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Olaparib: Predicting Response in Breast Cancer

Panelists:Joyce OShaugnessy, MD, Baylor University Medical Center; Tiffany A. Traina, MD, Memorial Sloan Kettering Cancer Center; Nadine M. Tung, MD, Harvard Medical School
Published: Tuesday, Apr 24, 2018



Transcript: 

Joyce O’Shaughnessy, MD: Now, there was a companion diagnostic, right? It was a complement to the approval of olaparib. But truthfully, we can use any of the germline….

Nadine Tung, MD: I think we do. By any preapproved lab, I think BRCA germline mutation would qualify for use of olaparib.

Joyce O’Shaughnessy, MD: You have to have the germline BRCA. But preapproved—that’s fine. If we’re going to get the germline BRCA testing, should we do panel testing for our metastatic patients? Is it more costly to do that? We anticipate it being covered because we’re kind of getting used to it, across the board, in the early stage. What do you think? What do you do?

Nadine Tung, MD: For the early stage, or for germline testing, for most patients, it’s not very common to just be getting BRCA1 or BRCA2 anymore, honestly. There are other high-risk breast cancer susceptibility genes. There are moderate-risk ones like ATM and CHEK2, and there aren’t any predictors or indications specifically for testing for those more moderate-risk ones. I think a lot of breast cancer patients are getting the panels for breast cancer susceptibility genes, and perhaps for ovarian cancer susceptibility genes, because there are some new genes for which that mutation carrier should probably be having a discussion about prophylactic oophorectomy.

I think a lot of these genes that are breast and ovarian cancer susceptibility genes are DNA repair genes just like BRCA1 and BRCA2. They function in the same pathway. Whether or not the patients with germline or somatic mutations in those other genes will respond to any of these therapies or anything that we’re talking about—we don’t know yet. But in terms of risk prediction and risk management, I think a lot of patients are getting multigene panels with cancer susceptibility genes to other cancers.

Joyce O’Shaughnessy, MD: And that may help them, with regard to enrollments in clinical trials, if they’re in the metastatic setting. They get the panel. They detect ATM. There’s a trial for them, right? So that’s pretty good.

Nadine Tung, MD: Absolutely.

Transcript Edited for Clarity 
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Transcript: 

Joyce O’Shaughnessy, MD: Now, there was a companion diagnostic, right? It was a complement to the approval of olaparib. But truthfully, we can use any of the germline….

Nadine Tung, MD: I think we do. By any preapproved lab, I think BRCA germline mutation would qualify for use of olaparib.

Joyce O’Shaughnessy, MD: You have to have the germline BRCA. But preapproved—that’s fine. If we’re going to get the germline BRCA testing, should we do panel testing for our metastatic patients? Is it more costly to do that? We anticipate it being covered because we’re kind of getting used to it, across the board, in the early stage. What do you think? What do you do?

Nadine Tung, MD: For the early stage, or for germline testing, for most patients, it’s not very common to just be getting BRCA1 or BRCA2 anymore, honestly. There are other high-risk breast cancer susceptibility genes. There are moderate-risk ones like ATM and CHEK2, and there aren’t any predictors or indications specifically for testing for those more moderate-risk ones. I think a lot of breast cancer patients are getting the panels for breast cancer susceptibility genes, and perhaps for ovarian cancer susceptibility genes, because there are some new genes for which that mutation carrier should probably be having a discussion about prophylactic oophorectomy.

I think a lot of these genes that are breast and ovarian cancer susceptibility genes are DNA repair genes just like BRCA1 and BRCA2. They function in the same pathway. Whether or not the patients with germline or somatic mutations in those other genes will respond to any of these therapies or anything that we’re talking about—we don’t know yet. But in terms of risk prediction and risk management, I think a lot of patients are getting multigene panels with cancer susceptibility genes to other cancers.

Joyce O’Shaughnessy, MD: And that may help them, with regard to enrollments in clinical trials, if they’re in the metastatic setting. They get the panel. They detect ATM. There’s a trial for them, right? So that’s pretty good.

Nadine Tung, MD: Absolutely.

Transcript Edited for Clarity 
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