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Updates in the Pathology and Therapy of BRCA Germline–Associated Breast Cancer with a Focus on HER2 Amplification

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Abstract

Purpose of Review

Germline pathogenic variants of the breast cancer type 1 or 2 susceptibility genes (BRCA1 or BRCA2) are associated with the majority of hereditary breast and ovarian cancer syndromes (HBOC). The prevalence of human epidermal growth factor receptor 2 (HER2) gene amplification or protein overexpression in BRCA1/2-associated breast cancers is low. Simultaneous BRCA1/2 pathogenic variants and HER2 alterations confer a poor prognosis. The purpose of this review is to evaluate the recent literature characterizing the concurrent presence of BRCA1/2 and HER2 alterations in breast cancer patients, current management, associated outcomes, and potential opportunities for novel therapeutic approaches.

Recent Findings

Simultaneous BRCA1/2and HER2 alterations are uncommon, reporting a prevalence of up to 10% in BRCA1 and 13% in BRCA2-associated breast cancers. Available prognostic data is limited, with some series reporting lower invasive disease-free survival (iDFS) and overall survival (OS) in HER2-positive BRCA1/2-associated breast cancers compared to other tumor phenotypes. Current therapeutic guidelines in the non-metastatic setting recommend the combination of a cytotoxic regimen with HER2-directed therapy. BRCA1/2-mutated breast cancers are susceptible to platinum-based agents and poly(ADP-ribose) polymerase (PARP) inhibitors. Preclinical data shows increased antitumor response with HER2-targeted therapy in HER2-positive BRCA2-mutated cancer cell lines. These findings open the opportunity for combinatorial targeted therapies including anti-HER2 agents, PARP inhibitors, and/or platinum-based chemotherapy. Given that most BRCA-associated cancers are not HER2-amplified, treatment strategies for HER2-low breast cancer could also have applications to patients with BRCA pathogenic variants.

Summary

Although available data on HER2 and BRCA1/2 co-alterations in breast cancer is limited, encouraging preclinical and clinical findings could potentially guide trials with novel combinatorial therapies.

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Data Availability

Data used in the development of this review will be made available upon reasonable request to the corresponding author.

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Author information

Author notes

  1. Dong Won Kim and Christian X. Cruz Pico contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Dong Won Kim & Lori J. Goldstein

  2. Division of Breast Surgical Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Christian X. Cruz Pico, Emily Forester, Aakash Belsare, Richard J. Bleicher & Austin D. Williams

  3. Rowan University School of Osteopathic Medicine, Stratford, NJ, USA

    Emily Forester

  4. Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA

    Aakash Belsare

  5. Department of Medical Oncology, MedStar Health, Washington, DC, USA

    Kristen Whitaker

  6. Hackensack Meridian Health Network, Edison, NJ, USA

    Elias Obeid

  7. Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA

    Mary B. Daly & Austin D. Williams

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Contributions

D.K and C.C. wrote the main manuscript text.

E.F, A.B., K.W., and A.W. abstracted and analyzed data.

A.W. conceptualized the review.

All authors participated in critical review of the manuscript.

Corresponding author

Correspondence to Austin D. Williams.

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Ethical Approval

The retrospective analysis of institutional data in this report was deemed exempt by the Fox Chase Cancer Center Institutional Review Board (IRB), which waived the need for individual informed consent.

Conflict of Interest

Lori J. Goldstein: research funding: Merck (Inst), Genentech/Roche (Inst); other relationship: Daiichi Sankyo (Data and Safety Committee)

Richard J. Bleicher: consultant: Elucent Medical

Austin D. Williams: consultant: Elucent Medical

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Kim, D.W., Cruz Pico, C.X., Forester, E. et al. Updates in the Pathology and Therapy of BRCA Germline–Associated Breast Cancer with a Focus on HER2 Amplification. Curr Breast Cancer Rep 15, 364–370 (2023). https://doi.org/10.1007/s12609-023-00510-5

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