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Bruno L, Ostinelli A, Waisberg F, Enrico D, Ponce C, Rivero S, Blanco A, Zarba M, Loza M, Fabiano V, Amat M, Pombo MT, Noro L, Chacón M, Coló F, Chacón R, Nadal J, Nervo A, Costanzo V. Cyclin-Dependent Kinase 4/6 Inhibitor Outcomes in Patients With Advanced Breast Cancer Carrying Germline Pathogenic Variants in DNA Repair-Related Genes. JCO Precis Oncol 2022; 6:e2100140. [PMID: 35235412 DOI: 10.1200/po.21.00140] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE In recent years, unprecedented benefits have been observed with the development of cyclin-dependent kinase (CDK) 4 and 6 inhibitors for the treatment of hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer. However, there is scarce evidence of their value in specific populations, such as patients carrying germline pathogenic variants in DNA repair-related genes. PATIENTS AND METHODS We retrospectively studied the efficacy of CDK 4/6 inhibitors plus endocrine therapy in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer. Three cohorts were compared, including patients harboring germline pathogenic variants in DNA repair-related genes (gBRCA1/2-ATM-CHEK2 mutated), those tested without these mutations (wild type [WT]), and the nontested subgroup. Relevant prognostic factors including age, metastatic site (visceral v nonvisceral), Eastern Cooperative Oncology Group, and prior treatment with CDK 4/6 inhibitors were stratified by univariate and multivariate Cox regression models. RESULTS Among the total population (n = 217), 15 (6.9%) patients carried gBRCA1/2 (n = 10)-ATM (n = 4)-CHEK2 (n = 1) pathogenic variants, 45 (20.7%) were WT, and 157 (72.4%) were nontested. Gene pathogenic variant carriers were younger (P < .001). Most patients (164, 75.6%) had not received prior endocrine therapy in the advanced setting. Median progression-free survival was shorter in patients with evaluated germline pathogenic variants (10.2 months [95% CI, 5.7 to 14.7]), compared with WT and nontested patients (15.6 months [95% CI, 7.8 to 23.4], and (17.6 months [95% CI, 12.9 to 22.2]; P = .002). Consistently, a worse median overall survival was observed in the subgroup with germline pathogenic variants than in the WT group (P = .006). Multivariable analysis showed that mutation status was an independent prognostic factor of progression-free survival (P = .020) and overall survival (P = .012). CONCLUSION In this retrospective real-world study, gBRCA1/2-ATM-CHEK2 pathogenic variants were independently associated with poor outcomes in patients with advanced breast cancer treated with CDK4/6 inhibitors.
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Affiliation(s)
- Luisina Bruno
- Genetic Counselling Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Alexis Ostinelli
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Federico Waisberg
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Research Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Diego Enrico
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Research Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Carolina Ponce
- Genetic Counselling Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Department of Breast Surgery, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Sergio Rivero
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Albano Blanco
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Martín Zarba
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Martín Loza
- Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Department of Breast Surgery, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Verónica Fabiano
- Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Department of Breast Surgery, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Mora Amat
- Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Department of Pathology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - María Teresa Pombo
- Department of Pathology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Laura Noro
- Department of Laboratory Medicine, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Matías Chacón
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Research Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Federico Coló
- Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Department of Breast Surgery, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Reinaldo Chacón
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Jorge Nadal
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Adrián Nervo
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Victoria Costanzo
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina.,Breast Cancer Unit, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
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Vázquez C, Orlova M, Zarba M, Catanzariti MJ, Christiansen SB, Dalurzo MCL, Freixas AA, Vallone MG. [Timely diagnosis of disseminated paracoccidioidomycosis in an immunocompetent adult]. Medicina (B Aires) 2018; 78:199-202. [PMID: 29940548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Paracoccidioidomycosis is endemic in subtropical rainforests of Latin America. Acute/subacute presentations involve an aggressive dissemination throughout the lymphatic system, while chronic forms (more frequent) arise as differential diagnosis for other conditions involving lung, oropharynx, skin, and eventually the brain. We present the case of a man referred for evaluation and treatment of a possible lung tumor with brain metastasis. The finding of multibudded yeasts and the microbiological isolation of a dimorphic fungus identified as Paracoccidioides sp. from a brain biopsy prompted a cardinal change in prognosis and treatment. This case alerts on the importance of considering systemic fungal diseases as differential diagnosis of compatible clinical presentations in patients who had lived in, or visited, endemic areas.
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Affiliation(s)
- Carolina Vázquez
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. E-mail:
| | - María Orlova
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martín Zarba
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María J Catanzariti
- Micología, Laboratorio Central, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Antonio A Freixas
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo G Vallone
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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