Efficacy of platinum in advanced triple-negative breast cancer with germline BRCA mutation determined by next generation sequencing.

objective
To compare the efficacy of platinum and non-platinum-based regimens as first-line treatment for triple-negative breast cancer is advanced (TNBC) and analyze the relationship between their success and status of the BRCA genes.


method
Retrospectively analyzed clinical data from 220 patients diagnosed with advanced pathological TNBC and treated in the Department of Breast Oncology, Peking University Cancer Hospital from 2013 to 2018 and evaluate the effectiveness of chemotherapy. A total of 114 patients had BRCA1 / 2 genes were tested by next generation sequencing (NGS) using peripheral blood, and we analyzed the correlation between efficacy and BRCA1 / 2 gene status.


result
non-platinum-based chemotherapy (NPCT) was given to 129 and platinum-based chemotherapy (PBCT) to 91 study patients. The level of clinical benefit (CBR) and median progression-free survival (PFS) were not statistically different between groups NPCT and PBCT. Overall average life (OS) was 30.0 and 22.5 months for PBCT and NPCT groups, respectively [P = 0.090, hazard ratio (HR) = 0.703]. BRCA status assessed 114 patients, 14 of whom have a detrimental germline BRCA1 / 2 (gBRCA) mutation (seven in each group). In PBCT group, CBR was 85.7% and 35.1% for patients with and without mutations that destroy gBRCA, respectively (P = 0.039). Median PFS was 14.9 and 5.3 months and the median OS was 26.5 and 15.5 months for patients with and without mutations that destroy gBRCA, respectively (P = 0.001, P = 0.161, respectively). Patients in group PBCT have significantly greater levels of grade 3-4 anemia (5.5% vs. 0%) and thrombocytopenia (8.8% vs 0%), while the palmar-plantar erythrodysesthesia (12.4% vs 0% ) and peripheral neuropathy (8.6% vs. 1.1%) occurred more frequently in the group NPCT.

Efficacy of platinum in advanced triple-negative breast cancer with germline BRCA mutation determined by next generation sequencing.
Efficacy of platinum in advanced triple-negative breast cancer with germline BRCA mutation determined by next generation sequencing.


conclusion
platinum-based regimen was more effective in patients with mutations gBRCA damage, but there was no difference in patients without BRCA gene mutation, so that the non-platinum is an option in patients without BRCA gene mutation consider the toxicity and side effects. And we suggest that patients with advanced TNBC must have a BRCA gene test.

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