González-Rivera Milagros, Lobo Miriam, López-Tarruella Sara, Jerez Yolanda, Del Monte-Millán María, Massarrah Tatiana, Ramos-Medina Rocío, Ocaña Inmaculada, Picornell Antoni, Santillán Garzón Sonia, Pérez-Carbornero Lucía, García-Saenz José A, Gómez Henry, Moreno Fernando, Márquez-Rodas Iván, Fuentes Hugo, Martin Miguel
Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Medical Genetics Unit, Sistemas Genómicos SA, Valencia, Spain.
Breast Cancer Res Treat. 2016 Apr;156(3):507-515. doi: 10.1007/s10549-016-3792-1. Epub 2016 Apr 15.
We describe the status and frequency of germline DNA genetic findings in an unselected prospective cohort of triple negative breast cancer patients participating in a platinum-based neoadjuvant chemotherapy trial. Study population includes 124 consecutive patients with stage II-III TNBC from a trial exploring the antitumor activity of neoadjuvant carboplatin/docetaxel chemotherapy enrolled between 2012 and March 2015, to determine the frequency of germline DNA genetic mutations. 17.1 % of the patients with germline DNA tested had deleterious mutations in any of the analyzed genes (12.38 % in BRCA1, 1.9 % in BRCA2 and BARD1 and 0.95 % in RAD51D). Attending the intrinsic subtype, all the BRCA1/2 carriers tested had basal-like subtype. Among wild-type (WT) patients, 70.11 % had basal subtype, 16.09 % HER2 enriched, 1.15 % Luminal B, and 4.60 % Normal-like. Mean age at diagnosis was significantly lower in mutation-carriers compared with no carriers (43.72 vs 53.10, p = 0.004). 3 BRCA1/2 carriers were detected between 51 and 60 years, and only one deleterious mutation (BARD1) over 60 years. A positive familiar history of breast and ovarian cancer was more frequent in patients with deleterious mutations (39.39 vs 17.94 %, p = 0.043). Our study confirms the prevalence of BRCA1/2 mutations in TNBC patients. TNBC should therefore be considered by itself as a criterion for BRCA1/2 genetic testing. Determination of other breast cancer predisposition genes implicated in homologous recombination should also be discussed in this population. However, no definitive conclusions can be reached due to the low prevalence and the uncertain clinical impact of most of the genes included.
我们描述了参与铂类新辅助化疗试验的三阴性乳腺癌患者未选择的前瞻性队列中种系DNA基因检测结果的现状和频率。研究人群包括2012年至2015年3月期间参加一项探索新辅助卡铂/多西他赛化疗抗肿瘤活性试验的124例连续的II-III期三阴性乳腺癌患者,以确定种系DNA基因突变的频率。接受种系DNA检测的患者中有17.1%在任何一个分析基因中存在有害突变(BRCA1中为12.38%,BRCA2和BARD1中为1.9%,RAD51D中为0.95%)。就内在亚型而言,所有接受检测的BRCA1/2携带者均为基底样亚型。在野生型(WT)患者中,70.11%为基底亚型,16.09%为HER2富集型,1.15%为管腔B型,4.60%为正常样型。与非携带者相比,突变携带者的诊断时平均年龄显著更低(43.72岁对53.10岁,p = 0.004)。在51至60岁之间检测到3例BRCA1/2携带者,60岁以上仅检测到1例有害突变(BARD1)。有害突变患者中乳腺癌和卵巢癌的家族史阳性更为常见(39.39%对17.94%,p = 0.043)。我们的研究证实了三阴性乳腺癌患者中BRCA1/2突变的患病率。因此,三阴性乳腺癌本身应被视为BRCA1/2基因检测的一个标准。在该人群中也应讨论与同源重组相关的其他乳腺癌易感基因的检测。然而,由于大多数所纳入基因的患病率较低且临床影响不确定,无法得出明确结论。