Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline

Abstract

PURPOSE To develop recommendations for management of patients with breast cancer (BC) with germline mutations in BC susceptibility genes. METHODS The American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology convened an Expert Panel to develop recommendations based on a systematic review of the literature and a formal consensus process. RESULTS Fifty-eight articles met eligibility criteria and formed the evidentiary basis for the local therapy recommendations; six randomized controlled trials of systemic therapy met eligibility criteria. RECOMMENDATIONS Patients with newly diagnosed BC and BRCA1/ 2 mutations may be considered for breast-conserving therapy (BCT), with local control of the index cancer similar to that of noncarriers. The significant risk of a contralateral BC (CBC), especially in young women, and the higher risk of new cancers in the ipsilateral breast warrant discussion of bilateral mastectomy. Patients with mutations in moderate-risk genes should be offered BCT. For women with mutations in BRCA1/ 2 or moderate-penetrance genes who are eligible for mastectomy, nipple-sparing mastectomy is a reasonable approach. There is no evidence of increased toxicity or CBC events from radiation exposure in BRCA1/ 2 carriers. Radiation therapy should not be withheld in ATM carriers. For patients with germline TP53 mutations, mastectomy is advised; radiation therapy is contraindicated except in those with significant risk of locoregional recurrence. Platinum agents are recommended versus taxanes to treat advanced BC in BRCA carriers. In the adjuvant/neoadjuvant setting, data do not support the routine addition of platinum to anthracycline- and taxane-based chemotherapy. Poly (ADP-ribose) polymerase (PARP) inhibitors (olaparib and talazoparib) are preferable to nonplatinum single-agent chemotherapy for treatment of advanced BC in BRCA1/ 2 carriers. Data are insufficient to recommend PARP inhibitor use in the early setting or in moderate-penetrance carriers. Additional information available at www.asco.org/breast-cancer-guidelines .

Management of Hereditary Breast Cancer: ASCO, ASTRO, and SSO Guideline

“…In this editorial, we summarize and comment on the ASCO, ASTRO, and SSO Guideline on the Management of Hereditary Breast Cancer, published in this issue of the Annals of Surgical Oncology. 1 The expert panel's recommendations focused on the surgical management of patients with breast cancer and germline mutations, as well as on the use of radiation therapy and systemic therapy for such patients.…”

Radiation therapy and secondary malignancy in Li‐Fraumeni syndrome: A hereditary cancer registry study

“…This is due to the high incidence of disease recurrence in these populations which is difficult to treat and tied to poor outcomes because of distant disease spread. The current guidelines according to the American Society of Radiation Oncology, however, are to withhold PMRT in LFS patients based on the assumption that the risk of radiation‐associated malignancy is greater than the risk of recurrent disease 19 . In our study, although underpowered for statistical analysis, the risk of developing a local recurrence after mastectomy alone (22% at median follow‐up time of 29 months) appears to be greater than the risk of a radiation‐associated malignancy (0% at median follow‐up time of 87 months).…”

Real-World Data Analysis of Pregnancy-Associated Breast Cancer at a Tertiary-Level Hospital in Romania

“…The increased frequency of genetic mutation (VUS and BRCA1 mutations) in young BC patients may explain the different pathogenesis. Genetic testing of all patients can allow treatment personalization and improved outcomes [ 59 ].…”