatment lines received by patients was two (interquartile range 1-3), and eight or more lines of chemotherapy were identified for 12 patients. Median survival from diagnosis onwards was 47 months from the end of first-line treatment, median survival was 32 months, and from the end of second-line treatment, it was 14 months. Predominantly beyond second-line treatment, there is much variety in treatment patterns with chemotherapy for OC. Although uncertainty remains regarding the desirability of this observed treatment variation, there seems a need for detailed clinical guidance, assuring that physicians can properly choose the most suitable treatment for each patient.
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Affiliation(s)
- E Houben
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands.
| | - H G M van Haalen
- AstraZeneca BV, Zoetermeer, The Netherlands.,Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| | - N P M Ezendam
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J L Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M P P van Herk-Sukel
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
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9
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Zaaijer LH, van Doorn HC, Mourits MJE, van Beurden M, de Hullu JA, Adank MA, van Lonkhuijzen LRCW, Vasen HFA, Slangen BFM, Gaarenstroom KN, Zweemer RP, Vencken PMLH, Seynaeve C, Kriege M. Outcome of ovarian cancer after breast cancer in BRCA1 and BRCA2 mutation carriers. Br J Cancer 2016; 115:1174-1178. [PMID: 27755534 PMCID: PMC5104898 DOI: 10.1038/bjc.2016.333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is unknown whether a history of breast cancer (BC) affects the outcome of BRCA1/2-associated epithelial ovarian cancer (EOC). This was investigated in the current analysis. METHODS We included 386 BRCA1/2-associated EOC patients diagnosed between 1980 and 2015. Progression-free survival (PFS), progression-free interval (PFI), overall survival (OS) and ovarian cancer-specific survival (OCSS) were compared between EOC patients with and without previous BC. RESULTS BRCA-associated EOC patients with, vs without, a BC history had a significantly worse PFS and PFI (multivariate hazard ratio (HRmult) 1.47; 95% confidence interval (CI) 1.03-2.08 and HRmult 1.43; 95% CI 1.01-2.03), and a non-significantly worse OS (HRmult 1.15; 95% CI 0.84-1.57) and OCSS (HRmult 1.18; 95% CI 0.85-1.62). Ovarian cancer-specific survival was significantly worse for the subgroup treated with adjuvant chemotherapy for BC (HRmult 1.99; 95% CI 1.21-3.31). CONCLUSIONS Our results suggest that BRCA1/2-associated EOC patients with a previous BC have a worse outcome than EOC patients without BC, especially when treated with adjuvant chemotherapy.
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Affiliation(s)
- Leendert H Zaaijer
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Helena C van Doorn
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marian J E Mourits
- Department of Obstetrics and Gynaecology, Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marc van Beurden
- Department of Obstetrics and Gynaecology, Netherlands Cancer Institute NKI-AVL, Amsterdam, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Muriel A Adank
- Department of Clinical Genetics, VU Medical Centre, Amsterdam, The Netherlands
| | | | - Hans F A Vasen
- Foundation for the Detection of Hereditary Tumours (STOET), Leiden, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ronald P Zweemer
- Department Gynaecological Oncology, UMC Utrecht Cancer Centre, Utrecht, The Netherlands
| | - Peggy M L H Vencken
- Department of Obstetrics and Gynaecology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Caroline Seynaeve
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Mieke Kriege
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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10
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Slade I, Hanson H, George A, Kohut K, Strydom A, Wordsworth S, Rahman N. A cost analysis of a cancer genetic service model in the UK. J Community Genet 2016; 7:185-94. [PMID: 26922077 PMCID: PMC4960025 DOI: 10.1007/s12687-016-0266-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/27/2016] [Indexed: 12/27/2022] Open
Abstract
Technological advances in DNA sequencing have made gene testing fast and more affordable. Evidence of effectiveness and cost-effectiveness of genetic service models is essential for the successful translation of sequencing improvements for patient benefit, but remain sparse in the genetics literature. In particular, there is a lack of detailed cost data related to genetic services. A detailed micro-costing of 28 possible pathways relating to breast and/or ovarian cancer and BRCA testing was carried out by defining service activities and establishing associated costs. These data were combined with patient-level data from a Royal Marsden Cancer Genetics Service audit over a 6-month period during which BRCA testing was offered to individuals at ≥10 % risk of having a mutation, in line with current NICE guidance. The average cost across all patient pathways was £2227.39 (range £376.51 to £13,553.10). The average cost per pathway for an affected person was £1897.75 compared to £2410.53 for an unaffected person. Of the women seen in the Cancer Genetics Service during the audit, 38 % were affected with breast and/or ovarian cancer, and 62 % were unaffected but concerned about their family history. The most efficient service strategy is to identify unaffected relatives from an affected individual with an identified BRCA mutation. Implementation of this strategy would require more comprehensive testing of all eligible cancer patients, which could be achieved by integrating BRCA testing into oncology services. Such integration would be also more time-efficient and deliver greater equity of access to BRCA testing than the standard service model.
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Affiliation(s)
- Ingrid Slade
- Oxford University Hospitals NHS Trust, Oxford, UK.
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
- The Ethox Centre, University of Oxford, Oxford, UK.
| | - Helen Hanson
- The Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Angela George
- The Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Kelly Kohut
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Ann Strydom
- The Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- TGLclinical, The Institute of Cancer Research, London, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Nazneen Rahman
- The Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
- TGLclinical, The Institute of Cancer Research, London, UK
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11
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Szatkowski W, Blecharz P, Mituś JW, Jasiówka M, Łuczyńska E, Jakubowicz J, Byrski T. Prognostic factors in Polish patients with BRCA1-dependent ovarian cancer. Hered Cancer Clin Pract 2016; 14:4. [PMID: 26807161 PMCID: PMC4724399 DOI: 10.1186/s13053-015-0041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/07/2015] [Indexed: 11/24/2022] Open
Abstract
Background Treatment outcomes appear to be better for ovarian cancer (OC) patients carrying the BRCA1/2 germline mutation than for patients with sporadic OC. However, most published data are for North American, British and Jewish populations. There have been very few studies on treatment outcomes in Central and Eastern European patients with OC. The aim of this study was to analyse prognostic factors in Polish patients with BRCA1-dependent OC (BRCA1-OC). Methods The records of patients with OC treated with surgery and chemotherapy at the Centre of Oncology in Kraków, Poland, between 2004 and 2009 were reviewed. Based on family history, a group of 249 consecutive patients fulfilling the criteria for risk of hereditary OC were selected and tested for the germline BRCA1 mutation. Response to combination therapy (surgery and chemotherapy) in the BRCA1-OC group was assessed based on clinical examination, imaging and serum CA125. Results Germline BRCA1 mutations were detected in 69 of the 249 patients, but three of these patients failed to complete the study. Finally, 66 patients with BRCA1-OC were included in the study group. The median age of the study patients was 49.5 years. All had undergone primary or interval cytoreductive surgery and chemotherapy. Progression occurred in 48 (72.7 %) of the 66 patients and median time to progression was 20 months. The 5-year overall survival rate in was 43.9 % and median survival time was 32.3 months. On multivariate analysis, the endometrial subtype of OC and serum CA125 < 12.5 U/ml at the end of treatment were independent, positive prognostic factors for 5-year overall survival. Conclusion Prognostic factors for favourable treatment outcomes in Polish patients with BRCA1-OC do not appear to differ from those in patients with sporadic OC. The incidence of the endometrial subtype of OC was relatively high (34.9 %) among women in the study. This was unexpected and has not been reported previously. This subtype of OC was an independent prognostic factor for favourable treatment outcomes.
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Affiliation(s)
- Wiktor Szatkowski
- Department of Gynaecological Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Kraków Branch, ul. Garncarska 11, 31-115 Kraków, Poland
| | - Paweł Blecharz
- Department of Gynaecological Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Kraków Branch, ul. Garncarska 11, 31-115 Kraków, Poland
| | - Jerzy W Mituś
- Department of Surgical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Kraków Branch, ul. Garncarska 11, 31-115 Kraków, Poland ; Department of Anatomy, Collegium Medicum, Jagiellonian University, ul. Kopernika 12, 31-034 Kraków, Poland
| | - Marek Jasiówka
- Department of Medical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Kraków Branch, ul. Garncarska 11, 31-115 Kraków, Poland
| | - Elżbieta Łuczyńska
- Department of Radiology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Kraków Branch, ul. Garncarska 11, 31-115 Kraków, Poland
| | - Jerzy Jakubowicz
- Department of Radiotherapy, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Kraków Branch, ul. Garncarska 11, 31-115 Kraków, Poland
| | - Tomasz Byrski
- Department of Genetics and Pathology, International Hereditary Cancer Center and Clinic of Oncology Pomeranian Medical University, Szczecin, ul. Połabska 4, 70-115 Szczecin, Poland
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12
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Harmsen MG, Arts-de Jong M, Hoogerbrugge N, Maas AHEM, Prins JB, Bulten J, Teerenstra S, Adang EMM, Piek JMJ, van Doorn HC, van Beurden M, Mourits MJE, Zweemer RP, Gaarenstroom KN, Slangen BFM, Vos MC, van Lonkhuijzen LRCW, Massuger LFAG, Hermens RPMG, de Hullu JA. Early salpingectomy (TUbectomy) with delayed oophorectomy to improve quality of life as alternative for risk-reducing salpingo-oophorectomy in BRCA1/2 mutation carriers (TUBA study): a prospective non-randomised multicentre study. BMC Cancer 2015; 15:593. [PMID: 26286255 PMCID: PMC4541725 DOI: 10.1186/s12885-015-1597-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/11/2015] [Indexed: 01/12/2023] Open
Abstract
Background Risk-reducing salpingo-oophorectomy (RRSO) around the age of 40 is currently recommended to BRCA1/2 mutation carriers. This procedure decreases the elevated ovarian cancer risk by 80–96 % but it initiates premature menopause as well. The latter is associated with short-term and long-term morbidity, potentially affecting quality of life (QoL). Based on recent insights into the Fallopian tube as possible site of origin of serous ovarian carcinomas, an alternative preventive strategy has been put forward: early risk-reducing salpingectomy (RRS) and delayed oophorectomy (RRO). However, efficacy and safety of this alternative strategy have to be investigated. Methods A multicentre non-randomised trial in 11 Dutch centres for hereditary cancer will be conducted. Eligible patients are premenopausal BRCA1/2 mutation carriers after completing childbearing without (a history of) ovarian carcinoma. Participants choose between standard RRSO at age 35–40 (BRCA1) or 40–45 (BRCA2) and the alternative strategy (RRS upon completion of childbearing and RRO at age 40–45 (BRCA1) or 45–50 (BRCA2)). Women who opt for RRS but do not want to postpone RRO beyond the currently recommended age are included as well. Primary outcome measure is menopause-related QoL. Secondary outcome measures are ovarian/breast cancer incidence, surgery-related morbidity, histopathology, cardiovascular risk factors and diseases, and cost-effectiveness. Mixed model data analysis will be performed. Discussion The exact role of the Fallopian tube in ovarian carcinogenesis is still unclear. It is not expected that further fundamental research will elucidate this role in the near future. Therefore, this clinical trial is essential to investigate RRS with delayed RRO as alternative risk-reducing strategy in order to improve QoL. Trial registration ClinicalTrials.gov (NCT02321228)
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Affiliation(s)
- Marline G Harmsen
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Marieke Arts-de Jong
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Steven Teerenstra
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Eddy M M Adang
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Jurgen M J Piek
- Gynaecologic Oncologic Center South location Elisabeth-TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands. .,Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Helena C van Doorn
- Department of Gynaecology, Erasmus MC Cancer Clinic, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Marc van Beurden
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Marian J E Mourits
- Department of Gynaecology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - M Caroline Vos
- Gynaecologic Oncologic Center South, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
| | - Luc R C W van Lonkhuijzen
- Center for Gynaecological Oncology Amsterdam (CGOA), AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Leon F A G Massuger
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Joanne A de Hullu
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
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13
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Harmsen MG, Hermens RPMG, Prins JB, Hoogerbrugge N, de Hullu JA. How medical choices influence quality of life of women carrying a BRCA mutation. Crit Rev Oncol Hematol 2015; 96:555-68. [PMID: 26299336 DOI: 10.1016/j.critrevonc.2015.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/19/2015] [Accepted: 07/16/2015] [Indexed: 12/24/2022] Open
Abstract
Germline mutations in BRCA1 and BRCA2 genes were discovered twenty years ago. Female BRCA mutation carriers have an increased risk of breast and ovarian cancer at a relatively young age. Several choices have to be made with respect to cancer risk management, and consequences of these choices may affect quality of life. A review of the literature was performed to evaluate quality of life in unaffected BRCA mutation carriers and the influence of these medical choices. Overall, general quality of life appears not to be permanently affected in BRCA mutation carriers or by their choices. Risk-reducing salpingo-oophorectomy and its subsequent premature menopause affect (menopause specific) quality of life most. Hormone replacement therapy does not fully alleviate climacteric symptoms and therefore, there is a strong need for alternative strategies to reduce ovarian cancer risk and/or for improvements in postoperative care. Future research should focus on these needs.
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Affiliation(s)
- Marline G Harmsen
- Department of Obstetrics & Gynaecology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics & Gynaecology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Ricci MT, Sciallero S, Mammoliti S, Gismondi V, Franiuk M, Bruzzi P, Varesco L. Referral of Ovarian Cancer Patients for Genetic Counselling by Oncologists: Need for Improvement. Public Health Genomics 2015; 18:225-32. [DOI: 10.1159/000431352] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/13/2015] [Indexed: 11/19/2022] Open
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15
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Affiliation(s)
- Nazneen Rahman
- The Institute of Cancer Research, Sutton, Surrey, UKThe Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
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16
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Realizing the promise of cancer predisposition genes. Nature 2014; 505:302-8. [PMID: 24429628 DOI: 10.1038/nature12981] [Citation(s) in RCA: 411] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 11/21/2013] [Indexed: 12/14/2022]
Abstract
Genes in which germline mutations confer highly or moderately increased risks of cancer are called cancer predisposition genes. More than 100 of these genes have been identified, providing important scientific insights in many areas, particularly the mechanisms of cancer causation. Moreover, clinical utilization of cancer predisposition genes has had a substantial impact on diagnosis, optimized management and prevention of cancer. The recent transformative advances in DNA sequencing hold the promise of many more cancer predisposition gene discoveries, and greater and broader clinical applications. However, there is also considerable potential for incorrect inferences and inappropriate clinical applications. Realizing the promise of cancer predisposition genes for science and medicine will thus require careful navigation.
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