Stella Mokiou, PhD1; Richard W. DeClue, PhD, MPH2; Santosh Gautam, PhD2; Lisa Herms, PhD2; Miao Jiang, PhD3; Ping Sun, PhD4; Susan McCutcheon, PhD4; Vered Stearns, MD5; Maria Raquel Nunes, MD5
1AstraZeneca, Cambridge, England, UK; email@example.com
2ConcertAI, Memphis, TN
3AstraZeneca, Gaithersburg, MD
4AstraZeneca, Cambridge, England, UK
5Johns Hopkins School of Medicine, Baltimore, MD
Despite several reports of the real-world clinical characteristics and treatment patterns of patients with early-stage breast cancer (ESBC), specific information is lacking for patients with BRCA-mutated (BRCAm) ESBC. We conducted a retrospective study focusing on patients with BRCAm, HER2-negative (HER2–) ESBC, including both hormone receptor–positive (HR+) and –negative (HR–), as well as triple-negative breast cancer (TNBC).
Materials and Methods
We identified patients ( 18 years) from the CancerLinQ electronic medical record database, diagnosed with stage I through IIIA HER2– breast cancer between January 1, 2014 and January 1, 2019. BRCA mutation status was determined based on available test results: BRCAm, wild-type BRCA (BRCAwt), or unknown/untested (BRCAunk). Patient characteristics and treatments were summarized by BRCA status for HR+ and TNBC cohorts. AstraZeneca– ConcertAI Confidential and Proprietary Information Version 3.0 Page 2 of 2 January 13, 2021.
In total, 4566 patients (BRCAm = 41; BRCAwt = 492; BRCAunk = 4033) were identified in the HR+ cohort and 703 (BRCAm = 20; BRCAwt = 135; BRCAunk = 548) in the TNBC cohort. Patients with BRCAm were younger and received surgery plus adjuvant therapy more frequently, whereas fewer patients received radiation versus BRCAwt and BRCAunk overall. Among the HR+ cohort, 68.3% of patients with BRCAm were stage II or IIIA at diagnosis (vs 46.5% BRCAwt and 40.4% BRCAunk), and 53.7% had a poorly differentiated grade 3 tumor (vs 19.9% BRCAwt and 16.3% BRCAunk). Clinical characteristics were similar
by BRCA status for the TNBC cohort. Among patients receiving neoadjuvant treatment (n = 282 [6.2%] HR+; n = 206 [29.3%] TNBC), doxorubicin plus cyclophosphamide and either paclitaxel or docetaxel (AC-T regimen) was the most common therapy (42.9%, HR+; 50.0%, TNBC). Among patients with HR+ disease, 66.7% of those with BRCAm disease received AC-T alone; among those with TNBC, 71.4% patients with BRCAm disease received AC-T alone. Among patients with HR+ disease receiving adjuvant treatment (n = 2641; 57.8%), 63.4% received hormonal therapy and 9.6% received both AC-T and hormonal therapy. Among those with HR+ and BRCAm, 31.0% received adjuvant AC-T/hormonal therapy. Among patients with TNBC receiving adjuvant treatment (n = 370; 52.6%), 31.6% received AC-T alone (similar across BRCA groups), with 92.3% BRCAm receiving chemotherapy.
This study provides insight into characteristics and treatment patterns of patients with BRCAm ESBC in real-world oncology settings in the United States. Consistent with prior studies, patients with BRCAm were diagnosed at a younger age, and for the HR+ cohort, with higher tumor grade and at a later disease stage. The use of chemotherapy, in both neoadjuvant and adjuvant settings, was more frequent for patients with BRCAm.