BRCA1 或 BRCA2 种系突变携带者中发生的乳腺癌:具有潜在不同治疗机会的不同生物学和临床实体。
Breast cancers arising in subjects with germline BRCA1 or BRCA2 mutations: Different biological and clinical entities with potentially diverse therapeutic opportunities.
机构信息
Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; IFOM ETS, the AIRC Institute of Molecular Oncology, Milan, Italy.
出版信息
Crit Rev Oncol Hematol. 2023 Oct;190:104109. doi: 10.1016/j.critrevonc.2023.104109. Epub 2023 Aug 27.
Breast cancers (BCs) arising in carriers of germline BRCA1 and BRCA2 pathogenic variants (PVs) have long been considered as indistinguishable biological and clinical entities. However, the loss of function of BRCA1 or BRCA2 proteins has different consequences in terms of tumor cell reliance on estrogen receptor signaling and tumor microenvironment composition. Here, we review accumulating preclinical and clinical data indicating that BRCA1 or BRCA2 inactivation may differentially affect BC sensitivity to standard systemic therapies. Based on a different crosstalk between BRCA1 or BRCA2 and the ER pathway, BRCA2-mutated Hormone Receptor-positive, HER2-negative advanced BC may be less sensitive to endocrine therapy (ET) plus CDK 4/6 inhibitors (CDK 4/6i), whereas BRCA2-mutated triple-negative breast cancer (TNBC) may be especially sensitive to immune checkpoint inhibitors. If validated in future prospective studies, these data may have relevant clinical implications, thus establishing different treatment paths in patients with BRCA1 or BRCA2 PVs.
BRCA1 和 BRCA2 种系致病性变异(PV)携带者发生的乳腺癌(BC)长期以来被认为是生物学和临床特征无法区分的实体。然而,BRCA1 或 BRCA2 蛋白的功能丧失会对肿瘤细胞对雌激素受体信号和肿瘤微环境组成的依赖产生不同的影响。在这里,我们综述了越来越多的临床前和临床数据,这些数据表明 BRCA1 或 BRCA2 失活可能会影响 BC 对标准全身治疗的敏感性。基于 BRCA1 或 BRCA2 与 ER 途径之间不同的串扰,BRCA2 突变的激素受体阳性、HER2 阴性晚期 BC 可能对内分泌治疗(ET)加 CDK4/6 抑制剂(CDK4/6i)的敏感性降低,而 BRCA2 突变的三阴性乳腺癌(TNBC)可能对免疫检查点抑制剂特别敏感。如果在未来的前瞻性研究中得到验证,这些数据可能具有相关的临床意义,从而为 BRCA1 或 BRCA2 PV 患者建立不同的治疗路径。