BRCA2和BRCA1突变的乳腺癌,对靶向药的疗效,还有不同?是的!
  • 88例MBC患者参与比较Trabectedin(TR)和lurbinectedin(L)治疗BRCA1和2突变类型MBC时活性差异实验(二期临床实验);
  • 34例TR,54例L(单药治疗);
  • 两种药物对BRCA2型比BRCA1型临床疗效更强(TR:33% vs 9%,L:61% vs 26%) ;
  • 主要AE:骨髓抑制(3-4级中性粒细胞减少、血小板减少、发热性中性粒细胞减少症);非血液毒性(多为1-2级疲劳、恶心/呕吐、高转氨酶);
  • TR和L对BRCA2型MBC都有着显著的疗效,并具可接受与易控的安全性。
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Antitumor activity of trabectedin and lurbinectedin in germline BRCA2 carriers with metastatic breast cancer (MBC) as compared to BRCA1 carriers: Analysis of two phase II trials

二期临床实验:比较trabectedin和lurbinectedin对BRCA1和2突变类型转移性乳腺癌抗肿瘤活性

2017-06-04

Abstract & Authors:展开

Abstract:收起
Background: BRCA 1/2-associated breast cancer share homologous recombination deficiency, but also have independent and potentially actionable roles. Novel drugs with innovative mechanism of action, lacking cross-resistance with other used agents are needed for BRCA 1/2 MBC. Trabectedin (TR) and its analog, lurbinectedin (L), have shown to be active in BRCA 1/2 MBC. This study was sought to determine if there was a difference in activity of these agents between BRCA1 and 2 carriers.
Methods: Safety and efficacy in MBC BRCA 1/2 were analyzed in 2 separate phase II trials of single agent TR and L.
Results: 88 patients were evaluated: 34 with TR, 54 with L. Median age: 46 and 43, respectively. Median (range) prior chemotherapy lines: TR, 4 (1-10); L, 2 (0-5). Clinical responses were seen in the 2 trials (see table) and were higher in BRCA2 than in BRCA1 (33% vs 9% with TR and 61% vs 26% with L). Main adverse event was myelosuppression (grade 3-4 neutropenia / thrombocytopenia / febrile neutropenia: TR, 62.1%/24.3%/10.8% L, 66.7%/20.4%/20.4%). Non-hematological toxicity was mostly grade 1-2: fatigue, nausea/vomiting and high transaminases (grade 3/4 TR, 40.5%, L 18.5%).
Conclusions: Remarkable activity of trabectedin and lurbinectedin as single agents was observed in BRCA 2 associated MBC. This finding warrants further investigation. One potential mechanistic rationale is the role of both lurbinectedin and BRCA 2 in transcription. Safety was acceptable and manageable in both studies.

All Authors:
Judith Balmana Gelpi

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