eCase - BRCA Testing and Targeting in EBC

Introduction

In this case-based module, Tanya Gupta, MD, reviews important data informing the use of adjuvant PARP inhibition in patients with high-risk HER2-negative early-stage breast cancer (EBC) harboring germline BRCA mutations, along with how to identify eligible patients and perform genetic testing.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Two questions will be asked twice: once at the beginning of the activity and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

For those providing patient care, how many patients with breast cancer do you provide care for in a typical month?

A.
1-5
B.
6-10
C.
11-15
D.
16-20
E.
>20

A 36-year-old premenopausal woman is diagnosed with cT3N2M0 invasive ductal carcinoma, grade 3, estrogen receptor positive at 90%, progesterone receptor positive at 70%, HER2 negative (immunohistochemistry [IHC] 0). Breast imaging demonstrates a 6-cm tumor and bulky axillary lymph node involvement; on physical examination, the axillary lymph nodes are matted. PET/CT does not find any distant disease. Genetic testing identifies a germline BRCA1 mutation.

The patient receives neoadjuvant dose-dense doxorubicin and cyclophosphamide followed by paclitaxel (AC-T). She then undergoes mastectomy and axillary surgery, with pathology demonstrating a 5-cm tumor and involvement of 4/9 lymph nodes. She undergoes postmastectomy radiation to the chest wall and regional stations. Her clinical and pathological stage plus estrogen receptor and nuclear grade (CPS + EG) score is 3, based on a neoadjuvant therapy outcomes calculator.

The patient begins adjuvant endocrine therapy with ovarian suppression and aromatase inhibitor. She presents to discuss additional adjuvant therapy options.

In addition to ovarian suppression and the aromatase inhibitor, which of the following adjuvant therapy options would you recommend for this patient?

A.
Abemaciclib only
B.
Olaparib only
C.
Abemaciclib plus olaparib concurrently
D.
No additional adjuvant therapy

A 52-year-old woman with high-risk, BRCA2-mutated triple-negative breast cancer (TNBC) initiates adjuvant olaparib. Four weeks after starting olaparib, routine testing shows her absolute neutrophil count (ANC) is 450/mm³.

Which of the following management strategies would you recommend for this patient with grade 4 neutropenia?

A.
Continue olaparib at the same dose
B.
Hold olaparib until ANC recovery and resume at the same dose
C.
Hold olaparib until ANC recovery and resume at reduced dose
D.
Permanently discontinue olaparib

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Germline BRCA Testing and Targeting in HER2-Negative Early-Stage Breast Cancer

Tanya Gupta, MD

Activity

Introduction

For those providing patient care, how many patients with breast cancer do you provide care for in a typical month?

In addition to ovarian suppression and the aromatase inhibitor, which of the following adjuvant therapy options would you recommend for this patient?

Which of the following management strategies would you recommend for this patient with grade 4 neutropenia?