BRCA mutations and their influence on pathological complete response and prognosis in a clinical cohort of neoadjuvantly treated breast cancer patients
BRCA1/2 mutations influence the molecular characteristics and the effects of systemic treatment of breast cancer. This study investigates the impact of germline BRCA1/2 mutations on pathological complete response and prognosis in patients receiving neoadjuvant systemic chemotherapy.
Breast cancer patients were tested for a BRCA1/2 mutation in clinical routine work and were treated with anthracycline-based or platinum-based neoadjuvant chemotherapy between 1997 and 2015. These patients were identified in the tumor registry of the Breast Center of the University of Erlangen (Germany). Logistic regression and Cox regression analyses were performed to investigate the associations between BRCA1/2 mutation status, pathological complete response, disease-free survival, and overall survival.
Among 355 patients, 59 had a mutation in BRCA1 or in BRCA2 (16.6%), 43 in BRCA1 (12.1%), and 16 in BRCA2 (4.5%). Pathological complete response defined as “ypT0; ypN0” was observed in 54.3% of BRCA1/2 mutation carriers, but only in 22.6% of non-carriers. The adjusted odds ratio was 2.48 (95% CI 1.26–4.91) for BRCA1/2 carriers versus non-carriers. Patients who achieved a pathological complete response had better disease-free survival and overall survival rates compared with those who did not achieve a pathological complete response, regardless of BRCA1/2 mutation status.
BRCA1/2 mutation status leads to better responses to neoadjuvant chemotherapy in breast cancer. Pathological complete response is the main predictor of disease-free survival and overall survival, independently of BRCA1/2 mutation status.
KeywordsBRCA1/2 Neoadjuvant chemotherapy Pathological complete response Prognosis Survival
The authors are grateful to Michael Robertson for professional medical editing services.
MW, AH, PG, and PAF contributed substantially to the acquisition and interpretation of data, to the conception and drafting of the manuscript, and to critical revision. LH performed statistical analyses and contributed to the conception, drafting, and critical revision of the manuscript. The contribution of VMF to this publication was made in partial fulfillment of the requirements for obtaining the degree of Doctor of Medicine; parts of the research published here were used for her doctoral thesis at the Medical Faculty of Friedrich Alexander University Erlangen–Nuremberg (FAU). CR, MRB, CCH, MGS, SMJ, JE, RE, ABE, JH, GV, CK, AR, AH, MPL, MWB, and AH were involved in the acquisition of patient and tumor data and genetic information. All authors have read the manuscript and have given their final approval for publication of this study.
Compliance with ethical standards
Conflict of interest
PAF has received honoraria from Amgen, Celgene, Roche, Pfizer, and Novartis. MPL has received honoraria from MSD and AstraZeneca. PG has received honoraria from Novartis and financial support for symposia from Roche, Novartis, and PharmaMar. All other authors declare that they do not have any conflicts of interest.
This retrospective study and the anonymized scientific use of the data were approved by the Ethics Committee of the Medical Faculty of Friedrich Alexander University Erlangen–Nuremberg.
Informed consent was obtained from each individual participant included in the study.
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