1
|
Sorin V, Bufman H, Bernstein-Molho R, Faermann R, Friedman E, Raskin D, Balint Lahat N, Sklair-Levy M. Breast cancer screening in BRCA1/2 pathogenic sequence variant carriers during pregnancy and lactation. Clin Imaging 2024; 111:110189. [PMID: 38759599 DOI: 10.1016/j.clinimag.2024.110189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Women harboring germline BRCA1/BRCA2 pathogenic sequence variants (PSVs) are at an increased risk for breast cancer. There are no established guidelines for screening during pregnancy and lactation in BRCA carriers. The aim of this study was to evaluate the utility of whole-breast ultrasound (US) screening in pregnant and lactating BRCA PSV carriers. METHODS Data were retrospectively collected from medical records of BRCA PSV carriers between 2014 and 2020, with follow-up until 2021. Associations between imaging intervals, number of examinations performed and pregnancy-associated breast cancers (PABCs) were examined. PABCs and cancers diagnosed at follow-up were evaluated and characteristics were compared between the two groups. RESULTS Overall 212 BRCA PSV carriers were included. Mean age was 33.6 years (SD 3.93, range 25-43 years). During 274 screening periods at pregnancy and lactation, eight (2.9 %) PABCs were diagnosed. An additional eight cancers were diagnosed at follow-up. Three out of eight (37.5 %) PABCs were diagnosed by US, whereas clinical breast examination (n = 3), mammography (n = 1) and MRI (n = 1) accounted for the other PACB diagnoses. One PABC was missed by US. The interval from negative imaging to cancer diagnosis was significantly shorter for PABCs compared with cancers diagnosed at follow-up (3.96 ± 2.14 vs. 11.2 ± 4.46 months, P = 0.002). CONCLUSION In conclusion, pregnant BRCA PSV carriers should not delay screening despite challenges like altered breast tissue and hesitancy towards mammography. If no alternatives exist, whole-breast ultrasound can be used. For lactating and postpartum women, a regular screening routine alternating between mammography and MRI is recommended.
Collapse
Affiliation(s)
- Vera Sorin
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel.
| | - Hila Bufman
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| | - Rinat Bernstein-Molho
- The Faculty of Medicine, Tel-Aviv University, Israel; Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Renata Faermann
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| | - Eitan Friedman
- The Faculty of Medicine, Tel-Aviv University, Israel; Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Daniel Raskin
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| | - Nora Balint Lahat
- The Faculty of Medicine, Tel-Aviv University, Israel; Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Miri Sklair-Levy
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| |
Collapse
|
2
|
Bernstein-Molho R, Shhada NA, Laitman Y, Netzer I, Shoval S, Friedman E. Targeted genotyping for recurring variants in cancer susceptibility genes in non-Ashkenazi Jewish patients with breast cancer diagnosed ≥50 years. Cancer 2024. [PMID: 38630906 DOI: 10.1002/cncr.35329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Several recurring pathogenic variants (PVs) in BRCA1/BRCA2 and additional cancer susceptibility genes are described in the ethnically diverse Israeli population. Since 2019, testing for these recurring PVs is reimbursed unselectively for all patients with breast cancer (BC) in Israel. The aim was to evaluate the yield of genotyping for these PVs in non-Ashkenazi Jewish (AJ) patients with BC diagnosed ≥age 50 years. METHODS Clinical and genotyping data of all patients with BC undergoing oncogenetic counseling at the Oncology Institute at Sheba Medical Center from June 2017 to December 2023 were reviewed. RESULTS Of 2706 patients with BC (mean age at diagnosis, 54 years; range, 20-92 years) counseled, 515 patients of non-AJ (all four grandparents) descent, diagnosed ≥age 50 years of age were genotyped, 55 with triple-negative BC (TNBC) and 460 with non-TNBC. One of the recurring PVs in BRCA1/BRCA2 were detected in 12.7% (7/55) of TNBC patients and 0.65% (3/460) of non-TNBC. One patient with non-TNBC had PMS2 PV. Low-penetrance variants were found in 2.5% of genotyped TNBC and in 3.7% of patients with non-TNBC, including CHEK2 c.499G>A (n = 3), APC c.3920T > A (n = 4), and heterozygous MUTYH c.1187G>A (n = 5). Following first-pass genotyping, 146 patients performed multigene panel testing, none carried a BRCA1/BRCA2 PV, and only 5/127 non-TNBC (3.9%) harbored PVs in CHEK2 (n = 2, c.846+1G>C and c.592+3A>T), ATM c.103C>T (n = 2), and NBN c.966C>G (n = 1). CONCLUSIONS The observed low rates of PV detection in non-AJ non-TNBC cases ≥age 50 years at diagnosis, mostly for clinically insignificant variants, questions the justification of unselected genotyping in this subset of patients.
Collapse
Affiliation(s)
- Rinat Bernstein-Molho
- The Suzanne Levy-Gertner Oncogenetics Unit, Sheba Tel Hashomer Medical Center, Ramat-Gan, Israel
- Faculty of Medical and Health Sciences, School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Narmeen Abu Shhada
- Breast cancer Institute, The Jusidman Cancer Center, Sheba Tel Hashomer Medical Center, Ramat-Gan, Israel
| | - Yael Laitman
- The Suzanne Levy-Gertner Oncogenetics Unit, Sheba Tel Hashomer Medical Center, Ramat-Gan, Israel
| | - Iris Netzer
- The Suzanne Levy-Gertner Oncogenetics Unit, Sheba Tel Hashomer Medical Center, Ramat-Gan, Israel
| | - Shelley Shoval
- The Suzanne Levy-Gertner Oncogenetics Unit, Sheba Tel Hashomer Medical Center, Ramat-Gan, Israel
| | - Eitan Friedman
- Faculty of Medical and Health Sciences, School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Meirav high-risk clinic - Sheba Tel Hashomer Medical Center, Ramat-Gan, Israel
| |
Collapse
|
3
|
Laish I, Schechter M, Dancour A, Lieberman S, Levi Z, Goldberg Y, Kedar I, Hasnis E, Half E, Levi GR, Katz L, Vainer ED, Genzel D, Aharoni M, Chen-Shtoyerman R, Abu-Freha N, Raitses-Gurevich M, Golan T, Bernstein-Molho R, Ben Yehoyada M, Gluck N, Rosner G. The benefit of pancreatic cancer surveillance in carriers of germline BRCA1/2 pathogenic variants. Cancer 2024; 130:256-266. [PMID: 37861363 DOI: 10.1002/cncr.35052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/22/2023] [Accepted: 08/03/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Surveillance of high-risk individuals for pancreatic ductal adenocarcinoma (PDAC) is recommended. This study aimed to determine the prevalence and outcomes of PDAC and its precursor lesions in BRCA1/2 pathogenic variants (PVs) carriers undergoing pancreatic surveillance. METHODS A retrospective multicenter cohort study of pancreatic surveillance outcomes in Israeli BRCA1/2 carriers preferably with a family history of PDAC. RESULTS A total of 180 asymptomatic carriers participated in the screening programs, including 57 (31.7%) with BRCA1 PVs, 121 (67.2%) with BRCA2 PVs, and 12 (6.6%) with PVs in BRCA1/2 and other genes, for a median follow-up period of 4 years. Ninety-one individuals (50.5%) fulfilled the International Cancer of the Pancreas Screening (CAPS) criteria for surveillance whereas 116 (64.4%) fulfilled the American College of Gastroenterology (ACG) criteria. There were four cases of adenocarcinoma and four cases of grade 1-neuroendocrine tumor (G1-NET). All were BRCA2 carriers, and two had no family history of PDAC. Three cancer patients were at resectable stages (IA, IIA, IIB) whereas one had a stage IIIB tumor. Of the G1-NET cases, one had surgery and the others were only followed. Success rate for detection of confined pancreatic carcinoma was thus 1.6% (three of 180) in the whole cohort, 1.6% (two of 116) among individuals who fulfilled ACG criteria and 2.2% (two of 91) in those fulfilling CAPS criteria for surveillance. CONCLUSIONS Despite the low detection rate of PDAC and its' high-risk neoplastic precursor lesions among BRCA1/2 carriers undergoing pancreatic surveillance, 75% of cancer cases were detected at a resectable stage.
Collapse
Affiliation(s)
- Ido Laish
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menachem Schechter
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Alain Dancour
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sari Lieberman
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Zohar Levi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gastroenterology Institute, Beilinson Hospital, Petah Tikva, Israel
| | - Yael Goldberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Raphael Recanati Genetics Institute, Beilinson Hospital, Petah Tikva, Israel
| | - Inbal Kedar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Raphael Recanati Genetics Institute, Beilinson Hospital, Petah Tikva, Israel
| | - Erez Hasnis
- Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel
| | - Elizabeth Half
- Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel
| | | | - Lior Katz
- Section of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Elez D Vainer
- Section of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dor Genzel
- Section of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Maya Aharoni
- Gastroenterology Institute, Kaplan Medical Center, Rehovot, Israel
| | - Rakefet Chen-Shtoyerman
- The Genetic Institute, Kaplan Medical Center, Rehovot, Israel
- The Adelson School of Medicine and the Molecular Biology Department, Ariel University, Ariel, Israel
| | - Naim Abu-Freha
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Maria Raitses-Gurevich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Talia Golan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Rinat Bernstein-Molho
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Merav Ben Yehoyada
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nathan Gluck
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Guy Rosner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
4
|
Jia KY, Menes TS, Bernstein-Molho R, Nissan A, Zippel D. Characterization of patients with a diagnosis of breast cancer and melanoma: genetic susceptibility or increased surveillance? Eur J Cancer Prev 2023; 32:418-422. [PMID: 36912151 DOI: 10.1097/cej.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Breast cancer diagnosis had been linked to an increased risk of melanoma in several reports. The aim of the current study was to assess the role of genetics, increased surveillance, and radiation treatment in patients with a dual diagnosis of breast cancer and melanoma (DBM). MATERIALS AND METHODS All patients treated at Sheba Medical Center between 2007 and 2021 with DBM were included in the cohort. Data on family history, genetic tests, characteristics, and treatment of both cancers were collected. The proportion of patients with a pathogenic variant (PV) in BRCA1 and BRCA2 genes was compared to a control group of patients with breast cancer. The proportion of patients presenting with in-situ disease was compared to the national registry data. RESULTS The cohort included 222 DBM patients of whom 114 had documentation of genetic testing. Twenty patients tested positive for PVs of which 13 (11%) were in BRCA genes. This was comparable to the proportion in patients with a diagnosis of breast cancer (736; 19%). The proportion of melanoma diagnosed at stage 0 was comparable to the national proportion ( N = 40; 30% vs. 28%, respectively). In comparison to the national registry, a larger proportion of breast cancers were ductal carcinoma in situ or lobular carcinoma in situ [10% in the registry vs. 19% (22) in the cohort; P < 0.003]. CONCLUSIONS In patients with DBM we did not find an increased proportion of PVs in BRCA genes. Our findings suggest that the increased standardized incidence ratio of the dual diagnosis may be partially explained by increased surveillance and detection of earlier-stage cancers.
Collapse
Affiliation(s)
- Karen Y Jia
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York, USA
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Tehillah S Menes
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer
| | - Rinat Bernstein-Molho
- Susanne Levy Gertner Oncogenetics Unit, The Danek Gertner Institute of Human Genetics, Chaim, Israel
| | - Aviram Nissan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer
| | - Dov Zippel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer
| |
Collapse
|
5
|
Eshet Y, Tau N, Levanon K, Bernstein-Molho R, Globus O, Itay A, Shapira T, Oedegaard C, Eifer M, Davidson T, Nidam M, Gal-Yam E, Domachevsky L. The Role of 68 Ga-FAPI PET/CT in Breast Cancer Response Assessment and Follow-Up. Clin Nucl Med 2023; 48:685-688. [PMID: 37339456 DOI: 10.1097/rlu.0000000000004744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE 68 Ga-fibroblast activation protein inhibitor (FAPI), a new PET/CT radiotracer targeting cancer-associated fibroblasts in tumor microenvironment, can detect many types of cancer. We aimed to assess whether it can also be used for response assessment and follow-up. METHODS We followed up patients with FAPI-avid invasive lobular breast cancer (ILC) before and after treatment changes and correlated qualitative maximal intensity projection images and quantitative tumor volume with CT results and blood tumor biomarkers. RESULTS Six consenting ILC breast cancer patients (53 ± 8 years old) underwent a total of 24 scans (baseline for each patient and 2-4 follow-up scans). We found a strong correlation between 68 Ga-FAPI tumor volume and blood biomarkers ( r = 0.7, P < 0.01), but weak correlation between CT and 68 Ga-FAPI maximal intensity projection-based qualitative response assessment. CONCLUSIONS We found a strong correlation between ILC progression and regression (as assessed by blood biomarkers) and 68 Ga-FAPI tumor volume. 68 Ga-FAPI PET/CT could possibly be used for disease response assessment and follow-up.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Meital Nidam
- From the Department of Nuclear Imaging, Sheba Medical Center, Ramat Gan
| | | | | |
Collapse
|
6
|
Michaelson-Cohen R, Laitman Y, Kedar I, Baris-Feldman H, Reish O, Lieberman S, Bernstein-Molho R, Goldberg Y, Reznick Levi G, Gershoni R, Beller U, Levy-Lahad E, Catan R, Friedman E. [GENOTYPE-PHENOTYPE CORRELATIONS BY SPECIFIC FOUNDER VARIANTS IN BRCA IN ISRAELI WOMEN]. Harefuah 2023; 162:370-375. [PMID: 37394440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Hereditary breast and ovarian cancer (HBOC) is predominantly accounted for by pathogenic variants (PVs) in BRCA1/BRCA2 genes. Population screening for recurring PVs in Ashkenazi Jews (AJ) was incorporated into the Israeli health basket in 2020, increasing the identification of BRCA carriers. Information on cancer risks for each PV in Israel is limited. AIMS To assess genotype phenotype correlations of recurring BRCA PVs in Israeli carriers. METHODS A retrospective cohort of 3,478 BRCA carriers followed-up in 12 medical centers, comprising the HBOC Consortium, formed the basis of the study. Data were collected using the electronic database, and analyzed by Chi square, t-tests and Kaplan-Meier survival analysis. RESULTS Overall, 2145 BRCA1, 1131 BRCA2, and 22 double heterozygote PV carriers were analyzed. BRCA1 carriers had more cases of cancer (53.1% vs. 44.8%, p<0.001), ovarian cancer (OC) (17.1% vs. 10.6%, p<0.001), younger age at breast cancer (BC) (45.4 ±11.6SD years vs. 49.1 ±11.1SD years, p<0.001) and OC diagnosis (52.8 ±10.1SD yrs. vs. 61±10.6SD yrs. p<0.001), and more family history of BC (64.5% vs. 59.0%, p<0.001) and OC (36.7% vs. 27.3%, p<0.001) compared with BRCA2 carriers. Carriers of BRCA15382insC had more BC and less OC than BRCA1185delAG: 46.4% vs. 38.6% and 12.9% vs. 17.6% (p<0.04), respectively. CONCLUSIONS In our population, similar to others, BRCA1 carriers have higher cancer rates and earlier age at diagnosis compared with BRCA2 carriers. The two recurring BRCA1 PVs have different risks: 5382insC carriers had more BC; 185delAG carriers had more OC. Risk-reducing measures should be based on variant-specific cancer risk.
Collapse
Affiliation(s)
- Rachel Michaelson-Cohen
- Medical Genetics Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem
| | - Yael Laitman
- Oncogenetics Unit, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University
| | - Inbal Kedar
- Recanati Genetics Institute, Beilinson Medical Center, Sackler Faculty of Medicine, Tel Aviv University
| | - Hagit Baris-Feldman
- Genetics Institute, Ichilov Medical Center, Sackler Faculty of Medicine, Tel Aviv University
| | - Orit Reish
- Genetics Institute, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University
| | - Sari Lieberman
- Medical Genetics Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem
| | - Rinat Bernstein-Molho
- Oncogenetics Unit, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University
| | - Yael Goldberg
- Recanati Genetics Institute, Beilinson Medical Center, Sackler Faculty of Medicine, Tel Aviv University
| | | | | | - Uzi Beller
- Medical Genetics Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem
| | - Ephrat Levy-Lahad
- Medical Genetics Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem
| | - Raphael Catan
- Oncology Institute, Shaare Zedek Medical Center, Sackler Faculty of Medicine, Tel Aviv University
| | - Eitan Friedman
- Oncogenetics Unit, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University
| |
Collapse
|
7
|
Laitman Y, Bernstein-Molho R, Golan T, Friedman E. Loss of Function RET Gene Variant and Cancer: Co-occurrence or an Association? Isr Med Assoc J 2023; 25:445-446. [PMID: 37381943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- Yael Laitman
- Levy Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Rinat Bernstein-Molho
- Oncology Institute, Sheba Medical Center, Tel Hashomer, Israel, Levy Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Golan
- Oncology Institute, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Friedman
- Meirav High Risk Clinic, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Eshet Y, Tau N, Apter S, Nissan N, Levanon K, Bernstein-Molho R, Globus O, Itay A, Shapira T, Oedegaard C, Gorfine M, Eifer M, Davidson T, Gal-Yam E, Domachevsky L. The Role of 68 Ga-FAPI PET/CT in Detection of Metastatic Lobular Breast Cancer. Clin Nucl Med 2023; 48:228-232. [PMID: 36638243 DOI: 10.1097/rlu.0000000000004540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Invasive lobular breast cancer (ILC) may be hard to detect using conventional imaging modalities and usually shows less avidity to 18 F-FDG PET/CT. 68 Ga-fibroblast activation protein inhibitor (FAPI) PET/CT has shown promising results in detecting non- 18 F-FDG-avid cancers. We aimed to assess the feasibility of detecting metastatic disease in patients with non- 18 F-FDG-avid ILC. METHODS This prospective study included patients with metastatic ILC, infiltrative to soft tissues, which was not 18 F-FDG avid. The patients underwent 68 Ga-FAPI PET/CT for evaluation, which was correlated with the fully diagnostic CT performed at the same time. RESULTS Seven women (aged 57 ± 10 years) were included. Among the 30 organs and structures found to be involved by tumor, the number of findings observed by FAPI PET/CT was significantly higher than that observed by CT alone ( P = 0.022), especially in infiltrative soft tissue and serosal locations. CONCLUSIONS This small pilot trial suggests a role for 68 Ga-FAPI PET/CT in ILC, which needs to be confirmed by subsequent trials.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Malka Gorfine
- Department of Statistics and Operations Research, Tel-Aviv University, Tel Aviv, Israel
| | | | | | | | | |
Collapse
|
9
|
Halperin R, Arnon L, Nasirov S, Friedensohn L, Gershinsky M, Telerman A, Friedman E, Bernstein-Molho R, Tirosh A. Germline CDKN1B variant type and site are associated with phenotype in MEN4. Endocr Relat Cancer 2023; 30:ERC-22-0174. [PMID: 36256846 DOI: 10.1530/erc-22-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Multiple endocrine neoplasia 4 (MEN4) is a rare multiglandular endocrine neoplasia syndrome clinically hallmarked by primary hyperparathyroidism (PHPT), pituitary adenoma (PitAd), and neuroendocrine tumors (NET), clinically overlapping MEN1. The underlying mutated gene - CDKN1B, encodes for the cell-cycle regulator p27. Possible genotype-phenotype correlations in MEN4 have not been thoroughly assessed. Prompted by the findings in three Israeli MEN4 kindreds, we performed a literature review on published and unpublished data from previously reported MEN4/CDKN1B cases. Univariate analysis analyzed time-dependent risks for developing PHPT, PitAd, or NET by variant type and position along the gene. Overall, 74 MEN4 cases were analyzed. PHPT risk was 53.4% by age 60 years (mean age at diagnosis age 50.6 ± 13.9 years), risk for PitAd was 23.2% and risk for NET was 16.2% (34.4 ± 21.4 and 52.9 ± 13.9 years, respectively). The frameshift variant p.Q107fs was the most common variant identified (4/41 (9.7%) kindreds). Patients with indels had higher risk for PHPT vs point mutations (log-rank, P = 0.029). Variants in codons 94-96 were associated with higher risk for PHPT (P < 0.001) and PitAd (P = 0.031). To conclude, MEN4 is clinically distinct from MEN1, with lower risk and older age for PHPT diagnosis. We report recurrent CDKN1B frameshift variants and possible genotype-phenotype correlations.
Collapse
Affiliation(s)
- Reut Halperin
- ENTIRE Endocrine Neoplasia Translational Research Center, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Liat Arnon
- ENTIRE Endocrine Neoplasia Translational Research Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Sapir Nasirov
- ENTIRE Endocrine Neoplasia Translational Research Center, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Limor Friedensohn
- ENTIRE Endocrine Neoplasia Translational Research Center, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Gershinsky
- Department of Endocrinology and Diabetes, Lady Davis Carmel Medical Center and Linn Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Alona Telerman
- ENTIRE Endocrine Neoplasia Translational Research Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Eitan Friedman
- Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
- Personalized Preventive Genetics Center, Assuta Medical Center, Tel-Aviv, Israel
| | - Rinat Bernstein-Molho
- Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
- The Susanne Levy Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Tirosh
- ENTIRE Endocrine Neoplasia Translational Research Center, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| |
Collapse
|
10
|
Hermann N, Mor P, Kaidar-Person O, Bernstein-Molho R, Brodsky M, Madorsky Feldman D, Flugelman AA, Aboody Nevo H, Meshoulam Avital D, Sklair-Levy M, Friedman E, Allweis TM. Variations in Practice and Geographic Disparities Between Dedicated Multidisciplinary Clinics for BRCA1/BRCA2 Mutation Carriers in Israel. Isr Med Assoc J 2023; 25:18-22. [PMID: 36718731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Population screening for the BRCA mutations in Ashkenazi Jewish women was recently implemented in Israel and is expected to lead to a 10-fold increase in the diagnosis of asymptomatic carriers. Performing the screening follow-up within multidisciplinary dedicated clinics for carriers is recommended for early detection and risk reduction. OBJECTIVES : To determine the availability, capacity, and practices of dedicated screening clinic for BRCA carriers in Israel. METHODS A telephone-based survey of all public hospitals in Israel was conducted October 2020 to August 2021 to determine whether they had a dedicated clinic. Dedicated clinics were defined as multidisciplinary screening clinics offering at least breast and gynecological screening and risk reducing services on site. The clinic director or nurse navigator answered a questionnaire about screening practices followed by a semi-structured interview. RESULTS Of the ten dedicated BRCA clinics found in Israel, nine participated. Approximately 4500 BRCA carriers are currently being followed. No specialized clinics are available in the southern district or in the northernmost half of the northern district of Israel, leading to a disparity between periphery and center. Screening recommendations, although asserted as adhering to international guidelines, vary among clinics including age at initiating of clinical exam, use of adjunct imaging modalities, and follow-up during lactation and after risk reducing surgery. CONCLUSIONS There is a suboptimal distribution of dedicated clinics for BRCA carriers in Israel. Nationally centralized attempt to create guidelines that will unify screening practices is warranted, especially considering the expected increase in demand.
Collapse
Affiliation(s)
- Naama Hermann
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Mor
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orit Kaidar-Person
- Breast Radiation Unit, Oncology Institute, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Bernstein-Molho
- Levy Gertner Oncogenetics Unit, Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mali Brodsky
- Meirav High Risk Clinic, Sheba Medical Center, Tel Hashomer, Israel
| | - Dana Madorsky Feldman
- Meirav High Risk Clinic, Sheba Medical Center, Tel Hashomer, Israel, Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - Anath A Flugelman
- BRCA Clinic, Rambam Health Care Campus, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | | | | | - Miri Sklair-Levy
- Meirav High Risk Clinic, Sheba Medical Center, Tel Hashomer, Israel, Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Friedman
- Meirav High Risk Clinic, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanir M Allweis
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| |
Collapse
|
11
|
Bernstein-Molho R, Friedman E, Evron E. Controversies and Open Questions in Management of Cancer-Free Carriers of Germline Pathogenic Variants in BRCA1/BRCA2. Cancers (Basel) 2022; 14:cancers14194592. [PMID: 36230512 PMCID: PMC9559251 DOI: 10.3390/cancers14194592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Females harboring germline BRCA1/BRCA2 (BRCA) P/LPV are offered a tight surveillance scheme from the age of 25−30 years, aimed at early detection of specific cancer types, in addition to risk-reducing strategies. Multiple national and international surveillance guidelines have been published and updated over the last two decades from geographically diverse countries. We searched for guidelines published between 1 January 2015 and 1 May 2022. Differences between guidelines on issues such as primary prevention, mammography screening in young (<30 years) carriers, MRI screening in carriers above age 65 years, breast imaging (if any) after risk-reducing bilateral mastectomy, during pregnancy, and breastfeeding, and hormone-replacement therapy, are just a few notable examples. Beyond formal guidelines, BRCA carriers’ concerns also focus on the timing of risk-reducing surgeries, fertility preservation, management of menopausal symptoms in cancer survivors, and pancreatic cancer surveillance, issues that, for some, there are no data to support evidence-based recommendations. This review discusses these unsettled issues, emphasizing the importance of future studies to enable global guideline harmonization for optimal surveillance strategies. Moreover, it raises the unmet need for personalized risk stratification and surveillance in BRCA P/LPV carriers.
Collapse
Affiliation(s)
- Rinat Bernstein-Molho
- The Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 5265601, Israel
| | - Eitan Friedman
- Assuta Medical Center, Tel-Aviv, Israel, The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 8436322, Israel
| | - Ella Evron
- Oncology, Kaplan Medical Institute, Rehovot, Hadassah Medical School, The Hebrew University, Jerusalem 9190501, Israel
- Correspondence: or ; Tel.: +972-502-056-171
| |
Collapse
|
12
|
Laitman Y, Nielsen SM, Bernstein-Molho R, Heald B, Hatchell KE, Esplin ED, Friedman E. Cancer risks associated with heterozygous ATM loss of function and missense pathogenic variants based on multigene panel analysis. Breast Cancer Res Treat 2022; 196:355-361. [PMID: 36094610 DOI: 10.1007/s10549-022-06723-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/19/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Cancer risks conferred by germline, heterozygous, ATM pathogenic/likely pathogenic variants (PSVs) are yet to be consistently determined. The current study assessed these risks by analysis of a large dataset of ATM heterozygote loss of function (LOF) and missense PSV carriers tested with a multigene panel (MGP). METHODS De-identified data of all individuals who underwent ATM sequencing as part of MGP between October 2015 and February 2020 were reviewed. In cancer cases, rates for the six most prevalent variants and for all LOF and missense PSV combined were compared with rates of the same PSV in ethnically matched, healthy population controls. Statistical analysis included Chi-square tests and odds ratios calculations. RESULTS For female breast cancer cases, LOF )1794/219,269) and missense (301/219,269) ATM PSVs were seen at higher rates compared to gnomAD non-cancer controls (n = 157/56,001 and n = 27/61,208; p < 0.00001, respectively). Notably, the rate of the c.103C > T variant was higher in controls than in breast cancer cases [p = 0.001; OR 0.31 (95% CI 0.1-0.6)]. For all cancer cases combined, compared with non-cancer population controls, LOF (n = 143) and missense (n = 15) PSVs reported in both datasets were significantly more prevalent in cancer cases [ORLOF 1.7 (95% 1.5-1.9) ORmissense 3.0 (95% CI 2.3-4); p = 0.0001]. CONCLUSION Both LOF and missense heterozygous ATM PSVs are more frequently detected in cases of several cancer types (breast, ovarian, prostate, lung, pancreatic) compared with healthy population controls. However, not all ATM PSVs confer an increased cancer risk (e.g., breast).
Collapse
Affiliation(s)
- Yael Laitman
- The Oncogenetics Unit, Institute of Human Genetics, The Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Rinat Bernstein-Molho
- The Oncogenetics Unit, Institute of Human Genetics, The Sheba Medical Center, Tel-Hashomer, Israel.,The Breast Cancer Unit, Oncology Institute, The Sheba Medical Center, Tel-Hashomer, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | | | - Eitan Friedman
- The Oncogenetics Unit, Institute of Human Genetics, The Sheba Medical Center, Tel-Hashomer, Israel. .,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Meirav High-Risk Clinic, Sheba Medical Center, 52621, Tel-Hashomer, Israel.
| |
Collapse
|
13
|
Gal-Yam EN, Sklair-Levi M, Vachnish Y, Balint-Lahat N, Morzaev-Sulzbach D, Bakalenik-Gavry M, Fearmann R, Halshtok O, Shalmon A, Gotlieb M, Yagil Y, Levanon K, Bernstein-Molho R, Itay A, Shapira-Rotenberg T, Globus O, Barshack I, Salpeter S, Bar V, Aharon S, Turovsky L, Zundelevich A, Mallel G, Shahar H, Shapira H, Dadiani M. Abstract P1-08-25: Evaluating an ex vivo organ culture system for predicting response to neoadjuvant chemotherapy in breast cancer patients. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-08-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Neoadjuvant chemotherapy (NACT) is increasingly administered for high-risk breast cancer patients. Yet, oncologists lack an effective method for assessing response to treatment beyond clinicpathological features. Organ tissue slices freshly obtained from the tumor and incubated in appropriate media, recapitulate the tumor’s heterogeneity and may provide a superior ex-vivo model for predicting response/resistance to treatment. While these models were tested in metastatic tumors, no studies up to date have been reported in early breast cancer or for NACT. These tests have short turnaround time (7-9 days), critical for the neoadjuvant setting. Here we aimed to prove the feasibility of performing cResponse assay, an ex vivo organ culture (EVOC), on freshly derived pre-treatment core needle biopsies and to evaluate it as a tool for predicting response to NACT in breast cancer. Methods. Pre-treatment tumor biopsies were obtained from breast cancer patients about to undergo NACT at the time of routine tumor clip marking. The fresh samples were immediately placed in cold medium, sliced into 250um sections and cultured in multiwell plates. The samples were treated with the clinically administered therapies or a vehicle control. The various therapies included Doxorubicin (A), Paclitaxel (T), Cytoxan (C) and in TN cases, Carboplatin (Cr), as single agents or in combination in clinically administered ratios. After 4 days of treatment, tumor slices were fixed and stained to allow morphological analysis. A trained pathologist examined the stained slides and scored the viable cancer cells. A response-score was generated and compared to the pathological result (pCR status and RCB class) of the patient at surgery.Results. Tumor samples from 15 breast cancer patients were examined. The cohort median age was 42 (32—82), LN involvement 9/15, subtypes status: 9 HR+, 2 TNBC, 3 HR+HER2+ and 1 HR-HER2+. Nine samples were either excluded due to insufficient viable cancer cells or necrosis and one sample failed technically. Five samples (2 TNBC, 2 HR+ and 1 HR+HER2+) were adequate for analysis and obtained cResponse scores. The HR+HER2+ case received a different protocol than actually tested, thus was not compared. For the four successful cases, the cResponse score was highly concordant with response to therapy (Table I). For the two TNBC samples, a maximal cResponse score (100) was demonstrated for AC-T or AC-TC combination and both patients achieved complete response (pCR, RCB-0) at surgery. Notably, in one patient, the assay predicted maximal response for the TC combination, suggesting that this protocol could be sufficient. For the HR+ patients, one patient demonstrated a strong cResponse to AC-T (85) and achieved near complete response (RCB-I), while the second patient demonstrated a moderate cResponse score (70) and achieved partial pathological response (RCB-II). Conclusions. We provide initial evidence for the feasibility and validity of an EVOC platform to predict response to NACT in breast cancer. Further optimizations are needed to increase the assay’s success rates. We expect the results to set the ground for a clinical trial, examining the utility of the cResponse test as predictive biomarker in determining NACT. This technology may provide a tool for the oncologist to select the most efficient therapies, maximizing pCR rates and minimizing toxicity from ineffective drugs, eventually improving prognosis of breast cancer patients.
Table IPatientSubtypeBest cResponse scoreBest treatmentsPathological ResponseRCB classNAT-2HR+70AC-T/AC/CPartialRCB-IINAT-3TN100AC-TCr/TCrpCRRCB-0NAT-12TN100A/AC-TpCRRCB-0NAT-16HR+85AC-TPartialRCB-I
Citation Format: Einav Nili Gal-Yam, Miri Sklair-Levi, Yaeli Vachnish, Nora Balint-Lahat, Dana Morzaev-Sulzbach, Michal Bakalenik-Gavry, Renata Fearmann, Osnat Halshtok, Anat Shalmon, Michael Gotlieb, Yael Yagil, Keren Levanon, Rinat Bernstein-Molho, Amit Itay, Tali Shapira-Rotenberg, Opher Globus, Iris Barshack, Seth Salpeter, Vered Bar, Sara Aharon, Lubov Turovsky, Adi Zundelevich, Giuseppe Mallel, Hamutal Shahar, Hagit Shapira, Maya Dadiani. Evaluating an ex vivo organ culture system for predicting response to neoadjuvant chemotherapy in breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-08-25.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amit Itay
- Sheba Medical Center, Ramat Gan, Israel
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Wolf I, Waissengrin B, Zer A, Bernstein-Molho R, Rouvinov K, Cohen JE, Cherny NI, Bar-Sela G. Implementation of the ESMO-Magnitude of Clinical Benefit Scale: real world example from the 2022 Israeli National Reimbursement Process. ESMO Open 2022; 7:100379. [PMID: 35121523 PMCID: PMC8818899 DOI: 10.1016/j.esmoop.2021.100379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 01/16/2023] Open
Affiliation(s)
- I Wolf
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - B Waissengrin
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Zer
- Institiute of Oncology, Rambam Health Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - R Bernstein-Molho
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Oncology Division, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - K Rouvinov
- The Legacy Heritage Oncology Center, Dr Larry Norton Institute, Soroka Medical Center, and Ben-Gurion University, Beer-Sheva, Israel
| | - J E Cohen
- Sharett Institute of Oncology and The Wohl Institute for Translational Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - N I Cherny
- Institute of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - G Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Cancer Center, Emek Medical Center, Afula, Israel
| |
Collapse
|
15
|
Bernstein-Molho R, Evron E, Yerushalmi R, Paluch-Shimon S. Genetic testing in patients with triple-negative or hereditary breast cancer. Curr Opin Oncol 2021; 33:584-590. [PMID: 34474437 DOI: 10.1097/cco.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In recent years there has been a dramatic evolution in the clinical utility of genetic testing with expanding therapeutic implications for individuals with breast cancer who harbor a germline mutation in BRCA1/2. As these therapeutic opportunities expand and evolve, this requires the clinical and research community to rethink the approach to genetic testing for individuals with breast cancer. RECENT FINDINGS Genetic testing is evolving from traditional testing models based on pretest counseling with the aim of identifying hereditary and individual risk for purposes of screening and risk reduction to contemporary models that utilize technology to improve accessibility and oncology led mainstreaming of testing where the oncologist refers for genetic testing, discloses the results and formal counseling occurs later in the process than in traditional models. The cost and accessibility to multigene panel testing have resulted in broad uptake despite the fact that clinical utility and appropriate interpretation of results are not yet well established. Furthermore, somatic testing for genomic alterations may also yield results beyond the disease with detection of germline mutations impacting the individual and their family more broadly than anticipated. SUMMARY With the establishment of poly (adenosine diphosphate-ribose) polymerase inhibitors as part of the treatment armamentarium for early and advanced breast cancer, paradigms, algorithms, and resources for genetic testing need to rapidly change in order to adapt to the evolution of germline mutations from hereditary and individual risk predictors to predictive therapeutic biomarkers.
Collapse
Affiliation(s)
- Rinat Bernstein-Molho
- Susanne Levy Gertner Oncogenetics Unit, The Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel-Hashomer.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Ella Evron
- Department of Oncology, Kaplan Medical Center, Rehovot.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rinat Yerushalmi
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Shani Paluch-Shimon
- Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
16
|
Safra T, Waissengrin B, Gerber D, Bernstein-Molho R, Klorin G, Salman L, Josephy D, Chen-Shtoyerman R, Bruchim I, Frey MK, Pothuri B, Muggia F. Breast cancer incidence in BRCA mutation carriers with ovarian cancer: A longitudal observational study. Gynecol Oncol 2021; 162:715-719. [PMID: 34172288 DOI: 10.1016/j.ygyno.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We evaluated the incidence of breast cancer and overall survival in a multi-center cohort of ovarian cancer patients carrying BRCA1/2 mutations in order to assess risks and formulate optimal preventive interventions and/or surveillance. METHODS Medical records of 502 BRCA1/2 mutation carriers diagnosed with ovarian cancer between 2000 and 2018 at 7 medical centers in Israel and one in New York were retrospectively analyzed for breast cancer diagnosis. Data included demographics, type of BRCA mutations, surveillance methods, timing of breast cancer diagnosis, and family history of cancer. RESULTS The median age at diagnosis of ovarian cancer was 55.8 years (range, 23.9-90.1). A third (31.5%) had a family history of breast cancer and 17.1% of ovarian cancer. Most patients (67.3%) were Ashkenazi Jews, 72.9% were BRCA1 carriers. Breast cancer preceded ovarian cancer in 17.5% and was diagnosed after ovarian cancer in 6.2%; an additional 2.2% had a synchronous presentation. Median time to breast cancer diagnosis after ovarian cancer was 46.0 months (range, 11-168). Of those diagnosed with both breast cancer and ovarian cancer (n = 31), 83.9% and 16.1% harbored BRCA1 and BRCA2 mutations, respectively. No deaths from breast cancer were recorded. Overall survival did not differ statistically between patients with an ovarian cancer diagnosis only and those diagnosed with breast cancer after ovarian cancer. CONCLUSION The low incidence of breast cancer after ovarian cancer in women carrying BRCA1/2 mutations suggests that routine breast surveillance, rather than risk-reducing surgical interventions, may be sufficient in ovarian cancer survivors.
Collapse
Affiliation(s)
- Tamar Safra
- New York University Cancer Institute, New York, ,NY, United States of America; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.
| | | | - Deanna Gerber
- New York University Cancer Institute, New York, ,NY, United States of America
| | - Rinat Bernstein-Molho
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel; Chaim Sheba Medical Center, Breast Cancer Center, Oncology Institute, Ramat Gan, Israel
| | - Geula Klorin
- Rambam Health Care Campus, Haifa, Israel; Technion Institute of Technology, Rappaport School of Medicine, Haifa, Israel
| | | | - Dana Josephy
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel; Meir Medical Center, Kfar Saba, Israel
| | - Rakefet Chen-Shtoyerman
- The Oncogenetic Clinic, The Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Israel; Ariel University, Ariel, Israel
| | - Ilan Bruchim
- Technion Institute of Technology, Rappaport School of Medicine, Haifa, Israel; Hillel Yaffe Medical Center, Hadera, Israel
| | - Melissa K Frey
- New York University Cancer Institute, New York, ,NY, United States of America
| | - Bhavana Pothuri
- New York University Cancer Institute, New York, ,NY, United States of America
| | - Franco Muggia
- New York University Cancer Institute, New York, ,NY, United States of America
| |
Collapse
|
17
|
Bernstein-Molho R, Galmor L, Laitman Y, Segev S, Friedman E. Yield of targeted genotyping for the recurring pathogenic variants in cancer susceptibility genes in a healthy, multiethnic Israeli population. Cancer 2021; 127:3599-3604. [PMID: 34157778 DOI: 10.1002/cncr.33560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several recurring pathogenic variants in BRCA1/BRCA2 and other cancer susceptibility genes are encountered in ethnically diverse Jewish populations. The yield of genotyping for these recurring pathogenic variants in healthy Israeli individuals unselected for ethnicity, sex, or a family history of cancer has not been previously reported. METHODS Individuals voluntarily participating in annual medical surveillance at the Institute of Medical Screening of Sheba Medical Center were offered genotyping for predominant pathogenic variants in BRCA1/BRCA2 and recurring variants in CHEK2, MUTYH, APC, and the Lynch syndrome genes via a chip-based assay at the oncogenetic service of Sheba Medical Center from May 15, 2018, to December 15, 2020. All study participants were unrelated to one another. The study was approved by the Sheba ethics committee. RESULTS Overall, 1764 individuals, including 1008 females (57%), with a mean age of 54.2 years (range, 25-86 years) were genotyped. The yield of the testing was 4% (71 of 1764), and it was higher in Ashkenazi Jews (AJs) and mixed AJ-non-AJ participants (4.75% [58 of 1222]; 1.8% for BRCA1/BRCA2 pathogenic variants) than non-AJ patients (2.2% [9 of 401]; 1% for BRCA1 pathogenic variants). When BRCA1/BRCA2 pathogenic variants were excluded, 2.44% carried low-penetrance variants, including CHEK2 c.1283C>T (n = 3), APC c.3920T>A (n = 36), and heterozygous MUTYH c.1187G>A (n = 4). A family history of cancer was not associated with a higher yield of pathogenic variant detection. CONCLUSIONS The observed rates of positive genotyping in a healthy, unselected, multiethnic Israeli population warrant consideration of the inclusion of targeted genotyping of selected pathogenic variants in high-penetrance and perhaps lower penetrance cancer susceptibility genes for all Jewish individuals in Israel, regardless of their ethnicity or family history of cancer.
Collapse
Affiliation(s)
- Rinat Bernstein-Molho
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Lee Galmor
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Laitman
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Medical Screening, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eitan Friedman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| |
Collapse
|
18
|
Goldberg Y, Laitman Y, Ben David M, Bazak L, Lidzbarsky G, Salmon LB, Shkedi-Rafid S, Barshack I, Avivi C, Darawshe M, Shomron N, Bruchim R, Vinkler C, Yannoukakos D, Fostira F, Bernstein-Molho R, Friedman E. Re-evaluating the pathogenicity of the c.783+2T>C BAP1 germline variant. Hum Mutat 2021; 42:592-599. [PMID: 33600035 DOI: 10.1002/humu.24189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
BAP1 germline pathogenic sequence variants (PSVs) underlie a unique tumor predisposition syndrome (BAP1-TPDS) associated with an increased lifetime risk for developing primarily pleural and peritoneal mesothelioma and uveal and cutaneous melanoma. Overwhelmingly, BAP1 PSVs are unique, family-specific inactivating variants. We identified seven families, six of Jewish Iraqi origin, harboring an identical BAP1 splice variant (c.783+2T>C), currently assigned a "likely pathogenic" status. Given a nonclassical BAP1-TPDS tumor type clustering and low penetrance in these families, the pathogenicity of this variant was re-evaluated by a combined approach including literature analysis, revised bioinformatics analysis, allelic loss, effect on the transcript, and tumor protein expression patterns. None of the three available tumors showed an allelic loss, there was no discernable effect on alternative splicing based on reverse-transcription polymerase chain reaction, and there was no decrease or loss of somatic protein expression in 2/3 analyzed tumors. This led to assigning a Benign Strong (BS) criteria, BS4, supporting BS3 criteria, and weakening the Pathogenic Supporting (PP) criteria PP5. Combined, these data suggest that this sequence variant should be reclassified as a variant of unknown significance by American College of Medical Genetics (ACMG) criteria.
Collapse
Affiliation(s)
- Yael Goldberg
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Laitman
- Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Merav Ben David
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Radiation Oncology Unit, Assuta Medical Center, Tel-Aviv, Israel
| | - Lily Bazak
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Gabriel Lidzbarsky
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Lina B Salmon
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Shkedi-Rafid
- Department of Genetics, Hadassah-Hebrew University Hospital, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Iris Barshack
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pathology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Camila Avivi
- Pathology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Malak Darawshe
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Shomron
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Revital Bruchim
- Naot Clinic, Maccabi Health Care Organization, Tel-Aviv, Israel
| | - Chana Vinkler
- Onco Genetis Unit, Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
| | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, INRASTES, National Centre for Scientific Research "Demokritos", Athens, Greece
| | - Florentia Fostira
- Molecular Diagnostics Laboratory, INRASTES, National Centre for Scientific Research "Demokritos", Athens, Greece
| | - Rinat Bernstein-Molho
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Breast Cancer Unit, Institute of Oncology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eitan Friedman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| |
Collapse
|
19
|
Douvdevani A, Bernstein-Molho R, Asraf K, Doolman R, Laitman Y, Friedman E. Circulating cell-free DNA (cfDNA) levels in BRCA1 and BRCA2 mutation carriers: A preliminary study. Cancer Biomark 2021; 28:269-273. [PMID: 32280079 DOI: 10.3233/cbm-190718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Female carriers of BRCA1 or BRCA2 germline mutations are at a substantially increased risk for developing breast and ovarian cancer. The lack of effective early detection schemes for ovarian cancer, mandate surgical removal of adnexa at age 35-40 years in these high-risk women. The role of circulating cell-free DNA (cfDNA) levels as a marker for early detection in high-risk women has rarely been reported. OBJECTIVE To quantify cfDNA levels in BRCA1BRCA2 carriers. METHODS Serum cfDNA levels, measured by direct fluorometric assay in cancer-free female BRCA1BRCA2 mutation carriers were compared with cancer-free controls recruited from among women undergoing breast biopsy or routine colonoscopy. RESULTS Overall, 10 BRCA1 (185delAG) and 10 BRCA2 (6174delT) mutation carriers, 20 breast biopsy controls, and 20 colonoscopy controls participated. cfDNA levels [Median (95% CI)], were 472 (317-589) ng/ml and 525 (339-621) ng/ml in breast biopsy and colonoscopy controls, respectively. Median levels of cfDNA in BRCA1 and BRCA2 mutation carriers combined were 921 (835-1087) ng/ml, significantly higher than in both controls (P< 0.0001). CONCLUSIONS cfDNA levels are significantly higher in BRCA1 and BRCA2 mutation carriers compared with non-carriers. This finding, if validated, may facilitate development of early detection breast/ovarian cancer biomarker in high-risk women.
Collapse
Affiliation(s)
- Amos Douvdevani
- Department of Clinical Biochemistry and Pharmacology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rinat Bernstein-Molho
- Breast Cancer Unit, Institute of Oncology, Tel Aviv University, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Keren Asraf
- Automated Mega-Laboratory, Tel Aviv University, Tel-Aviv, Israel
| | - Ram Doolman
- Automated Mega-Laboratory, Tel Aviv University, Tel-Aviv, Israel
| | - Yael Laitman
- Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Eitan Friedman
- Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| |
Collapse
|
20
|
Bernstein-Molho R, Laitman Y, Galper S, Jacobson G, Boursi B, Gal-Yam EN, Kaufman B, Friedman E, Kaidar-Person O. Locoregional Treatments and Ipsilateral Breast Cancer Recurrence Rates in BRCA1/2 Mutation Carriers. Int J Radiat Oncol Biol Phys 2020; 109:1332-1340. [PMID: 33259931 DOI: 10.1016/j.ijrobp.2020.11.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE There is a paucity of data on the rates of ipsilateral breast tumor recurrence (IBTR) in BRCA1/2-associated breast cancer (BC). Scarcer yet are outcomes data in BRCA1/2 mutation carriers in the setting of newer mastectomy techniques, such as skin-sparing mastectomies (SSM) and nipple-sparing mastectomies (NSM). METHODS Data were extracted from the medical records of BRCA1/2 carriers who were diagnosed with BC and treated at a single institution between 2006 and 2020. The data extracted included patient demographics, tumor characteristics, disease stage, surgical treatment, use of radiation therapy (RT), and disease outcome. RESULTS Overall, 255 BC patients with BRCA1/2 germline mutations were identified. Of these, 128 (50.2%) underwent a mastectomy (SSM or NSM in 82% of them), 76 (59.4%) without postmastectomy RT (non-PMRT) and 52 (40.6%) with PMRT, whereas 127 (49.8%) elected for breast-conserving treatment (BCT). The non-PMRT group had earlier disease stages (82.3% were Tis and T1N0) compared with the PMRT and BCT groups (3.6% and 48.1%, respectively; P < .05). The IBTR cumulative rate was 9 of 76 (11.8%) in the non-PMRT cohort compared with 0 of 52 in the PMRT group (P = .01) and 6 of 127 (4.7%) in the BCT group (P = .06). The cumulative incidences of IBTR at 5 and 10 years were 9.8% and 27.4%, respectively, in the non-PMRT group versus 2% and 11.3%, respectively, in the BCT group (P = .0183). No significant difference in overall survival was observed at the time of follow-up. CONCLUSIONS BRCA1/2 mutation carriers treated with mastectomy without PMRT had higher rates of IBTR than those who underwent mastectomy and PMRT or BCT, despite earlier stages of disease. The safety of SSM/NSM should be evaluated in a prospective trial.
Collapse
Affiliation(s)
- Rinat Bernstein-Molho
- Breast Cancer Center, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yael Laitman
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Shira Galper
- Breast Radiation Unit, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Galia Jacobson
- Breast Radiation Unit, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ben Boursi
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Gastrointestinal Oncology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Einav Nili Gal-Yam
- Breast Cancer Center, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; The Pinchas Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Bella Kaufman
- Breast Cancer Center, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eitan Friedman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; The Meirav High-Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Orit Kaidar-Person
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Breast Radiation Unit, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
21
|
Laitman Y, Michaelson-Cohen R, Chen-Shtoyerman R, Goldberg Y, Reish O, Bernstein-Molho R, Levy-Lahad E, Baruch NEB, Kedar I, Evans DG, Haim S, Paluch-Shimon S, Friedman E. Age at diagnosis of cancer in 185delAG BRCA1 mutation carriers of diverse ethnicities: tentative evidence for modifier factors. Fam Cancer 2020; 20:189-194. [PMID: 33165727 DOI: 10.1007/s10689-020-00216-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
Germline pathogenic sequence variants (PSVs) in BRCA1 substantially increase risk for developing breast (BC) and ovarian cancer (OvC). Yet, incomplete penetrance suggests that modifier factors affect phenotypic expression of mutant BRCA1 alleles. Analysis of identical BRCA1 PSV carriers of diverse ethnicities may provide further evidence for modifier factors. Female carriers of the 185delAG BRCA1 PSV identified through high-risk clinics in Israel, and Manchester England from 1998-2018 were eligible. Data were retrieved from patients records and confirmed (in Israel) by cross referencing with the Israeli National Cancer Registry. Overall, 2503 female carriers were included: 1715 (71.4%) Ashkenazi Jews (AJ), 201 (8.3%) Iraqi Jews and 383 (15.9%) of mixed ethnicity. In 102 (4.2%) cases ethnicity could not be ascertained. Of Israeli AJ carriers 649 (37.8%), 256 (14.9%) and 62 (3.6%) were diagnosed with BC, OvC or both cancers, respectively. For the Iraqi Jews these frequencies were 76 (37.8%), 43 (21.4%), and 8 (3.98%), respectively. Age at diagnosis of BC in AJ and Iraqi Jews was 46.7 ± 12.3 years and 52.8 ± 12.2 years, respectively (p = 0.001). For OvC age at diagnosis for AJ was 53.5 ± 10.7 years and for Iraqi Jews 50.1 ± 8.8 years (p = 0.0027). No differences in these parameters were noted between English Jews (n = 110) and non-Jews (n = 32). Age at diagnosis of BC and OvC differs between AJ and Iraqi Jews who carry an identical BRCA1 PSV. This finding supports the existence of modifier factors that may be ethnic specific.
Collapse
Affiliation(s)
- Yael Laitman
- The Oncogenetics Unit, Institute of Human Genetics, and the Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Rachel Michaelson-Cohen
- The Medical Genetics Institute and the NOGA High Risk Clinic, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
- Department of Obstetrics & Gynecology Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Rakefet Chen-Shtoyerman
- The Oncogenetics Clinic, The Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Yael Goldberg
- Rabin Medical Center, Recanati Genetics Institute, Belinson Hospital, 4941492, Petah Tikvah, Israel
| | - Orit Reish
- Genetics Institute, Shamir Medical Center, Zerifin, Affiliated to The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Bernstein-Molho
- The Oncogenetics Unit, Institute of Human Genetics, and the Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
- The Breast Cancer unit, Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
- The Department of Human Genetics and Biochemistry, Sackler School of Medicine, Tel-Aviv University, Tel- Aviv, Israel
| | - Ephrat Levy-Lahad
- The Medical Genetics Institute and the NOGA High Risk Clinic, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Noa Ephrat Ben Baruch
- The Oncology Department, Kaplan Medical Center, Rehovot, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Inbal Kedar
- Rabin Medical Center, Recanati Genetics Institute, Belinson Hospital, 4941492, Petah Tikvah, Israel
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sara Haim
- Genetics Institute, Shamir Medical Center, Zerifin, Affiliated to The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Paluch-Shimon
- Department of Oncology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Eitan Friedman
- The Oncogenetics Unit, Institute of Human Genetics, and the Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
- The Department of Human Genetics and Biochemistry, Sackler School of Medicine, Tel-Aviv University, Tel- Aviv, Israel.
| |
Collapse
|
22
|
Galmor L, Bernstein-Molho R, Sklair-Levy M, Madoursky-Feldman D, Zippel D, Laitman Y, Friedman E. Time trends in uptake rates of risk-reducing mastectomy in Israeli asymptomatic BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat 2020; 185:391-399. [PMID: 33000375 DOI: 10.1007/s10549-020-05949-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The rate of risk-reducing bilateral mastectomy (RRBM) among cancer-free Israeli female BRCA1/BRCA2 mutation carriers was reportedly 13% in 2010. Current RRBM rates in Israel and factors seemingly associated with opting for RRBM were reevaluated. METHODS Israeli female cancer-free BRCA1/BRCA2 mutation carriers, who were followed at the high-risk clinic at Sheba Medical Center between January 2011 and April 2020 were eligible. Univariate Cox regression and log-rank test were used to study the crude association between potential predictors and performance of RRBM. RESULTS Overall, 427 cancer-free BRCA1 (n = 218) or BRCA2 (n = 209) mutation carriers were included. Median age at genotyping was 33.6 years (interquartile range 26.8-41.8 years), median follow-up 4.4 years (range 0.1-7.6 years). Overall, 41/427 (9.6%) participants underwent RRBM, all of them within 5 years of genotyping. Being married (HR-2.57, p = 0.017) and having a first degree relative with breast cancer (BC) (HR-2.19, p = 0.017) were positively associated with RRBM, whereas any previous benign breast biopsy was negatively associated (HR-0.48, p = 0.029) with performing RRBM. CONCLUSIONS RRBM is still infrequently elected by Israeli BRCA1/BRCA2 mutation carriers, with married women with one relative with BC who have not undergone previous breast biopsy more likely to opt for RRBM.
Collapse
Affiliation(s)
- Lee Galmor
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rinat Bernstein-Molho
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Miri Sklair-Levy
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Meirav High-Risk Clinic-Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Dov Zippel
- The Meirav High-Risk Clinic-Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Yael Laitman
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel
| | - Eitan Friedman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- The Meirav High-Risk Clinic-Chaim Sheba Medical Center, Tel-Hashomer, Israel.
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
| |
Collapse
|
23
|
Laitman Y, Michaelson-Cohen R, Levi E, Chen-Shtoyerman R, Reish O, Josefsberg Ben-Yehoshua S, Bernstein-Molho R, Keinan-Boker L, Rosengarten O, Silverman BG, Perri T, Korach J, Mor P, Ephrat Ben-Baruch N, Levy Lahad E, Friedman E. Uterine cancer in Jewish Israeli BRCA1/2 mutation carriers. Cancer 2018; 125:698-703. [PMID: 30489631 DOI: 10.1002/cncr.31842] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND BRCA1/2 mutation carriers have an increased risk of developing ovarian cancer, leading to the recommendation of risk-reducing salpingo-oophorectomy (RRSO) at 35-40 years of age. The role, if any, that BRCA mutations play in conferring uterine cancer risk, is unresolved. METHOD Jewish Israeli women, carriers of one of the predominant Jewish mutations in BRCA1/2 from 1998 to 2016, were recruited. Cancer diagnoses were determined through the Israeli National Cancer Registry. Uterine cancer risk was assessed by computing the standardized incidence ratio of observed-to-expected number of cases, using the exact 2-sided P value of Poisson count. RESULTS Overall, 2627 eligible mutation carriers were recruited from 1998 to 2016, 2312 (88%) of whom were Ashkenazi Jews (1463 BRCA1, 1154 BRCA2 mutation carriers, 10 double mutation carriers). Among these participants, 1310 underwent RRSO without hysterectomy at a mean (± standard deviation) age of 43.6 years (± 4.4 years). During 32,774 women-years of follow up, 14 women developed uterine cancer, and the observed-to-expected rate of all histological subtypes was 3.98 (95% confidence interval [CI], 2.17-6.67; P < .001). For serous papillary (n = 5), the observed-to-expected ratio was 14.29 (95% CI, 4.64-33.34; P < .001), and for sarcoma (n = 4) it was 37.74 (95% CI, 10.28-96.62). These rates were also higher than those detected in a group of 1844 age- and ethnicity-matched women (53% with breast cancer). CONCLUSION Israeli BRCA1 or BRCA2 mutation carriers are at an increased risk for developing uterine cancer, especially serous papillary and sarcoma. These elevated risks of uterine cancer should be discussed with BRCA carriers.
Collapse
Affiliation(s)
- Yael Laitman
- Oncogenetics Unit, Institute of Human Genetics, and Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Rachel Michaelson-Cohen
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Einat Levi
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Rakefet Chen-Shtoyerman
- Oncogenetics Clinic, Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Hebrew University School of Medicine, Jerusalem, Israel
| | - Orit Reish
- Genetics Institute, Assaf Harofe Medical Center, Zerifin, Israel
| | - Sagi Josefsberg Ben-Yehoshua
- Oncogenetics Clinic, Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Hebrew University School of Medicine, Jerusalem, Israel
| | - Rinat Bernstein-Molho
- Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lital Keinan-Boker
- Israeli National Cancer Registry, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Ora Rosengarten
- Gyneco-Oncology Unit, Institute of Oncology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Barbara G Silverman
- Israeli National Cancer Registry, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Tamar Perri
- Department of Gyneco-Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Korach
- Department of Gyneco-Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Pnina Mor
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Noa Ephrat Ben-Baruch
- Oncology Department, Kaplan Medical Center, Rehovot, Hebrew University School of Medicine, Jerusalem, Israel
| | - Ephrat Levy Lahad
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Eitan Friedman
- Oncogenetics Unit, Institute of Human Genetics, and Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | |
Collapse
|
24
|
Barnes-Kedar I, Bernstein-Molho R, Ginzach N, Hartmajer S, Shapira T, Magal N, Kalis ML, Peretz T, Shohat M, Basel-Salmon L, Friedman E, Bazak L, Goldberg Y. The yield of full BRCA1/2 genotyping in Israeli high-risk breast/ovarian cancer patients who do not carry the predominant mutations. Breast Cancer Res Treat 2018; 172:151-157. [PMID: 30014164 DOI: 10.1007/s10549-018-4887-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/11/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE BRCA1 and BRCA2 genotyping results have clinical implications for cancer risk assessment and targeted therapy. Current practice in Israel is to genotype for the predominant BRCA1/2 mutations first, followed by full gene analysis in eligible mutation-negative individuals. This work assessed the rate of non-predominant mutations in BRCA1/2 in ethnically diverse high-risk cases. METHODS Breast and/or ovarian cancer patients who tested negative for the predominant BRCA1/2 mutations were referred for comprehensive BRCA1/2 genotyping if calculated risk for carrying a BRCA mutation was ≥ 10%. RESULTS Of 1258 eligible patients, 41 (3.3%) carried one of 38 mutations: 3% of Ashkenazi Jews and 3.4% of mixed ethnicities. Detection rate was < 5% among patients diagnosed with cancer younger than 40 or with bilateral breast cancer, and was 5.5% of ovarian cancer patients. Three of the carriers (7.3%) carried gene rearrangements. Three mutations were reported in more than one case. CONCLUSIONS The overall yield of comprehensive BRCA1/2 testing in ethnically diverse high-risk Israeli individuals is 3.3%. This is lower than expected by probability models. A slightly higher rate of BRCA1/2 carriers was seen among ovarian cancer cases. These data should guide BRCA1/2 optimal testing strategy in Israel.
Collapse
Affiliation(s)
- Inbal Barnes-Kedar
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Rinat Bernstein-Molho
- Breast Cancer Center, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nava Ginzach
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | | | | | - Nurit Magal
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Marina Lifshitc Kalis
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | | | - Lina Basel-Salmon
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.,Susanne Levy Gertner Oncogenetics Unit, The Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eitan Friedman
- Susanne Levy Gertner Oncogenetics Unit, The Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lily Bazak
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Yael Goldberg
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel. .,Maccabi Health Services, Rehovot, Israel.
| |
Collapse
|
25
|
Schayek H, Korach H, Laitman Y, Bernstein-Molho R, Friedman E. Mutational analysis of candidate genes in Israeli male breast cancer cases. Breast Cancer Res Treat 2018; 170:399-404. [PMID: 29560538 DOI: 10.1007/s10549-018-4765-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/17/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To define the mutational spectrum of several candidate gene mutations in Israeli male breast cancer cases. METHODS MBC cases counselled at the Oncogenetics unit, Sheba Medical Center from January 1998 to June 2017 were included. Relevant clinical and oncological data and cancer phenotype were retrieved. All participants were genotyped for the predominant Jewish BRCA1 and BRCA2 germline mutations using a chip-based assay. Those who tested negative were further genotyped for three recurring mutations in CHEK2 (c.1100delC, p.S428F, p.I157T), and single mutations in the FANCM (c.5791C>T), and RAD51D (c.556C>T) genes, by direct sequencing. The ethics committee approved the study. RESULTS Overall, 61 MBC were identified and genotyped, 41 (67.2%) were Ashkenazim, age at diagnosis was 58.1 ± 12.6 years, and 31 (50.8%) had a family history of cancer. Of genotyped individuals, one (1.6%) harboured the 185delAG* BRCA1 mutation, 7 (11.4%) the 6174delT*BRCA2 mutation and 2 (3.2%) other recurring mutations in BRCA2 (overall 10/61-16.4% BRCA1/BRCA2 mutation carriers). Of BRCA-negative cases, 3/51 (5.9%) carried the p.S428F *CHEK2 mutation. None was a carrier of the other genotyped mutations in CHEK2, FANCM or RAD51D. CONCLUSION BRCA1, BRCA2 and CHEK2 germline mutations contribute to inherited predisposition to MBC in Israel.
Collapse
Affiliation(s)
- Hagit Schayek
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Sheba Medical Center, Tel-Hahsomer, Israel
| | - Hila Korach
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Sheba Medical Center, Tel-Hahsomer, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Laitman
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Sheba Medical Center, Tel-Hahsomer, Israel
| | - Rinat Bernstein-Molho
- The Breast Cancer Unit, Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eitan Friedman
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Sheba Medical Center, Tel-Hahsomer, Israel. .,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,The Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
| |
Collapse
|
26
|
Bokstein F, Dubov T, Toledano-Alhadef H, Bernstein-Molho R, Constantini S, Evans DG, Ben-Shachar S. Cranial irradiation in childhood mimicking neurofibromatosis type II. Am J Med Genet A 2017; 173:1635-1639. [DOI: 10.1002/ajmg.a.38211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/14/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Felix Bokstein
- The Gilbert Israeli Neurofibromatosis Center; Tel-Aviv Medical Center; Tel-Aviv Israel
- Department of Oncology; Tel-Aviv Medical Center; Tel-Aviv Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Tom Dubov
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Hagit Toledano-Alhadef
- The Gilbert Israeli Neurofibromatosis Center; Tel-Aviv Medical Center; Tel-Aviv Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Rinat Bernstein-Molho
- Department of Oncology; Tel-Aviv Medical Center; Tel-Aviv Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Shlomi Constantini
- The Gilbert Israeli Neurofibromatosis Center; Tel-Aviv Medical Center; Tel-Aviv Israel
- Department of Pediatric Neurosurgery; Tel-Aviv Medical Center; Tel-Aviv Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - D. Gareth Evans
- Genomic Medicine; Manchester Academic Health Science Center; Institute of Human Development; Center Manchester NHS Foundation Trust; Manchester Royal Infirmary; University of Manchester; Manchester UK
| | - Shay Ben-Shachar
- The Gilbert Israeli Neurofibromatosis Center; Tel-Aviv Medical Center; Tel-Aviv Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| |
Collapse
|
27
|
Bernstein-Molho R, Kollender Y, Issakov J, Bickels J, Dadia S, Flusser G, Meller I, Sagi-Eisenberg R, Merimsky O. Clinical activity of mTOR inhibition in combination with cyclophosphamide in the treatment of recurrent unresectable chondrosarcomas. Cancer Chemother Pharmacol 2012; 70:855-60. [DOI: 10.1007/s00280-012-1968-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 08/28/2012] [Indexed: 12/19/2022]
|
28
|
Merimsky O, Bernstein-Molho R, Kollender Y. Clinical activity of mTOR inhibition in combination with cyclophosphamide in the treatment of recurrent nonresectable chondrosarcomas. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.10043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10043 Background: Chondrosarcomas (CS) represent a heterogeneous group of rare sarcomas, poorly responsive to chemotherapy or radiotherapy. When local therapies in recurrent or metastatic disease are exhausted, chemotherapy plays a marginal role. Different molecular pathways have been shown to be activated in CS. In this retrospective study we summarize our experience in treating a cohort of patients with recurrent nonresectable CS with a combination of sirolimus and cyclophosphamide. Methods: Nine consecutive patients with nonresectable CS were offered off-label treatment with sirolimus and cyclophosphamide between 2007-2011. Tumor response, progression-free survival (PFS), adverse events and other relevant clinical data were analyzed. Results: The median patients’ age was 52 (range, 35-68). Median disease-free interval (DFI) since the primary diagnosis was 24 months. Median time from the disease recurrence to initiation of sirolimus and cyclophosphamide treatment was 20.9 months due to additional local surgical treatments/excision of metastases/slow and asymptomatic progression. One (11%) objective response was observed and five (56%) patients had stabilization of disease for at least 6 months. One patient has been treated for only 3.5 months and reported symptomatic improvement at this stage, two patients had progressive disease. Median time to treatment failure (TTF) was 15 months (range, 2.8-30.3). No significant adverse events were observed. Conclusions: Although advanced CS remains an incurable disease, our experience suggests that a combination of sirolimus and cyclophosphamide is well-tolerated and has meaningful clinical activity with clinical benefit rate of 67%. Further prospective studies are warranted.
Collapse
Affiliation(s)
| | - Rinat Bernstein-Molho
- Department of Oncology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
29
|
Greenberg J, Stemmer SM, Bernstein-Molho R, Pelles-Avraham S, Stephansky I, Inbar MJ, Geffen DB, Safra T. The protective effect of zoledronic acid on bone loss in postmenopausal women with early breast cancer treated with sequential tamoxifen and letrozole: 36-month follow-up. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
30
|
Safra T, Bernstein-Molho R, Greenberg J, Pelles-Avraham S, Stephansky I, Sarid D, Inbar MJ, Stemmer SM, Geffen DB. The Protective Effect of Zoledronic Acid on Bone Loss in Postmenopausal Women with Early Breast Cancer Treated with Sequential Tamoxifen and Letrozole: A Prospective, Randomized, Phase II Trial. Oncology 2011; 81:298-305. [DOI: 10.1159/000334456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 10/07/2011] [Indexed: 01/17/2023]
|
31
|
Merimsky O, Bernstein-Molho R, Soyfer V, Grisaru D. Metastatic uterine leiomyosarcomas: A single sarcoma center experience. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e20510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
32
|
|