Young patients with BRCA­-mutation positive, triple-negative breast cancer (TNBC) may have a survival advantage compared with non-BRCA-mutation carriers during the first 2 years after diagnosis, according to a study published in Lancet Oncology.

Previous studies assessing the prognostic impact of BRCA mutation on survival among breast cancer patients have led to mixed results.

For the Prospective Outcomes in Sporadic vs Hereditary breast cancer (POSH) study, researchers evaluated the outcomes of 2733 younger women with first-diagnosis breast cancer, of whom 338 (12%) carried the BRCA germline mutation. Patients were identified within the first 12 months of diagnosis, and clinical data and outcomes were assessed at 6 months, 12 months, then yearly.

During the median follow-up of 8.2 years, 651 (96%) of 678 deaths were attributed to breast cancer. Further multivariable analysis revealed that there were no significant differences in overall survival (OS) among patients with BRCA-positive breast cancer compared with those with BRCA-negative disease throughout the study with a 2-year OS rate of 97.0% vs 96.6%, 5-year OS rate of 83.8% vs 85.0%, and 10-year OS rate of 73.4% vs 70.1%, respectively.

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A prespecified subgroup analysis, however, revealed that study patients with triple-negative breast cancer and BRCA-mutations had an improved 2-year OS rate of 95% compared with 91% for noncarriers. These differences were not observed at 5-year or 10-year analyses.

The authors concluded that “decisions about timing of additional surgery aimed at reducing future second primary-cancer risks should take into account patient prognosis associated with the first malignancy and patient preferences.”

Reference

Capson ER, Maishman TC, Tapper WJ, et al. Germline BRCA mutation and outcome in young-onset breast cancer (POSH): a prospective cohort study [published online January 11, 2018]. Lancet Oncol. doi: 10.1016/S1470-2045(17)30891-4